Pregnancy in an abnormal uterus is a high-risk situation in obstetrics. Uterus bicornis unicollis with a rudimentary horn is often discovered incidentally. The aim of this report is to warn obstetricians about recurrent abdominal pain in the second trimester of pregnancy without any cause identified. Pregnancy can proceed in the rudimentary horn. We presented a case of a rupture of the rudimentary horn which occurred at 25 weeks of amenorrhea in an unmarried 19-year-old primigravida. The rudimentary horn was removed after performing an emergency laparotomy for an intraperitoneal hemorrhage with signs of shock. This abnormality is often revealed by uterine rupture, which usually occurs in the second trimester of pregnancy. Conclusion: We emphasize the importance of early diagnosis of this uterine abnormality, before pregnancy if possible. Undiagnosed, this condition evolves towards uterine rupture during pregnancy and requires emergency surgery with excision of the rudimentary horn.
Uterine myomas are observed in about 3-12% of pregnant women. These uterine fibroids can affect the outcome of pregnancy. There is an increased risk of spontaneous abortion, irregular fetal presentation, aseptic necrosis, placenta previa, premature birth, caesarean section, peripartum hemorrhage and also compression of nearby organs. Although myomectomy during pregnancy is not recommended, some emergency situations lead to retain this surgical indication. The authors report 2 cases of voluminous uterine myomas (FIGO type VI) that caused mechanical compression of the urinary tract with ureterohydronephrosis during the second trimenon of pregnancy. In our first clinical observation, the presence of fibroid was associated with severe bilateral ureterohydronephrosis, myomectomy was essential before the evolutionary risk towards renal failure. In our reported second case, there was no pain but acute retention of urine that required bladder catheterization. This retention was associated with sub-occlusive symptoms with stopping the materials for two weeks without gas. They benefited from a laparotomic myomectomy before term, with a favourable outcome for the mother and the child. The myomectomy during pregnancy remains exceptional and the evolutionary modalities are unpredictable with an increased risk of haemorrhage which can darken the obstetric prognosis, or even the vital one of the mother-child couple. Close prenatal monitoring is still necessary after the myomectomy.
Spontaneous uterine rupture following a history of surgical treatment of an interstitial tubal ectopic pregnancy (EP) is a rare clinical form. This uterine rupture occurring after a wedge resection of the uterine horn, is a serious obstetric complication involving maternal and fetal vital prognosis and obstetric fate of patients in the absence of immediate management. Our observation concerned a 32-year-old gestant, G3P1 (without living children), with a history of interstitial EP dating back to 3 years during which a uterine wedge resection was performed. For this patient, a prophylactic caesarean was recommended between 36 and 37 weeks of amenorrhea. The patient presented during her prenatal follow-up at 37 weeks and 6 days, a complete uterine rupture involving the right uterine horn with the death of a fetus weighing 2900g. The rupture extended throughout the uterine horn, with the right uterine pedicle intact and the right fallopian tube absent. A conservative treatment of the uterus was decided since the patient had no living children. The purpose of our observation is to recall the risk of uterine rupture after cornual uterine excision hence the importance of performing during a EP if possible, a salpingectomy at the level of the uterine horn and if necessary coagulate the intramural portion of the tube. And also in case of uterine wedge resection, to hasten the prophylactic caesarean section as soon as sufficient maturity of the fetus to reduce the incidence of this pregnancy complication.
Background: The purpose of this study was to describe the characteristics of respiratory pathologies during pregnancy and postpartum.Methods: This was a case-control study over a 7-year period from January 2008 to December 2014 at CHU de COCODY. We compiled 86 cases of the PPH department hospitalized patients for pulmonary disease during pregnancy and for postpartum up to 42 days after delivery. The control samples were represented by those hospitalized in Obstetrics for a non-respiratory general condition during the same gravido puerperal period.Results: The age group of 20-29 years was the most affected in both groups with extremes ranging from 16 to 40 years (p=0.827). Respiratory pathology was common among housewives or unemployed women (p=0,001). Pauciparous and multiparous were the most affected (p=0.020). They had a medical history in 55.8% of cases versus 22.8% in controls (p=0.001). Positive HIV serology was also found (p=0.001) and was most often passive tobacco related (p=0.015). Respiratory pathology was progressive in 72.9% in cases vs 8.9% (p=0.001) with dyspnoea as the main sign (58%). Tuberculosis (29.70%) was the most common respiratory disease. Maternal complications accounted for 48.1% of PPH vs 25.6% (p=0.001) with maternal mortality of 11.6% (p = 0.001). As for foetal prognosis, 25.6% of foetal complications were noted in patients admitted to PPH versus 48.1% (p = 0.001).Conclusions: Respiratory disease during the gravido puerperal period is severe with significant maternal repercussion.
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