Hydranencephaly is a rare severe abnormality characterized by replacement of cerebral hemisphere with fluid covered by leptomeninges such that absent cerebral cortex. We present the Ultrasonographic diagnosis of a case of fetal Hydranencephaly at 38 weeks of gestation. Sonography revealed the absence of cerebral cortex, thalami and basal ganglia with disrupted falx and preserved posterior fossa structures. This was the first reported case of Hydranencephaly with absence thalami and basal ganglia along with midbrain. Confirmation of diagnosis was made with postnatal computed tomography. Even though it was diagnosed in the late third trimester, it allowed prompt and finest obstetric management which reduced the risk for both fetus and mother. Furthermore it allowed arrangement of optimal conditions for birth at a unit with accessible specialized pediatric facilities.
Introduction Obstetric haemorrhage is the leading cause of maternal mortality worldwide and in most cases it relates to uterine atony. Even though an oxytocin bolus is used routinely, additional infusion of oxytocin may be required if haemorrhage occurs.Objectives To compare the effects of 20 IU oxytocin infusion and 5 IU bolus with 5 IU bolus and 500ml normal saline on the control of blood loss in antepartum lower segment caesarean section.Methods A double-blind randomized controlled trial was conducted in the Teaching Hospital, Peradeniya, Sri Lanka. Ninety two pregnant women, forty six from each group were randomized to receive either intravenous slow 5 IU oxytocin bolus over 1 minute and additional 20 IU oxytocin infusion in 500 ml of 0.9% saline solution over 4 hours (Group-A) or 5 IU oxytocin bolus over 1 minute and 500 ml of 0.9% Saline over 4 hours (Group B). Visual assessment of mean blood loss was done by the surgeon and anaesthetist. Blood loss was calculated based on the body weight and haematocrit before and 48 hours after delivery.Results Calculated mean blood loss (456.0ml vs 569.8ml) was significantly less in group A (p=0.046). Visual estimation of blood loss by surgeon (476.9 vs 552.1) (p=0.01) and anaesthetist (492.7 vs 557.2) (p= 0.03) were also significantly less in group A.Conclusion Additional oxytocin infusion at antepartum caesarean section reduces blood loss during and after caesarean section significantly.
Amyotrophic lateral sclerosis (ALS) is a degenerative motor neurone disease that is rarely seen in the obstetric population. We present a 32-year-old patient who presented in her fourth pregnancy with a background history of ALS. There was complete involvement of the upper and lower motor neurone system and bulbar system without involvement of the sensory system. At 34 weeks of gestation, she had a full course of steroids and an elective caesarian section under general anaesthesia due to extreme restricted mobility and difficulty of breathing. A multidisciplinary team managed the pregnancy, and both maternal and fetal outcomes were good.
Hydranencephaly is a rare congenital abnormality characterized by the absence and replacement of the cerebral hemispheres with cerebrospinal fluid. Here, we present an ultrasonographic diagnosis of a case of a rare variant of fetal hydranencephaly at 38 weeks of gestation. Obstetric sonography revealed the absence of the cerebral cortex, thalami and basal ganglia with a disrupted falx and preserved posterior fossa structures. This is the first reported case of hydranencephaly with the absence of the thalami and basal ganglia, which was diagnosed prenatally. The diagnosis was confirmed with postnatal computed tomography. The early prenatal diagnosis allowed for prompt obstetric attention at a tertiary care hospital which had specialized pediatric facilities including prenatal counseling and support.
Hydranencephaly is a rare congenital abnormality characterized by the absence and replacement of the cerebral hemispheres with cerebrospinal fluid. Here, we present an ultrasonographic diagnosis of a case of a rare variant of fetal hydranencephaly at 38 weeks of gestation. Obstetric sonography revealed the absence of the cerebral cortex, thalami and basal ganglia with a disrupted falx and preserved posterior fossa structures. This is the first reported case of hydranencephaly with the absence of the thalami and basal ganglia, which was diagnosed prenatally. The diagnosis was confirmed with postnatal computed tomography. The early prenatal diagnosis allowed for prompt obstetric attention at a tertiary care hospital which had specialized pediatric facilities including prenatal counseling and support.
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