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• W2474003254 abstract "A 40-year-old woman, gravida 5, para 2, abortus 2, at 19 weeks’ gestation, presented with the sensation of pressure at the introitus. The patient denied any vaginal discharge or bleeding, nor did she have any sensation of contractions. Conception was natural and the pregnancy thus far was without complications. On examination, the abdomen was gravid at the appropriate fundal height for gestational age, with the remainder of the examination results being unremarkable. The physician assistant and emergency physician deferred a pelvic examination but performed bedside ultrasonography (Figures 1 and 2; Videos 1 and 2).Figure 2Longitudinal section demonstrating landmarks of the bladder (short white arrow), along with fetal head (white arrowhead), intact amnion (red arrowhead), and prolapsed amnion (red arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Amniotic sac prolapse. The patient was admitted to the obstetric service and was found to have complete effacement of the cervix. Unfortunately, no intervention could be performed, and the patient delivered the fetus the next day. The fetus died immediately in the neonatal period. Amniotic sac prolapse in the second trimester is a rare and severe complication of pregnancy. Rates of amniotic sac prolapse are 1 to 2 cases per 1,000 births.1Hochuli E. Vogt H.P. Die “Doppelcerclage.”.Geburtshilfe Frauenheilkd. 1987; 47: 537-538Crossref PubMed Scopus (4) Google Scholar One of the primary causes of amniotic sac prolapse is cervical incompetence,2Harger J.H. ACOG Committee on Practice Bulletins Cervical InsufficiencyACOG practice bulletin no. 48.Obstet Gynecol. 2003; 102 (1091-1099)Google Scholar which occurs in 0.2% to 7% of all pregnancies.3Stupin J.H. David M. Siedentopf J.P. et al.Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestation weeks. A retrospective, comparative study of 161 women.Eur J Obstet Gynecol Reprod Biol. 2008; 139: 32-37Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar Emergency consultation with obstetrics is required for further management, which may range from observation to surgical intervention.3Stupin J.H. David M. Siedentopf J.P. et al.Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestation weeks. A retrospective, comparative study of 161 women.Eur J Obstet Gynecol Reprod Biol. 2008; 139: 32-37Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlZDRmMDU1ZTIxODJlZTg0NDFmNGRkZjkwMGQzMTQ2ZCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MDM5MTE0fQ.eIjpYNimfLgJaeNKSq7kByaYYnVA-lfxP4tqo_TZpA1gNQb5PY798LRbezyswKXQyBQOC8Oad4Lp_4LL5KzRT5cZV1qF2o4QH2WSAC0axAdjQqJoVma6AO7xnNp8c91qYloe5p1ZxzbwUmRb_R2lzEQaJYztgwkEqv7IZq8pXbntICkrltcavhCyIA1vLFNYu98Q-bZWlW31GTBIQQo3NI1DIctqotOeEGdtLIxpbKI8uIic44MOCOyDd9RDM5MoKKJ70BXgm9-8248YqvzehRWJhE37XliiJHY0u4e0IaorVTjZxRf1We-kkQCI6n_kCj8HbmSQbw4Ue-s6ds6dtQ Download .mp4 (2.04 MB) Help with .mp4 files Video 1Longitudinal section demonstrating fetal head, with prolapsed amnion just superior and inferior to the bladder.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5NTU4MTMyZjkxYzc1MGQxMjI1NTExMGZiYmIzYzczNSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MDM5MTE0fQ.Nlcd51aFD2h4oxSLRUqGYf-bxy7TdJ8Z8Mmc3SOAOjC8_YlmOxMurldGis4I_-3AD6OjcS_KEO1Tgxe6EXk2Rt3ol-VoIdf_XnJjstp3t52bAFIPYvLDuT-dLumeCFGKFSYKub6Tr06OVPOEvskzG2lb-dDyQmRO6WC2Fax6WZUW782Hc2J762RN8Odv4xfvV3h2vBgEc8HIv_WT19Fs_ikehO8yYX3s7Y2oZFfs1PBUziz-fCHjcZF3xqaQWR3gWdAgqNkZFn1rv3n4qtE8Upy6h6ksHC3s87WXH3hsdEgKpeKRHNXb3VA7vy4VQ0pfzDFnD6t8jZaUjYL-T4Mjog Download .mp4 (3.8 MB) Help with .mp4 files Video 2Transverse appearance of the prolapsed amnion observed in the far field." @default.
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• W2474003254 date "2016-07-01" @default.
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• W2474003254 title "Pregnant Woman With Vaginal Pressure" @default.
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• W2474003254 doi "https://doi.org/10.1016/j.annemergmed.2015.11.018" @default.
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