A 40-year-old, gravida 3 para 2 (1-1-0-2), previous primary cesarean section for nonreassuring fetal status, presented at a tertiary hospital for confirmation of cesarean scar pregnancy (CSP). Transvaginal ultrasound confirmed a CSP at 8 2/7 weeks age of gestation with good embryonic cardiac activity, raising concern for early placenta accreta spectrum. A multidisciplinary team composed of an obstetrician, advanced pelvic surgeon, urologist, and anesthesiologist managed the patient. The patient underwent total abdominal hysterectomy with bilateral salpingectomy, as the patient has a completed family size. Before the procedure, she was given cefuroxime as prophylactic antibiotic. Intraoperatively, there were dense adhesions between the posterior bladder wall and the previous cesarean section scar. Inadvertent injury to the bladder wall was incurred during adhesiolysis. Cystorrhaphy was done by a urologist, while the rest of the surgery was unremarkable, with a 450 ml estimated blood loss. The postoperative course was unremarkable. Bladder rest was achieved by maintaining an indwelling Foley catheter, which remained in place upon discharge on postoperative day 3 and was continued for 7 days thereafter. At follow-up, a successful voiding trial was conducted, confirming the return of normal bladder function.

Human ; Female ; Adult: 25-44 Yrs Old ; Cesarean Section ; Salpingectomy ; Hysterectomy ; Fetal Distress ; Placenta Accreta ; Cefuroxime ; Catheters ; Cicatrix

Humans ; Female ; Pregnancy ; Cesarean Section/standards* ; China ; Consensus ; Postoperative Complications/prevention & control* ; Obstetric Labor Complications/surgery*

Emergency cesarean section has always been a challenge for patients, surgeons, and anesthesiologists, as it endangers the safety of both parturients and fetuses. Obesity and hypertension are common among pregnant women, but severe obesity combined with refractory hypertension is very rare in clinical practice. The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable. This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy. Owing to fetal heart rate abnormalities, she was scheduled for emergency cesarean section. Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture, the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia. Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure, and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs. The entire anesthesia and surgical procedure proceeded uneventfully, with no major adverse events observed. Both the patient and fetus achieved favorable outcomes. This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount, necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.
Humans ; Female ; Cesarean Section/methods* ; Pregnancy ; Adult ; Hypertension/complications* ; Obesity/complications* ; Obesity, Morbid/complications* ; Anesthesia, Obstetrical/methods*

A uterocutaneous fistula is an abnormal tract between the endometrium of the uterus and the skin. It is a rare but significant postcesarean section complication. This is a case of a 39-year-old female who presented with cyclical bleeding from her cesarean section scar during menstruation over the past 4 years. The assessment revealed a discharging sinus in the scar and an acutely anteverted, fixed uterus. Symptoms persisted despite medical treatment for the provisional diagnosis of endometriosis. The diagnosis was updated as uterocutaneous fistula based on a computed tomography scan of the pelvis and abdomen and a hysterosalpingogram. The fistula was surgically excised, and a hysterectomy was performed. This report elaborates on the rare presentation, diagnosis, and definitive surgical management. The surgical management resulted in a successful resolution, highlighting the importance of choosing the appropriate treatment modality while adhering to a patient-centered approach.
Cesarean Section

Wunderlich Syndrome is a rare potentially life-threatening phenomenon that involves spontaneous non-traumatic retroperitoneal hemorrhage. At present, identifying the course of conservative management in these patients, especially in pregnancy, has not been clinically established. Presented here is a known case of Tuberous Sclerosis Complex with a Bilateral, 10cm Angiomyolipoma in a 31-year-old female, initially managed with active surveillance. At 27 weeks of pregnancy, she presented with a sudden onset of left flank pain with a hematocrit of 22%. Anemia was corrected with blood transfusions. A contrast-enhanced MRI of the abdomen showed a large subcapsular perirenal hematoma of the left kidney. Renal angioembolization of the bleeding segmental renal artery was done. The patient was conservatized until 37 weeks of pregnancy and underwent cesarean section delivery.

Four months after angioembolization, she had a recurrence of the left flank pain associated with gross hematuria and hypovolemic shock. The patient underwent emergency renal exploration of the left kidney via a transabdominal approach. Three liters of hemoperitoneum and a large expanding left retroperitoneal hematoma were noted intraoperatively. Early vascular control before nephrectomy of the left kidney was done. The postoperative course was unremarkable and the patient was discharged with improved condition.

This case displays a unique course in the management of a bleeding angiomyolipoma especially during pregnancy. Renal angioembolization can aid in achieving the age of viability in pregnancy. However, close monitoring for rebleeding should be kept in mind. A lower threshold for conservative management should be utilized when patients have a previous history of bleeding.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Anemia ; Angiomyolipoma ; Arteries ; Blood ; Blood Transfusion ; Cesarean Section ; Conservative Treatment ; Emergencies ; Female ; Flank Pain ; Hematocrit ; Hematoma ; Hematuria ; Hemoperitoneum ; Hemorrhage ; History ; Hypovolemia ; Insemination, Artificial, Heterologous ; Kidney ; Life ; Nephrectomy ; Pain ; Patients ; Pregnancy ; Recurrence ; Renal Artery ; Research Report ; Sclerosis ; Shock ; Syndrome ; Tuberous Sclerosis ; Watchful Waiting

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Human ; Female ; Adult: 25-44 Yrs Old ; Achondroplasia ; Cesarean Section ; Dwarfism ; Anesthesia, Spinal

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Human ; Female ; Adult: 25-44 Yrs Old ; Achondroplasia ; Cesarean Section ; Dwarfism ; Anesthesia, Spinal

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Human ; Female ; Adult: 25-44 Yrs Old ; Achondroplasia ; Cesarean Section ; Dwarfism ; Anesthesia, Spinal

Pregnancy ; Humans ; Female ; Cesarean Section ; Consensus ; Trial of Labor

Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.
Sinus of Valsalva ; Aortic Rupture ; Cesarean Section ; Anesthesia, Spinal