Showing papers in "Case Reports in Obstetrics and Gynecology in 2015"
TL;DR: A case of didelphys uterus that successfully conceived, carried her pregnancy to term, and delivered vaginally without any significant complications is discussed, which is one of the least common amongst MDAs.
Abstract: Background. Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a “double uterus,” is one of the least common amongst MDAs. This report discusses a case of didelphys uterus that successfully conceived, carried her pregnancy to term, and delivered vaginally without any significant complications. Case. Patient is a 29-year-old G2P0010 from Bangladesh, initially came a year prior in her first pregnancy, with spontaneous abortion (SAB). Pelvic Sonogram at that time showed a diagnosis of bicornuate versus didelphys uterus. There were no renal anomalies on subsequent abdominal CT scan. Patient presented with the second pregnancy and had uncomplicated prenatal care and did not have signs of preterm labor; fetus showed appropriate growth and the pregnancy was carried in the left uterus. Patient presented at 38 4/7 wks with Premature Rupture of Membrane and underwent induction of labor with Cytotec. Antibiotics were started for chorioamnionitis. Patient had a vaginal delivery with left mediolateral episiotomy and complete tear of vaginal septum. Third stage of labor was complicated with retained placenta, which was removed manually in the operating room with total EBL of 600 cc.
36 citations
TL;DR: The authors' patient presented with no endocrine or hematological abnormalities, adding to a review of the literature for differential diagnoses, workup, and management of cases of gestational gigantomastia with normal hormone levels.
Abstract: Background. Gestational gigantomastia is a rare disorder without clear etiology or well-established risk factors. Several pathogenic mechanisms contributing to the disease process have been proposed, all of which can lead to a similar phenotype of breast hypertrophy. Case. A 28-year-old Guinean woman presented at 37 weeks of gestation with bilateral gigantomastia, mastalgia, peau d’orange, and back pain. Prolactin levels were 103.3 μg/L (with a normal reference value for prolactin in pregnancy being 36–372 μg/L). The patient was treated with bromocriptine (2.5 mg twice daily), scheduled for a repeat cesarean, and referred to surgery for bilateral mammoplasty. Conclusion. Gestational gigantomastia is a rare disorder, characterized by enlargement and hypertrophy of breast tissue. Our patient presented with no endocrine or hematological abnormalities, adding to a review of the literature for differential diagnoses, workup, and management of cases of gestational gigantomastia with normal hormone levels.
29 citations
TL;DR: An unusual case of giant pedunculated subserous giant lipoleiomyoma misdiagnosed preoperatively as leiomyosarcoma is reported, which should be kept in mind in the differential diagnosis of leiomersic or ovarian malignancy.
Abstract: Introduction. Uterine leiomyoma is the most common benign pathology in women and lipoleiomyoma is an extremely rare and specific type of leiomyoma. Here, we report an unusual case of giant pedunculated subserous lipoleiomyoma misdiagnosed preoperatively as leiomyosarcoma. Case. A 45-year-old woman admitted to our gynecology outpatient clinic for complaints of abdominal distention, tiredness, and pelvic pain for the last 6 months. Sonography and abdominal magnetic resonance imaging (MRI) showed a giant semisolid mass that filled whole abdominal cavity from pelvis to subdiaphragmatic area. A primary diagnosis of uterine sarcoma or ovarian malignancy was made. On operation, total abdominal hysterectomy with a pedunculated mass of size 30 × 23 × 12 cm and weighing 5.4 kg and bilateral salpingo-oophorectomy were performed. The histopathology revealed a lipoleiomyoma with extensive cystic and fatty degeneration without any malignancy. Discussion. The diagnosis of leiomyoma is done usually with pelvic ultrasound but sometimes it is difficult to reach a correct diagnosis especially in cases of giant and pedunculated lipoleiomyoma that included fatty tissue which may mimick malignancy. Conclusion. Subserous pedunculated giant lipoleiomyoma should be kept in mind in the differential diagnosis of leiomyosarcoma or ovarian malignancy.
24 citations
TL;DR: The novel case of a 62-year-old woman with an ovarian tumor who spontaneously developed tumor lysis syndrome is presented, and surgical reduction of the tumor mass vastly improved her condition.
