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Dhamecha R, Pajai S, Bhasin T. Acute Abdomen in Pregnancy: A Comprehensive Review of Diagnosis and Management. Cureus 2023; 15:e40679. [PMID: 37485109 PMCID: PMC10357893 DOI: 10.7759/cureus.40679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
An unusual diagnostic and treatment challenge is presented by an acute abdomen during pregnancy. Obstetric factors and other causes unrelated to pregnancy also contribute to acute abdominal discomfort in pregnancy. Due to the changing clinical presentations brought on by the anatomical and physiological changes of pregnancy as well as the hesitation to utilize certain radiological studies out of concern about damaging the fetus, the diagnosis of the acute abdomen during pregnancy can be challenging. Delays in identification and treatment may have negative effects on the mother as well as the fetus. This review sheds light on the importance of anatomical and physiological considerations, early diagnoses, and understanding the various modalities and etiologies of acute abdomen in pregnancy (AAP). We then move on to discuss the various diagnostic techniques that can help the physician determine the causes and plan well-informed treatment. We examine and contrast different radiographic tests, including X-rays, computed tomography, magnetic resonance imaging, and ultrasound. We also talk about the various roles that these investigational methods can play in the evaluation and treatment throughout the duration of the pregnancy. The paper additionally addresses how to handle patients who appear with AAP and the different techniques used to treat them, including pre-operative laparoscopy. Before going over some more broad points that might be useful, we eventually dive into some of the more intriguing etiologies relating to AAP, such as isolated tubal torsion and neoplastic complications.
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Affiliation(s)
- Rishi Dhamecha
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Taanvi Bhasin
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Pina Moreno JM, Ruiz Minaya M, Fraile López A, Feltrer Hidalgo M, Ortega Abad V, García-Tizón Larroca S. Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review. Int J Gynaecol Obstet 2022. [PMID: 36495234 DOI: 10.1002/ijgo.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses. METHODS A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed. RESULTS Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05). CONCLUSION The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks.
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Affiliation(s)
- Juan Manuel Pina Moreno
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - María Ruiz Minaya
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Andrea Fraile López
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marta Feltrer Hidalgo
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Virginia Ortega Abad
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
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Moghadam MN, Salarzaei M, Shahraki Z. Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis. Emerg Radiol 2022; 29:437-448. [PMID: 35150362 DOI: 10.1007/s10140-022-02021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lack of timely diagnosis of acute appendicitis (AA) can lead to perforation and peritonitis, which might be associated with complications such as miscarriage, preterm delivery, fetal loss, and even maternal mortality. The aim of the present systematic review and meta-analysis was to evaluate the accuracy of ultrasonography (US) for diagnosing AA in pregnant patients. METHODS We performed the present systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using a pre-designed standard datasheet, the two authors summarized the data of each study independently. Pregnant women with diagnosed or suspected AA, who have undergone ultrasonography, as well as using CT scan or surgery as the standard method, were included. RESULTS A total of 8 studies consisting of 1593 patients were included. The main analysis showed that the overall sensitivity and specificity were 77.6% and 75.3% for US in diagnosing AA in pregnancy. The sensitivity of US in the first, second, and third trimesters of pregnancy were 69%, 63%, and 51%, respectively. While the corresponding figures for specificity were 85%, 85%, and 65%. There was a significant difference in the diagnostic performance of US between the first two trimesters and the third one. The DORs in these three trimesters were 36, 26, and 1.92, respectively. CONCLUSIONS Ultrasound evaluation showed a low diagnostic accuracy for acute appendicitis in pregnant women, especially during the third trimester. These patients should be diagnosed early and accurately to prevent both complications and unnecessary operations. It can be recommended to consider alternative imaging, mostly after negative or uncertain US.
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Affiliation(s)
| | - Morteza Salarzaei
- Department of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Shahraki
- Department of Gynecology and Obstetrics, Zabol University of Medical Sciences, Zabol, Iran.
