RESUMEN
With increasing caesarean section rates during the past decades, a rising trend of placenta percreta is observed. Although rare, placenta percreta can present as acute abdomen due to haemoperitoneum during antepartum period. A 24 years old pregnant lady with two previous caesarean sections, presented in emergency at 12 weeks of gestation with syncope, acute abdominal pain and distension. Ultrasonography revealed an ectopic pregnancy in right adnexa with intraperitoneal haemorrhage. On laparotomy, there was moderate hemoperitoneum, both adnexa were normal and placental tissue was protruding through a bleeding previous caesarean scar. Hysterectomy was done. Histopathological report was consistent with the diagnosis of placenta percreta.
Asunto(s)
Abdomen Agudo/etiología , Cicatriz/complicaciones , Hemoperitoneo/complicaciones , Placenta Accreta/fisiopatología , Rotura Uterina/etiología , Abdomen Agudo/cirugía , Cesárea Repetida/efectos adversos , Femenino , Hemoperitoneo/cirugía , Humanos , Embarazo , Síncope , Rotura Uterina/cirugía , Adulto JovenRESUMEN
OBJECTIVE: To describe the profile of patients with vesico-vaginal fistula (VVF) and success rate of the surgery. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. patients and METHODS: All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. RESULTS: Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years (range 25-45) with parity varying from 0-9 (median 4). The position of majority of the fistulas (57.2%) was high (vault, juxta-cervical). Success rate of the surgery in the study was 85.7%. Majority of the repairs (78.6%) were done through vaginal route. CONCLUSION: The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention.