Proceedings in Obstetrics and Gynecology
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Tubal splenosis: unusual location of the spleen
Get PDFIntroduction: Splenosis is defined as the autotransplantation of splenic tissue to abnormal locations after splenic injury. Heterotopic spleen can be found within the abdominal and pelvic cavities. We report a tubal splenosis case in a 48 year old woman who underwent splenectomy following a blunt trauma 41 years prior to presentation.Case report: A 48 years old gravida 3, para 3, was admitted to our gynecology clinic for pelvic pain, menstrual irregularities and abnormal bleeding. The patient had a six months history of sonographically detected 40 x 20 mm pelvic mass. She also had a blunt trauma and splenectomy history from 41 years ago. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Intraoperative exploration revealed a 40 mm sized suspicious mass immediately adjacent to the right fallopian tube. The histopathologic examination of the specimen reported normal splenic tissue with polymorphous small lymphocytes, granulocytes, and frequent hemosiderin laden macrophages.Discussion: Posttraumatic pelvic splenosis is a rare condition. Splenosis should be kept in mind as a differential diagnosis especially for patients with a history of posttraumatic splenectomy who are scheduled for pelvic mass surgery. Although most of the patients are diagnosed postoperatively, if preoperative diagnosis could be made, there is no medical indication for this normally functioning tissue to be resected
Herniated gravid uterus through an infra-umbilical laparotomy scar: a case report
Get PDFHerniation of a gravid uterus through the abdominal wall is a rare and potentially serious condition due to its antecedent complications. Management is determined by gestational age. Simultaneous hernioplasty with cesarean section is considered safe. Clinical awareness of this complication will prevent delay in its diagnosis and treatment. Delay in recognition of this condition can lead to incarceration and subsequent strangulation of the gravid uterus. Strangulation at or near term appears to be a genuine indication for early hospitalization and elective cesarean section, possibly combined with hernia repair. Here we report the case of a middle aged woman who presented with abdominal pain at 28 weeks of gestation with an unusual bulge of her abdomen. The lower abdominal bulge turned out to be her gravid uterus herniated through the anterior abdominal wall. Cesarean delivery with herniorrhaphy was done for the large abdominal defect
Small bowel obstruction: a recurrence of melanoma during the second trimester of pregnancy
Get PDFBackground: The incidence of melanoma is on the rise in the United States and is particularly prevalent among women of childbearing age. Obtaining a complete history and understanding the unpredictable behavior of melanoma is essential to make the diagnosis of recurrent disease during pregnancy.Case: A 35-year-old G2P1 at 23 weeks and 1 days’ gestation with a remote history of (treated) cutaneous melanoma underwent an exploratory laparotomy for small bowel obstruction. Pathology was consistent with recurrent metastatic melanoma.Conclusion: Metastatic melanoma diagnosed during pregnancy is rare. There are no guidelines on how or when to proceed with treatment of metastatic disease or delivery of the fetus. Immunotherapy is changing the management of melanoma and is extending life expectancy. The significant survival benefits for mother with immunotherapy may outweigh the risks of preterm delivery for the baby
True knot of the umbilical cord in advanced weeks of pregnancy: a case report
Get PDFTrue knot of the umbilical cord is a very rare condition. Usually a true knot is noticed after delivery and does not lead to problems. It is relatively less common than the other umbilical cord anomalies. Most authors agree that there is little that can be done to prevent fetal death in undiagnosed true knot. In our case, the patient gave birth to a healthy male baby weighing 2700 grams by normal vaginal delivery after an ultrasound was suggestive of intrauterine growth restriction (IUGR). The baby’s Apgar scores were 8 at one minute and 9 at five minutes. The umbilical cord measured 125 cm and contained two loose true knots. It was surprising that the baby could survive until term with these two knots and we hypothesize that this was the cause of the IUGR. Our case was interesting as neither neurologic sequela nor intrauterine death developed, despite two true umbilical cord knots
Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman
Get PDFAdnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group
Utility of extra biopsies during colposcopy: experience with a cervical imaging system at an academic center
Get PDFObjective: Determine if additional non-random biopsies beyond clinician directed biopsy enhance the detection of high-grade cervical disease.Methods: A cervical imaging system (CIS) was used as an adjunct to colposcopy in an academic colposcopy clinic between July 2008 and October 2010 in an IRB approved post-FDA approval study. A post hoc analysis explored if additional biopsies through the CIS added diagnostic value to the clinician’s biopsies.Results: Of 181 women with complete analysis, 50 (27.6%) were found to have CIN2+ disease. Clinician directed biopsy detected 45 of 50 (90%) of CIN2+. CIS directed biopsy detected an additional 5 of 50 (10%) of CIN2+.Clinicians directed 180 total biopsies meaning that 1 of every 4 clinician biopsies detected CIN2+ disease, whereas CIS directed an additional 68 biopsies resulting in a yield of one case of CIN2+ disease for approximately 14 additional biopsies.Conclusion: Additional non-random biopsies based on CIS increased the detection of high-grade disease in cases where clinicians did not identify high-grade disease. As noted by others, both random and non-random additional biopsies increase the sensitivity of traditional colposcopy. What is not clear is whether the additional cases identified represent clinically significant disease. Our study is particularly relevant as colposcopists explore standardizing high yield diagnostic techniques
