Spontaneous pregnancy during ulipristal acetate treatment of giant uterine leiomyoma.

WHAT IS KNOWN AND OBJECTIVE: Ulipristal acetate, a progesterone receptor modulator, pharmacologically inhibits endometrial proliferation and thereby prevents pregnancy. It is primarily used as emergency contraception, but also for the treatment of fibroids in women of reproductive age. There have been no published cases of pregnancy, while on therapy with ulipristal acetate. CASE DESCRIPTION: In this article, we present a case report of spontaneous pregnancy during ulipristal acetate therapy. WHAT IS NEW AND CONCLUSION: To our knowledge, this is the first patient with spontaneous conception, while on ulipristal acetate treatment. There were no drug-related complications, and the pregnancy resulted in the delivery of a healthy baby.

Acute Abdomen in the 17th Week of Twin Pregnancy due to Ovarian Torsion - A Late Complication of IVF.

Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Conclusion: Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation.

Prenatal Diagnosis of a Fetal Epidural Hematoma.

A fetal epidural hematoma is a rare finding during the prenatal period, with different etiologies such as maternal trauma, infections, or maternal use of specific medications such as warfarin. Both ultrasonography and magnetic resonance imaging (MRI) have been used successfully to evaluate the fetal central nervous system. Although these methods are also useful in detecting and evaluating a fetal epidural hematoma, brain function of the neonate cannot be exactly predicted on the basis of the prenatal findings. According to the literature data to date, this is the first reported case of prenatally detected fetal epidural hematoma of unknown etiology with a good outcome.

[Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918].

This article presents a historical review of the performance of 23 cesarean sections at the King's Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

[MASSIVE RECTORRHAGIA MIMICKING POSSIBLE GENITAL HAEMORRHAGE].

A case is presented of a 76-year-old woman who was initially considered to have massive genital hemorrhage, but exclusion examination and treatment proved it to be massive rectorrhagia. The patient died due to irreversible hemorrhagic shock and rupture of rectal angiodysplasia was proved on autopsy.

Massive labia minor hypertrophy following vulvar edema and abscess in pregnancy--case report.

A rare case is presented of vulvar edema and abscess with subsequent labia minor hypertrophy in a 26-year-old woman, which developed during two consecutive pregnancies with normal maternal and neonatal outcome. After a first pregnancy, the patient was initially treated conservatively, followed by incision of the abscess. After the second pregnancy, surgical correction of the hypertrophic labia minor was performed. The possible causes, complications and therapeutic options are discussed.

Intraumbilical injection of uterotonics for retained placenta.

OBJECTIVE: To assess the effect of injecting an uterotonic agent in the umbilical vein during the third stage of labor in women with retained placentas. METHODS: In this prospective clinical study, 75 women with retained placentas received 20 mL of a 0.9% saline solution with either 20 IU of oxytocin (n=54), 0.5 mg of carboprost tromethamine (n=7), or 0.2 mg of methylergometrine (n=14) injected in the umbilical vein after clamping. The treatment success was determined by the clinical signs of placental ablation. RESULTS: There were no statistically significant differences among the 3 therapeutic groups regarding age, parity, risk factors, pregnancy duration, type of delivery (spontaneous, induced, or augmented), or possible early postpartum complications caused by the intraumbilical injection. The rates of therapeutic success were 76.9% in the oxytocin group, 85.7% in the synthetic prostaglandin group, and 64.2% in the methylergometrine group. CONCLUSION: The intraumbilical injection of uterotonics is a noninvasive, effective, and clinically safe method of shortening the third stage of labor in women with retained placentas.

Heterotopic trigeminal pregnancy in infertile women after ovulation stimulation and embolisation of a uterine myoma.

Heterotopic pregnancy is a simultaneous occurrence of intra-uterine pregnancy and ectopic pregnancy. The incidence of ectopic pregnancy has increased as a consequence of assisted reproduction and ovulation stimulation agents. In this report, we describe the case of a 34-year-old nulliparous woman who became pregnant after ovulation induction with clomiphene. According to her gynaecologic history, she had embolisation of a uterine myoma. The report presents a case of ectopic and twin intra-uterine pregnancy. After total laparoscopic salpingectomy, she had normal intra-uterine pregnancy.

Unsuccessful Acupuncture Conversion of Breech Presentation.

A case is presented of fetal oblique position with compound presentation, where acupuncture conversion of breech presentation failed due to the umbilical being wrapped three times around the fetus with a knot in the umbilical cord, so that delivery was terminated by cesarean section. Conversion of the fetal breech presentation was induced by manual acupuncture stimulation of the UB 67 acupoint with simultaneous CTG control in the 35th week of pregnancy. During the first acupuncture stimulation, CTG showed protracted uterine contraction with subsequent regular low amplitude contractions with intensified fetal activity and CTG curve reactivity. In the 39th week of gestation, the patient felt regular contractions verified by CTG records showing reactive curves. Obstetrical examination revealed a cervical dilatation of 4 cm, a compound presentation involving both legs and the umbilical cord, and oblique position. Therefore, a cesarean section according to a modified Misgav-Ladach method was performed and the patient gave birth to a healthy male neonate (3330 g, 49 cm, Apgar 10/10, pH 7.334). The obstetrician should warn the patient of the potential risks and complications associated with any method of breech presentation conversion.

Tuboovarian abscess mimicking intraligamentar uterine myoma and a intrauterine device: a case report.

