morphine and Hematoma

Many pathologic features of the umbilical cord affect fetal well-being adversely. Excessively long or short umbilical cords may be the cause of hematomas and thrombosis of cord vessels and the placental surface, thus causing fetal death and/or thrombocytopenia. In other cases, fetal hypoxia and central nervous system damage are possible outcomes. Thrombosis is also frequently induced by velamentous insertion of the cord, as are hemorrhages when the membranous vessels rupture during parturition. Entangling and knotting of the cord, especially of excessively long cords, may lead to similar lesions and fetal death. It was recognized recently that prolonged meconium exposure to the surface of the cord can cause partial necrosis of umbilical vessels and cord ulceration. The noxious moiety of meconium also causes contraction of the umbilical vessels, leading to fetal hypoperfusion and hypoxia. A stricture at the fetal end of the cord and excessive spiralling of a very long umbilical cord are often present in cases of unexplained fetal demise, especially in early pregnancy. Less common abnormalities are obstruction of the circulation by amnionic bands and varices.

Topics: Aneurysm; Female; Fetal Diseases; Hematoma; Humans; Meconium; Pregnancy; Thrombosis; Torsion Abnormality; Umbilical Arteries; Umbilical Cord; Umbilical Veins

Topics: Adult; Amniotic Fluid; Autopsy; Cesarean Section; Female; Fetal Death; Hematoma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal Age; Meconium; Middle Aged; Obstetric Labor Complications; Obstetrical Forceps; Pregnancy; Umbilical Cord; Umbilical Veins

A subcapsular hematoma of the liver is often found during autopsy in stillborn infants rather than clinically. It is usually asymptomatic unless ruptured; thus, the diagnosis is often delayed or missed. Rupture of a subcapsular hematoma in a premature neonate causes massive intraabdominal hemorrhage, which is associated with high mortality. Thus, early recognition and treatment to avoid rupture are imperative. We describe a case of life-threatening hemorrhage from a subcapsular hematoma of the liver during emergent laparotomy for mechanical obstruction in an 860 g premature neonate and discuss the appropriate preoperative preparation and anesthetic management for this case.

Topics: Blood Loss, Surgical; Emergencies; Fatal Outcome; Heart Arrest; Hematoma; Hemostasis, Surgical; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Intraoperative Complications; Laparotomy; Liver Diseases; Male; Meconium; Rupture, Spontaneous