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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.
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PMID:Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. 132 30

In 1988, the American College of Obstetricians and gynecologists (ACOG) decided that vaginal delivery after a previous cesarean delivery (trial of labor, TOL) was an acceptable alternative to elective repeat cesarean delivery. ACOG stated that there appears to be no absolute contraindication to epidural anesthesia for labor during TOL. The concern is that should there be a uterine rupture, would the epidural anesthesia mask the abdominal pain? The incidence of complete rupture with trial of labor is reported to be 0.3-0.5%. In our review of 10,967 patients undergoing TOL, only 22% of complete ruptures presented with abdominal pain; 76% presented with signs of fetal distress diagnosed by continuous electronic fetal monitoring. Thus abdominal pain is an unreliable sign of complete uterine rupture. There have been no reports of epidural anesthesia delaying the diagnosis of uterine rupture. In the review of 10,967 patients undergoing TOL, there were no maternal deaths and only nine fetal deaths secondary to complete uterine rupture. The literature strongly suggests that epidural anesthesia is safe in TOL even when oxytocin is used for augmentation of labor.
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PMID:The role of epidural anesthesia in trial of labor. 229 86

A case of intrapartum rupture of the uterus in an unscarred uterus uterus is reported. The patient was stimulated with oxytocin infusion at 42 weeks of gestation because of mild preeclampsia. Labour was uneventful for four hours, when the patient suddenly complained of abdominal pain during contractions. The fetus was found in transverse lie and no fetal heart rate could be registered. An acute cesarean section was performed and both the placenta and the child were delivered through a complete rupture extending from the right uterine horn to the vagina. Intrapartum uterine rupture is a rare but serious complication carrying high mortality rates for both mother and child. It is usually considered to be related to a weakness in the uterine wall, e.g. a previous cesarean section.
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PMID:[Rupture of the pregnant uterus]. 230 Oct 55

A case report of a ligamentary ectopic pregnancy that failed to respond to prostaglandin E2 for induced abortion for sepsis at 24 weeks is presented. The 27-year-old nullipara had normal ultrasound findings for gestational age up to 21 weeks gestation. She had consulted at 5 weeks for abdominal pain and bleeding, at 14 weeks again for abdominal pain, shoulder pain and vaginal bleeding, although both times the pain and bleeding resolved spontaneously. She was seen again at 16 and 21 weeks gestation, when ultrasound scans were normal for dates. At 24 weeks, she experienced vaginal discharge of blood and tissue, and was managed as premature rupture of membranes. She became septic 12 days later. She was treated with transcervical PGE2 and iv oxytocin without response for 3 days. Surgical evacuation was successful, but bleeding persisted. During laparotomy she had a large left broad ligament hematoma, a left ruptured uterus, and open left internal iliac artery and vein. These were repaired, and she received 40 units of blood, 8 platelets and 14 of plasma. Only after histology was the diagnosis of ligamentary pregnancy made. The lack of response to PG for abortion should raise suspicion of ectopic pregnancy, although preoperative diagnosis of ligamentary pregnancy is extremely rare.
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PMID:A rare gynecologic contraindication to the use of prostaglandins and oxytocin to induce abortion. A case report. 279 68

Dilapan (DTD) rods of 4 mm diameter and 65 mm length made with polymetric polyacrylonitrile by the Swiss Robapharm firm were used in 42 women 5-8 weeks pregnant and in 27 women 8-12 weeks pregnant for cervical dilatation prior to miniabortion and conventional abortion,respectively. In addition, they were also used in 10 women with advanced pregnancy of more than 12 weeks' duration, and in 2 women for preventive diagnostic curettage. A total of 103 rods were used in 83 women. 76.2% of the 1st group of 42 women were multigravidas, 14.3% were secundigravidas, and 9.5% were primigravidas. Insertion lasted an average of 60-90 minutes. In the 2nd group of 27 women, 77.8% were multigravidas, 11.1% were secundigravidas, and 11.1% were secundigravidas, and 11.1% were primigravidas. Insertion took longer: 90-150 minutes in 55.6% of these patients. In the 3rd group of 10 patients abortion was indicated because of psychiatric reasons or renal insufficiency of for fear of stillbirth. 60% were primigravidas, 20% were secundigravidas, and 20% were secundigravidas, and 20% were tercigravidas. In 7 cases of 17-20 week old pregnancies and 3 cases of 22-30 week old gravidity, oxytocin and other methods were also used, 3 or 4 rods were inserted, and the procedure lasted up to 20-25 hours. Dilatation of the cervix reached 6.6 to 7.4 mm in 1-1 1/2 hours, and 7.1 to 8.1 mm in 1 1/2-2 hours corresponding to Hegar 8-9. In 2 cases extraction of the rods became difficult, and in 1 case of a 20-year old primigravida only 3 cm of insertion succeeded because of rigidity. Side effects included minor lower abdominal pain (4 cases) or sensation of pressure (1 case), and temperature of 38.5 degrees Celsius (1 case) 14 hours after insertion, although this could have been associated with the fact that Endoprost was administered at the same time.
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PMID:[Advantages of an economic method of dilatation of the uterine cervix using Dilapan rods for abortions and mini-abortions]. 316 18

