Fetal death secondary to nonpenetrating trauma to the gravid uterus

Communications

Table

I. Ovarian

cancer

with

pleural Survival

NO.

Cfinical Stage II3 Cytology positive

Average

1

Clinical Stage III Cytology positive negative doubtful unsatisfactory

26 2 3 1

Clinical Stage IV Cytology positive negative

effusion (mos.) ) Range

3.4 3.5 5.3

< l-13 3-4 < 1-12

<1

a

< i-a

1

Fetal death secondary to nonpenetrating trauma to gravid uterus

Appleton,

H.

RANEY,

313

of stillborn infants. One infant had a depressed skull fracture and the other an intercranial hemorrhage. In the following case, the trauma resulted from an automobile accident in which the patient was wearing a lap-type seat belt.

13

metastases, negative pleural fluid and doubtful ascitic fluid who survived 24 months. The side of effusion was right in 16, left in 18, and biIatera1 in 8. As expected those with bilateral effusion had a briefer life expectancy than those with a unilateral effusion: 3 versus 4.5 months. In this series of 42 patients with pleural effusion, all but 1 are dead. The average duration of survival was 4.5 months with a range of one day to 24 months. The International Classification states that ascites will not influence the staging for Stages II, III, and IV. We suggest that the presence of free pleural fluid in association with ovarian cancer, otherwise classified as Stage IIB or III, should advance the stage to IV,

EUGENE

in brief

the

M.D.

Wisconsin

THE VULNERABLE pregnant uterus has been the recipient of abdominal trauma of all types including the lap-type seat belt. Fetal loss has been attributed to maternal death or uterine rupture. However, Piker and Dyer and Barclays reported trauma cases in which women had no serious maternal injuries, but later were delivered

The patient, a 28year-old multipara, 28 weeks pregnant, was sitting in the right front seat of an automobile driven by her husband which was involved in a head-on collision. Both husband and wife were wearing lap-type seat belts. No ejection of the passengers accompanied the accident. The car did not roll over. The patient’s husband sustained multiple fractures. The children, who were in the back seat, had multiple minor injuries and one had a fracture. The patient was first attended by a physician in an out-lying area at 8: 30 P.M. and in the hospital emergency room at 11: 30 P.M. and then hospitalized. Examination revealed blood pressure 94/70, pulse 90 bilaterally and strong, multiple bruises of the head and face, a wide belt-like bruise across the abdomen where the seat belt had been located, and bruises and excoriations of the skin with hematomas in the right and left inguinal regions. The uterus was 28 cm. Fetal position was LOT. The head was not engaged. Fetal heart tones were present to the left below the umbilicus. There was no vaginal bleeding, uterine irritability, or cramps. The urine was grossly clear, but microscopically showed hematuria; and clinically 30 mg. of protein. The patient’s bruised areas were delineated for observation to see if there would be any increase in the size of the hematomas. The admission hemoglobin of 11.2 Gm. and hematocrit of 33 vohnes per cent feI1 to 8.1 Gm. and 24 volumes per cent, respectively, on the second day but slowly returned to normal levels. The fibrinogen was 110 to 115 mg. per cent and the prothrombin time was 41 per cent. Treatment consisted of oral streptokinase-streptodornase, intramuscular progesterone 100 mg. in oil, bed rest, and observation. After 5% hours minor cramping and marked vaginal bleeding began and loss of fetal heart tones occurred. The kagnosis of abruptio placentae was made. Intravenous oxytocin (Pitocin) 10 I.U. in 100 c.c. 5 per cent dextrose/water was started and an amniotomy performed. After 3 hours of labor and with pudendal block anesthesia, the premature, stillborn infant was delivered spontaneously. Examination of the uterus revealed no lacerations or hematomas in the broad ligaments. The placenta revealed a 5 cm. area of abruption at the periphery extending for a distance of 3 cm. toward the central portion. Postmortem examination of the infant showed acute intracranial hemorrhage due to bilateral traumatic tears of the tentorium cerebellum and prematurity. This was considered sufficient evidence to make a diagnosis of partial abruption but was felt not extensive enough to cause the death of the

infant.

Death

of

the

infant

was

attributed

314

Communications

in brief

Amer.

January 15, 1970 J. Obstet. Gym-c.

to tentorial tears resulting from the forceful sudden compression and upward thrust of the passenger against the lap-type seat belt. More fetal damage without uterine rupture in nonpenetrating traumatic injuries of the gravid uterus will probably come to our attention. REFERENCES

1. Pike, 2. Dyer

J. S.: M. Times 86: 869, 1958. and Barclay, D. L.: AM. J. GYNEC. 83: 907, 1962.

Endometriosis STEVEN

of the I.

LEOPOLD

&

kidney

HAJDU, G.

OBST.

M.D.

KOSS,

M.D.

Department of Pathology, Memorial Hospital for Cancer and Allied Diseases, and James Ewing Hospital, New York, New York

Fig. 1. Low-power photomicrograph dometrial tissue in renal parenchyma. lin and eosin. x25.)

showing en(Hematoxy-

of the kidney is extremely Since Marshall9 reported the first histologically proved case in 1943, there have been only 5 further case reports of this condition.2v 316110311 This is a report of yet another case and a review of the literature. ENDOMETRIOSIS

rare.

A 49-year-old white female the hospital because of epigastric

vomiting.

Two

years prior

was admitted pain, nausea,

to and

to present admission,

she had right radical mastectomy for carcinoma. At the time of admission, there was evidence of generalized carcinomatosis. She underwent therapeutic adrenalectomy 2 weeks after admission. There was metastatic mammary carcinoma in both adrenal glands. Postoperatively, she received steroids and she showed some clinical improvement. One month after operation, she developed low back pain and gross hematuria. Her general condition began to deteriorate. There was decrease in urinary output and increase in ascitis. Bilateral pleural effusion was noted. She was considered for radiation treatment when she became lethargic and suddenly died. A complete postmortem examination was done shortly after death. At autopsy, there was metastatic mammary carcinoma on the peritoneal and pleural surfaces. The weight of the kidneys was within normal limits. On cut sections, both kidneys were congested. A well-demarcated, triangular shaped reddish brown area measuring 1.5 X 1 cm. was noted in the parenchyma of left kidney. It was thought to be a hemorrhagic cyst or infarction. The microscopic examination of this area showed endometrial-iike glands surrounded by typical endometrial stroma and smooth muscle fibers (Figs. 1 and 2). There. was an atrophic and somewhat cystic

Fig. 2. Endometrial glands toxylin and eosin. x250.)

and

stroma.

(Hema-

endometrium. There was no endometriosis or adenomyosis of pelvic organs. The cause of death was attributed to massive necrotizing bronchopneumonia in a patient with extensive metastatic breast carcinoma. Ectopic endometrial tissue is occasionally found in extragenital locations, such as the lung,8 sciatic nerve,’ ureters,4 and lymph nodes.5