Spontaneous bladder rupture during labor or postpartum, although uncommon, is a surgical emergency. Creatinine and urea levels and ratio are helpful in reaching a diagnosis prior to laparotomy. Postpartum patients, especially those who have had repair of perineal laceration, should be encouraged to empty their bladder completely, and should be observed carefully for signs of urinary retention so as to avoid or reduce the risks of possible spontaneous bladder rupture. Case ReportA 30-year-old nulliparous lady with a 10-year history of primary infertility was admitted at 40 weeks' gestation for induction of labor. The indication for induction was pregestational diabetes treated with insulin therapy, at term. Cervical ripening was carried out with three doses of Prepidil (prostaglandin) gel, 0.5 mg, given six to eight hours apart. Subsequently, artificial rupture of membranes was performed and Pitocin augmentation initiated six hours after the last prostin insertion. Labor progressed satisfactorily, with the first stage lasting nine hours, and the second stage 42 minutes. During the course of labor, the patient emptied her bladder three times. Two hours prior to full dilatation, a full bladder was noted. The bladder was catheterized with a Foley's catheter and 600 mL of clear urine was obtained. The patient had a normal vaginal delivery of a live female infant weighing 3254 grams. There was a second-degree perineal tear, which was repaired. The patient was discharged home 48 hours postpartum in satisfactory condition.The patient was admitted to the emergency room 84 hours after delivery with sudden onset of severe abdominal pain, oliguria and hematuria three hours prior to admission. She gave a history of nonspecific mild abdominal pain and frequency of micturition since delivery, without vomiting or change in bowel habits. She denied any history of trauma to the abdomen or a fall at home. On examination, she was dehydrated and dyspneic. Blood pressure was 110/70, pulse 120/minute and temperature 36.6°C. She had bilateral lower limb edema, while her abdomen was markedly distended with diffuse tenderness, guarding and rebound. The uterus was difficult to palpate and the lochia was normal. The bladder was catheterized and a small amount of clear urine obtained. Urine culture grew group D Enterococcus. Ultrasound scan of the uterus suggested either retained products or blood clots within a uterus of relatively normal size.The results of blood tests are detailed in Table 1. The total WBC was 6.7 K/mm 3 , while BUN (40 mg/L) and creatinine (5 mg/L) were significantly elevated. Plain abdominal x-ray showed left subdiaphragmatic air trap. A tentative diagnosis of a ruptured viscus, probably a ruptured peptic ulcer, was made and a laparotomy was carried out. Three to four liters of serous fluid were found within the peritoneal cavity. This grew Enterococcus fecalis. There was a 5 cm laceration in the dome of the bladder. This was repaired in two layers. There was no evidence of uterine or cervical lacerations, nor of any d...

SummaryBromocriptine Parlodel, Sandoz)

No abstract

Summary Pituitary apoplexy or spontaneous pituitary necrosis is an ill-understood clinical syndrome. It may occur as a neurological emergency requiring urgent interference in a patient with a known pituitary dysfunction or it may be responsible for drawing attention to an as yet unrecognized pituitary pathology. It has a bizarre clinical profile and an unpredictable neurological and endocrine course. Patients may die at once or may recover with or without endocrine/neurological deficit. Six cases of pituitary apoplexy with varied clinical presentation are cited.

BackgroundPrior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002.Patients and MethodsAll patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage.ResultsOf the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%).ConclusionTrial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.