Vernix caseosa peritonitis – no longer rare or innocent: a case series

<p>Abstract</p> <p>Introduction</p> <p>Vernix Caseosa peritonitis is a rare post caesarean section complication with only 19 case reports in the literature to date. Vernix caseosa spilt at the time of caesarean section is thought to incite an inflammatory reaction, causing symptoms resembling an acute abdomen.</p> <p>Case Presentation</p> <p>We discuss three Caucasian patients (aged 32 to 43 years) who presented in our health sector in Sydney with vernix caseosa peritonitis. Each had a protracted course with significant comorbidities requiring surgical and medical intervention. This contrasts with other reports suggesting that a rapid resolution can be expected.</p> <p>This cluster may be a consequence of the rising caesarean section rate, a heightened local awareness of the condition and possibly a result of leaving material in the paracolic gutters intraoperatively.</p> <p>Conclusion</p> <p>Our aim is to increase awareness among our obstetric and surgical colleagues of the characteristic clinical presentation and intra-operative findings of vernix caseosa peritonitis. We also point out that, in contrast to those presented here, not all patients require laparotomy.</p

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

<p>Abstract</p> <p>Background</p> <p>Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.</p> <p>Methods</p> <p>From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.</p> <p>Results</p> <p>We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.</p> <p>Conclusions</p> <p>The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.</p

Intra-operative blood salvage and autotransfusion in the management of ruptured ectopic pregnancy: A review

(East African Medical Journal 2001 78 (9): 465-467

Risk factors for placenta praevia in Southern Nigeria

Objective: To determine the risk factors for placenta praevia in Ile-Ife, southern Nigeria. Design: A prospective case control study. Setting: A tertiary center - Obafemi Awolowo University Teaching Hospital, Ile-Ife, southern Nigeria. Subjects: One hundred and thirty six patients with confirmed placenta praevia constituted the cases. Controls consisted of one hundred and thirty six patients who delivered at term immediately after each indexed case and did not have placenta praevia. Results: Cases and controls were similar in terms of twin deliveries (P=0.72) and past history of uterine surgery (P=0.47). After adjusting for confounders, factors associated with risk of placenta praevia were history of retained placenta [OR=6.7(95% CI 1.2- 36.6)], previous caesarean section [OR=4.7, (95% CI 1.9-11.4)], previous abortion [OR=2.9 (95% CI 1.1-5.1)], grand multiparity [OR=2.1 (95% CI 1.6-7.1)] and age over 35 years [OR=1.4 (95% CI 1.2-6.6)]. Conclusions: From our study, the risk factors for placenta praevia are a history of retained placenta, previous caesarean section, previous abortion, grand multiparity and maternal age over 35 years. (East African Medical Journal: 2002 79(10): 536-538

Interstitial cystitis coexisting with vulvar vestibulitis in a 4-year-old girl

Interstitial cystitis (IC) is a disorder that is difficult to diagnose and is thought to be uncommon in children. We report the first case of IC coexisting with vulvar vestibulitis in a 4-year-old girl. She presented with urinary symptoms and pelvic and vulvar pain. Cystoscopic and histological investigation confirmed interstitial cystitis and vulvar vestibulitis. Gynecologists are often called upon to deal with symptoms referable to the genital tract. It is important to always include interstitial cystitis in the differential diagnosis of urinary symptoms associated with pelvic pain