Delivery through an undiagnosed major placenta praevia: good outcome for mother and baby
| Autor: | Miren J. Turner, A. Ikomi, Y. Ville, K. O. Oyelese, I. T. Manyonda |
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| Rok vydání: | 1998 |
| Předmět: | |
| Zdroj: | Journal of Obstetrics and Gynaecology. 18:385-386 |
| ISSN: | 1364-6893 0144-3615 |
| DOI: | 10.1080/01443619867227 |
| Popis: | Case report A 23-year-old woman, para 1 1 1, had induction of labour at 39 weeks’ gestation for severe symphyseal pain. A transabdominal ultrasound scan at 22 weeks’ gestation showed a posterior and low-lying placenta. At 35 weeks, a repeat trans-abdominal scan localised the placenta anteriorly and high, with its lower edge 5 8 cm from the internal cervical os. At induction, the fetus presented as a vertex, with two® fths of the head palpable abdominally. The cervix was 2 cm long, closed, posterior, and soft, with the presenting part 2 cm above the ischial spines. Prostaglandin gel (2 mg) was inserted into the posterior fornix, and repeated 4 hours later. The cardiotocograph was normal. After 3 hours, the cervix was fully effaced, 3 cm dilated, and arti® cial rupture of membranes was performed, yielding heavily bloodstained liquor . Following this, a small amount of vaginal bleeding was noted, but as the uterus was soft and non-tender, the cardiotocograph remained normal, and labour progressed rapidly to full dilatation and vaginal delivery of a live infant 3 hours later, no further action was taken. Apgar scores were 9 and 10 at 1 and 5 minutes respectively. Immediately following delivery, she passed about 1 litre of fresh clots per vaginam. She was given syntometrine intravenously, an oxytocin infusion commenced, and the placenta was delivered by controlled cord traction. However, brisk bleeding continued, and her uterus was explored under anaesthesia. The uterine cavity was empty, and there were no vaginal or cervical tears to account for the bleeding. The uterine atony following exploration was managed by bimanual massage, intravenous oxytocin and intramuscular carboprost. She was transfused with four units of blood and two units of fresh frozen plasma. The bleeding soon subsided, and the rest of the post-delivery period was uncomplicated. Examination of the placenta revealed intact membranes and a large centrally located hole in the body of the placenta through which the fetus presumably delivered (Figure 1). Subsequent pathological examination con® rmed intact membranes, and a defect in the placental body completely surrounded by villous tissue, without communication between the defect and the membranes. |
| Databáze: | OpenAIRE |
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