Abstract: Tumor lysis syndrome (TLS) is a potentially life-threating complication of tumors or chemotherapy treatment. TLS commonly occurs in hematological malignancies, but it is very rare in patients with a solid tumor. In cases of solid tumors, TLS usually occurs spontaneously and after the initiation of anticancer therapy, and it has a high mortality rate. We present the novel case of a 62-year-old woman with an ovarian tumor who spontaneously developed TLS. Surgical reduction of the tumor mass vastly improved her condition. She showed no sign of tumor recurrence 8 months after treatment. As TLS is life-threatening, successful treatments must be seriously considered.
23 citations
TL;DR: A case of 30-year-old woman consulting with a vulvar mass of 7 cm in the Bartholin glands area, which showed characteristic of epithelioid leiomyoma with myxoid stroma with both estrogen receptor (ER) and progesterone receptor (PR) staining negative, which was really rare.
Abstract: Leiomyoma of vulva is rare, and usually misdiagnosed clinically as Bartholin cyst. It usually presents spindle-shaped tumor cells, but some rare cases consisted mainly of atypical epithelioid tumor cells. We report here a case of 30-year-old woman consulting with a vulvar mass of 7 cm in the Bartholin glands area. The lesion was surgically excised with its capsule completely. Pathological examination and immunochemistry showed characteristic of epithelioid leiomyoma with myxoid stroma with both estrogen receptor (ER) and progesterone receptor (PR) staining negative, which was really rare as only 2 cases of vulvar leiomyoma with both ER and PR were reported before.
22 citations
TL;DR: This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen, who was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis, but was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage.
Abstract: This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.
21 citations
TL;DR: It is suggested that a Bakri postpartum balloon can be used to noninvasively reduce uterine inversion and prevent its recurrence.
Abstract: Uterine inversion is a state wherein the endometrial surface is inverted. Although this condition may be observed in nonpregnant women, it most commonly develops at the time of delivery. In the present case, a 37-year-old woman without any remarkable history developed acute puerperal uterine inversion after the successful induction of labor. Following the delivery, she complained twice of severe lower abdominal pain; subsequently, hemorrhage was noted at the site of partial detachment of the placenta. These findings led to a diagnosis of placenta accreta, and the patient developed a state of shock. A Bakri postpartum balloon was inserted into the uterine cavity under ultrasonographic guidance and was filled with physiological saline for treatment of this condition. With this procedure, the uterine inversion was completely reduced and the hemorrhage was stopped. Moreover, no reinversion was observed in the postoperative period. These findings suggest that a Bakri postpartum balloon can be used to noninvasively reduce uterine inversion and prevent its recurrence.
17 citations
TL;DR: Considering the limited long-term therapeutical possibilities for pregnancies complicated by PE, plasmapheresis seems to be a therapeutical option, especially to pregnancies with early-onset preeclampsia, in which, after first conventional treatment of PE, prolongation of pregnancy should be above all.
Abstract: An imbalance of angiogenic and antiangiogenic placental factors such as endoglin and soluble fms-like tyrosine kinase 1 has been implicated in the pathophysiology of preeclampsia. Extraction of these substances by plasmapheresis might be a therapeutical approach in cases of severe early-onset preeclampsia. Case Report. A 21-year-old primigravida with antiphospholipid syndrome developed early-onset preeclampsia at 18 weeks' gestation. She was treated successfully with plasmapheresis in order to prolong pregnancy. Endoglin and sflt-1-levels were measured by ELISA before and after treatment. Endoglin levels decreased significantly after treatment (p < 0.05) and showed a significant decrease throughout pregnancy. A rerise of endoglin and sflt-1 preceded placental abruption 4 weeks before onset of incident. Conclusion. Due to the limited long-term therapeutical possibilities for pregnancies complicated by PE, plasmapheresis seems to be a therapeutical option. This consideration refers especially to pregnancies with early-onset preeclampsia, in which, after first conventional treatment of PE, prolongation of pregnancy should be above all.
16 citations
TL;DR: This case represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration and represents an example of when a migrating device may remain in situ in an asymptomatic patient.
Abstract: Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.
15 citations
TL;DR: A 28-year-old female, who had a past obstetrical history complicated by uncontrolled blood pressure, early onset preeclampsia, and a fetal demise at 29 weeks, is presented, who remained normotensive and initially presented with normal blood urea nitrogen and creatinine levels, however, after the early first trimester, she developed nephrotic range proteinuria, hypoalbuminema, and peripheral edema.
