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Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival
K. Navaratnam,P. Ulaganathan,M. A. Akhtar,S. D. Sharma,M. G. Davies
Case Reports in Obstetrics and Gynecology , 2011, DOI: 10.1155/2011/426127
Abstract: Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.
Maternal and Foetal Deaths from Ruptured Spleen Following Abdominal Massage by Traditional Birth Attendants in the Niger Delta, Nigeria
GO Igberase
Afrimedic Journal , 2012,
Abstract: Background: Abdominal massage is a harmful cultural practice sometimes leading to maternal and Foetal mortality and morbidity. Aim: To report a case of maternal and foetal deaths from abdominal massage with review of relevant literature. Method: A case of maternal and fetal deaths from abdominal massage is reported. Result: A case of a 34 year old unbooked gravida 3 para 1 1+ lady admitted at 32 weeks gestation with 2 weeks history of cough and a 3 day history of fever, labour pains and difficulty with breathing is presented. She had abdominal massage done on 2 occasions in a traditional birth attendant's home. Abdominal ultrasound revealed massive intraperitoneal fluid collection with twin intrauterine foetal death. Findings at laparotomy showed a ruptured spleen, massive haemoperitoneum of 4.5 litres and twin intrauterine foetal deaths. She died 2 hours post operatively of hypovolemic shock and cardiac arrest. Conclusion: Widespread public health enlightenment of traditional birth attendants and pregnant women on the harmful effect of abdominal massage is needed.
Endotension: rupture of abdominal aortic aneurysm
Amato, Alexandre Campos Moraes;Abraham, Flávio Amim;Kraide, Henrique Dini;Rocha, Leandro Teixeira;Santos, Ricardo Virginio dos;
Jornal Vascular Brasileiro , 2012, DOI: 10.1590/S1677-54492012000200016
Abstract: aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. stents and an aortic endoprosthesis are placed in the renal arteries. this method is primarily used when open surgery is too risky. the mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. the expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. its diagnosis is made by exclusion. we present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. a second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. endotension is a possible cause of aneurysm rupture and death.
Isolated duodenal rupture due to blunt abdominal trauma  [cached]
Celik Atilla,Altinli Ediz,Onur Ender,Sumer Aziz
Indian Journal of Critical Care Medicine , 2006,
Abstract: Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.
Abdominal aortic aneurysm: Rupture of the anterior wall  [PDF]
Dra?kovi? Miroljub,Mi?ovi? Sidor,Jevti? Miodrag,?arac Momir
Medicinski Pregled , 2007, DOI: 10.2298/mpns0702080d
Abstract: Introduction An aneurysm is a focal dilatation of an artery (aorta), involving an increase in diameter of at least 50% as compared to the expected normal diameter (over 3 cm). Abdominal aortic aneurysms (AAA) cause thousands of deaths every year, many of which can be prevented with timely diagnosis and treatment. AAA can be asymptomatic for many years, but in one third of patients whose aneurysm ruptured, the mortality rate is 90%. In the past, palpation of the abdomen was the preferred method for identifying AAA. However, diagnostic imaging techniques, such as ultrasonography and computed tomography are more accurate and offer opportunities for early detection of AAA. Case report This paper is a case report of an 83-year old female patient. She was admitted due to severe pain in the abdomen. We already knew about the AAA (from her medical history). After using all available diagnostic procedures, rupture or dissection of the AAA were not confirmed. The patient underwent emergency surgery. During the operation, rupture of the anterior wall of the aneurysm was found. The anterior wall was filled with parietal thrombus, which hermetically closed the perforation. The patient was successfully operated and recovered. Conclusion The aim of this case report was to point out that our diagnostic procedures failed to confirm the rupture of AAA. We decided to apply surgical treatment, based on medical experience, clinical findings, ultrasonography and computed tomography and during operation rupture of AAA was confirmed. Patients with an already diagnosed AAA, or patients with clinical picture of rupture or dissection, are in urgent need for surgery, no matter what diagnostic tools are being used.
Neonatal Complications Related with Prolonged Rupture of Membranes  [PDF]
Hassan Boskabadi,Gholamali Maamouri,Shahin Mafinejad
Macedonian Journal of Medical Sciences , 2011,
Abstract: Background. Prolonged rupture of membranes (PROM) is a common and significant cause of preterm labor and has a major impact on neonatal morbidity and mortality. The aim of this study was to determine maternal risk factors and the prevalence rate of neonatal complications following PROM . This study also detected the role of maternal antimicrobial treatment on neonatal complications.Methods: This cross-sectional study was performed at Ghaem hospital, Mashhad, Iran; from March 2008 to April 2010 to evaluate newborns’ outcome that were born from mothers with prolonged premature rupture of membranes (PROM> 18 hours). Maternal risk factors, antibiotic administration and its influences on neonatal complications were evaluated. Eligible infants were categorized into group I (symptomatic infants), II (mother with chorioamnionitis) and III (asymptomatic infants).Results. 150 infants were included in the study. 12 (7.7%) infants had definitive infections (meningitis, sepsis, pneumonia), 101(67%) infants were premature and 88(58.6%) infants had mothers with a history of antibiotic intake. Maternal risk factors were reported in the following order: previous PROM (10%), addiction (8%), high urinary tract infection (5/3%), diabetes (4.7%), placenta abruption (4.7%), preeclampsia (3/3%) and cercelage (2%). Neonatal complications related with PROM were prematurity (67.3%), respiratory distress syndrome (22.6%), asphyxia (8.6%), meningitis (5.2%), sepsis (4%), pneumonia (1.3%) and death (4.6%). History of antibiotic administration to mothers with PROM was negative in four babies with sepsis and one with meningitis.Conclusion. The most common complication of PROM was prematurity and its side effects, but infection is the most important modifiable complication. Although antimicrobial treatment of women with a history of PROM improves neonatal outcome through reducing neonatal sepsis and respiratory distress syndrome (RDS), but the incidence rate of meningitis and pneumonia may be increased.
