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A case of gravid uterus in an incisional hernia is reported. The pregnancy was further complicated by intrauterine growth restriction, oligohydramnios and pregnancy induced hypertension. The management of the case is discussed.
Eighteen pregnancies, occurring in 15 patients in whom a simple repair of a ruptured gravid uterus had been performed previously, are reviewed. Seventeen of these had a successful outcome. There was no case of recurrent rupture.
1. Effects of atrial natriuretic peptide (ANP) on tension development, particulate guanylate cyclase activity and guanosine 3':5'-cyclic monophosphate (cyclic GMP) concentrations of uteri from oestrogen-treated, progesterone-treated, ovariectomized and pregnant rats were determined in vitro. 2. ANP inhibited the tension development by myometrial tissues from oestrogen-treated virgin rats and the sterile horn of 10 to 14 day pregnant rats but not of the uterus from pregnant and progesterone-treated rats. 3. Inhibition of cyclo-oxygenase and lipoxygenase activities did not restore the tocolytic activity of ANP on gravid uterus. ANP exerted a tocolytic effect on nongravid uterus submaximally stimulated by prostaglandin F2 alpha (PGF2 alpha), oxytocin, vasopressin, angiotensin II or 5-hydroxytryptamine (5-HT). 4. Ovariectomy decreased the tocolytic effects of ANP, which could be restored by oestrogen treatment. 5. The refractoriness to the tocolytic effect of ANP in pregnant rats was not accompanied by a decrease in its relaxant effects on isolated aortic strips. 6. Tocolytic effects of isoprenaline, isobutylmethyl xanthine and hydroxylamine were not influenced by pregnancy or progesterone treatment. Up to a concentration of 3 mM, sodium nitroprusside did not affect myometrial tension development. 7. Pregnancy and progesterone treatment markedly inhibited ANP-induced increases in myometrial particulate guanylate cyclase activity and cyclic GMP concentrations but did not influence the effects of ANP on aortic cyclic GMP concentrations. 8. It is concluded that exposure of the myometrium to circulating and placentally-produced progesterone is responsible for the pregnancy-induced decrease in the effects of ANP on myometrial particulate guanylate cyclase activity and cyclic GMP concentrations and in turn on myometrial tension development.
Uterine torsion secondary to sacculation of the uterine horns was diagnosed in two non-gravid bitches which were presented with anorexia, polydipsia and an acutely swollen abdomen. On the basis of the radiological and ultrasonographic findings, which indicated the presence of an enlarged spherical or tubular structure filled with hypoechoic material in the caudal abdomen, a tentative diagnosis of pyometra was made. Exploratory laparotomy revealed unilateral uterine horn torsion along the longitudinal axis, with bilateral fluid-filled sacculations. Ovariohysterectomy was performed in both cases. Pathological examination of the uteri demonstrated haematometra in one dog and pyometra in the other.
Among 1954 pregnant women who booked before the end of the 14th week of gestation the uterus was retroverted in 220 (11.2%). The incidence of bleeding in early pregnancy and spontaneous abortion was significantly higher in the retroverted group. Only three patients (1.4%) with a retroverted gravid uterus developed acute retention of urine. Patients with retroverted uteri did not have a higher incidence of previous infertility, nor any increase in the incidence of common obstetric abnormalities.
PURPOSE: To assess the implications of spontaneous changes in the length and configuration of the gravid cervix during a single ultrasound (US) examination and to correlate specific cervical dimensions with pregnancy outcome. MATERIALS AND METHODS: Sonograms in 27 pregnant patients with a spontaneously changing cervix were studied prospectively. The length and width of cervical funneling and the length of intact cervix caudal to the funneling were measured when the cervical dimensions were most normal and most abnormal. Sonographic measurements were correlated with clinical and delivery data. RESULTS: Twenty patients delivered preterm, although only six delivered within a week of the US examination. Wider funneling of the internal os and a shorter segment of intact cervix caudal to the funneling both correlated with an increased likelihood of preterm delivery. CONCLUSION: Most patients with a spontaneously changing cervix deliver preterm. Measurements obtained when the cervix appears most abnormal are most predictive of early delivery.
