To our knowledge this is the first reported case of a subdural hematoma, related to fetal autoimmune thrombocytopenia, diagnosed prenatally by ultrasound. The underlying etiology was hidden maternal autoimmune thrombocytopenia. This disease, which is as serious as alloimmune thrombocytopenia, causes severe fetal thrombocytopenia, which carries with it a high risk of intracranial hemorrhage and recurrence in subsequent pregnancies. Only 14 cases of fetal subdural hematomas have been reported in the literature. The etiologies of these cases were principally traumatic, or due to disorders of hemostasis. Their prognoses were generally poor, with 50% resulting in fetal death in utero and the remaining 50% demonstrating post-natal sequelae. The presence of reverse flow in the middle cerebral artery is rare and its association with a subdural hematoma unusual. Abnormalities found on cerebral Doppler studies indicate an adaptive response to a fetal condition for which the prognosis is then very poor. Monitoring fetuses at risk for hemorrhage by ultrasound imaging and Doppler studies enables us to detect indicators of a worsening prognosis before the ultrasound appearance of morphological hemorrhage. The development of intracranial hemorrhage raises difficult management issues during the index pregnancy and in subsequent pregnancies.
Objective
To evaluate the complications of ‘classic’ laparoscopic entry in a university tertiary care centre.
Design
An analysis of the complications of classic laparoscopic entry for diagnostic and operative laparoscopies. We considered a consecutive series of 8324 cases with the same entry technique: CO2 insufflation, followed by insertion of the umbilical trocar and subsequent placement of accessory trocars under direct vizualization.
Subjects
Between November 1 1992 and December 31 1998, 8324 patients underwent laparoscopies. The 978 diagnostic laparoscopies (11.75%) and 7346 operative laparoscopies (88.25%) were performed by 14 experienced gynaecological surgeons or by trained surgeons under the supervision of one of the experienced surgeons.
Main outcome measures
Peri‐ and postoperative complications of laparoscopic entry were assessed and analysed.
Results
Laparoscopic entry complications occured in 10 cases out of 8324 laparoscopies (0.12%). These included six vascular injuries, three bowel perforations and one bladder complication. No death occurred and no blood transfusions were required. No adverse consequences were observed in five cases. A laparotomy was performed in four cases and in one instance the laparotomy was delayed.
Conclusion
The complication rate of classic laparoscopic entry was quite low in our experience. These results suggest that no modifications to the technique for classic laparoscopic entry are needed.
Objective To assess the efficacy, tolerance, and cost of external version under epidural anaesthesia and Design Prospective open study.Participants Sixty-eight women with breech presentation at around 36 weeks of gestation and an attempted external cephalic version under salbutamol that failed, who consented to try a second attempt under epidural anaesthesia.The overall success rate under epidural anaesthesia was 39.7% (27/68), and complications occurred in two cases. The total cost of attempting external version was higher than the cost of expectant management.Conclusions The efficacy of external cephalic version under epidural reduces the rate of caesarean sections associated with breech presentation, but its relative safety remains in question. Moreover, our economic analysis discourages the hope of lowered costs suggested by earlier reports that this technique is more expensive than expectant management, except in institutions with a policy of systematic caesarean sections when version fails.beta-mimetic tocolysis after the failure of an initial attempt with tocolysis alone.Results
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