Touch and Massage for Medically Fragile Infants  [PDF]
Karen Livingston,Shay Beider,Alexis J. Kant,Constance C. Gallardo,Michael H. Joseph,Jeffrey I. Gold
Evidence-Based Complementary and Alternative Medicine , 2009, DOI: 10.1093/ecam/nem076
Abstract: Research investigating the efficacy of infant massage has largely focused on premature and low birth weight infants. The majority of investigations have neglected highly acute patients in academic neonatal intensive care units (NICUs). The current study was developed with two aims: (Phase 1) to develop, implement and demonstrate the feasibility and safety of a parent-trained compassionate touch/massage program for infants with complex medical conditions and (Phase 2) to conduct a longitudinal randomized control trial (RCT) of hand containment/massage versus standard of care in a level III academic Center for Newborn and Infant Critical Care (CNICC). Certified infant massage instructors (CIMIs) taught parents to massage their hospitalized infants. Massage therapy and instruction were performed for seven consecutive days and health outcomes were collected for up to 1 month following treatment. Caregivers, nurses and certified infant massage therapists indicated moderate to high levels of satisfaction and feasibility with the implementation of hand containment/massage in a level III academic center CNICC. In addition, infant behavioral and physiological measures were within safe limits during the massage sessions. All caregivers participating in the massage group reported high levels of satisfaction 7 days into the intervention and at the 1-month follow-up with regards to their relationship with their infant, the massage program's impact on that relationship and the massage program. Due to unequal and small sample sizes, between group analyses (control versus massage) were not conducted. Descriptive infant characteristics of health outcomes are described. Preliminary data from this study indicates feasibility and safety of infant massage and satisfaction among the caregivers, CIMIs and the nurses in the CNICC. An important contribution from this study was the demonstration of the infants' safety based on physiological stability and no change in agitation/pain scores of the infants receiving massage. Massage in a tertiary urban academic NICU continues to be an area of needed study. Future studies examining infant health outcomes, such as weight gain, decreased length of hospitalization and caregiver–infant bonding, would provide greater insight into the impact of massage for medically fragile infants.
Effect of Rolling Massage on Particle Moving Behaviour in Blood Vessels

YI Hou-Hui,FAN Li-Juan,YANG Xiao-Feng,CHEN Yan-Yan,

中国物理快报 , 2008,
Abstract: The rolling massage manipulation is a classic Chinese massage, which is expected to eliminate many diseases. Here the effect of the rolling massage on the particle moving property in the blood vessels under the rolling massage manipulation is studied by the lattice Boltzmann simulation. The simulation results show that the particle moving behaviour depends on the rolling velocity, the distance between particle position and rolling position. The average values, including particle translational velocity and angular velocity, increase as the rolling velocity increases almost linearly. The result is helpful to understand the mechanism of the massage and develop the rolling techniques.
Diagnosis and Surgical Treatment of Diaphragmatic Rupture Following Blunt Abdominal Traumas
Ahmet Karamercan,Osman Kurukahvecioglu,Yildirim Imren,Tonguc Utku Yilmaz,Mustafa Sare,Bulent Aytac
Surgery Journal , 2012,
Abstract: Diaphragmatic rupture observed in trauma patients with multiple organ injuries is a rare but serious problem. The incidence rate for diaphragmatic rupture is 0.8-5% while mortality rate is between 16.6-33.3%. There are cases in the literature which diaphragmatic rupture was diagnosed years after the trauma. Symptoms related to heart or lung compression due to early or delayed displacement of the abdominal viscera into the thorax or strangulation of abdominal viscera lead the physician to diagnosis. A 75-year old female patient who presented to the emergency room with shortness of breath, abdominal pain, nausea and vomiting complaints had been in a traffic accident 20 days earlier and admitted to the hospital. Abdominal ultrasound, plain radiographs and laboratory tests after the accident had been normal and the patient was discharged after a 24 h follow-up. Patient had signs of intestinal obstruction and abnormal blood gas values and posterior-anterior chest radiograph revealed elevation of the left hemidiaphragm. Thoracic computarized tomography demonstrated elevation of the posterolateral region of the left hemidiaphragm and displacement of the subdiaphragmatic organs within the thorax, up to the level of the carina. The patient had laparotomy under emergency conditions when rupture of the diaphragm was identified and repaired transabdominally. Diaphragmatic ruptures secondary to blunt traumas can be diagnosed with its early or late symptoms. Non-specific symptoms like chest pain, dyspnea, tachypnea, shortness of breath observed in patients should raise suspicion. Early or late deterioration in blood gas analyses following blunt traumas should be assessed carefully. Diagnosis can be rapidly established with direct radiographs, thoracic computarized tomography and magnetic resonance imaging. Treatment of rupture is surgery. Generally the diaphragm is repaired by the transabdominal approach while complicated ruptures can be assessed with a lower thoracic incision. Being extra vigilant following serious blunt traumas is an important factor in establishing the diagnosis.
NEONATAL COMPLICATIONS OF PREMATURE RUPTURE OF MEMBRANES
F. Nili AA. Shams Ansari
Acta Medica Iranica , 2003,
Abstract: Premature rupture of membranes (PROM) is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91%) cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86%) of neonates was less than 37 completed weeks. Thirty five infants (21.47%) had respiratory distress syndrome and 33 (20.245%) had clinical sepsis. Pneumonia in 6 (3.7%) and skeletal deformity in 7 (4.294%) were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6%) of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours ) showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11%) of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane were higher than previous studies.
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