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Coleman B, Ramakrishnan K. Surgical Problems of the Digestive System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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DiLeo Thomas L, Henn MC. Perfecting the Gastrointestinal Physical Exam: Findings and Their Utility and Examination Pearls. Emerg Med Clin North Am 2021; 39:689-702. [PMID: 34600631 DOI: 10.1016/j.emc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The physical examination of the patient is the cornerstone of the practice of medicine, and the skills to complete a thorough abdominal examination are critical in the care of patients. When performed correctly, the abdominal examination can be revealing when it comes to the overall health of the patient as well as acute pathology. The examination of the abdomen has the potential to minimize further testing or radiation and serves as a key diagnostic tool. In this article, we will discuss each portion of the abdominal examination in detail as well as pathologic findings, abdomen-specific signs, special patient populations, and clinical pearls.
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Affiliation(s)
- Liza DiLeo Thomas
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Megan C Henn
- Department of Emergency Medicine, Emory University, 531 Asbury Circle, Annex Building, Suite N340, Atlanta, GA 30322, USA. https://twitter.com/megan_henn
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Kim AM, Kim JW, Kim YH, Kim TY, Ryu HK, Choi MG. Corrective surgery using a gridiron incision for abdominal pain caused by a folded ovary in the third trimester of pregnancy. J Int Med Res 2021; 49:300060521997743. [PMID: 33729868 PMCID: PMC7975525 DOI: 10.1177/0300060521997743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Sonography and magnetic resonance imaging (MRI) may be helpful to obtain an accurate
diagnosis of acute abdominal pain in pregnancy. Adnexal torsion presenting in the first
or second trimester can be confirmed and treated through laparoscopic surgery; however
laparoscopic surgery in the third trimester can be difficult owing to the large uterus,
and a gridiron incision can be useful. Case Report/Case presentation An 18-year-old gravida 1, para 0 (G1P0) woman at 30 + 4 weeks of gestation presented
with sudden-onset cyclic pain in the right lower quadrant. Abdominal ultrasonography
showed a normal appendix, and MRI showed a normal appendix and normal ovaries. The
patient’s prominent tender point was marked and compared with the MR images, which
confirmed the mark as the position of the right ovary. Laparotomy was performed through
a gridiron incision, and a folded right ovary was identified. The ovary was unfolded,
and TachoSil® and Surgicel® were used to maintain the unfolded position. The patient’s
pain resolved, and her postoperative course was uneventful. She delivered a healthy,
2540-g male baby at 35 weeks’ gestation. Discussion/Conclusions A gridiron incision was useful to treat a folded ovary in the third trimester and to
evaluate the adnexa and minimize uterine manipulation.
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Affiliation(s)
- A Mi Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yoon Ha Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Tae Young Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyun Kyung Ryu
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
| | - Myeong Gyun Choi
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, South Korea
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Ali MF, He H, Friedel D. Inflammatory bowel disease and pregnancy: fertility, complications and treatment. Ann Gastroenterol 2020; 33:579-590. [PMID: 33162735 PMCID: PMC7599341 DOI: 10.20524/aog.2020.0536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022] Open
Abstract
Inflammatory bowel disease (IBD) is commonly diagnosed and treated in the young population. Therefore, it is common that women anticipating or undergoing pregnancy will have to cope with the additional burden of their IBD. Pregnancy in an IBD patient also presents challenges for the practitioner, in that the usual diagnostic and therapeutic armamentarium of potential tests and therapies is disrupted. This review covers the implications of IBD for fertility, pregnancy and offspring, and discusses the management of IBD in pregnancy.
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Affiliation(s)
- Mohammad Fahad Ali
- Department of Gastroenterology and Hepatology, Guthrie Cortland Medical Center (Mohammad Fahad Ali)
| | - Harry He
- Department of Medicine, NYU Winthrop University Hospital (Harry He)
| | - David Friedel
- Department of Gastroenterology, NYU Winthrop University Hospital (David Friedel), USA
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Surgical Problems of the Digestive System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mervak BM, Altun E, McGinty KA, Hyslop WB, Semelka RC, Burke LM. MRI in pregnancy: Indications and practical considerations. J Magn Reson Imaging 2019; 49:621-631. [PMID: 30701610 DOI: 10.1002/jmri.26317] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
There is a constantly evolving knowledgebase regarding the safety of MRI in pregnant patients, as well as the safety of gadolinium administration, given potential fetal risks. This review provides an overview of national and international recommendations for patient screening and safety by trimester, evaluates the most recent literature regarding administration of gadolinium in pregnant patients, and discusses technical requirements when imaging pregnant patients. A protocol for imaging pregnant patients is provided, and multiple common indications for MRI in pregnancy are discussed. Level of Evidence 5. Technical Efficacy Stage 5. J. Magn. Reson. Imaging 2019;49:621-631.
