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Puerperal ovarian vein thrombosis (POVT) commonly results from purulent necrotic endomyometritis. The incidence is published to be 1 in 600 deliveries, however, according to own data, the incidence is at least 10 times less frequent. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain localized anteriorly to the psoatic muscle and a tender, barrel shaped unilateral tumor. Discrepancy between the grave clinical picture and the insignificant findings on gyn. examination is common. Ultrasound and computed tomography frequently add in the correct diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course. If clinical improvement is delayed despite non-invasive treatment, surgical intervention with resection of the involved veins and all septic foci becomes mandatory. Despite non-invasive and invasive treatment, pulmonary emboli or septic complication refractory to therapy may contribute to mortality. Therefore POVT should always be included in the differential diagnosis of those patients presenting with a variable fever curve or an unexplained septic course following delivery or miscarriage.

Endomyocardial biopsies were performed in 11 African women in Nairobi who presented with the clinical features of peripartum cardiomyopathy. The samples were studied by light and electron microscopy. In five patients there was evidence of a "healing myocarditis", that is the presence of a mild inflammatory cell infiltration within the myocardium with foci of necrosis and variable amounts of hypertrophy and fibrosis. Of the nine patients who were followed up, three out of four with myocarditis had persistent heart failure and four out of five without myocarditis improved. Peripheral blood T lymphocyte cell subsets were measured in nine patients by means of monoclonal antibodies. A high helper:suppressor T cell ratio was found in three patients. Almost half of this group of patients with peripartum cardiomyopathy had myocarditis in their biopsy specimens. The myocarditis may have been due to an inappropriate immunological reaction in some patients.

The clinical significance of decidual changes and inflammation in Fallopian tubes of women undergoing sterilization shortly after the delivery was assessed microscopically in 133 resected specimens. Thirteen excision specimens obtained from non pregnant patients served as controls. Foci of ectopic decidua in the mucosa were found in 14.3% of cases in the first group, whereas none was noted in the control group. An inflammatory reaction consisting of edema, hyperemia, and lymphocytic, histiocytic and occasional granulocytic infiltration was noted in 67.6% of patients ligated after delivery. No significant inflammatory reaction was demonstrated in specimens of the control group. In the post partum group the clinical findings and the gross examination of the tubes at the time of operation did not suggest any inflammatory changes. The microscopic changes observed therefore do not warrant the diagnosis of a salpingitis and are to be considered as a physiological response during pregnancy.

In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3-8 weeks. Each patient had between 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 6 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.

Reported in this paper are four cases of puerperal inversio uteri which occurred within six months. Manual reposition was vaginally applied in two cases, whereas abdominal hysterectomy had to be performed on the other two.

All maternal deaths which occurred in relation to labour at the Department of Obstetrics and Gynaecology, University Hospital, Graz, between 1963 and 1978 were reviewed and analysed. 24 mothers died over this 15-year period. The maternal death rate was 0.34 per thousand. In all cases a post mortem examination was performed. The youngest woman was 19, the oldest 42 years old. Most of the decreased mothers were primiparae. The main cause of maternal death was post-partum haemorrhage, followed by infection of the uterus especially after Caesarean section. Three mothers died of liver distrophy. The remaining causes were eclampsia (2 cases); pulmonary artery embolism after Caesarean section (2 cases); irreversible shock from amniotic fluid and air embolism (one case each); uraemia due to glomerulo- or pyelonephritis (one case each); malignant melanoma (one case). It is demonstrated that special risk factors are advanced maternal age, low social status and lack of antenatal care.

Although a number of studies have suggested that granulocyte sequestration is an important pathophysiologic event in ARDS, histologic evidence of aggregated granulocytes in the pulmonary microvasculature is limited, and serial histologic data have not been reported with physiologic measurements. We report a patient with ARDS who demonstrated microvascular granulocyte aggregation and lung edema in sections of a lung biopsy obtained seven days after the onset of symptoms. Pulmonary vascular resistance and pulmonary capillary wedge pressure were normal immediately before the biopsy. A second biopsy performed 12 days later showed decreased lung edema and no evidence of intravascular leukostasis. This case provides histologic support for the hypothesis that granulocyte aggregates contribute to pulmonary edema associated with ARDS.

There were repeated histological bioptic examinations of the endometrium during the period from the second to twentieth day post partum (p.p.) in cows with afterbirth retention (n = 5), with developing puerperal endometritis (n = 5), and with a physiological course of puerperium (n = 5). In cows with a physiological course of puerperium, a finished process of epithelization of endometrium with a morphological and functional consolidation of the epithelium could be observed on the 20th day p.p. In cows with disturbed puerperium, the surface epithelium still exhibited signs of disintegration and a low secretion activity. The endometria of both groups of cows with pathological puerperium had a high degree of infiltration with neutrophil granulocytes: in cows with retained afterbirth this picture was characteristic already the second day p.p. On the other hand, the endometrium of cows with physiological puerperium was characterized by a higher occurrence of folliculoid nodules as early as on the tenth day p.p., and a rapid increase in the number of fat cells and activated histiocytes--macrophages could be observed in the endometrium of these cows between the 15th and 20th day p.p. The dynamics of occurrence of mobile cells in the studied groups of cows confirmed their importance for a physiological course of the restitution of endometrium during the puerperium of cows.