Abstract: We present a case of 28-year-old female, who had a past obstetrical history complicated by uncontrolled blood pressure, early onset preeclampsia, and a fetal demise at 29 weeks. Her blood pressure normalized after each pregnancy, and no diagnosis of renal disease was ever established. In her most recent pregnancy, she remained normotensive and initially presented with normal blood urea nitrogen and creatinine levels. However, after the early first trimester, she developed nephrotic range proteinuria, hypoalbuminemia, and peripheral edema. After delivery of the baby, all clinical symptoms rapidly resolved and laboratory values normalized. We review the clinical course, diagnosis, and management of new onset nephrotic syndrome in pregnancy.
15 citations
TL;DR: A 68-year-old female patient with ECOG Performance Score of 1 presented with pervaginal bleeding for 20 days and was found to have mass in the anterior fornix of vagina, and there was a partial response to decitabine according to RECIST criteria.
Abstract: Myeloid sarcoma (chloroma, granulocytic sarcoma, or extramedullary myeloid tumour) is an extramedullary mass forming neoplasm composed of myeloid precursor cells. It is usually associated with myeloproliferative disorders but very rarely may precede the onset of leukemia. Here, we are presenting a rare case of primary vaginal myeloid sarcoma in a geriatric female patient without initial presentation of acute myeloid leukemia (AML). A 68-year-old female patient with ECOG Performance Score of 1 presented with pervaginal bleeding for 20 days. On colposcopic examination, she was found to have mass in the anterior fornix of vagina. A punch biopsy specimen revealed chloromatous infiltration of the vagina. LCA (leukocyte common antigen), MPO (myeloperoxidase), and c-kit were strongly positive on IHC (immunohistochemistry). The patient's routine blood investigations were normal including peripheral smear, lactose dehydrogenase, uric acid, 2D echocardiography, conventional cytogenetics, bone marrow aspiration, and biopsy. The patient was given 4 cycles of decitabine (Decitex, manufactured by Sun Pharmaceutical Industries Limited, India), 20 mg/m(2) for 5 days at an interval of 28 days. There was a partial response to decitabine according to RECIST criteria. As decitabine therapy was well tolerated, we are continuing in the same way until disease progression without any complications. The patient is undergoing regular follow-up at our centre.
TL;DR: This study illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from the experience.
Abstract: Ectopic pregnancy is commonly located in the fallopian tube. Nevertheless, two unusual types of ectopic pregnancy, intramural pregnancy and rudimentary horn pregnancy, seriously threaten maternal life. The diagnosis and treatment of these unusual implantation sites present a clinical challenge. In this study, we illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from our experience.
TL;DR: Vaginal leiomyosarcoma is exceedingly rare with an aggressive course, high recurrence, and undetermined ideal treatment regimen; the gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy.
Abstract: Background. Primary leiomyosarcoma of the vagina is an exceedingly rare diagnosis. Current estimates are that this tumor could at most represent a mere 0.062% of malignant neoplasms in the female genital tract, although in actuality it is likely far less common. Case Presentation. A 70-year-old female gravida 3 para 2 with new onset palpable vaginal mass and pink vaginal discharge is diagnosed with primary leiomyosarcoma of the vagina. Chemotherapy is complicated by acute Lyme disease, and the patient requires a robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and partial vaginectomy. The patient remains without recurrence 18 months after surgery. Conclusion. Vaginal leiomyosarcoma is exceedingly rare with an aggressive course, high recurrence, and undetermined ideal treatment regimen. Its diagnosis can be delayed and its presentation varied. Information on this rare tumor type is predominantly through rare case reports with collective consensus on management lacking. The gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy.
TL;DR: It was the first time that the renal vein and ovarian vein thrombosis were observed in the postpartum period, and there was no coagulation abnormality.
Abstract: Although there is no other underlying disease, women can sometimes experience rare and serious diseases such as ovarian vein thrombosis (OVT) and renal vein thrombosis (RVT) after giving birth. The widespread development of thrombosis is treated for the first time in this study. Stasis, coagulation factor abnormalities, and intimal damage to the venous thrombosis risk can increase during pregnancy. It was mentioned that it diagnoses an abnormality in the hypercoagulability half of women with OVT. Despite the hypercoagulant abnormality observed in pregnant women, it was very unusual that the renal vein thrombosis led to this complication. It can lead to severe complication of OVT which can even cause death. It was the first time that the renal vein and ovarian vein thrombosis were observed in the postpartum period, and there was no coagulation abnormality. It is known that the thrombus in the postpartum period can be observed with the fever of unknown origin. The problematic, but rarely observed, postpartum disease such as ovarian venous thrombosis (OVT) is generally observed in the right ovarian vein. In this disease, avoiding the resulting laparotomy heparin and intravenous antibiotics is best solution for the patient. If it is to be noted a fever for unknown reasons, that it be thrombosis.