Electromagnetic blood flow transducers and uterine arterial, uterine venous, umbilical venous, fetal femoral arterial, and fetal femoral venous catheters were implanted in 11 cows on day 161 +/- 4 of gestation. Antipyrine (0.66 M) plus NaCl (0.16 M) dissolved in deuterium oxide (D2O), or H2O, was infused at a constant rate into the fetal femoral vein catheter. Concentrations of antipyrine and D2O in uterine arterial and venous blood and antipyrine in fetal arterial and umbilical venous blood, as well as middle uterine arterial blood flow (electromagnetic transducer), were determined. Antipyrine and D2O gave similar estimates (steady-state diffusion method) of gravid uterine blood flow. In addition, the slope of the regression of D2O on antipyrine estimates was not different (P greater than 0.10) from one. Electromagnetic transducers gave estimates of uterine blood flow that were 32-42% of those obtained with steady-state diffusion but were correlated (P less than 0.05) with estimates obtained by use of both antipyrine and D2O. The transplacental clearance rate of antipyrine was similar (per kg placenta) to that observed in ewes. It was suggested that the maternal and fetal microvasculatures of the bovine placenta could have a concurrent arrangement with vascular shunts or maldistribution of flows, as has been suggested for the ewe.
We report a case of renal cortical abscess in a gravid woman. The abscess was documented by US as well as by MRI. The development of a kidney abscess is extremely rare despite the fact that urinary tract infections are quite common during pregnancy. The limitations of the diagnostic work-up during pregnancy are emphasized.
The effects of epidural anesthesia and surgery on serum iodothyronine and cortisol levels were studied in 10 gravid ewes during the last trimester. The mean serum T3 concentration was significantly decreased 24 h after surgery, returning to the preanesthesia level at 48 h. The mean serum rT3 and cortisol levels were significantly increased after the start of anesthesia and surgery, returning to baseline levels after 48 h. There was a significant positive correlation between the rT3/T3 ratio and serum cortisol values. In the chronic ovine fetal-maternal model, studies which may be affected by corticosteroids of thyroid hormones should be delayed for at least 48 h following surgery to allow maternal serum iodothyronine and cortisol concentrations to return to baseline values.
The hemorrhagic disease of the newborn can be prevented by administration of vitamin K1. The modes of utilization of the vitamin need to be studied in the mother and child. An experimental pharmacokinetic study was conducted, using the gravid female rat. Results showed rapid intestinal absorption of phylloquinone. The fetus plasma concentration rose from 8.6 micrograms/l at time 0 to 0 to 44.3 micrograms/l at 8 h. Such an increase is an evidence of phylloquinone diffusion across the placenta. The phenomenon requires a high gradient. On the other hand, maximum plasma concentrations are not reached until the 8th hour.
Fifty emergency laparotomies were performed over a period of 5 years for rupture of the gravid uterus at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The associated morbidity and mortality rates were very high. Contributory factors were lack of antenatal care, high parity, late presentation, inadequate resuscitation, delayed surgery and poor perioperative monitoring and anaesthetic management. More widespread and efficient antenatal care and better referral centre services will improve patient outcome.
The uptake of substrates by the pregnant uterus defines the "diet" of the uterus and conceptus. In order to determine the uterine substrate uptake, catheters were placed in the femoral artery and uterine veins of guinea pigs at 40-49 days gestation. After at least 2 days recovery from perioperative stress, systemic arterial and uterine venous concentrations of oxygen, glucose, lactate, acetoacetate, beta-hydroxybutyrate, acetate, and free fatty acids were measured and metabolic quotients were calculated. The glucose/O2 quotient was 1.22 +/- 0.07 (mean +/- SEM), the lactate/O2 quotient was -0.40 +/- 0.09, the acetoacetate/O2 quotient was 0.03 +/- 0.02, the beta-hydroxybutyrate/O2 quotient was 0.01 +/- 0.006, the acetate/O2 quotient was 0.03 +/- 0.01, and the free fatty acid/O2 quotient was 0.24 +/- 0.21. Among the substrates measured, glucose appears to be the major metabolic fuel of the pregnant guinea pig uterus, but does not account for all of the oxygen consumed by the uterus if adjusted for lactate production, since lactate is produced within the gravid uterus in large quantities. Acetoacetate and beta-hydroxybutyrate are utilized in negligible amounts.
This study aimed at identifying the best ovitrap installation sites for gravid Aedes aegypti in Mirassol, state of São Paulo, Brazil. Ovitraps were installed in ten houses per block over ten blocks. Four ovitraps were placed per residence, one in the bedroom, one in the living room, and two outdoors with one in a sheltered area and one in an outside site. Each week for eleven weeks, visits were made to examine the ovitraps and to change the paddles used for egg-laying. Eggs were analyzed according to the trap location. The results showed that the outdoor sites received significantly more oviposition than indoor sites. Additionally, in respect to the outdoor sites, the outside site received significantly more oviposition than the sheltered site. A strong correlation was observed between positive traps and egg numbers. The results are discussed with respect to the best installation site of the traps and their implications in surveillance and control of dengue vectors.
