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Case Reports in Obstetrics and Gynecology

Jessian L Munoz, Amanda Kalan, Katherine Singh
Cervical ectopic pregnancies are a rare occurrence in the United States. Here we present the interdisciplinary and conservative management approach to a cervical ectopic at an advanced gestational age. In addition, we review the surgical management of hemorrhage from cervical ectopic pregnancies, which is often catastrophic and life-threatening.
2018: Case Reports in Obstetrics and Gynecology
Kristen Stearns, Antoun Al Khabbaz
Congenital Mullerian duct anomalies are conditions involving the female genital tract. Cases of complex Mullerian duct anomalies with involvement of the renal system are rare. Occasionally, these cases can be associated with obstetrical complications. Cervical prolapse infrequently complicates pregnancy, and an association between uterine malformations and cervical prolapse has not been cited in the literature. We describe the case of a primigravid patient at 38 weeks of gestation noted to have cervical prolapse during evaluation for preeclampsia and labor induction...
2018: Case Reports in Obstetrics and Gynecology
Kohei Hamada, Yoshitsugu Chigusa, Eiji Kondoh, Yusuke Ueda, Shunsuke Kawahara, Haruta Mogami, Akihito Horie, Tsukasa Baba, Masaki Mandai
Pulmonary edema caused by severe preeclampsia can be an indication for pregnancy termination. We aimed to investigate whether noninvasive positive-pressure ventilation (NPPV) was useful for preeclampsia-induced pulmonary edema. Three cases of preeclampsia-induced pulmonary edema managed with NPPV in our institute were reviewed retrospectively. A literature review was conducted regarding NPPV usage during pregnancy. NPPV was initiated at 30, 20, and 24 weeks of gestation in the 3 cases. In all cases, NPPV slowed the progression of pulmonary edema and succeeded in delaying pregnancy termination by 17 days on average...
2018: Case Reports in Obstetrics and Gynecology
Clare E Thiele
Background: Ruptured spinal arteriovenous malformation (AVM) is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal AVMs during pregnancy in the literature. Case: A 32-year-old woman presented at 37 weeks gestation with back pain and rapidly progressive lower limb neurological symptoms. MRI showed a previously undiagnosed spinal AVM at T8. A healthy girl was delivered by caesarean under general anaesthesia to facilitate further investigation...
2018: Case Reports in Obstetrics and Gynecology
Melese Gezahegn Tesemma, Mikiyas Tadesse Yadeta
The incidence of triplet is raising several hundred percent due to wide availability of fertility therapies. It is associated with different perinatal and maternal complications. The average duration of gestation and birth weight for triplet are 32.5 weeks and 1735 grams (total weight of triplet set being about 5.2kg), respectively. However, it is not uncommon to find the rarest situations in obstetrics. Here we present a case of triplet set born from gravida 5 para 4 mother at full term (GA of 39 weeks and 3 days), dated from reliable last normal menstrual period (LNMP)...
2018: Case Reports in Obstetrics and Gynecology
Amanda Lino de Faria, Cinthia Moreno Garcia, Gabriela de Andrade Rodrigues, Lais Helena Dumbra Toloni Dos Santos, Gabriela B K Uyeda, Simone Elias, Marair G F Sartori, Afonso Celso Pinto Nazário, Gil Facina
The case reports a 49-year-old patient, drug-addicted, undernourished, and homeless, who was referred to our service presenting a diagnostic of breast sarcoma and ulcerating tumor which extended from the right breast to the right flank. She underwent hygienic mastectomy and, as it developed, she presented a range of complications, culminating in the recurrence of the tumor and pulmonary metastasis few months after her initial treatment. There is relevance in our study not only because it reports the development of the breast sarcoma, rare neoplasm, and its aggressiveness with fast recurrence, but also because it exposes the impact of biopsychosocial behavior of this patient in her clinical outcome...
