Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Elderly Gravida with Bombay Blood Group and Placenta Previa Managed with Autologous Blood Transfusion

The Bombay blood group is a rare blood type with an incidence of around one in a million. There is no known reported case of an obstetric patient with the Bombay blood group from Nepal. People with this rare blood group can receive blood only from those with the same blood type. We report an elderly gravida with the Bombay blood group who had a pregnancy complicated by diabetes, placenta previa, and transverse lie (back up) following an in vitro fertilization. Placenta previa posed a greater risk of hemorrhage and hence the need for transfusion. The main challenge was arranging blood for transfusion, and as the Bombay blood group was unavailable, she was managed with autologous blood transfusion which was performed for the first time in a pregnant lady in our institute. She underwent Cesarean section for placenta previa with transverse lie, and both mother and baby were sent home in good health.

Successful Myomectomy with Pregnancy

The prevalence of Leiomyomas with pregnancy is reported as 0.3-2.9%1.They usually remain asymptomatic during pregnancy, if they are small.In symptomatic one, management is generally expectant and surgical removal is particularly delayed until after delivery. Symptomatic myoma, which does not respond to conservative management need antenatal myomectomy. Second trimester is preferable for its better outcome8,12.We present a case of symptomatic multiple uterine fibroids which include a huge one, diagnosed during pregnancy clinically & ultrasonography confirmed it. The casewas managed successfully by antenatal myomectomy due to failure of conservative management.Totalweight of fibroids was 1500gms. The pregnancy progressed to term uneventfully & elective caesarian section was done on 28/04/2019 for transverse lie. A healthy female baby weighing 03Kg was delivered. The patient was discharged in good condition on 05/05/2019. J Bangladesh Coll Phys Surg 2021; 39(1): 59-61

Celebrate Birth!—Ava's Arrival

As a Certified Lamaze Childbirth Educator and poet, I wrote this poem to help a new mother come to terms with the fact she was unable to have a vaginal delivery. Her first born was in a transverse lie the entire third trimester. Despite numerous interventions, the baby would not turn and had to be delivered by cesarean surgery. This was the safest possible birth for mother and baby. The couple desperately wanted to hold true to the Lamaze Philosophy and Healthy Birth Practices. They insisted labor begin spontaneously, and so it did. The poem and photographs reveal the parents' fortitude, demonstrating the core premise of their birth plan was not negated. The outcome: healthy mother and healthy baby.

Etiological factors and maternal outcome in pregnancies with malpresentation: an observational study

Background: The most common presentation of the fetus is malpresentation. These include breech, face, brow, shoulder and compound presentations. Malpresentations of fetus complicate labor in about 5% of pregnancies. To find out the incidence of malpresentation, to analyze etiological factors of malpresentation, to evaluate the maternal outcome in cases with a malpresentation.Methods: This prospective observational study was done in, Chengalpattu Government medical college and hospital. Study period from October 2018 to September 2019. Pregnancies with malpresentation presenting to the department of obstetrics and gynecology at CMCH were included in the study.Results: A total of 680 malpresentation were admitted in this period were included in this study. The incidence of malpresentation during the study period was 7.72%. The incidence of the breech was 4.38%, transverse lie 1.11%, face 0.28%, brow 0.05% and compound presentation 0.13%. The common causes were prematurity, multiple gestations, grand multiparty, IUGR, oligohydramnios, anomalies of uterus, polyhydramnios, contracted pelvis, placenta previa, hydrocephalus, prematurity was reported as the commonest cause of breech presentation and multiparty for transverse lie, face and brow presentations. The most common complication was obstructed labor 6.9% followed by post-partum hemorrhage 3.65%. There was no maternal death due to malpresentation during the period of study.Conclusions: Early diagnosis and timely management can prevent the complications of labor associated with a malpresentation. Delivery should be planned at centers which have expertise in conducting vaginal delivery in malpresentation with good intrapartum monitoring and with facilities for cesarean section for the better feto-maternal outcome.