Spontaneous rupture of splenic artery aneurysm in pregnancy

Abstract

gestation, the intensity and frequency of contractions increased. At this time, atosiban tocolysis was administered. An initial bolus dose was followed by a continuous infusion, and maternal and fetal observations remained satisfactory. An antiseptic vaginal pack was also inserted in this case. Following a 48-hour infusion of atosiban, the woman's pains had settled completely. Gestation was now 25 weeks and again it was felt that, on an individual basis, this woman would benefit from a more prolonged infusion of tocolysis. Regular cardiotocographs remained reassuring.At 25 weeks and 5 days (1 week after starting tocolysis), spontaneous rupture of the membranes occurred and the atosiban infusion was discontinued. On vaginal examination, the breech was at the pelvic brim and a rim of cervix was present. It was felt that caesarean section would be the safest way to deliver this preterm fetus and the woman was counselled regarding the possible need for a classical uterine incision. Informed consent was obtained and general anaesthetic was administered. A lower-segment caesarean section was performed and a female infant weighing 745 g was delivered easily. No complications were associated with the procedure or the woman's postoperative course. As with the previous case study, this baby continues to do well in neonatal intensive care. DiscussionThese two cases show that, in selected cases of spontaneous preterm labour at very early gestation, there can be a benefit in prolonging the pregnancy with tocolysis. In addition, our cases show that, rather than limit the treatment to a 48-hour infusion to facilitate corticosteroid administration and/or in-utero transfer, in selected cases longer infusions can be administered to further improve outcome. However, this was made possible only by the favourable safety profile of atosiban, which allowed prolonged infusion, and may have contributed to the successful outcome (The Worldwide Atosiban versus Beta-agonists Study Group 2001). We have no doubt that the outcomes for the six babies in these two cases could have been very different had their deliveries occurred when they first presented in labour.

Rotura De Un Aneurisma Esplénico Durante El Embarazo: A Propósito De 2 Casos Clínicos

“…La verdadera prevalencia se desconoce; en autopsias se ha reportado rangos de 0,01 a 10,4%, y se han encontrado en el 0,78% de los angiogramas (1,2). Además se presenta en el 7,1% de los pacientes con hipertensión portal cirrótica (2).…”

“…La verdadera prevalencia se desconoce; en autopsias se ha reportado rangos de 0,01 a 10,4%, y se han encontrado en el 0,78% de los angiogramas (1,2). Además se presenta en el 7,1% de los pacientes con hipertensión portal cirrótica (2). La ateroesclerosis es raramente la causa primaria, y por lo general es el resultado de la degeneración de la capa media de las arterias (2).…”

“…Además se presenta en el 7,1% de los pacientes con hipertensión portal cirrótica (2). La ateroesclerosis es raramente la causa primaria, y por lo general es el resultado de la degeneración de la capa media de las arterias (2).…”

“…Si bien es cierto, la rotura de un aneurisma de la arteria esplénica ocurre en un 3 a 9% de los casos, la mitad de esta complicación acontece durante el embarazo (1,2). La mortalidad materna alcanza alrededor de un 75% y la mortalidad fetal hasta un 95% (1,2,3,4,5), complicándose más frecuentemente durante el tercer trimestre (69%) (1,2,3,4).…”

“…Hasta 1999 en la literatura inglesa se habían publicado alrededor de 100 casos de aneurismas de la arteria esplénica, y sólo en 14 sobrevivió la madre y el feto (2).…”