Pregnancy in the older gravida: how old is old?
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Biomedical subjects
Publications and source records attributed to J L Breen.
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A case of acute polyhydramnios successfully managed via therapeutic amniocentesis is reported. A discussion and review of this rare entity is presented.
Sarcoidosis of the female genital tract is a rare clinical entity with only 20 cases reported in the world literature to date. An additional case is presented with a review of the previously reported cases. The diagnostic and histologic aspects of the disease are also discussed. The presence of granulomatous diseases in the female genital tract should initiate a thorough investigation for potential etiologies by both the pathologist and clinician. Etiologies of granuloma fraction must include coccidiomycosis, foreign body reactions, lymphogranuloma inguinale, and tuberculosis. Bacteriologic proof is essential to differentiate these from sarcoidosis.
Hemipelvectomy is a most radical attempt at cure of malignant tumors of the pelvis and the upper portion of the femur. Pregnancy following this severely mutilating operation is rare. Despite the considerable loss of pelvic support patients do remarkably well. A case of pregnancy following hemipelvectomy is presented and represents the 16th report in the English literature. The anatomic consequences of hemipelvectomy are described and a review of the past 61 years experience with pregnancy following this operation is presented.
Mitral valve prolapse is usually a benign condition, however, serious complications have been reported to be associated with it. A report of retinal artery occlusion associated with mitral valve prolapse and pregnancy is presented.
Splenic rupture in pregnancy and the puerperium is a rare and potentially catastrophic event. A case of splenic rupture in pregnancy due to partial torsion and internal trauma of a floating spleen is presented, and represents the 89th pregnancy-puerperal report of splenic rupture. Nineteen additional cases have been identified by the authors over the past 20 years. A 20-year review (1967-1986) of clinical presentations, pathogenesis, and therapy are presented.
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Forty patients with placenta accreta, increta, or percreta are presented. Clinical features revealed an average age of 29.5 years and an average parity of 3-2-1. Twenty-five had no antepartum complications. Nine were admitted with silent hemorrhage, of which 6 had a total placenta previa and 1 a low-lying previa. Postpartum hemorrhage occurred in 39% with an associated perinatal mortality of 25% and 1 maternal death. Histopathologic evaluations revealed the predominant factor to be an absent decidua. Etiologic in decidual deficiency was a previous cesarean section (12 patients). Therapy consisted of total abdominal hysterectomy in 38 patients.
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Three cases of sacrococcygeal teratoma of the neonate occurred during a two-year period in which approximately 6,000 live births occurred in our hospital. Two infants were delivered vaginally and one by cesarean section. One infant underwent immediate surgery and survived, whereas the other two were in too poor condition to warrant surgery. Early excision is the treatment of choice; radiotherapy and chemotherapy are not effective in the malignant variety of sacrococcygeal lesion.