This case report describes a case of heterotopic cervical ectopic pregnancy in a nulliparous woman that was successfully treated with single-dose local, intra-amniotic methotrexate injection in the gestational sac. Pregnancy was achieved spontaneously. The patient had previously undergone hysteroscopic myomectomy. By using local, single-dose treatment we avoided the continued effects of the drug on the intrauterine pregnancy and the possible adverse effect of systemically applied methotrexate. The treatment resulted in the term vaginal delivery of a healthy child and preserved the patient's fertility for future pregnancies.
Introduction: Intra-amniotic maternal hemorrhage is a rare condition, hard to differentiate from some other conditions in pregnancy. We report an unusual case of intra-amniotic maternal hemorrhage in term pregnancy ending in urgent cesarean section, identified on ultrasound examination. Case Report: A 24-year-old female (gravida 3, para 2, abortion 0) was admitted to hospital at 40 weeks’ gestation for collapse and general weakness. Her blood pressure was 90/60 mm Hg, pulse 112 bpm, temperature 36°C. The fetal heart race tracings were stable and reactive. The cervix was opened 3 cm. Further examination revealed no vaginal bleeding and normal amnioscopic findings. An ultrasound examination confirmed singleton, head-presenting gestation without any visible congenital anomalies, amniotic fluid index was at the 50th percentile, anterior placenta without evidence of previa, abruption or retroplacental hematoma. An inhomogeneous echogenic mass, measuring 12 × 8 cm, was noted within the amniotic cavity, there was no evidence of pathological flow through the mass on color Doppler. After admittance to the hospital, the patient complained of regular pains, weakness and collapsed with signs of hemorrhagic shock. Repeated ultrasound evaluation showed no change in acoustic texture and size, but the amniotic fluid now had a hyperechoic appearance which revealed increasing intra-amniotic hemorrhage. Because of clinical signs of maternal hemorrhagic shock confirmed by laboratory findings of decreasing red blood parameters, an urgent cesarean section was performed. A female infant weighing 3,070 g, Apgar score 5/7, was delivered. After removal of the placenta there was no sign of abruption, which was confirmed at histopathology. Hemoglobin A was detected in the amniotic fluid by Abt’s test. The patient had an uncomplicated postoperative course. The infant developed normally. Conclusion: When there are signs of fetal distress or maternal hemorrhagic shock, an urgent cesarean section should be performed.
This study aimed to investigate diet quality in healthy pregnant women based on the Na-to-K ratio from 24 h urine sample and food frequency questionnaire (FFQ), to compare dietary micro- and macronutrient intake with current nutritional recommendations (RDA), and to investigate whether gestational weight gain (GWG) is associated with Na-to-K ratio and diet quality during pregnancy in general. Sixty-four healthy pregnant women between 37 and 40 weeks of gestation participated in the study. Participants’ GWG, body composition, molar 24 h urine Na-to-K ratio, and FFQ data on average daily total energy, food groups, and micro-/macronutrient intake were obtained. A Na-to-K ratio of 2.68 (1.11–5.24) does not meet nutrition quality and is higher than the WHO recommendations due to excessive sodium and insufficient potassium intake. FFQ Na-to-K ratio was associated with a higher daily intake of soups, sauces, cereals, fats, and oils and a low intake of fruit and non-alcoholic beverages. A total of 49% of pregnant women exhibited excessive GWG, which was attributed to the increase in adipose tissue mass. GWG was not associated with total energy but may be the result of insufficient physical activity during pregnancy. Daily intake of vitamin D, vitamin E, folate, niacin, riboflavin, calcium, iron, and zinc was suboptimal compared to RDA.
War in Croatia resulted in a significant release of contaminants into the environment as a result of the use of combat assets, mainly conventional, mostly aimed at civilian targets. The aim of the study was to investigate the concentration of metals and metalloids in the soils of eastern Croatia. Compared with soil samples from areas exposed to low intensity combat activity soil samples from areas exposed to heavy fighting had higher concentrations of As, Hg and Pb than allowed by national legislation for ecologic farming as well as even higher concentrations of Hg than the maximum allowed values for agriculture in general. Descriptive statistics shows that mean values of Cu, Zn, Ni, Pb, P and Ba are all higher in samples collected at the areas of high combat activity compared with the ones collected from the low combat activity areas. Sb concentration was elevated in one location, which can also be correlated with population exposure. The results of the principal component analysis suggest possible correlation between the war activity and the degree of contamination by the metals found in ammunition.
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