Obstetrics and Gynecology
Seyed Mojtaba Alavi; Mohammad Hosein Arjmandnia; meysam feizollahjani; enayatollah Noori; Maryam Yousefi
Articles in Press, Accepted Manuscript, Available Online from 12 December 2023
Abstract
Background: Placenta Accreta Spectrum is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean deliveries, which have been increasing without medical indication. This study ...
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Background: Placenta Accreta Spectrum is a condition in pregnant women where trophoblastic tissue attaches abnormally to the uterus myometrium, causing maternal deaths. Major risk factors include placenta previa and cesarean deliveries, which have been increasing without medical indication. This study aims to explore the risk factors of PAS, clinical outcomes, and strategies to minimize maternal morbidity and mortality.
Materials and Methods: A total of 142 women who had undergone at least one cesarean delivery in the past were included in our evaluation. Among them, 85 women had placenta accreta spectrum (PAS) in their current pregnancy (group 1) while the remaining 57 did not have PAS (group 2). We gathered information about their demographics and previous gynecological history, including placenta previa.
Results: The risk of placenta accreta spectrum (PAS) is significantly higher in cases where there has been a previous cesarean delivery or placenta previa (p-value<0.05). There were no significant differences between past elective or emergent CD (p-value>0.05). PAS was associated with more emergent cesarean deliveries (p-value<0.001) and hysterectomies (p-value<0.001). 97% of patients with history of placenta previa developed PAS (p-value<0.001). Most of the patients who underwent hysterectomy had PAS and placenta previa (p-value<0.001). There was no significant correlation found between previous hysteroscopies and curettages and a higher risk of PAS. (p-value>0.05)
Conclusion: Women with previous cesarean delivery are significantly at risk of placenta accreta in their future pregnancies. Pregnant women should avoid insisting on elective cesarean delivery without medical indication. Planned cesarean delivery could reduce the maternal complications
General surgery
Maryam Yousefi; Fariba Yarandi; Elham Shirali; Shahab Rajabzadeh; Pershang Nazemi
Articles in Press, Accepted Manuscript, Available Online from 07 February 2024
Abstract
We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable ...
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We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable amount of sterile normal saline, and evaluated and cultures were sent for microbiological and histological evaluation. The patient was promptly initiated on a combination antibiotic regimen, including ceftazidime, levofloxacin, metronidazole, and vancomycin, under the guidance of the infectious disease team. Fungal mycelium was found in the smear of wound discharge in recent microbiological exam. In response to the suspected fungal infection, fluconasol was promptly added to the treatment regimen to combat the fungal pathogen. According to result of microbiological cultures, non-albicans candida and its resistance to fluconasol, caspofungin was substituted. Patient's condition dramatically improved with the combined treatment of meropenem and caspofungin. The development of necrotizing fasciitis in this patient's case added a critical layer of complexity to an already challenging clinical scenario. The rapid recognition, aggressive surgical intervention, and targeted antimicrobial therapy collectively played a pivotal role in her successful recovery. This case underscores the importance of vigilance in monitoring postoperative patients, particularly those with risk factors, and highlights the need for a multidisciplinary approach in managing this severe soft tissue infection.