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Affiliation(s)
- Benjamin M Mervak
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Ersan Altun
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Katrina A McGinty
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - W Brian Hyslop
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Richard C Semelka
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA.,Richard Semelka, MD. Consulting
| | - Lauren M Burke
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
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Logrado A, Constantino J, Pereira J, Casimiro C. Laparostomy during pregnancy: A case report. Int J Surg Case Rep 2018; 51:120-124. [PMID: 30149329 PMCID: PMC6110995 DOI: 10.1016/j.ijscr.2018.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Acute appendicitis is the main indication for surgery during pregnancy. Physiologic changes during pregnancy and fear of using ionising radiation exams are some of the reasons to delayed diagnosis and consequently to higher morbidity and mortality rates for mother and fetus. PRESENTATION OF CASE We present the case of a 38-year-old woman that resorted to the emergency room on the 13th week of pregnancy with abdominal discomfort, nausea and vomiting that lasted for 7 days. She had been in the Obstetric Emergency Department 6 days prior with the same complaints. She had no fever and she was discharged home following normal obstetric ultrasound. On this second visit, after surgical consultation, septic shock with abdominal source was recognised and patient was taken for emergency exploratory laparotomy. Intraoperatively we found generalised purulent peritonitis secondary to perforated acute appendicitis. Appendectomy, thorough abdominal washing and laparostomy were performed. Patient was admitted on the Intensive Care Unit with septic shock, need for vasopressor therapy and dialysis. Four days after the first intervention the abdominal cavity was closed. She was discharged home on the 14th post-operative day and maintained obstetric follow-up for the remaining uncomplicated pregnancy. DISCUSSION In the presented clinical case, diagnostic delay evolves to abdominal sepsis that demanded a damage control approach. Laparostomy constitutes a damage control gesture, limiting abdominal contamination, preventing abdominal compartment syndrome and allowing subsequent surgical revisions. CONCLUSION Acute abdominal approach using laparostomy allowed for a good outcome, maintaining ongoing pregnancy and with incisional hernia as the only observed morbidity.
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Affiliation(s)
- Ana Logrado
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Júlio Constantino
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Jorge Pereira
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Carlos Casimiro
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
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Posthumus L, Donker ME. Uterine rupture in a primigravid patient, an uncommon but severe obstetrical event: a case report. J Med Case Rep 2017; 11:339. [PMID: 29208037 PMCID: PMC5718063 DOI: 10.1186/s13256-017-1507-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. CASE PRESENTATION A 34-year-old white primigravid woman, 31 + 3 weeks of gestation, presented with pre-eclampsia and developed a sudden acute abdomen. An emergency laparotomy was performed and a uterine rupture was found as the cause of the event. A stillborn girl was born. CONCLUSION A rupture of the pregnant uterus should always be considered in a pregnant woman presenting with abdominal pain, even in a primigravid patient.
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Affiliation(s)
- Lotte Posthumus
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Skubic JJ, Salim A. Emergency general surgery in pregnancy. Trauma Surg Acute Care Open 2017; 2:e000125. [PMID: 29766116 PMCID: PMC5887777 DOI: 10.1136/tsaco-2017-000125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/20/2017] [Accepted: 08/28/2017] [Indexed: 01/07/2023] Open
Abstract
It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options.