A case report of twin reversed arterial perfusion sequence with expectant management
Get PDFAcardiac twin or TRAP (twin reversed arterial perfusion) sequence is a rare complication of monochorionic pregnancies. In these cases, the heart is either absent or non-functional. It’s controversial whether conservative management or therapeutic treatment is better in TRAP-sequence.In this case, we present a 19-years old, primigravida diagnosed with spontaneous monochorionic monoamniotic twin pregnancy at 7th week of gestation. One of the fetuses had a crown-rump length of 8 mm and fetal heart rate 122/minute while the other one had a crown-rump of 7 mm with no detected fetal heartbeat. At the 11th week of gestation, the acardiac twin continued growing despite the absence of the fetal heart beat and fetal extremities. The cranium could not be evaluated clearly. The diagnosis of TRAP sequence was confirmed by the reversed direction of flow observed in the umbilical artery. Since the patient and her husband did not want any intervention, no interventional diagnostic and treatment modalities were applied. Preterm labor started at the 32th week. Because the presentations were transverse and breech, pump and acardiac fetus, respectively, a cesarean delivery was performed. A healthy female baby, weighing 1650 gr with APGAR scores of 9-10, first and fifth minutes, respectively, was delivered along with the acardiac fetus which was 1550 gram in weight, fetal heart beat negative, with upper and lower extremity deformities. The uniqueness of the present case is that there was no significant difference in the weight of both twins. The acardiac twin was as large as the pump twin. Except for twenty days hospitalization because of neonatal respiratory distress syndrome, which was a consequence of preterm labor, there were no problems with the pump twin even though managed conservatively.In monochorionic twin pregnancies, when one of the twins is found to be fetal heartbeat negative and it continues to grow with concomitant structural abnormalities, the TRAP sequence should come to mind. If the acardiac fetus is small and the pump fetus has no complications, the conservative approach can be considered. Our goal should be to deliver the pump twin with minimal complications. To achieve this, follow-ups and treatment should be individualized for each patient, the pump fetus should be monitored closely
Effects of irregular antenatal care attendance in primiparas on the perinatal outcomes: a cross sectional study
Get PDFAim: Antenatal care (ANC) is a key strategy for reducing maternal and neonatal morbidity and mortality rates because adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. The current study aims to identify the factors causing lack of regular attendance at ANC clinics in primiparas and to determine the effects of lack of antenatal care on perinatal outcomes.Methods: A cross sectional study was carried out at Assiut Women's Health Hospital, Egypt between October 2015 and September 2016. Estimated sample size of 516 primiparous women were divided into two groups according to number of attendance to ANC clinics; women who came four visits or more were considered regular and those who came to less than four visits were considered irregular. Data was collected via a structured interview questionnaire that included personal data, obstetrical, data about current pregnancy and labor. The researcher interviewed the women within 24 hours postpartum.Results: The majority of the study sample (74.8%) had regular ANC visits while only (25.2%) had <4 antenatal visits. Financial problems (44.6%) or lack of awareness about the importance of ANC (20%) were the most common reasons for irregular ANC visits. The incidence of preeclampsia and eclampsia is significantly higher in the irregular attendants (p=0.000). Similarly, preterm birth, stillbirth and low birth weight were significantly more common among irregular attendants (p=0000).Conclusion: Women with irregular antenatal care attendance are much more prone to pregnancy complications such as preeclampsia, eclampsia and anemia besides higher adverse birth outcomes including preterm birth, low birth weight and stillbirth
Management of preeclampsia after heart transplant
Get PDFWe present a 20-year-old primiparous patient status post heart transplant at 6 months with long-standing hypertension progressing to super-imposed preeclampsia. Pregnancy and delivery after thoracic transplantation is no longer a rare occurrence, however, these women are at a greater risk of gestational hypertension and preeclampsia.1 Current literature does not provide treatment guidelines for treatment of hypertensive disorders in patients with a transplanted heart. In this case report, we explore the different treatments for maintaining blood pressures in the transplanted neurovascular system, effects of eclampsia prevention on blood pressure, and how fluctuations in blood pressure in a long-standing hypertensive can affect fetal heart tracings. A literature search was conducted using terms “solid organ transplant and preeclampsia”, “Anti-hypertensive drugs post heart transplant”, and “hypertension after heart transplantation”. No reviews on treatment of preeclampsia in cardiac transplant recipients were evident
Recurrent second-trimester intrauterine fetal death due to undiagnosed atrioventricular block: A case report
Get PDFFetal cardiac abnormalities are one of the common causes of non-immune fetal hydrops. Early diagnosis and treatment may prevent the late consequences that can occur as heart failure and intrauterine fetal death. Herein we report the case of a 32-year-old patient with a history of recurrent second trimester intrauterine fetal death. She presented with fetal hydrops at 23 weeks. A detailed echocardiography revealed that the fetus had a third degree atrioventricular block and advanced hydropic changes due to heart failure. Corticosteroid therapy was started but the fetus died in utero after 2 weeks