Recurrent mild abruptio placentae occurring immediately after repeated electroconvulsive therapy in pregnancy

Article Abstract:

Electroconvulsive therapy has been considered relatively safe in treating severe cases of depression, mania, or psychosis in pregnant patients, and no reports of adverse outcomes have been found. A case is described in which a 35-year-old woman experienced mild abruptio placentae, premature detachment of the placenta, after each session of electroconvulsive therapy. At 19 weeks of gestation, the patient began to experience anxiety attacks and intermittent suicidal thoughts. The patient responded initially to diazepam, but her mental condition then deteriorated and she became more depressed. After a suicide attempt at 26 weeks, the patient was hospitalized. Haloperidol, an antipsychotic drug, was administered, but she continued to have intense delusions, severe lack of appetite, and suicidal tendencies. Electroconvulsive therapy was then initiated while the patient was continually monitored, and given intravenous fluids and oxygen. After the therapy-induced seizure, she immediately developed high blood pressure, regular uterine contractions, and mild uterine bleeding, which gradually subsided. The therapy was performed weekly with the same outcome for seven weeks. Uterine contractions were treated, and only minor changes occurred in uterine and umbilical arteries. At 37 weeks, the patient went into labor spontaneously, and because of uterine bleeding, a cesarean section was performed. The infant weight 5.9 pounds and had healthy vital signs at five minutes after delivery. A placental clot was noted, indicating that partial placental detachment had occurred. The uterine bleeding and contractions were probably related to the transient episodes of high blood pressure. Continuous fetal monitoring during electroconvulsive therapy is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Risk factors, Electroconvulsive therapy, Electroshock, Abruptio placentae, Placental abruption

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Extensive pulmonary embolism presenting as severe adult respiratory distress syndrome after surgical resection of a cornual pregnancy

Article Abstract:

Adult respiratory distress syndrome is respiratory failure resulting from fluid build-up in the lungs not related to heart problems. It often occurs in patients that have suffered severe trauma or shock, and cases have occurred during pregnancy. Between 50 to 80 percent of those who develop subsequent brain damage die. The case is described of a woman who developed adult respiratory distress syndrome after undergoing surgery for a cornual pregnancy (in which the fetus is located in the cornual area of the uterus). The patient was a 32-year-old woman complaining of abdominal pain and vaginal bleeding. A fetus with no fetal heart beat was discovered in the right cornual area of her uterus. Surgery involving right cornual resection (removal) was performed. Twelve hours after surgery, severe bleeding was clotting in the patient's abdomen. The clotted blood was removed and she was given fresh blood to replace what she had lost. She then underwent a second operation. Thirty hours after this surgery, she became unresponsive and spit up large volumes of sputum. Heart rate and blood pressure were normal but a lung X-ray showed the lungs were filled with fluid. She was placed on a respirator and further examination revealed a number of pulmonary blood clots. Heparin therapy was given to dissolve the clots. She eventually recovered and suffered no brain damage. This case was unusual in that shock was not also present and that no brain damage occurred despite severely low oxygenation. The obstetrician-gynecologist should be aware of the symptoms of this disorder, as rapid detection and treatment are imperative. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Pulmonary embolism, Acute respiratory distress syndrome, Adult respiratory distress syndrome

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Severe obstructive sleep apnea and associated snoring documented during external tocography

Article Abstract:

A tocodynamometer is an instrument specifically used for measuring the force of uterine contractions. The instrument may also record maternal coughing and respirations and some types of fetal activity, although such recording is usually artifactual and unintended. The case is described of a 27-year-old obese, diabetic, and pregnant woman being monitored with a tocodynamometer where artifacts of the recordings were useful in diagnosing a serious problem. The patient's pregnancy was carefully monitored because of her medical condition. Beginning at 32 weeks' gestation, nonstress testing using a tocodynamometer was begun to monitor fetal heart rate and uterine activity. The patient had begun complaining of excessive sleepiness during the day and she fell asleep during each of the stress tests. During these sleep episodes there were recurrent periods of apnea (cessation of breathing) followed by loud snoring. The tocodynamometer, initially thought to be recording uterine activity, picked up her respiratory patterns during these sleep episodes. Subsequent examination of these recordings showed they were picking up severe sleep apnea. The patient developed preeclampsia, a condition involving pregnancy-related high blood pressure, at 37 weeks of gestation, but she eventually delivered a healthy baby. A sleep study performed on the patient after she delivered diagnosed the severe obstructive sleep apnea. This case study reveals another type of artifact that may show up on tocodynamometer recordings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Uterus, Uterine contractions, Sleep apnea syndromes, Sleep apnea, Apnea

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