TL;DR: Two patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic washings, and abdominal wall lesion resection for clear cell carcinoma transformation arising from endometriosis in abdominal wall scars.
Abstract: Clear cell carcinoma is the least common of the malignant transformations reported in nonpelvic sites of endometriosis. Two cases with clear cell carcinoma transformation arising from endometriosis in abdominal wall scars are presented. These patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic washings, and abdominal wall lesion resection. The first case had initial treatment with chemotherapy, while chemotherapy and radiation therapy were given for the second case. A recurrence was noted for the chemotherapy only case for, which she was subsequently given radiation, with further resolution of the lesion.
TL;DR: The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis of tracheal agenesis would have been easy if a systematical examination of upper airways had been performed.
Abstract: Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd’s type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology.
TL;DR: A case of fetal bowel dilatation diagnosed in the third trimester is described, which is a difficult prenatal diagnosis since ultrasound has limited accuracy for bowel evaluation.
Abstract: Fetal bowel dilatation is an indirect sonographic sign of mechanical or functional bowel obstruction. The etiology of fetal bowel dilatation is a difficult prenatal diagnosis since ultrasound has limited accuracy for bowel evaluation. The authors describe a case of fetal bowel dilatation diagnosed in the third trimester.
TL;DR: A 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section is presented; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth.
Abstract: Youssef's syndrome is characterized by cyclic hematuria (menouria), absence of vaginal bleeding (amenorrhea), and urinary incontinence due to vesicouterine fistula (VUF), the least common of the urogynecological fistulas. Youssef's syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature.
TL;DR: Evaluation of vitamin K status could potentially prevent this rare and disfiguring embryopathy from HG, which has many maternal and fetal effects.
Abstract: A 21-year-old primigravida had a pregnancy complicated by hyperemesis gravidarum (HG) beginning at 7-week gestation. Despite medical therapy, she lost 18% of her prepregnancy weight. Early ultrasound at 14 weeks demonstrated a flattened facial profile with nasal hypoplasia (Binder phenotype) consistent with vitamin K deficiency from HG. She had a percutaneous endoscopic gastrojejunostomy tube placed for enteral feeding at 15-week gestation. At repeated anatomy ultrasound at 21-week gestation, delivery, and postnatal pediatric genetics exam, nasal hypoplasia was consistent with vitamin K deficiency embryopathy from HG. Nausea and vomiting of pregnancy is a common condition. HG, the most severe form, has many maternal and fetal effects. Evaluation of vitamin K status could potentially prevent this rare and disfiguring embryopathy.
TL;DR: Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation.
Abstract: Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Mullerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation.
TL;DR: In this case report, the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy is discussed.
Abstract: We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy.
TL;DR: A modified tamponade method was developed and applied to two cases of refractory postpartum hemorrhage after vaginal delivery and brought complete hemostasis and no further treatments were needed.
Abstract: While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.
TL;DR: Though, it is very rare in pediatric age group, xanthogranulomatous salpingooophoritis as one of the differential diagnoses should be kept in mind while dealing with tuboovarian masses in this age group.
Abstract: Background. Xanthogranulomatous inflammation is an uncommon affection of the female genital tract. The youngest case reported of xanthogranulomatous salpingooophoritis in literature was by Shilpa et al. in 2013 in an eighteen-year-old female. Case Report. We report a case of 2-year-old female child with right-sided xanthogranulomatous salpingooophoritis presented as mass in abdomen. This is a case report of the youngest documented case of xanthogranulomatous salpingooophoritis in literature. As per abdominal examination, there was generalized distention of abdomen and a mass was palpable which was arising out of pelvis more on the right side. The ultrasonography (USG) abdomen and pelvis revealed a thick-walled mass measuring 9.2 cm × 6.0 cm × 7.6 cm in pelvis. We did right salpingooophorectomy of the patient. On histopathology, the diagnosis of xanthogranulomatous salpingooophoritis was confirmed. Conclusion. Clinical presentation, radiological appearance, and gross features of xanthogranulomatous lesions of ovary can mimic neoplastic lesions and lead to misdiagnosis. Though, it is very rare in pediatric age group, xanthogranulomatous salpingooophoritis as one of the differential diagnoses should be kept in mind while dealing with tuboovarian masses in this age group.
