Proceedings in Obstetrics and Gynecology
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Development and implementation of guided, self-directed learning modules in graduate medical education
Get PDFThis study sought to investigate the use of interactive iBook learning modules as a guided, self-directed learning resource for trainees within an obstetrics and gynecology residency program. The implementation of an iBook learning module as a supplement to lecture was studied in comparison to teaching sessions with lecture only
Dexamethasone for the prevention of neonatal respiratory morbidity before elective cesarean section at term
Get PDFBackground: Respiratory distress syndrome (RDS) is the principal cause of early neonatal morbidity and mortality.Objective: The current study aims to evaluate the effect of dexamethasone administration 48 hours before elective cesarean section (CS) at term on neonatal respiratory morbidity.Methods: The current study was a case-control study conducted between June 2015 and November 2015. Women who attended the labor ward in Sohag University Hospital, Egypt, after 37 weeks of gestation for elective CS were approached for participation. The patients received 2 intramuscular doses of 12 mg dexamethasone 12 hours apart in the 48 hours before CS (N=246). The control group included women who did not receive dexamethasone before CS during the same period of the study (N=275).Results: No significant differences were detected between the study and control groups with regard to age, parity or gestational age at delivery. There was a significantly higher number of neonates with RDS and transient tachypnea in the control group compared to the study group (p=0.001). The rate of neonatal admission to the neonatal care unit (NICU) was significantly lower in the study group (p=0.001).Conclusions: Prophylactic dexamethasone administration before elective CS at term significantly reduces neonatal respiratory morbidity and admission to NICU
Huge immature teratoma of the ovary with gliomatosis peritonei in childhood
Get PDFGerm cell tumors account for less than 3% of all ovarian cancers. These tumors generally appear in childhood or in those under 30 years of age. Immature ovarian teratoma is the third most frequent germ cell tumor after dysgerminoma and endodermal sinus tumors. These tumors should be distinguished from mature teratomas. Discrimination of malignant and benign tumors depends on the presence of the neuroectodermal components, made up of neural and glial cells. Gliomatosis peritonei is the intraabdominal and particularly peritoneal and omental distribution of the neuroectodermal components, observed very rarely with immature teratoma. Mature teratoma, on the other hand, is even rarer. This report aims to discuss a case of immature teratoma completely filling the abdomen and concomitant omental distribution related gliomatosis peritonei in a 7-year-old child
Ectopic ureter in an adolescent female with vaginal discharge: a case report
Get PDFBackground: An ectopic ureter inserts at a site other than the bladder neck, including urethra, vagina, and vestibule in women. These are typically diagnosed in childhood with the onset of continuous urinary incontinence after toilet training. However, they can be difficult to diagnose and rarely present in adults as urinary incontinence refractory to treatment.Case: A 17-year-old female presented with a five-year history of profuse, watery vaginal discharge and recurrent urinary tract infections, in the setting of normal voiding patterns. Discharge was initially categorized as physiologic. After months without improvement, CT urogram revealed a duplex left sided ureteral system that drained the upper moiety of the left kidney and inserted into the vagina. She was treated with surgical ureteral reimplantation.Conclusion: Ectopic ureters can commonly implant in the vagina and can rarely present with profuse, watery vaginal discharge in the setting of normal voiding patterns. Physicians must have a high index of suspicion for ectopic ureters in the patient with vaginal discharge refractory to treatment
A case of hysteria: anti-N-methyl-D-aspartate receptor encephalitis resulting from a mature ovarian teratoma
Get PDFAnti-N-methyl-D-aspartate receptor encephalitis in young healthy women while rare may be the result of an ovarian teratoma that produces anti-NMDA receptor antibodies. Symptoms from this encephalitis can be severe enough to result in hypoventilation, autonomic instability, and coma. Although treatable with tumor removal via oophorectomy and immunosuppression, median time to diagnosis is 8 weeks, which may lead to the onset of severe symptoms.The case presented highlights the severity of symptoms including rhabdomyolysis and respiratory distress in a female who had a previous history of functional somatic syndromes, which possibly resulted in a delayed diagnosis. This case demonstrates the importance of a thorough evaluation for causes of new onset neurological symptoms when the patient’s clinical status continues to deteriorate. This includes an evaluation for anti-N-methyl-D-aspartate receptor encephalitis. Following salpingo-oophorectomy, IVIG/methylprednisolone, and rituximab/cyclophosphamide treatment, this patient demonstrated improvement although she continues to require rehabilitation therapy, maintenance Keppra and low-dose Prednisone
Treatment of Hailey-Hailey Disease of the vulva: a retrospective case series