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Affiliation(s)
- Jeffrey J Skubic
- Division of Trauma, Burn and Surgical Critical Care, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ali Salim
- Division of Trauma, Burn and Surgical Critical Care, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Acute Appendicitis in Pregnancy and the Developing World. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:2636759. [PMID: 28808675 PMCID: PMC5541817 DOI: 10.1155/2017/2636759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
Background Acute appendicitis is the commonest nonobstetric surgical emergency during pregnancy. The aim of the study was to compare perioperative outcomes of acute appendicitis in pregnant and nonpregnant patients. Methods A retrospective review of medical records of 56 pregnant patients between 2011 and 2016 who were compared with 164 nonpregnant women of reproductive age who underwent open appendectomy between 2014 and 2016 for acute appendicitis. The patient's demographics and perioperative data were analyzed. Results The median age of pregnant and nonpregnant patients observed was 26 years (range 19–37) and 26 years (range 18–43). There were no significant differences between the groups in negative appendectomy (21.4 and 21.3%, P = 0.52), perforated appendicitis (25 and 23.8%, P = 0.85), postoperative complications (28.6 and 26.8%, P = 0.80), and median length of hospital stay (5 and 4.5 days, P = 0.36). There were 3.6% preterm labour, no maternal mortality, and no fetal loss. In multivariate analysis, WBC >18000/mm3 and long patient time to surgery were independent risk factors for appendicular perforation and postoperative complication (P < 0.05). Conclusion Our results of appendectomy in pregnant patients are comparable with nonpregnant patients. Hence the same perioperative treatment protocol can be followed in pregnant and nonpregnant patients even in resource-poor setting.
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El abdomen agudo en el embarazo aumenta el riesgo de complicaciones obstétricas sin influir en el pronóstico materno-fetal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sanci M, Töz E, Ince O, Özcan A, Polater K, Inan AH, Beyan E, Akkaya E. Reference values for maternal total and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period in western Turkey. J OBSTET GYNAECOL 2017; 37:571-575. [PMID: 28604181 DOI: 10.1080/01443615.2016.1268575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of this study was to investigate alterations in the leukocyte and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period. The study population consisted of 40,325 pregnant women. A full blood count and automated differential leukocyte count were performed and all the haemogram results in the different trimesters of pregnancy were recorded. Percentiles were calculated using statistical software. A total of 82,786 complete blood count evaluations were performed in 40,325 subjects from the 6th to 41st week of pregnancy and in the initial postpartum period. The leukocyte counts increased from the 1st to the 3rd trimester and peaked in the initial postpartum period. Our reference values for the total and differential leukocyte counts may assist clinicians in distinguishing between leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Impact statement Pregnancy requires profound adaptation by multiple systems to accommodate the demands of the developing foetus. Similar to all other systems, many haematological changes occur during pregnancy. Studies of normal variation in leukocyte counts were insufficient to distinguish normal from abnormal leukocyte counts during pregnancy and in the initial postpartum period, due to small numbers of patients and a lack of differential leukocyte counts. Without reference leukocyte levels, infections may be more difficult to assess during pregnancy and in the postpartum period. In this study, we report the 3rd, 5th, 10th, 50th, 95th and 99th percentile values for the total and differential leukocyte counts according to trimester in normal pregnancy and the initial postpartum period. Our reference values for the total and differential leukocyte counts in each trimester and the initial postpartum period may assist clinicians in distinguishing between normal leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Our results may prevent misdiagnosis of physiological elevated leukocytes as bacterial infection that leads to unnecessary medication use that may compromise the foetus.
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Affiliation(s)
- Muzaffer Sanci
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Emrah Töz
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Onur Ince
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Aykut Özcan
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Kevser Polater
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Abdurrahman Hamdi Inan
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Emrah Beyan
- a Department of Gynecology and Obstetrics , Tepecik Education and Research Hospital , İzmir , Turkey
| | - Emrah Akkaya
- b Department of Gynecology and Obstetrics , Manisa Maternity and Child Hospital , Manisa , Turkey
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Surgical Problems of the Digestive System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Pregnant women with an acute abdomen present a critical issue due to the necessity for an immediate diagnosis and treatment; in fact, a diagnostic delay could worsen the outcome for both the mother and the fetus. There is evidence that emergencies during pregnancy are subject to mismanagement; however, the percentage of errors in the diagnosis of emergencies in pregnancy has not been studied in depth. The purpose of this article is to review the most common imaging error emergencies. The topics covered are divided into gynecological and non-gynecological entities and, for each pathology, possible errors have been dealt with in the diagnostic pathway, the possible technical errors in the exam execution, and finally the possible errors in the interpretation of the images. These last two entities are often connected owing to a substandard examination, which can cause errors in the interpretation. Consequently, the systemization of errors reduces the possibility of reoccurrences in the future by providing a valid approach in helping to learn from these errors.