TL;DR: A high index of suspicion and good imaging during pregnancy are important in making this diagnosis of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation.
Abstract: Introduction. Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case Presentation. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation. Patient had history of two prior classical cesarean sections. She underwent cesarean section, with delivery of a healthy male infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion. Silent spontaneous rupture of the uterus before term with extrusion of an intact amniotic sac is rare. A high index of suspicion and good imaging during pregnancy are important in making this diagnosis.
TL;DR: Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.
Abstract: Pregnancy and birth after a Pelvic Organ Prolapse (POP) surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT) procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.
TL;DR: The IIABO procedure could result in a very small increase in the risk of harmful effects to the fetus, and the fetal radiation dose during the prophylactic IIABOs did not exceed 50 mGy.
Abstract: Background. Although radiation exposure is of great concern to expecting patients, little information is available on the fetal radiation dose associated with prophylactic internal iliac artery balloon occlusion (IIABO). Here we estimated the fetal radiation dose associated with prophylactic IIABO in Caesarean section (CS). Cases. We report our experience with the IIABO procedure in three consecutive patients with suspected placenta previa/accreta. Fetal radiation dose measurements were conducted prior to each CS by using an anthropomorphic phantom. Based on the simulated value, we calculated the fetal radiation dose as the absorbed dose. We found that the fetal radiation doses ranged from 12.88 to 31.6 mGy. The fetal radiation dose during the prophylactic IIABOs did not exceed 50 mGy. Conclusion. The IIABO procedure could result in a very small increase in the risk of harmful effects to the fetus.
TL;DR: Clinicians should be alert especially for the diagnosis in a tissue with smooth muscle content, as leiomyomas are quite rare outside of the uterus but they might occur in any tissue or organ containing smooth muscle after the spreading effect of an accident or surgical trauma.
Abstract: Round ligament of uterus leiomyoma is a rare, benign tumor of the vulva. Its incidence is not known exactly, and the mean age ranges from 13 to 70. Although clinical properties of benign and malignant diseases in the vulvar area are frequently similar, early diagnosis and treatment are essential. Local excision is recommended as definitive therapy. We present an 28-year-old female without any birth with a mass in anterior vaginal wall diagnosed as vulvar leiomyoma. In conclusion, a brief review of relevant literature emphasizes that leiomyomas are quite rare outside of the uterus but they might occur in any tissue or organ containing smooth muscle, spontaneously or parasitically after the spreading effect of an accident or surgical trauma. Clinicians should be alert especially for the diagnosis in a tissue with smooth muscle content.
TL;DR: A unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectom and survived, though fetus died before intervention.
Abstract: Uterine rupture is one of the most catastrophic complications during pregnancy. It is a rare complication in developed countries but a frequent cause of maternal and perinatal morbidity and mortality in Africa. Uterine rupture occurs in 1.6% of patients suffering blunt abdominal trauma. Here we report a unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectomy and survived, though fetus died before intervention. We also reviewed similar cases reported from different parts of Africa. This is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits.
TL;DR: The case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment is illustrated.
Abstract: Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.
TL;DR: In this paper, the authors presented the computed tomography (CT) and magnetic resonance (MR) imaging findings of a 71-year-old woman with a cardiac extension of intravenous leiomyoma (IVL) that arose from the uterus, extended to the inferior vena cava (IVC), and reached the right ventricle through the right ovarian vein.
Abstract: We present the computed tomography (CT) and magnetic resonance (MR) imaging findings of a 71-year-old woman with a cardiac extension of intravenous leiomyoma (IVL) that arose from the uterus, extended to the inferior vena cava (IVC), and reached the right ventricle through the right ovarian vein. Radiologic-pathologic correlation showed that the intravascular cord-like mass originating from the IVC and extending to the right ventricle was composed of degenerated smooth muscle cells with a number of large vessels that were regarded as arteries; moreover, the arteries within the cord-like mass appeared to be looping internally. Given the disappearance of the right ovarian venous wall around the IVL pathologically, extracting the tumor from the ovarian vein during an operation is considered to be impossible retrospectively. Also it was difficult to identify even the intravenous extension of the uterine leiomyoma histopathologically. Therefore, contrast-enhanced CT, in particular arterial phase imaging, provided important information that revealed the mass, range, and path of the lesion, ensuring that an appropriate operative plan could be drawn up and the tumor completely excised.