V Aaen1, L Cowan, E P Sakala, M L Small. 1. Department of Gynecology and Obstetrics, Loma Linda University Medical Center, California.
Abstract
BACKGROUND: Although successful pregnancy has been reported in women with prosthetic mesh abdominal wall grafts, the complication of severe pain in pregnancy from shearing of the graft has not been described. We report an unusual case of severe pain in pregnancy caused by abdominal wall stretching by the enlarging uterus. Pain was controlled with long-term intravenous meperidine analgesia. CASE: A 21-year-old multigravida with a previously placed mesh graft for multiple abdominal wall hernias presented at 30 weeks' gestation with severe abdominal pain. Meperidine patient-controlled analgesia at a mean dose of 14.2 mg/kg/day controlled the symptoms, allowing pregnancy prolongation for 28 days before induction of labor at 34 weeks when fetal lung maturity was confirmed. CONCLUSION: This is the first reported case of the use of high-dose patient-controlled parenteral narcotic analgesia in a woman whose abdominal wall mesh graft partially sheared from its attachments. The patient went on to have a successful vaginal delivery.
BACKGROUND: Although successful pregnancy has been reported in women with prosthetic mesh abdominal wall grafts, the complication of severe pain in pregnancy from shearing of the graft has not been described. We report an unusual case of severe pain in pregnancy caused by abdominal wall stretching by the enlarging uterus. Pain was controlled with long-term intravenous meperidine analgesia. CASE: A 21-year-old multigravida with a previously placed mesh graft for multiple abdominal wall hernias presented at 30 weeks' gestation with severe abdominal pain. Meperidinepatient-controlled analgesia at a mean dose of 14.2 mg/kg/day controlled the symptoms, allowing pregnancy prolongation for 28 days before induction of labor at 34 weeks when fetal lung maturity was confirmed. CONCLUSION: This is the first reported case of the use of high-dose patient-controlled parenteral narcotic analgesia in a woman whose abdominal wall mesh graft partially sheared from its attachments. The patient went on to have a successful vaginal delivery.