A case study is presented of tubo-ovarian abscess (pathohystological-verified actinomycosis) in a 41-year-old woman with an intrauterine device (IUD), which on US was found to be imposed upon an intraligamentary degenerated myoma (pyomyoma). The patient was afebrile, with normal vital functions (diuresis, blood pressure and pulse). Exposure of the abdominal cavity by lower transverse laparotomy performed under general endotracheal anaesthesia revealed slight uterus enlargement with normal left adnexa, whereas right adnexa were not exposed due to the soft tumour in the region of the right ligamentum latum, which displaced the urinary bladder and uterus leftward. The peritoneum fold was incised and deprepared, revealing a tumorous formation imposed onto the myoma or onto the 'cold' tubo-ovarian abscess. Total hysterectomy was then performed. Left adnexa showed a normal finding. Hemalaun-eosin staining of the preparation of the tumour capsule and tumour content showed colonies of threads extending radially to the surrounding tissues (drusen), surrounded by pus corpuscles, polymorphonuclears and macrophages containing lipids (sulfur granules). The patient was free from disease relapse at 2 years after the procedure. Thus, total abdominal hysterectomy and salpingoophorectomy, along with antibiotic therapy, were the definite mode of treatment for pelvic actinomycosis.

Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to evaluate the antiemetic effect of acupuncture (AP) and acupressure (APr) of the Pc 6 acupoint in pregnant women with hyperemesis gravidarum (HG). METHODS: A prospective, placebo-controlled trial included 36 pregnant women with HG. Two methods of acupuncture were used: bilateral manual AP of the Pc 6 (Neiguan) acupoint (group 1, n = 10) and bilateral APr of the Pc 6 acupoint (group 2, n = 11); furthermore, superficial intracutaneous placebo AP (group 3, n = 8) and placebo APr (group 4, n = 7) was carried out. RESULTS: Anxiodepressive symptoms occurred in 9 pregnant women with HG from group 1, 8 women from group 2, 7 women from group 3, and 5 women from group 4 (p < 0.001). The average gestation age at the occurrence of HG symptoms and the beginning of treatment was 7 weeks in group 1 and 8 weeks in groups 2, 3, and 4. Four women from group 1 and 7 women from groups 2, 3, an 4 needed intravenous compensation of liquid and electrolytes. The antiemetic metoclopramide was given intravenously to 1 woman from group 1, 2 women from group 2, 6 women from group 3, and 4 women from group 4. Promethazine was given to 1 woman from group 2, 1 woman from group 3, and to 3 women from group 4. The efficiency of the HG treatment with AP of the point Pc 6 was 90%, with APr of the Pc 6 63.6%, with placebo AP 12.5%, and with placebo APr 0%. CONCLUSION: Acupuncture (p < 0.0001) and acupressure (p < 0.1) are effective, nonpharmacologic methods for the treatment of HG.

[Intact cervical pregnancy]. / Intakte zervikale Gravidität.

The authors describe a case of intact cervical pregnancy in a 24-year-old secundigravida. The patient was treated successfully with Methotrexate. Conservative treatment is the first choice in the therapy of uncomplicated cervical pregnancy. Conservative and operative therapeutic procedures are discussed.

Ruptured interstitial pregnancy Two case reports.

The authors described two cases of the ruptured unrecognized interstitial pregnancy. 32-year-old woman, was admitted for abdominal colics in 17th week of uncontrolled pregnancy. Obstetric finding on admission was normal, while ultrasonography pointed to 17th week of gestation. During the first night of hospitalization, severe abdominal pain, with collapse, tachycardia and hypotension developed. Laparotomy was performed in general endotracheal anesthesia with resuscitation measures, and revealed hematoperitoneum and ruptured right-sided interstitial pregnancy with a dead fetus among the bowels. Abdominal hysterectomy without adnexa was performed. S. J., a 35-year-old tertigravida, six years before, left-sided adnexectomy was performed for perforated tubal pregnancy. 5 weeks before artificial abortion now, ultrasonography revealed a vital fetus biometrically corresponding to the 11th week of gestation. The condition was recognized as an unsuccessful artificial abortion and intact pregnancy. During preoperative preparation the patient lost consciousness and required immediate resuscitation. The abdominal cavity was opened by Pfannenstiel's relaparotomy, and revealed hematoperitoneum with numerous adhesions between the small intestine, sigma, uterus and urinary bladder, and ruptured left-sided interstitial pregnancy. Adhesiolysis was completed, a lesion in the sigma was sutured, and hysterectomy was performed. Exploration of the abdominal cavity revealed a dead fetus among small intestine loops, and an indurated, sharply delineated neoplasia of the head of the pancreas.

Using acupuncture to treat premenstrual syndrome.

More than 60% of the women in both groups suffered from premenstrual syndrome (PMS) symptoms, such as anxiety, mastalgia, insomnia, nausea and gastrointestinal disorders, whereas a smaller number of women suffered from phobic disorders, premenstrual headaches and migraines. There were three women from the first group and seven women from the second group who continued the medication treatment with progestins, whereas one woman from the first group and nine women from the second group continued to take fluoxetine. In the first group, nine women stopped having PMS symptoms after two AP treatments, eight women stopped having them after three treatments and one woman stopped having them after four treatments. In four women from the first group and 16 women from the second group, PMS symptoms appeared during the following period (cycle) or continued even after four treatments, so the medication was continued. In the first group, one woman had a smaller subcutaneous hematoma after the AP acupoint Ren 6. There was a statistical and relevant reduction in PMS symptoms with the AP treatments in the first group (P<0.001), whereas their reduction was irrelevant in the placebo AP group (P>0.05). The success rate of AP in treating PMS symptoms was 77.8%, whereas it was 5.9%. in the placebo group. The positive influence of AP in treating PMS symptoms can be ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. The initial positive results of PMS symptoms with a holistic approach are encouraging and AP should be suggested to the patients as a method of treatment.