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Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy. J Ultrasound 2016; 19:1-5. [PMID: 26941870 DOI: 10.1007/s40477-014-0109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/29/2014] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy. METHODS In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis (>2 cm dilatation of the renal pelvis) or presence of uterine contractions. RESULTS The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation >2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively. CONCLUSION Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.
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Barber-Millet S, Bueno Lledó J, Granero Castro P, Gómez Gavara I, Ballester Pla N, García Domínguez R. Update on the management of non-obstetric acute abdomen in pregnant patients. Cir Esp 2016; 94:257-65. [PMID: 26875476 DOI: 10.1016/j.ciresp.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022]
Abstract
Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.
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Affiliation(s)
| | - José Bueno Lledó
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
| | | | | | - Neus Ballester Pla
- Servicio de Cirugía, Hospital Universitari i Politècnic La Fe, Valencia, España
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Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Aliyu LD. Rare causes of acute abdomen in pregnancy: “ultrasound to the rescue”. A review of two cases. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2015-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Acute abdomen in pregnancy poses special challenge to the pregnant woman, her unborn infant, and the attending physician. The problems are multifactorial, as the physiological changes in pregnancy mask some of the clinical signs that can be elicited in making accurate diagnosis. Some diagnostic modalities are not feasible in pregnancy because of their effects on the fetus. Another dilemma is that two lives are at stake. It becomes even more challenging when one is faced with rare causes. For these reasons, the choice of diagnostic modality becomes critical. The chosen diagnostic modality should not only be readily available, non-invasive, least hazardous to the mother and fetus, but should also provide adequate information to enable accurate diagnosis. Ultrasonography provides such an opportunity and should be utilized whenever the need arises. We present two cases of acute abdomen in pregnancy managed at Abubakar Tafawa Balewa University Teaching Hospital: one was seen in the third trimester and the other in the first trimester, each with its peculiar presentation. The review is meant to alert obstetricians on the critical role of ultrasound in enhancing accurate diagnosis in the face of a complex clinical condition like acute abdomen in pregnancy.
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Affiliation(s)
- Labaran Dayyabu Aliyu
- Perinatal Medicine Unit, Department of Obstetrics and Gynecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi, Nigeria
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22
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Primary Fallopian Tube Clear Cell Adenocarcinoma in Pregnancy: Case Presentation and Review of the Literature. Case Rep Obstet Gynecol 2015; 2015:183243. [PMID: 26090245 PMCID: PMC4452342 DOI: 10.1155/2015/183243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
Primary fallopian tube cancer in pregnancy is rare and is even more so for the clear cell variant. Our case is the third case of primary fallopian tube cancer in pregnancy and the first case of clear cell adenocarcinoma of the fallopian tube in pregnancy. The patient presented with increasing pelvic pain starting in the second trimester. Serial ultrasound evaluations were performed and revealed a rapidly growing complex adnexal mass adjacent to the uterus. Her pregnancy was further complicated by spontaneous preterm labor and she delivered prematurely per vaginam at 31 weeks. She underwent an urgent laparotomy in the immediate postpartum period for acute aggravation of her right pelvic pain and fever. The diagnosis of tubal clear cell adenocarcinoma was subsequently made on histopathology examination.
