Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
Surgically curable illnesses in the pediatric population are a major public health issue with a high prevalence of 10%-33% of all pediatric admissions, and emergency situations account for 50%-78% of surgical cases. Emergency abdominal surgery in children necessitates proper and prompt surgical and perioperative supportive care. When compared to elective operations, emergency surgery has a greater rate of morbidity and fatality. Staffing concerns, access to operating theaters, and access to diagnostic investigations are all possible causes of this high fatality rate, in addition to patient-related factors. Literature from high-income countries (HICs) discusses the problem, and recommendations are available for high-quality setups with good infrastructure. However, surgical care facilities from resource-poor countries have altogether different challenges and bottlenecks when dealing with children requiring emergency surgical operative procedures to save lives. This review aims to discuss factors affecting the survival of children being operated on for abdominal emergencies in resource-poor setups and suggest recommendations.
Gynecologists are familiar with procidentia, a severe form of pelvic organ prolapse (POP) that includes herniation of the anterior, posterior, and apical compartments of the vagina, through the introitus. Usually, women with POP present with concerns of something coming out of the vagina, heaviness, discharge through the vagina, urinary complaints, and, rarely bowel, complaints. Intestinal obstruction secondary to procidentia is a rare complication and is seldom reported in the literature. We report one such case where an elderly woman presented with the primary concerns of constipation, retention of urine, and multiple episodes of vomiting. Clinical history revealed that herniated tissue protruding outside the vaginal introitus was reposited inside the vagina two days ago. Clinical examination and investigations were suggestive of intestinal obstruction, secondary to the reposition of procidentia. Exploratory laparotomy revealed gangrene of the terminal ileum. Right hemicolectomy with ileo-colic anastomosis was done, which saved the woman’s life. Reposition of the prolapsed uterus was thought to be the probable reason, leading to obstructed and gangrenous small bowel. As this case illustrates, the chronology of symptoms and signs and progression of disease should be appropriately interpreted to diagnose and manage such potentially life-threatening conditions.
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