Jugoslavenska ginekologija i opstetricija最新文献

A case of the femoral fracture in a child during spontaneous delivery by vertex presentation is described. The newborn was a male, weight 3600 g, height 52 cm, Apgar score 10. When and how such a fracture occurs under the action of labour forces and its medico-forensic significance are discussed.

A case is described of abdominal pregnancy in a 27-year-old patient with a previous salpingectomy of the right tube performed because of tubal pregnancy. The patient was hospitalized in the 22nd to the 28th week of pregnancy on suspicion of imminent abortion. Clinical and ultrasound examinations indicated intrauterine pregnancy, by just before the expected date of delivery, clinical symptoms suggested abdominal pregnancy. The oxytocin test was negative. Following laparotomy a live normal girl was born, weighting 3200 g. The placenta was inserted at the front wall and the right horn of the uterus from the outer side. In the right horn there was an opening at the site of the oviduct excision. Because of profuse bleeding, the uterus was amputated supravaginally.

In a patient aged 53, with metastatic adenocarcinoma in lymph nodes of the neck, laparoscopy was performed on suspicion of the presence of ovarian primary carcinoma. Laparotomy revealed a bluish tumour in the region of the right adnexa. A small part of the tumour was excised, producing profuse bleeding from the varicose swelling in the mesosalpinx, the size of a fist. The bleeding was stopped only by laparotomy. Here, too, a metastatic carcinoma was diagnosed histologically.

A patient, aged 23, first underwent conservative operation for oviductal pregnancy three times (once in the right and twice in the left oviduct), and then cesarean section (a full-term liveborn). Three years following cesarean section, because of tubal pregnancy, salpingectomy of the left tube and the ligation of the right tube stump were performed on the patient's wish for sterilization. Each time tubal pregnancy was verified histologically.

The analysis of thirty-seven cases of neural tube defects (NTD) resulted in the following conclusions: a) At least eleven cases had the Arnold-Chiari malformation, an autosomal recessive disorder which often remains unrecognized; b) Trisomy 18 and amniotic disease associated with NTD were diagnosed in two newborns; c) In eight cases there was one or more older children with NTD; d) In two families the parents were related. A review of the literature and the exposed data indicate a heterogeneous etiology and an important role of genetic factors in the genesis of NTD.

A case is presented of abdominal pregnancy in a pregnant woman with two previous deliveries and four spontaneous abortions. She was cachectic, had spider nevi, and palmar erythema. Hepatic insufficiency was suspected. In the 35th week of pregnancy, severe pain appeared in the epigastrium and a detailed examination indicated abdominal pregnancy. Following laparatomy, a liveborn was extracted, weight 1800 g, height 45 cm, without any malformations. Owing to an unfavourable insertion of the placenta and the patient's very bad condition, the placenta was left in situ, with the drainage of Douglas' space. Fourteen days after operation, the placenta was easily removed by relaparotomy. It was partly hyalinized and partly necrotic.

In a 28-year-old patient, without menstruation for 2 months, curettage was performed on suspicion of an incomplete abortion. Owing to a profuse bleeding, cervical pregnancy was suspected and the patient was at once operated on, abdominal hysterectomy was applied, and cervical pregnancy was confirmed histologically. In the uterine corpus adenomyosis was revealed. This might have aggravated a normal nidation of the ova and contributed to the development of cervical pregnancy.

From 1981 to 1983, 3660 intrauterine contraceptive devices were taken away, in 278 cases by the modified extractor after Soonawalla, because the short tread of the device was broken or drawn into the uterus. The most frequent indication for the removal of the device was irregular bleeding. Prior to extraction, X-ray and ultrasound were used to determine the position of the device in the uterus.

Artificial abortus was induced in a 26-year-old patient in the 8th week of pregnancy. Within a month, curettage was applied three times on suspicion of a remaining small portion of the fetus. Only during the third curettage was a defect of the posterior cervical wall observed. The posterior cervical up was then incised, and the defect edges excised up to the unaffected tissue and sutured. Cervical pregnancy was diagnosed histologically.

The advances of simultaneous ultrasonic and vaginal or rectal examinations are described with regard to a better evaluation of the size, localization, and consistency of the process in the pelvis.