Get PDFBackground: Hailey-Hailey disease (familial benign chronic pemphigus) of the vulva is a rare autosomal dominant dermatosis characterized by malformation of desmosomes and bullae, particularly in intertriginous areas.Cases: We reviewed the cases of 5 women followed at a single academic institution over a period of 17 years. Of the 5 patients, 4 carried a diagnosis of Hailey-Hailey at the time of presentation to our institution, and one was diagnosed on biopsy. 3 were members of a family group. Initial treatment of choice was a topical steroid (betamethasone in 3, fluocinonide and hydrocortisone in 1 each), vulvar skin guidelines, tepid soaks, a skin protectant (A&D; ointment, zinc oxide) and additional treatment (crotamiton in 1, clotrimazole in 2, and Polysporin in 1). Final treatment regimens in 3 patients followed long term were zinc oxide/A&D; and betamethasone-clotrimazole ointment in all 3, nystatin-triamcinolone ointment in 2, oral minocycline in 1, oral fluconazole prn in 1, and topical tacrolimus in 1. Treatment courses were complicated by superimposed fungal infections, superimposed bacterial infections, and lichen simplex chronicus flares. These were treated with antifungals, topical clindamycin and metronidazole, and steroid-antifungal bursts, respectively. Three of five patients followed long term achieved successful remission with occasional flares.Discussion: Treatment of Hailey-Hailey disease must be tailored to the individual patient. Adherence to vulvar skin care guidelines is critical for the remission of Hailey-Hailey disease. Treatment is long-term and may be complicated by episodes of fungal and bacterial superinfection and lichen simplex chronicus
Local contraceptive practice in Sub-Saharan Africa
Get PDFAlthough modern contraceptive options are becoming more widely available, even in the developing world, women still use traditional contraceptive methods. Other reports of the use of non-medical devices for contraception and abortion are available. With this report, we discuss a patient seeking treatment for the removal of a traditional contraceptive intrauterine device
Does preparation for childbirth training reduce the cesarean rate?
Get PDFPurpose: This study was conducted as experimental and prospective to determine the effect of birth preparation training on the birth route preparations of pregnant individuals.Methods: The study was conducted in three state hospitals which operate under Kocaeli State Hospitals Community. The study group included 110 pregnant individuals who attended the hospitals’ birth preparation training classes between 1 January – 30 June 2015 and the control group included 90 pregnant individuals from Kocaeli Maternity Hospital. The chi-squared test was used to measure the differences between groups in classified variables, and the t-test was used for parametric variables. P <0.05 was considered to be significantA survey form was used to identify individual demographic information, obstetric stories, and preferred birth route in order to collect relevant data.Findings: The survey reveals that 67% of the pregnant individuals prefer vaginal birth while 33% prefer cesarean birth. In choosing the birth route, 60% of the pregnant individuals make their own decisions, while 28.2% make the decision together with their partner, and 11.8% report the decision being made by their doctor. It is observed that—after attending the birth training—all of the individuals preferred vaginal birth. For the pregnant individuals, their birth route choices before and after the birth preparation training had been observed as highly statistically significant ( p<0, 005). However, when the choices of the pregnant individuals who participated in birth preparation training is compared to the control group’s choices, no statistical significance was found. Rates of cesarean were alike for both groups.Conclusions and Suggestions: In this study, for the individuals who participate in birth preparation training, the choice of the birth route is found to be affected by age, literacy, and former birth route experienced. However, no significant evidence was found regarding reducing the choice of cesarean. A pregnant individual’s birth route choice will be more healthy as she becomes qualified for, and receives sufficient treatment between the preconception stage to after birth, alternative birth routes, and consultancy for overcoming birth pain and relaxation methods
Renal failure secondary to uterine prolapse
Get PDFPelvic organ prolapse is a common problem in female population, and it may cause minor urological problems such as recurrent urinary system infection and voiding difficulty, as well as serious clinical problems such as advanced bilateral hydronephrosis and acute renal failure. Bilateral hydroureteronephrosis and acute renal failure secondary to pelvic organ prolapse are rarely seen. In our paper, we present the case of a 69 year old woman that developed bilateral hydroureteronephrosis, anuria and acute renal failure secondary to pelvic organ prolapse with a review of the literature
Abdominal resection of a cornual heterotopic pregnancy using intraoperative ultrasound: case report
Get PDFBackground: Heterotopic pregnancy is a rare complication of in vitro fertilization (IVF) and diagnosis and treatment can be challenging, particularly with unusual ectopic sites and desire to maintain the intrauterine pregnancy.Case: We review the case of a 29-year-old female who presented with a cornual heterotopic pregnancy following IVF treated with exploratory laparotomy and ultrasound guided resection of the cornual pregnancy, resulting in an ongoing viable singleton intrauterine pregnancy.Conclusion: The management of cornual heterotopic pregnancies is limited by lack of data regarding ideal treatment although several surgical and non-surgical strategies have been described. This case uses abdominal resection of cornual ectopic pregnancy using intraoperative ultrasound as an optimal approach to remove the ectopic pregnancy without disrupting the viable intrauterine pregnancy, which was in close proximity of the cornual ectopic