Proceedings in Obstetrics and Gynecology
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First trimester spontaneous rupture of an unscarred uterus in a multiparous woman: a case report
Get PDFThe rupture of an unscarred uterine is a rare life-threatening event that usually occurs late in pregnancy or during labor. Spontaneous uterine rupture, as in our case, is extremely uncommon and rarely diagnosed before laparotomy. Herein, we present a case of spontaneous uterine rupture in a 32 year old multiparous woman with no previous uterine surgery. The patient presented with acute abdomen at 11 weeks of gestation. Preoperative diagnosis based on clinical and ultra-sonographic findings was ruptured ectopic pregnancy. However, emergency laparotomy showed uterine rupture with extrusion of a dead fetus within intact amniotic sac in the abdomen. The defect was repaired in layers and the patient was discharged in a good condition after five days of hospital stay. Multiparity is a risk factor for spontaneous uterine rupture even in the first trimester. It should be kept in mind in any pregnant multiparous woman presenting with acute abdomen and shock. The absence of vaginal spotting and lack of history of uterine surgery give a false sense of security
Undiagnosed asymptomatic second trimester broad ligament ectopic pregnancy: a case report and mini-review
Get PDFPregnancy in the broad ligament is a retro-peritoneal abdominal pregnancy. It is a rare form in which the gestational tissue gets implanted between the layers of the broad ligament. Due to its rarity, the diagnosis is infrequently established before surgical intervention. A twenty-five year old nulliparous woman presented for routine antenatal care in the second trimester (±17 weeks). Routine ultrasound revealed an empty uterus with a large pelviabdominal mass. This picture suggested and undiagnosed extra-uterine pregnancy. A right broad ligament ectopic pregnancy was diagnosed at exploratory laparotomy, excision of pregnancy and right salpingectomy was performed. Postoperative course was uneventful and serum hCG was undetectable at the fourth week after surgery. Information about this rare form of ectopic pregnancy is observational and mainly comes from reported cases. A high index of suspicion is needed for early diagnosis and intervention
Factors affecting the occurrence of postpartum depression among puerperal women in Sohag city, Egypt
Get PDFAim: Postpartum Depression (PPD) is one of the most common complications of the postpartum period. In Egypt, previous studies have reported that the prevalence of PPD ranged from 20-50% depending on location in Lower and Upper Egypt. This study aimed to evaluate the co-factors affecting the occurrence of PPD amongst puerperal women in Sohag city, Egypt.Methods: The study was carried out at Sohag University Hospital from June 2015 to May 2016. All women within 6 weeks after birth who gave their consent were included. A pretested questionnaire including demographic, psychosocial, maternal and infant variables as well as the Edinburgh Postnatal Depression Scale (EPDS) was completed. A woman with an EPDS score ≥13 was considered to have PPD, while a score < 12 ruled out PPD.Results: We recruited 658 women, among whom 47 had an EPDS score ≥13, giving a prevalence of 7.14% of PPD. Women who delivered female babies or those who had a medical illness in their babies were significantly more likely to suffer from PPD.Conclusion: The prevalence of PPD in our setting was 7.14% which reflected the lowest prevalence among regions in Egypt. This could be due to differences of regional culture, families’ ties or other co-factors and needs further verification
A late-onset hematoma developed after sexual intercourse following sacrospinous hysteropexy and mid-urethral sling surgery: case report
Get PDFIntroduction: Sacrospinous hysteropexy is a minimally invasive surgical procedure option for apical prolapse repair. Despite a significant number of postoperative hemorrhage and hematoma cases reported in the literature, life-threatening hemorrhage as a complication after sacrospinous hysteropexy is rare. In this case, in addition to sacrospinous hysteropexy, midurethral sling surgery was performed via the needleless technique for stress urinary incontinence. The case presented here is of a hematoma that developed following sexual intercourse on the 10th postoperative day after sacrospinous hysteropexy and its successful management and treatment without re-operation. A review of the literature did not