Abigail C. Mancuso

Elevated delta OD 450 due to transient abnormal myelopoiesis in a Down syndrome fetus with hepatosplenomegaly on ultrasound

Transient abnormal myelopoiesis (TAM) is a relatively common finding in children with Down syndrome but has also been diagnosed prenatally, most often presenting with fetal hepatosplenomegaly. We report a case of TAM with hepatosplenomegaly found on ultrasound and associated with an increased amniotic fluid Δ OD 450 value. TAM is most commonly transient but can be associated with fatality and therefore should be considered in the differential diagnosis when fetal hepatosplenomegaly is found on ultrasound. Amniocentesis with chromosomal analysis and a Δ OD 450 may aid in diagnosing TAM and predicting the severity of the liver involvement.

Abdominal resection of a cornual heterotopic pregnancy using intraoperative ultrasound: case report

Background: Heterotopic pregnancy is a rare complication of in vitro fertilization (IVF) and diagnosis and treatment can be challenging, particularly with unusual ectopic sites and desire to maintain the intrauterine pregnancy. Case: We review the case of a 29-year-old female who presented with a cornual heterotopic pregnancy following IVF treated with exploratory laparotomy and ultrasound guided resection of the cornual pregnancy, resulting in an ongoing viable singleton intrauterine pregnancy. Conclusion: The management of cornual heterotopic pregnancies is limited by lack of data regarding ideal treatment although several surgical and non-surgical strategies have been described. This case uses abdominal resection of cornual ectopic pregnancy using intraoperative ultrasound as an optimal approach to remove the ectopic pregnancy without disrupting the viable intrauterine pregnancy, which was in close proximity of the cornual ectopic.

Deep sedation without intubation during second-trimester surgical termination in an inpatient hospital setting

OBJECTIVES Safety of outpatient dilation and evacuations with intravenous (iv) sedation without intubation has been demonstrated, but there is a paucity of data on deep iv sedation on an inpatient second trimester surgical termination population. The purpose of this study is to evaluate complications of deep sedation with propofol without the use of intubation during second trimester surgical terminations in an inpatient teaching institution. STUDY DESIGN A retrospective chart review of all obstetrical and anesthetic data from inpatient dilation and evacuations between gestational ages 15 0/7 and 24 0/7 during the years 2002 to 2015. We examined 332 patient charts. Primary outcomes included suspected perioperative pulmonary aspiration and conversion to an intubated general anesthesia. RESULTS No perioperative pulmonary aspiration cases were either suspected or confirmed. There were a total of 14 (4.2%) patients that had intubation compared to 313 with natural airway (94.3%) or laryngeal mask (1.5%). Of the 14 intubated, 9 (64%) were started with intubation, and 5 (36%) were converted during the procedure (1.7% of those started with nonintubated anesthesia). Cases requiring intubation were associated with longer procedure times (p=<0.001), higher American Society of Anesthesiologists (ASA) class (p=0.038), greater estimated blood loss (p=<0.001) and a primary indication of maternal health (p=<0.001) for the dilation and evacuation. CONCLUSIONS Deep sedation without intubation appears safe in a hospital setting with few complications reported. IMPLICATIONS Deep sedation without intubation for operating room dilation and evacuation is a safe option that rarely resulted in conversion to intubation and, in most cases, should be the anesthesia method of choice at initiation in an inpatient setting.