2018: Case Reports in Obstetrics and Gynecology
Chisato Kodera, Takashi Ohba, Tomomi Hashimoto, Munekage Yamaguchi, Hidetaka Yoshimatsu, Hidetaka Katabuchi
Congenital diaphragmatic hernia (CDH), a herniation of the abdominal contents through a defect or hypoplasia of the diaphragm, is a relatively common, severe congenital anomaly. Here we present the first case of two siblings with possibly isolated sac-type CDH and with a suspected genetic etiology. Although sibling recurrence of isolated CDH is rare, the incidence is higher than in the general population. Additionally, the second child had a more severe respiratory disorder than the first child. It is to be noted that siblings of children having isolated CDH are at risk for CDH, and prenatal evaluation should be considered individually...
2018: Case Reports in Obstetrics and Gynecology
Hidetake Kamei, Yu Wakimoto, Yumi Murakami, Maya Omote, Kayoko Harada, Atsushi Fukui, Hiroyuki Tanaka, Hideaki Sawai, Hiroaki Shibahara
Many patients, after artificial valve replacement surgery, receive warfarin anticoagulant therapy. However, it has been reported that warfarin administration during pregnancy can cause fetal teratogenicity. With reference to this case, we will discuss how warfarin administration in mid-pregnancy caused severe cerebral hemorrhage in the newborn child. The 36-year-old patient in this case underwent aortic valve replacement surgery when she was 11 years old; this requires the continued use of warfarin after surgery...
2018: Case Reports in Obstetrics and Gynecology
Anna Walch, Madeline Duke, Travis Auty, Audris Wong
We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks' gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission...
2018: Case Reports in Obstetrics and Gynecology
Lucia Pasquini, Elena Rita Magro-Malosso, Adalgisa Cordisco, Michele Trotta, Mariarosaria Di Tommaso
We report a case of early latent syphilis (reactive serologic tests without clinical evidence of disease within 24 months from the onset of the infection) in pregnancy. Despite an appropriate maternal treatment with benzathine penicillin G, sonographic signs of fetal syphilis were detected. Follow-up scans, in addiction to serial serological tests, have allowed the identification of fetal infection and therefore the failure of antibiotic therapy. We highlight the importance of ultrasound in suspecting fetal infection and in evaluation of the fetal response after penicillin treatment...
2018: Case Reports in Obstetrics and Gynecology
Rati Chadha
Background: Klippel-Trenaunay-Weber syndrome is a rare neurocutaneous syndrome with vascular involvement. Given the rarity of the syndrome, its management in pregnancy is based on the outcome of a few case reports and expert opinion. Case Summary: The management of a complicated case with its antepartum, intrapartum, and postpartum concerns has been addressed in this review. Conclusions: Prenatal consults with anesthesia, general surgery, intervention radiology, and internal medicine should be arranged, prior to delivery in anticipation of all the possible complications...
2018: Case Reports in Obstetrics and Gynecology
Ali Alhousseini, Sunil Jaiman, Edgar Hernandez-Andrade, Salam Zeineddine, Faisal Qureshi, Suzanne M Jacques
Background: Thrombosis of one of the umbilical arteries can be associated with adverse pregnancy outcomes such as stillbirth and severe intrauterine growth restriction (IUGR). Case: A 21-year-old gravida 1 patient, with a history of 3-vessel cord at 20 weeks, presented at 29 weeks with a single umbilical artery. The estimated fetal weight measurements at 26 weeks, 29 weeks, and 31 weeks were at the 27th percentile, the 26th percentile, and less than the 5th percentile, respectively...
2018: Case Reports in Obstetrics and Gynecology
Chiara Di Tucci, Daniele Di Mascio, Michele Carlo Schiavi, Giorgia Perniola, Ludovico Muzii, Pierluigi Benedetti Panici
The incidence of adnexal masses increases exponentially with age and the most frequent causes in young women are physiologic cysts and pelvic abscesses with pelvic inflammatory disease (PID). Clinical examination can direct physicians to an appropriate management of adnexal mass, but the role of transvaginal ultrasound is crucial for diagnosis and treatment decision, even if it sometimes can be misleading, especially in young women. Ca 125, blood count, and CRP are useful to clarify suspected etiology of a pelvic mass, but specificity and positive predictive value are low because elevation of laboratory tests may occur in several benign conditions...