reveal any cases similar to the present one.Method: Both sacrospinous hysteropexy using the Surelift® Contasure Prolapse System and midurethral sling surgeries were performed without any intraoperative complications.Case: A 40-year-old, female patient who had undergone both sacrospinous hysteropexy and midurethral sling surgery presented with pain following sexual intercourse on the 10th postoperative day. A hematoma of 4 cm was palpated at vaginal examination on the right posterolateral site and confirmed with computed tomography (CT) and magnetic resonance imaging (MRI). A vaginal tamponade was put in place and removed after 2 days follow-up in the hospital. After two weeks, contrast MRI revealed a hematoma smaller in size and after one month the hematoma was not observed.Discussion: Vascularity of the sacrospinous ligament (SSL) space includes an abundance of collateral blood vessels and significant anatomical variations can result from anastomosis. Finding and repairing injured vessels during SSL and pararectal area surgeries transvaginally or via laparotomy is difficult even for the experienced surgeon. Although sacrospinous hysteropexy is a minimally invasive transvaginal procedure, adverse effects may result due to the physical trauma of sexual intercourse so the patient should be warned to avoid sexual intercourse during the postoperative recovery period. If concurrent procedures have been performed along with sacrospinous hysteropexy, finding the source of the complication is essential for management and treatment.Conclusion: Knowledge of treatment options and pelvic vascular anatomy is fundamental for the diagnosis and management of complications. Although the literature is lacking in relevant data and case studies, the example of this case indicates that having sexual intercourse can result in postoperative development of hematoma in the SSL area, and that the patient should be warned to avoid sexual intercourse during the 6-week postoperative period. Vaginal packing should be the first treatment approach for management of intraoperative and postoperative hematoma and hemorrhage
Experimental pain sensitivity in women with vestibulodynia: a pilot study
Get PDFObjective: Investigate pain sensitivity in women with vestibulodynia using two experimental pain assessments outside the vulvar region: intramuscular infusion of an acidic phosphate buffer and pressure pain thresholds (PPTs) of the lower limb.Methods: Three women with a history of vestibulodynia (all 24 years old) participated after providing written informed consent. PPTs of the lower limb were assessed using a hand-held Somedic digital algometer (30 kilopascal (kPa)/sec) at baseline (pre-infusion) and during the intramuscular infusion. The acidic phosphate buffer (pH 5.2) was infused into the anterior tibialis muscle at a rate of 40 ml/hr for 15 min (10 ml total). Peak local (infusion site) and referred (ankle) pain ratings were assessed verbally, as well as vulvar pain at the time of the infusion (0 – 10 Borg Scale).Results: Peak local pain was higher in two of the three subjects (2.5, 4.0, 9.5) than the average pain ratings in 34 healthy age-matched (21 – 27 years old) women from our laboratory, mean 3.0/10 (standard deviation (SD) 2.2; range 0.5 to 10). Peak referred pain was also higher in the same two subjects (0, 4.25, and 7.5) than the average of the controls (mean 1.5; SD 1.8; range 0 – 9.0). Similarly, vulvar pain patients all exhibited greater mechanical pain sensitivity (lower PPT values) than the average of the healthy controls (mean [SD] 246.3 [101.7] kPa in patients vs. 431.3 [109.33] in controls).Conclusion: Preliminary data suggests women with vestibulodynia may exhibit greater generalized pain sensitivity to noxious stimuli than the general population of women
Management of vaginal wall perforation during a second trimester dilation and evacuation
Get PDFBackground: We report an unusual case involving vaginal perforation associated with second trimester dilation and evacuation. Review of the literature fails to identify additional reports.Case: A 22 year G3P1011 female at 16 weeks gestation referred for evaluation following incomplete dilation and evacuation was found to have vaginal perforation, and communication with the peritoneal cavity on pelvic examination. Examination under anesthesia and laparoscopy confirmed multiple vaginal perforations with intraperitoneal defects and hematomas but no viscus involvement. Cervical dilation was accomplished with osmotic dilators placed under ultrasound guidance during exam under anesthesia, with evacuation completed approximately 16 hours later without further complication.Conclusion: This is the first case of vaginal perforation at time of dilation and evacuation reported in the literature. Laparoscopy should be performed to evaluate for intraabdominal injury to bowel, bladder and/or blood vessels. Use of osmotic dilators during the second trimester could potentially decrease the risk of vaginal perforation during the dilation portion of the procedure