According to Schnitker, Mandel, Hirst and their associates, approximately half of the dissecting aneurysms in women under 40 years of age are associated with pregnancy. This significant relationship between dissecting aneurysm and pregnancy has been discussed by considering hemodynamic stress and also the hormonal changes of pregnancy. In this report, we describe five patients with dissecting aneurysm during pregnancy or the puerperium, review the literature and discuss the influence of pregnancy on the pathogenesis of this disease.

A young woman presented with an asymptomatic unilateral adnexal mass at six weeks postpartum. Her abdomen and pelvis had been considered unremarkable upon examination at parturition, at which time no adnexal masses were palpated. At laparotomy a 20 cm. right ovarian cyst was found, which was shown microscopically to be of corpus luteum origin. Each of the features--size, rapid development, and presentation in the postpartum state--is most unusual.

A two-year-old, six-week postpartum female dog was presented with acute congestive heart failure for treatment. The patient collapsed and suddenly died. Postmortem examination revealed an enlarged, dilated heart with thin ventricular walls. Histologically, scattered multifocal areas of myocardial degeneration and necrosis with fibrosis were seen in the myocardium. This case of acute cardiomyopathy in a female dog six weeks postpartum is similar to the well-described, postpartum cardiomyopathy in man. The etiology of this case was not ascertained.

Postpartum hemolytic uremic syndrome is characterized by the findings of renal failure and microangiopathic hemolytic anemia in the puerperium. The case reported and literature reviewed demonstrate the need for early recognition and aggressive therapy in this rare and generally fatal condition.

Eight cases of a rare type of ovarian cyst with distinctive clinical and pathologic features are reported. The patients presented with a palpable adnexal mass during pregnancy or the puerperium, or with a unilateral ovarian cyst during cesarean section at term. There were no associated endocrine disturbances. The cysts were large, solitary and unilocular and had a median diameter of 25 cm. On microscopical examination they were lined by luteinized cells that exhibited focal marked nuclear atypicality. All six patients who were followed postoperatively were alive and well at intervals of 5--68 months, suggesting that the cysts were luteinized follicle cysts related to the high gonadotropin levels of pregnancy rather than cystic neoplasms.

We report an unusual presentation of angiomyolipoma of the kidney. Whilst a conservative surgical approach is ideal, the greatly increased cardiac output in pregnancy makes haemorrhage more severe and hence more radical surgery is often required. The difficulty in reaching a correct pre-operative diagnosis can lead to an unusual approach to nephrectomy, of which the surgeon should be forewarned.

An unconscious, 29-year-old woman was taken to hospital where, 28 hours after admission, she succumbed to an intractable shock. Autopsy disclosed a lymphocytic adenohypophysitis (LAH). Judged by experiments on animals and by antibody examinations in women during puerpera, LAH is probably an autoimmune disease belonging to a group of autoimmune endocrinopathies, from which one or more is seen with LAH. The description of the present case is accompanied by a description of the disease in eight cases, all women; in only one patient was the diagnosis not made by autopsy. The patients can be divided into two groups, one group consisting of postmenopausal women, another who all became ill approximately one year after giving birth. It is suggested that this histopathological diagnosis also has a clinical significance.

Rupture of the urinary bladder at the time of parturition occurred in a 2 year old Angus cow. Anamnesis included a dystocia followed by a gradual (16 days) onset of anorexia and abdominal distension. Prominent findings on the physical examination were marked dehydration, symmetrical distension of the lower abdomen with ascitic fluid, pneumoperitoneum, absence of rumen contractions, and constipation. Significant laboratory findings were elevations of plasma protein, serum urea nitrogen (SUN) and creatinine, hypochloremia, hyponatremia, hyperkalemia, and metabolic acidosis. The ascitic fluid was present in large quantities (50 liters) and had a markedly elevated urea nitrogen and creatinine concentration when compared to serum values for these substances. Parotid salivary secretion had a reversal of the normal sodium: potassium ratio which was attributed to an increase in aldosterone levels brought about by the hyponatremia. A ventral tear in the urinary bladder was successfully repaired by laparotomy.

A study of 72 cervical biopsy specimens from puerperants revealed several pathogenetic features of endocervicitis, glandular ectropions, and authentic erosions. In particular, pseudoerosions were the result of excessive cervical gland hyperplasia that combined, in nearly all cases, with decidual transformation and chronic stromal inflammation. Ectropions were most likely to have been due to inversion of a moderately hyperplastic mucosa during delivery. In contrast, true erosions developed where the stratified squamous epithelium was hyperkeratotic and atrophic, and were often complicated by acute cervicitis.

Budd-Chiari syndrome following pregnancy is an extremely rare disease as reported in the literature. Reported here are 16 such cases in a total of 105 patients with Budd-Chiari syndrome seen at Postgraduate Institute of Medical Education and Research, Chandigarh, from 1963 to 1978. The clinical pointer to the diagnosis was sudden occurrence of abdominal pain and ascites following childbirth. Eleven patients had diuretic-resistant ascites. Percutaneous hepatography was valuable in detecting the site and the nature of the outflow block. The prognosis was uniformly bad, and eight patients died within one year from the onset of their illness. The various treatment schedules, including anticoagulant therapy, Rhodiascit ascitic fluid re-infusion and portasystemic shunt surgery, had no beneficial effect on the survival of these patients.