G. Luzi

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery

Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture) and internal (Bakri balloon) uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.

Management of preterm labor: pharmacological and non-pharmacological aspects

On December 6, 1999, under Public Law 106-129, the Agency for Health Care Policy and Research (AHCPR) was reauthorized and renamed the Agency for Healthcare Research and Quality (AHRQ).

Maternal haemodynamic and haemorrheologic considerations in fetal I.U.G.R.

IUGR is a symptom which has many causes; genetic abnormalities, feto-maternal infections, maternal drug intake, smoking, socio-demographic factors, all are related to fetal IUGR, but the most common underlying cause is the inadequate or inappropriate placental function. This is obvious because placenta plays a central role in fetal nutrition and there is no survival of the fetus in utero without the support of the placenta. The diminished fetal growth rate can be considered äs an intrauterine mechanism of defence against hypoxic damage, because in this way there is a saving of oxygen for the cerebral tissue.

Short-term effects of ritodrine, aminophylline and atropine on umbilical artery blood flow velocity waveform

With the recent introduction of Doppler technology, a non-invasive methodology which enables to evaluate qualitative changes in circulatory vessels, it is possible to investigate the possible effects of various drugs on several parameters of utero-placental-fetal circulation. In the present study we evaluate the flow velocity waveform (FVW) of umbilical artery (UA) during and after administration of aminophylline, atropine and ritodrine to healthy pregnant women. In our study we did not observe any significant short-term variation of PI after the administration of these drugs. Slight variations were detected, and they may be interpreted on the basis of the mode of action of these drugs. Doppler technology may be a useful tool for monitoring some effects on the fetus of the maternal administration of therapeutic agents.