Sexual preventative health in US sexual minority women: a review
Get PDFDespite growing interest and research in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health topics over the last 20 years, relatively little is known about sexual minority women. This review seeks to explore sexual practices, use of preventative measures including barrier methods during sexual activity, sexually transmitted infection rates, and use of screening healthcare services by sexual minority women. Additionally, the role healthcare providers can take in filling this knowledge gap and providing appropriate services is reviewed
The effect of regular daily walking on adverse pregnancy outcomes among overweight primigravidas: a prospective cohort study
Get PDFObjective: The study aims to evaluate the effect of regular daily walking on the occurrence of adverse pregnancy outcomes among overweight primigravidas.Materials and Methods: A prospective cohort study conducted at Aswan University Hospital from March 2015 to December 2016. The study included 360 overweight primigravidas, with singleton pregnancies, who were divided into two groups: Group I (control group) and Group II (study group) under supervised regular walking 5 times per week for 30 minutes, starting from 10-12 weeks of gestational age to 38-39 weeks of gestational age. The primary outcome of the study was the rate of gestational weight gain in participants in both groups. Secondary outcomes included the rate of gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm labor ( 4 kg), excessive maternal weight gain (>11.5 kg), and the rate of cesarean delivery.Results: There were no significant differences between groups with regard to the basic criteria. The exercise program decreased the incidence of preeclampsia (OR=0.120; 95% CI=0.015-0.970; p=0.037), postdate (OR=0.274; 95% CI= 0.099-0.759); p=0.008), excessive weight gain (OR=0.220; 95% CI=0.114-0.424), p=0.000), and cesarean delivery (OR=0.519; 95% CI=0.316-0.841, p=0.007).Conclusion: Regular maternal walking throughout the pregnancy may be a preventive tool for preeclampsia, postdate pregnancy, excessive weight gain and may decrease the incidence of cesarean delivery in primigravidas
Spontaneous triplet pregnancy with twin fetuses papyraeci: a rare case report and review of the literature
Get PDFA fetal death in a multiple pregnancy with one or more normally surviving fetus is unusual. Fetus papyraceous (FP) is a rare obstetric complication in multiple gestations. It is defined as retention of a mummified parchment like remains of a dead fetus in multiple pregnancy associated with a viable twin. It is important to reassure the patient of the normal outcome expected in most of the cases. Herein, we report a rare case of twin FP in a spontaneous triplet pregnancy with a literature review of maternal and neonatal outcomes and management of similar cases
A rare fetal umbilical cord complication: 37 week antenatal loss
Get PDFIntroduction: Investigation of antenatal fetal loss case due to the umbilical cord wrapping 3 times around the neck of a 37-week fetus and being truly knotted in 2 places in light of the literature.Case: A 35-year old G:4 P:3 patient applied with the complaint of no movement of the baby for 3 days. Ultrasonography observed fetal biometric measurements in accordance with 37 weeks gestation, 3210 gr weight with normal amount of amniotic fluid. Doppler USG observed an in utero mort fetus with 3 loops of nuchal cord. The placenta was observed on the anterior wall. Examination one week previously did not identify cord around the fetal neck, and biophysical profile was evaluated as 10 points. During cesarean section the cord was found to be fully wrapped around the neck of the fetus 3 times and true knots were found at 2 places in the cord. The total length of the umbilical cord was 125 cm and a wide and deep mark was left on the fetus’ neck.Discussion: Observed in 1 of 3 pregnancies and generally benign, nuchal cord is a complication that rarely causes antenatal loss