Ovarian torsion in a Heterotopic pregnancy: a case report

Background and Aim: Ovarian torsion is one of the rare causes of emergency surgeries during pregnancy. Heterotopic pregnancy is a rare type of pregnancy characterized by embryo implantation in two different locations. occurence of these two complications at the same time is a very rare condition. In this study, we present a rare case of heterotopic pregnancy accompanied by ovarian torsion

Patient presentation: A 33-year-old woman with fourth pregnancy presented with abdominal pain and spotting. Based on the last menstrual period, the gestational age was estimated as 7 weeks and 4 days. Ultrasound results revealed a heterotopic pregnancy with a live embryo in the uterus, a live embryo in the fallopian tube, and abundant fluid in the abdomen. Because of the patient's unstable vital signs, she was operated and we detected a ruptured right tubal pregnancy with a 5 cm ovarian cyst on the same side and two-folded adnexal torsion. Resolution of the torsion, right salpingectomy and removal of the ovarian cyst were performed. Two days after the operation, the intrauterine embryo had no sign of heart activity; therefore, two doses of misoprostol were prescribed for the patient and curettage was performed. The patient was discharged on the next day with a good general condition

Conclusion: The simultaneous occurance of heterotopic pregnancy and ovarian torsion is a rare condition. In these cases, early diagnosis will help to preserve the ovaries and future fertility and also at the same time, maintain the intrauterine pregnancy

Spontaneous unruptured bilateral tubal pregnancy: a case report

Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality

review of the literature on the association between vitamin D status and the risk of preeclampsia

Complications related to pregnancy and childbirth are the leading causes of disability and death among women of reproductive age in developing countries, constituting at least 18% of the global burden of disease in this age-group. Preeclampsia is a serious, pregnancy-specific disorder that affects up to 8% of pregnant women. Preeclampsia may lead to maternal and offspring mortality and it increases the risk of premature birth and fetal growth restriction. Vitamin D is a potent immunomodulatory agent. There is an evidence pointing toward an association between the vitamin D status and preeclampsia risk. The purpose of the present study is to review the available literature investigating the role of serum levels of vitamin D in preeclampsia. The study findings further highlight the possibility that vitamin D deficiency is a strong, independent risk factor for preeclampsia and vitamin D supplementation may be a simple step to reduce the risk of adverse pregnancy outcomes providing lifelong benefits both to the mother and her developing child

randomized clinical trial on comparing the cycle characteristics of two different initiation days of letrozole treatment in clomiphene citrate resistant PCOS patients in IUI cycles

There are still many questions about the ideal protocol for letrozole [LTZ] as the commonest aromatase inhibitor [AI] used in ovulation induction. The aim of this study is to compare the ultrasonographic and hormonal characteristics of two different initiation times of LTZ in clomiphene citrate [CC] failure patients and to study androgen dynamics during the cycle. This randomized clinical trial was done from March to November 2010 at the Mashhad IVF Center, a university based IVF center. Seventy infertile polycystic ovarian syndrome [PCOS] patients who were refractory to at least 3 CC treatment cycles were randomly divided into two groups. Group A [n=35] receiving 5 mg LTZ on cycle days 3-7 [CD3], and group B [n=35] receiving the same amount on cycle days 5-9 [CD5]. Hormonal profile and ultrasonographic scanning were done on cycle day 3 and three days after completion of LTZ treatment [cycle day 10 or 12]. Afterward, 5,000-10,000 IU human chorionic gonadotropin [hCG] was injected if at least one follicle >/= 18 mm was seen in ultrasonographic scanning. Intrauterine insemination [IUI] has been done 36-40 hours later. The cycle characteristics, the ovulation and pregnancy rate were compared between two groups. The statistical analysis was done using Fisher's exact test, t test, logistic regression, and Mann-Whitney U test. There were no significant differences between two groups considering patient characteristics. The ovulation rate [48.6 vs. 32.4% in group A and B, respectively], the endometrial thickness, the number of mature follicles, and length of follicular phase were not significantly different between the two groups. LTZ is an effective treatment in CC failure PCOS patients. There are no significant differences regarding ovulation and pregnancy rates between two different protocols of LTZ starting on days 3 and 5 of menstrual cycle

[ comparison of serum level of selenium in women with preeclampsia and normal pregnant women]

Preeclampsia is a common complication of pregnancy with the prevalence of 2-7% which increases fetal-maternal mortality. Despite many researches in this field, the etiology of preeclampsia is still unknown and different theories are suggested. Recently the role of deficiency of trace elements is emphasized. Selenium is one of the trace elements which as an antioxidant play an important role in protection of endothelial cells of blood vessel with counterbalancing of oxygen free radicals. The aim of this study was to compare serum level of selenium in women with preeclampsia and normal pregnant women. This cohort study was performed on 35 women with severe preeclampsia as case group and 30 normal pregnant women as control group in Emam Reza Hospital during 2007-2009. Two groups were matched in terms of maternal age, gestational age, and BMI. Serum level of selenium was measured by spectrophotometer with method of atomic absorption. Data was analyzed with SPSS software version 18 and T-student test. P

[Isolated torsion of fallopian tube in a 12-year-old premenarcheal girl; a case report]

Isolated torsion of the fallopian tubes is a rare condition. Although, it can occur at all ages, it is mostly observed during reproductive ages. Early diagnosis and urgent management of the condition is crucial to preserving the tube. A 12-year-old premenarcheal girl presented with a sudden, severe right-sided lower abdominal pain. The pain had begun 24 hours earlier. The girl had nausea and vomiting. Abdominal examination revealed tenderness in the right lower quadrant with no palpable mass. Pelvic ultrasound showed a right adnexal mass measuring 65X35 mm and containing dense and cystic tissues with simple appearance. At laparotomy, an isolated twist of the right fallopian tube with necrosis was found, leaving no choice other than salpingectomy. Menstruation began one week following surgery. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of acute abdominopelvic pain in premenarcheal adolescent girls. Prompt surgical intervention is necessary to preserve the fallopian tube