2018: Case Reports in Obstetrics and Gynecology
Fernando Augusto Rozário Garcia, Vanessa Pereira Gaigher, Rodrigo Neves Ferreira, Antônio Chambô Filho
Background: First described in 1945 by Morehead and Bowman, uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are rare tumors of the uterine body that tend to occur in menopausal women presenting with abnormal vaginal bleeding, abdominal pain, and increased uterine volume. UTROSCT are usually diagnosed from incidental histological findings following hysterectomy performed due to a suspected endometrial polyp or uterine fibroids. Objective: To report on a 46-year-old patient with abnormal vaginal bleeding...
2018: Case Reports in Obstetrics and Gynecology
Haruhisa Konishi, Iemasa Koh, Noriyuki Shiroma, Yukie Kidani, Satoshi Urabe, Norifumi Tanaka, Eiji Hirata, Koji Arihiro, Yoshiki Kudo
Intravenous leiomyomatosis (IVL) is a rare benign neoplasm. Herein, we describe two cases of IVL at different levels of progression. The tumor in Case 1 was extensive, invading the right atrium after a hysterectomy for a uterine myoma. The tumor temporarily responded to hormonal treatment; however, tumor regrowth occurred. In contrast, the tumor in Case 2 extended only to the pelvic veins and was revealed preoperatively. Hysterectomy and bilateral salpingo-oophorectomy were performed, resulting in the complete surgical resection of the tumor...
2018: Case Reports in Obstetrics and Gynecology
S Lahav-Baratz, I Blais, M Koifman, D Ishai, Z Wiener-Megnazi, G Peer, M Dirnfeld
We report a live birth from a heavily fragmented embryo which continued cleavage to a fully expanded blastocyst. A 32-year-old patient underwent 2 IVF cycles without achieving pregnancy. In the first cycle, 2 embryos with fragmentation were transferred; in the second, all embryos were fragmented and no embryo transfer was performed. In a third cycle, 12 oocytes were retrieved and 11 of them were fertilized. On day 2, all 11 embryos started to unwind to fragments. By careful annotation, using the time-lapse EmbryoScope, we observed that one embryo continued division as expected, discarding all fragments aside...
2018: Case Reports in Obstetrics and Gynecology
Sarah Eckhardt, Renee Rolston, Suzanne Palmer, Begum Ozel
Background: Angiomyofibroblastoma (AMFB) is a benign mesenchymal tumor most commonly found in the female genital tract of premenopausal women. Although rare, AMFB is an important consideration in the differential diagnosis of vulvar and vaginal masses, as it must be distinguished from aggressive angiomyxoma (AA), a locally recurrent, invasive, and damaging tumor with similar clinical and pathologic findings. Case: We describe a patient with a 4 cm vaginal AMFB and the relevant preoperative radiographic imaging findings...
2018: Case Reports in Obstetrics and Gynecology
Quinton Katler, Lindsey Pflugner, Anjali Martinez
Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β -hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy...
2018: Case Reports in Obstetrics and Gynecology
Shadi Rezai, Richard A Giovane, Heather Minton, Elise Bardawil, Yiming Zhang, Ninad M Patil, Cassandra E Henderson, Xiaoming Guan
Background: Heterotopic pregnancy occurs when two pregnancies occur simultaneously in the uterus and an ectopic location. Treatment includes removal of the ectopic pregnancy with preservation of the intrauterine pregnancy. Treatment is done laparoscopically with either a Laparoendoscopic Single-Site Surgery (LESS) or a multiport laparoscopic surgery. Case: We present a case of a first trimester heterotopic pregnancy in a 42-year-old gravida 5, para 0-1-3-1 female with previous history of left salpingectomy, who underwent laparoscopic right salpingectomy and lysis of adhesions (LOA) via Single-Incision Laparoscopic Surgery (SILS)...
2018: Case Reports in Obstetrics and Gynecology
Demetrio Larraín, Andrés Casanova, Iván Rojas
Ovarian torsion after hysterectomy is a rare event. The diagnosis of ovarian torsion is challenging because symptoms are nonspecific. We present a case of ovarian torsion 2 years after laparoscopic hysterectomy (LH). Furthermore, we performed a literature review about ovarian torsion after hysterectomy. This case shows that, in cases of acute onset pelvic pain in patients with history of hysterectomy, the adnexal torsion must be kept in mind in the differential diagnosis, especially in those women who had undergone LH...
2018: Case Reports in Obstetrics and Gynecology
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