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23
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Coleman B, Ramakrishnan K. Surgical Problems of the Digestive System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Bharadwaj S, Philpott JR, Barber MD, Graff LA, Shen B. Women's health issues after ileal pouch surgery. Inflamm Bowel Dis 2014; 20:2470-82. [PMID: 25185688 DOI: 10.1097/mib.0000000000000171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with ulcerative colitis and familial polyposis who require colectomy. This surgical intervention allows for resection of colon, while offering intestinal continuity with fecal continence, discontinuation of most medications related to ulcerative colitis and reduction in the risk of colitis-associated neoplasia. As a proportion of these patients are women of childbearing age, it is important to understand the impact on reproductive health and function. Although limited data exist, restorative proctocolectomy/IPAA does not seem to adversely affect menstrual function. In general, sexual function is reported to improve postsurgery with the ability to achieve orgasm unaltered. However, dyspareunia is commonly reported post restoratively. Of concern, there are data to suggest that fertility is decreased post-IPAA. The reasons stated are pelvic adhesions and obstruction of fallopian tubes. Laparoscopic approach may improve fertility outcomes by reducing postoperative adhesions as compared with the open approach. Once achieved, pregnancy in patients with IPAA is characterized by a transient increase in stool frequency that resolves postdelivery. Whether vaginal delivery or cesarean section is preferred route of delivery in these patients is still controversial. But commonly cesarean section is advocated for patients' post-IPAA to prevent anal sphincter injury and long-term effects on pouch function. All of these issues should be included in the discussion with women who are contemplating IPAA, so they are well aware of them before deciding on the best management plan.
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Affiliation(s)
- Shishira Bharadwaj
- Departments of *Gastroenterology & Hepatology, and †Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio; and ‡Department of Clinical Heath Psychology, University of Manitoba, Winnipeg, MB, Canada
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25
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26
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Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, Spencer J. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 2013; 23:3485-500. [DOI: 10.1007/s00330-013-2987-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/10/2013] [Accepted: 07/13/2013] [Indexed: 12/19/2022]
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27
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Franco Hernández JA, Remartínez Fernández JM, Alcázar Salillas MT, García Hernández A. [Anaesthetic treatment of acute abdomen in the first trimester of a twin pregnancy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:230-232. [PMID: 22695203 DOI: 10.1016/j.redar.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 04/23/2012] [Indexed: 06/01/2023]
Abstract
Surgery during pregnancy is not uncommon. It is estimated that some type of surgical procedure is performed in 2% of pregnancies. The risks of the anaesthesia for the mother and foetus in the first trimester are widely known (teratogenicity, aspiration risk…). We present the case of a patient in the 9th week of a twin pregnancy, who suffered from a clinical picture of small intestinal obstruction. Epidural anaesthesia was performed and the outcome of the patient and foetus is described.
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Affiliation(s)
- J A Franco Hernández
- Servicio de Anestesia y Reanimación, Hospital Universitario Miguel Servet, Zaragoza, España.
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28
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Li Y, Ang M, Miller JA. A rare cause of bowel obstruction in pregnancy. J Surg Case Rep 2012; 2012:rjs034. [PMID: 24968425 PMCID: PMC3855217 DOI: 10.1093/jscr/rjs034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present the case of a 30-year-old woman admitted at 38 weeks and 3 days gestation with a rare cause of bowel obstruction. Definitive diagnosis was not made until laparotomy. We present the unique management challenges posed and a review of the literature.
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Affiliation(s)
- Yingda Li
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Megan Ang
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Julie A Miller
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
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29
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Diegelmann L. Nonobstetric abdominal pain and surgical emergencies in pregnancy. Emerg Med Clin North Am 2012; 30:885-901. [PMID: 23137401 DOI: 10.1016/j.emc.2012.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The focus of this article is the evaluation and management of pregnant patients with nonobstetric abdominal pain and surgical emergencies. The anatomic and physiologic changes that occur during pregnancy can cause difficulties in interpreting patients' signs and symptoms in emergency departments. This article reviews some of the common causes of nonobstetric abdominal pain and surgical emergencies that present to emergency departments and discusses some of the literature surrounding the use of imaging modalities during pregnancy. After a review of these changes and their causes, imaging modalities that can be used for the assessment are discussed.
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Affiliation(s)
- Laura Diegelmann
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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30
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Abstract
Imaging of pregnant patients with non-obstetric abdominal pain is reviewed, with an accompanying pictorial essay of cases with concentration on magnetic resonance imaging. Non-obstetric causes of abdominal pain during pregnancy are similar to those of non-pregnant patients. The most common causes are appendicitis and cholecystitis. Other causes are myriad and include biliary, gastrointestinal, infectious, inflammatory, and malignant etiologies, among others. The approach to imaging in pregnant patient is unique, as it is imperative to minimize potentially harmful radiation exposures to the fetus. Ultrasound and MRI are the primary modalities for evaluation of the pregnant patient with abdominal pain. The use of intravenous contrast is discouraged, except in highly-selected patients where there is no other way to obtain vital diagnostic information. CT is still used as the mainstay of evaluation of blunt abdominal trauma and is commonly used for diagnosis of small bowel obstruction, stone disease, and work-up of malignancy during pregnancy. A discussion of test selection and underlying rationale is presented.