The use of gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries for the termination of pregnancy in the early second trimester has been further investigated. Of 113 women between 12 and 16 weeks gestation, 93 (82%) aborted within 24 hours of the administration of 4.4 +/- 0.1 1 mg gemeprost pessaries. The mean induction-abortion interval was 881 +/- 31 minutes. Successful abortion was achieved in 16 of the remaining 20 women after a second course of gemeprost pessaries without the need for oxytocin supplementation. There were no serious complications. Crampy abdominal pain and vaginal bleeding started after 275 and 756 minutes respectively. Twenty-two (19%) patients did not require pain relief during treatment, but 90 (80%) required parenteral opiates. Vomiting and diarrhoea occurred in 16 (14%) and 23 (20%) cases respectively. The safe induction of therapeutic abortion in 96% of women using vaginal prostaglandin alone offers an acceptable alternative to surgical evacuation in the early second trimester.
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PMID:Prostaglandin-induced pregnancy termination: further studies using gemeprost (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) vaginal pessaries in the early second trimester. 368 94

Forty-three cases of advanced extra-uterine pregnancy of more than 34 weeks' gestation, seen and treated at Baragwanath Hospital between 1966 and 1978, are reviewed. The incidence in our unit was 1 per 6 389 deliveries. Abdominal pain and vaginal bleeding were the most common complaints. Simple vaginal examination is of great help in establishing the diagnosis, while the abdominal signs are found to be disappointing in this respect. The oxytocin test is a helpful diagnostic aid and various radiographic methods, such as plain X-ray abdomen, hysterosalpingography and ultrasonography have their merits. The placenta, although attached to rather critical areas in the majority of patients, was removed safely without damage to neighboring structures in 93% of the cases. Four patients, however, required hysterectomy. There were two maternal deaths. Of the 18 babies born alive, only 8 survived. All the surviving infants had congenital anomalies but only 5 had problematic defects.
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PMID:Advanced extra-uterine pregnancy. 397 72

Uterine rupture during induced midtrimester abortion is infrequent. Often the diagnosis is established only after manual exploration of the uterus, exploratory laparotomy, or even autopsy. It is crucial to establish, the diagnosis rapidly and to offer efficient treatment immediately to prevent further complications. 14 cases revealed by a Medline search and 2 additional personal cases were reviewed. The most common complaint accompanying the rupture was abdominal pain; secondary complaints were signs of blood loss, such as vaginal bleeding, decreased hematocrit level, and decreased blood pressure. 72% of women with uterine rupture (10 of 14) did not abort within 24 hours after intra-amniotic injection, and 85% (11 of 13) had large quantities of oxytocin administered for more than 12 hours. The rupture occurred predominantly in the lower segment and there was no preference either for the right or left side of the uterus. It was shown that uterine rupture during midtrimester induced abortion is not unique to women of high parity or old age. The major complications occurring in induced midtrimester abortions are similar to those seen in patients who deliver in the 3rd trimester.
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PMID:Uterine rupture during induced mid-trimester abortion. 399 23

Uterine rupture was diagnosed in 2 postpartum mares with hemorrhagic vaginal discharge. Both mares had abdominal pain, as evidenced by pawing, kicking at the abdomen, or attempting to roll. Peritoneal fluid analysis was useful in establishing a diagnosis. One mare had many RBC in the peritoneal fluid and was anemic; this mare was managed medically with oxytocin, antibiotics, and blood transfusion. The mare was able to raise her foal to weaning age. The second mare had many RBC, degenerate neutrophils, and intracellular and extracellular bacteria in peritoneal fluid. Surgical repair of the uterus was performed, and the mare was treated for peritonitis. The mare later became pregnant.
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PMID:Uterine rupture as a postpartum complication in two mares. 408 60

This study examines the efficacy of transabdominal intraamniotic injection of prostaglandins (PGs) in therapeutic abortions. Transabdominal amniocentesis was performed under local anesthesia (1% lignocaine) in 27 patients 14-22 weeks pregnant. Uterine activity was monitored. PGF2alpha 25 mg was given as a single intraamniotic injection in the 1st 14 cases. It was given in 3 doses at 24-hourly intervals for 3 successive days in 1 patient. PGE2 was given in 13 patients, 1 mg initially followed by 2 further 1 mg doses at 10-minute intervals. Intravenous oxytocin infusions were used where necessary, as was hysterotomy. Blood samples were collected in 10 patients before and at 4-6 hourly intervals following PGF2alpha administration until abortion occurred, and in 3 patients 40 hours prior to PG administration. A single 25 mg intraamniotic injection of PGF2alpha successfully terminated pregnancy in only 6 of 14 cases. Average-induction delivery interval was 19.52 hours. 6 other patients necessitated intravenous oxytocin infusions to stimulate effective uterine activity; average induction-abortion interval was 59 hours. 2 patients failed to abort, requiring hysterotomy. 7 of 12 vaginally delivered patients had incomplete abortion. Success rate was higher in PGE2-treated patients, with 11 of 13 patients aborting; average induction-delivery interval was 23 hours and 16 minutes. Side effects experienced included severe abdominal pain (for PGF2alpha), vomiting and mild pyrexia (38 degrees Celsius). No consistant change was observed in plasma steroid concentration until after delivery of fetus and placenta occurred. Transamniotic administration of PGE2 appears effective for therapeutic abortion, but not PGF2alpha.
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PMID:Therapeutic abortion by intraamniotic injection of prostaglandins. 480 68


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