The role of thromboxane in the gravid normotensive (CD) and hypertensive (SHR) rat was investigated (by utilizing two thromboxane receptor-blocking drugs, EP092 and AH23848) both at mid-gestation and at term. The parameters examined were uterine blood flow (blood flows were measured by the microsphere technique) and uterine weight and placental blood flow at term, fetal mass and number. At mid-gestation EP092 significantly (P < 0.005) increased uterine blood flow in both strains whilst the increases seen with AH23848 were not statistically significant. At term (day 22 in the CD and day 23 in the SHR rat) the antagonists increased uterine blood flow in the CD rats alone. However, at this time the antagonists caused an increase in placental blood flow in both strains. Thromboxane appears to be involved in the regulation of uteroplacental blood flow. The observation that the antagonists were able to potentiate blood flow by mid-gestation may provide a clinical indication with respect to potential prophylactic use of this class of compounds in cases of pregnancy-induced hypertension in women.
Thirty mares in late gestation were used in a 3-yr study to assess effects of the tall fescue endophyte Acremonium coenophialum on serum prolactin (PRL) and progesterone. Two paddocks of each treatment, 0 or 100% infected 'Kentucky 31' tall fescue, were grazed by the mares for 21 d. Blood was collected three times per week until parturition. At 7-d intervals, mares were challenged with thyrotropin-releasing hormone (TRH) while grazing and blood was collected postinjection. Mares grazing 100% infected tall fescue (E+) had decreased serum PRL compared with mares grazing the 0% infected tall fescue (E-) in 2 of 3 yr. Within 8 d postgrazing, serum PRL for E+ mares equaled or surpassed values of the E- mares. Serum PRL was not different during the 3rd yr. In response to TRH, serum PRL rate of increase was similar between treatments but remained elevated (P less than .01) in the E+ mares at the 180-, 240-, and 300-min sample times. Serum progesterone was lowered (P less than .05) by E+ but increased to control values within 10 d postgrazing. It is concluded that serum PRL and progesterone in the gravid mare were decreased by the presence of A. coenophialum in 'Kentucky 31' tall fescue grass but normal levels were reestablished within 2 to 3 wk.
Acute renal failure due to ureteral obstruction by the gravid uterus is considered to be a rare complication of late pregnancy. Pleural effusion caused by urinary tract obstruction is also extremely uncommon. This presentation reports what is believed to be the first case in which both these complications appeared at the same time in a pregnant patient.
A prospective, longitudinal investigation of the relation between cortisol reactivity, self-report anxiety and labor and delivery outcomes was undertaken in a sample of non-urban pregnant adolescents. Cortisol and anxiety levels obtained in the first half of pregnancy and again in mid-third trimester were found to be related positively to several individual negative labor and delivery outcomes, as well as to a summary score of negative maternal intrapartal outcomes. However, when changes in cortisol and anxiety over pregnancy were examined, greater increases in cortisol and anxiety over time were negatively related to individual negative intrapartal outcomes, as well as to the maternal intrapartal outcomes summary score. Findings indicate that while an assessment of how individuals react to stress at certain points during pregnancy may be predictive of intrapartal outcomes, longitudinal examinations of gravid women's reactivity/anxiety states may be more indicative of their psychophysiological preparation for the intrapartum, and may be more predictive of outcome.
Central diabetes insipidus (CDI) arising in the puerperal period has been attributed mainly to Sheehan's syndrome or to lymphocytic infundibulo-neurohypophysitis. We report the case of a 24-year-old woman who came to our observation for the appearance, 3 weeks after a normal delivery, of a polyuric-polydipsic syndrome. Measurements of urinary volumes, plasma osmolality and urinary osmolality, in conditions of free water intake, water deprivation and a water deprivation-vasopressin administration test, demonstrated CDI. Brain magnetic resonance imaging showed a normal morphology of the adenohypophysis and total absence of the neurohypophysis. Assays of the pituitary hormones were found to be within normal limits. These results, incompatible with a diagnosis of Sheehan's syndrome and lymphocytic infundibulo-neurohypophysis, excluded all the other known causes of acquired CDI. Our diagnosis was therefore of post-gravid idiopathic CDI. Thus, it is possible that in the puerperal period other diseases of the posterior hypophysis may develop, of unknown etiopathogenesis but equally responsible for CDI.