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31
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32
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Lin ID, Wang HI, Wang PH, Huang CY, Chen CC, Shiu HL, Chiang MM, Lin HJ, Chen CY, Yang MJ, Chao KC. Mesentery band-like adhesion which caused entrapment of duodenum at 32 gestational weeks. Taiwan J Obstet Gynecol 2012; 50:534-6. [PMID: 22212333 DOI: 10.1016/j.tjog.2011.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2011] [Indexed: 11/30/2022] Open
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33
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Laffita W, Rodiles E, Jiménez-Reyes W, Rodríguez-Terrero I, Collado A. Oclusión intestinal por brida congénita en una gestante de 28 semanas. Informe de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2009.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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34
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Jang DG, Lee GSR, Yoon JH, Lee SJ. Placenta percreta-induced uterine rupture diagnosed by laparoscopy in the first trimester. Int J Med Sci 2011; 8:424-7. [PMID: 21814475 PMCID: PMC3149421 DOI: 10.7150/ijms.8.424] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/06/2011] [Indexed: 11/05/2022] Open
Abstract
Spontaneous uterine rupture is lethal in pregnant women. Placenta percreta-induced spontaneous uterine rupture in the first trimester is extremely rare and difficult to diagnose. A 35-year-old pregnant woman, with a history of 2 vaginal deliveries and 2 spontaneous abortions treated by dilatation and curettage, was admitted to the emergency department because of sudden severe abdominal pain; the gestational age as calculated by sonography was 14 weeks. Diagnostic laparoscopy was considered for surgical abdomen and fluid collection that was noted in sonography. During laparoscopy, uterine rupture with massive bleeding was detected; therefore, total abdominal hysterectomy was performed. The patient was discharged without any complications. Pathological analysis of the uterine specimen revealed placenta percreta to be the cause of the rupture. Uterine rupture should be considered in the differential diagnosis in all pregnant women who present with acute abdomen, show fluid collection in the peritoneal cavity. In addition, we recommend laparoscopy for the investigation of acute abdomen with unclear diagnosis in the first trimester of pregnancy.
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Affiliation(s)
- Dong Gyu Jang
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
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35
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Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? ACTA ACUST UNITED AC 2010; 36:596-603. [PMID: 21052664 DOI: 10.1007/s00261-010-9654-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Kwan LY, Mahadevan U. Inflammatory bowel disease and pregnancy: an update. Expert Rev Clin Immunol 2010; 6:643-57. [PMID: 20594137 DOI: 10.1586/eci.10.35] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Women with inflammatory bowel disease have similar rates of conception to the general population unless they have had pelvic surgery. Once pregnant, regardless of disease activity, they have an increased risk of adverse pregnancy outcome and should be followed as high-risk obstetric patients. Most medications are compatible with pregnancy and lactation, as described in this article. Ideally, women should discuss their plans for pregnancy with their physician prior to conception so that risks and benefits can be reviewed, medications adjusted and healthcare maintenance updated. Once pregnant, a multidisciplinary team of gastroenterologists, obstetricians and pediatricians should help to ensure the best care for the mother and child.
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Affiliation(s)
- Lola Y Kwan
- University of Rochester Medical Center, Rochester, NY, USA
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37
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Abstract
The first laparoscopic surgery in pregnancy was a cholecystectomy in 1991. Since that time, a number of articles and case series have been published addressing laparoscopy in pregnancy. Current recommendations are on the basis of these findings, such as operating during any trimester in pregnancy can be safely performed, fetal heart monitoring should be made preoperatively and postoperatively, prophylactic tocolytics should not be used, and multiple entry techniques (Veress needle, Hasson trocar, or optical trocar) can be safely performed. This article will review anesthesia, fetal effects, obesity, complications, adnexal masses, and gastrointestinal issues.
