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Table 1 Cases of placental abruption and intrauterine fetal death at Nara Medical University, Japan (2011–2013). Case no.
GA (weeks + days)
1 2 3 4 5
38 35 35 23 20
6 7 8 9
Background
Assistance for labor
Delivery time, h
Blood loss, g
0 0 1 2 2
None ROM Ox ROM Ox ROM PG Ox None
0.5 3.5 5.5 28.1 1.6
0
ROM Ox
13.1
Maternal age, y
Parity
2 2 2 4 4
32 27 31 35 36
36 + 3
20
+ + + + +
34 + 4 33 + 2 26 + 1
37 35 26
0 4 3
Ox None ROM Ox
b
6.4 7.8c 9.0
Blood transfusion, mL Red cell concentrates
Fresh frozen plasma
Platelet concentrate
1130 3603 480 1450 135
0 420 560 1960 0
0 960 960 1920 0
0 0 0 200 0
1092
1400
2400
1140 1050 370
1120 1960 0
1920 240 0
Hospital stay (days after delivery)
Follow up Next menses (month(s) after delivery)
Next pregnancy
Delivery
5 10 1 3 1
2 1 0 2 1
Yes Yes Yes No Yes
Vaginal Cesareana Vaginal
0
3
3
Yes
200 0 0
10 15 2
3
No
?
?
IUFD at 18 weeks; vaginal Artificial abortion
d
Abbreviations: GA, gestational age; IUFD, intrauterine fetal death; Ox, oxytocin drop infusion; PG, prostaglandin E1 vaginal tablet; ROM, manual rupture of membranes. a Emergency cesarean delivery was performed owing to recurrent placental abruption. Newborn was intact and survived. b Failure to progress and acute renal failure leading to emergency cesarean delivery. c No routine medical check-up. Uterine rupture found on the seventh day after vaginal delivery, leading to hysterectomy. d Unable to follow up owing to relocation of the patient.
http://dx.doi.org/10.1016/j.ijgo.2014.03.019 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Accidental electrocution in pregnancy Radmila Sparić a,⁎, Ivana Berisavac b, Saša Kadija a,c, Tatjana Mostić d, Biljana Lazović e, Andrea Tinelli f a
Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia c Medical Faculty, University of Belgrade, Belgrade, Serbia d Clinic for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia e Department of Pulmonology, Internal Medicine Clinic, University Clinical Hospital Center Zemun, Belgrade, Serbia f Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, 73100 Lecce, Italy b
a r t i c l e
i n f o
Article history: Received 7 January 2014 Received in revised form 6 March 2014 Accepted 26 March 2014 Keywords: Electrocution Fetal injuries Maternal complications Persistent vegetative state Pregnancy
Cases of electrocution in pregnancy are very rare. There are no reliable data on its overall incidence or on fetal impact [1,2]. The most important factors determining the effects on the fetus are the characteristics of the electricity and the path of the electrical current through the woman’s body and uterus [3]. Electrocution in pregnancy may cause maternal injuries, such as cardio-neurological complications [4] and life-threatening risks, or severe fetal damage and fetal death in 6%–73% of cases [2,5]. There is no consensus on the recommended ⁎ Corresponding author at: Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska 26, 11000 Belgrade, Serbia. Tel.: +381 66 8301 332; fax: +381 11 361 5603. E-mail address:
[email protected] (R. Sparić).
monitoring and treatment procedures for electrocution in pregnancy that positively affect pregnancy outcome [5]. A 20-year-old woman (Para 2) was admitted to an intensive care unit at 14 weeks of pregnancy in an unstable condition and comatose state; she had been intubated for respiratory insufficiency. The patient had been electrocuted while blow-drying her hair in the bath. The patient’s conscious state was recorded as 5 on the Glasgow Coma Scale (GCS) and this was maintained until 16 weeks of pregnancy when the patient was referred to the Clinical Center of Serbia, Belgrade. Ultrasound revealed that the patient’s obstetric condition was appropriate for gestational age. The patient was managed by a multidisciplinary team of clinicians with guidance from the hospital’s ethics committee. Neurological findings at 17 weeks of pregnancy corresponded with a persistent vegetative state (GCS 7). The pregnancy was routinely monitored by clinical, hematological, and ultrasound examinations and feeding was achieved by enteral and parenteral diets. Tracheotomy was performed on the 15th day of hospitalization and, 4 days later, the patient was taken off the respirator and provided with oxygen support. Microbiological analyses were conducted every 7–10 days, followed by eventual antibiotic therapy; physiotherapy was provided on a daily basis. At 21 weeks of pregnancy, the patient’s case was presented to the Institutional Board of Ethics, and to the family who, after being informed and consulted on the situation, provided their consent for the pregnancy to be continued. At the beginning of the 24th week, the patient’s general condition
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deteriorated showing hemodynamic fluctuations. It was decided that emergency cesarean delivery should be performed if vital parameters deteriorated. Four days later, hypotension (60/30 mm Hg), bradycardia (approximately 20 beats per minute), and respiratory arrest occurred. Although intensive resuscitation was conducted, the clinicians decided, in agreement with patient’s family, to perform a cesarean delivery. A stillborn male neonate weighing 450 g was delivered, 5 minutes after the mother’s death. Histopathology of the placenta and autopsy of the fetus excluded intrauterine infection and congenital anomalies, but diagnosed intrauterine asphyxia as the cause of fetal death. The autopsy of the mother revealed pathophysiological changes resulting in electrocutionprovoked cardiac arrest and hypoxia. Despite the attempts made to reach sufficient fetal maturity at birth—per the family’s wish and to achieve better fetal development—the sudden deterioration in maternal conditions caused fetal death, as reported in the small number of cases published on electrocution in pregnancy [3–5]. In general, cases of electrocution in pregnancy require multidisciplinary treatment, abidance of modern ethical principles, and the agreement of the patient’s family regarding treatment. General recommendations regarding pregnancy and fetal outcome in such patients are difficult since the incidence of electrocution in pregnancy is
unknown and the majority of these cases have not been published. The effect of electrocution on pregnancy outcome remains a controversial issue. More reports are necessary to obtain a better knowledge of pregnancy outcomes and to improve monitoring procedures in these cases.
Conflict of interest The authors have no conflicts of interest.
References [1] Powner DJ, Bernstein IM. Extended somatic support for pregnant women after brain death. Crit Care Med 2003;31(4):1241–9. [2] Spies C, Trohman RG. Narrative Review: Electrocution and life-threatening electrical injuries. Ann Intern Med 2006;145(7):531–7. [3] Awwad J, Hannoun A, Fares F, Ghazeeri G. Accidental electric shock during pregnancy: reflection on a case. AJP Rep 2013;3(2):103–4. [4] Goldman RD, Einarson A, Koren G. Electric shock during pregnancy. Can Fam Physician 2003;49:297–8. [5] Fish RM. Electric injury, part III: cardiac monitoring indications, the pregnant patient, and lightning. J Emerg Med 2000;18(2):181–7.
http://dx.doi.org/10.1016/j.ijgo.2014.03.018 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
