ABSTRACT
This case report outlines the clinical course of a young woman who presented as haemodynamically unstable due to uterine perforation. She had undergone suction dilation and curettage three weeks prior and received a diagnosis of complete molar pregnancy. During her most recent acute presentation, an emergency laparotomy revealed a full-thickness fundal uterine rupture in a region of newly identified arteriovenous malformation. Haemostasis was achieved with the primary repair of the perforation. She was subsequently diagnosed with gestational trophoblastic neoplasm (GTN), a condition characterised by abnormal proliferation of trophoblastic tissue. She received three courses of methotrexate followed by a two-month course of dactinomycin. At one-year surveillance, she had made a complete recovery.
ABSTRACT
Placenta accreta spectrum (PAS) refers to abnormal trophoblast invasion into the myometrium. The global prevalence of PAS is rising as the number of caesarean deliveries increases. PAS is associated with higher rates of maternal morbidity and mortality. Although mainstream management has been caesarean hysterectomy, uterine conservative techniques are also used, such as the extirpative technique, leaving the placenta in situ, the triple-P procedure, embolisation, uterine balloon tamponade and methotrexate medication. This case report describes an innovative yet simple and safe technique, namely partial myometrial resection of the focal adherent placenta. Unlike hysterectomy, this technique can preserve fertility. It was performed on an undiagnosed focal placental accreta during a caesarean section with a routine caesarean section theatre set-up and did not require obstetric follow-up after the patient was discharged. This procedure can be considered an option for managing focal placenta accreta.
ABSTRACT
Endometrial cancer is the most common type of gynaecological cancer in high-income countries. Abnormal uterine bleeding (AUB) is the most common symptom of endometrial cancer; however, patients can often present in an atypical fashion. This case is an example of an atypical presentation of endometrial cancer, with angina secondary to severe iron deficiency anemia, and a rare example of pancytopenia secondary to iron deficiency. A 46-year-old nulliparous woman with no past medical history presented to the emergency department with acute chest pain. All her vitals were normal. The ECG showed T-wave inversion with a negative serum troponin. She had obvious pallor but appeared well. She had a critical hemoglobin of 1.9 g/dL and severe iron deficiency with a plasma iron level of <2 µg/L. In the 6 months leading up to her presentation, she had heavy and prolonged menstruation of up to 10 days. She received a total of 6 units of packed red blood cells and an iron infusion. Her chest pain resolved, and her pancytopenia corrected following replenishment of iron stores. She underwent a laparoscopic total hysterectomy, bilateral salpingo-oophorectomy for stage 1b, grade 2 endometroid adenocarcinoma. This is one of the lowest hemoglobin levels recorded in a hemodynamically stable patient with endometrial cancer, and the only case report of iron deficiency induced pancytopenia secondary to abnormal uterine bleeding. This case is a reminder that female patients with angina should have their hemoglobin checked, and patients with anemia should have a thorough review of their gynaecological history.
ABSTRACT
Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder with unknown aetiology. Given the incidence of GBS is between 1.2 and 1.9 cases per 100,000 people annually [1], it is extremely rare in pregnancy. We report a case with a challenging diagnosis of pre-eclampsia (PET) in a 34-year-old diabetic primigravida who was diagnosed with GBS at 30 weeks of gestation. At her initial presentation, she complained of progressive weakness of her limbs and facial muscles. This was associated with difficulty swallowing. The diagnosis of GBS was made based on electromyography (EMG) and clinical findings. She was managed conservatively with supportive management and was delivered by lower segment caesarean section at 34 weeks of gestation due to rapidly deteriorating liver function tests (LFTs) in the likely setting of PET.