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Affiliation(s)
- Lubna Chohan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Medical School, Houston, Texas, USA.
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38
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Small bowel obstruction in a postpartum woman after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2010; 6:209-10. [DOI: 10.1016/j.soard.2009.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022]
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39
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40
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Cassina M, Fabris L, Okolicsanyi L, Gervasi MT, Memmo A, Tiboni GM, Di Gianantonio E, Clementi M. Therapy of inflammatory bowel diseases in pregnancy and lactation. Expert Opin Drug Saf 2009; 8:695-707. [DOI: 10.1517/14740330903357463] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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41
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Antal A. [Changes in epidemiology, etiology, diagnostics, and therapy of acute appendicitis]. Orv Hetil 2009; 150:443-6. [PMID: 19240014 DOI: 10.1556/oh.2009.28570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The frequency of acute appendicitis has fallen in the last three decades in developed industrialized countries. From 1961 to 1991 the number of appendectomies performed annually in Hungary decreased significantly. Since 1991 the numbers are essentially unchanged. Appendix lumen obstruction was formerly believed to be crucial in the etiology of the illness, while today mixed aerobic, anaerobic bacterial infection is considered more important. The inflammation process - according to immunogenetic differences - may lead to recovery or tissue necrosis and perforation. To date, no methods are known that could timely distinguish spontaneously healing or conservatively treatable appendicitis from those resulting in tissue necrosis, although routine usage of abdominal ultrasound technique is added to the clinical picture's modern diagnostic arsenal. The operative method for removing the appendix also has changed. Experience has confirmed that laparoscopic appendectomy is usually more favorable in the treatment of acute appendicitis than traditional surgery.
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Affiliation(s)
- András Antal
- Nagyatád Med Egészségügyi Szolgáltató Kft. Sebészet, Mátrixosztály Nagyatád Bajcsy-Zs. u. 1. 7500.
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42
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Abstract
Women with inflammatory bowel disease (IBD) and the physicians who care for them must make difficult decisions on issues of conception, pregnancy, and breastfeeding with very limited and often contradictory information. This review provides the most current information on the inheritance of IBD, fertility, pregnancy outcomes, the management of disease during pregnancy, and the safety of medications in pregnancy and breastfeeding. We would like to emphasize that the information presented here must be individualized to the specific situation of each patient, their acceptance of risk, and their degree of disease severity.
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Affiliation(s)
- Marla Dubinsky
- Department of Pediatrics, Inflammatory Bowel Disease Center, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
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43
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Current world literature. Curr Opin Obstet Gynecol 2008; 20:602-7. [PMID: 18989138 DOI: 10.1097/gco.0b013e32831ceeb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Buch KE, Tabrizian P, Divino CM. Management of Hernias in Pregnancy. J Am Coll Surg 2008; 207:539-42. [DOI: 10.1016/j.jamcollsurg.2008.04.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 04/25/2008] [Accepted: 04/25/2008] [Indexed: 11/28/2022]
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45
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Cappell MS. Hepatic disorders mildly to moderately affected by pregnancy: medical and obstetric management. Med Clin North Am 2008; 92:717-37, vii. [PMID: 18570940 DOI: 10.1016/j.mcna.2008.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatic, biliary, and pancreatic disorders are often complex and clinically challenging during pregnancy. Hepatic disorders can affect the pregnancy and vice versa. The differential diagnosis of hepatic diseases is particularly broad during pregnancy because it includes disorders related to, and unrelated to, pregnancy. This article discusses the physiologic effects of pregnancy on liver function; the differential diagnosis of hepatic findings during pregnancy; modifications of abdominal imaging and hepatobiliary endoscopic procedures during pregnancy; and the medical and obstetric management of hepatic, biliary, and pancreatic diseases that are mildly to moderately affected by pregnancy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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46
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Dietrich CS, Hill CC, Hueman M. Surgical Diseases Presenting in Pregnancy. Surg Clin North Am 2008; 88:403-19, vii-viii. [PMID: 18381120 DOI: 10.1016/j.suc.2007.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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