Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.

Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.

Correlation between first-trimester maternal serum markers, second-trimester uterine artery doppler indices and pregnancy outcome.

AIMS: The aim of this study was to assess the correlation between first trimester maternal serum free beta-human chorionic gonadotropin (fBHCG), pregnancy-associated plasma protein A (PAPPA), second-trimester uterine artery (UA) Doppler measurements and adverse pregnancy outcomes. METHODS: Serum levels of PAPPA and fBHCG were determined at the first trimester, and patients underwent bilateral UA Doppler assessments at 20-25 weeks of gestation. A serum PAPPA level <0.4 MoM was termed as low and the abnormal Doppler findings were the presence of bilateral notches and RI >0.52 (mean) or unilateral notch and RI >0.66 (90th percentile). RESULTS: Mean PAPPA level was significantly lower in cases with unilateral or bilateral notches (1.09; 0.79 and 0.80 MoM for 0, 1 and 2 notches, p < 0.001). Fifty-two cases (12.8%) had a low PAPPA level; in this group the incidence of abnormal Doppler was significantly higher (34.6 vs. 18.4%, p = 0.011). In the presence of abnormal Doppler in a case with a low serum PAPPA the risk of pregnancy-induced hypertension (OR = 4.56, p = 0.0067), low birth weight (OR = 6.8, p = 0.0002) and the risk of at least one complication (OR = 7.6, p = 0.00001) were significantly high. CONCLUSION: Combination of first- and second-trimester findings might improve the efficiency of screening for pregnancy complications.

A new metabolic scoring system for analyzing the risk of hypertensive disorders of pregnancy.

OBJECTIVE: The aim of this study was to investigate the relationship between some components of metabolic syndrome (MS) and pregnancy induced hypertension (PIH). STUDY DESIGN: Forty-one patients with PIH (gestational hypertension or preeclampsia) after 32 weeks of gestation were compared with 97 normotensive pregnant women. Metabolic scores (0-4) were created using standard deviations in normotensive cases: mean level + 1SD for BMI (>31 kg/m(2)), mean level + 1SD for triglyceride (>287 mg/dl), mean level + 1SD for fasting serum glucose (>90 mg/dl)) and mean level - 1SD for HDL (<48 mg/dl). RESULTS: The mean values for BMI (31.6 +/- 5.7 vs. 27.7 +/- 3.6; P < 0.0001), fasting triglyceride (341 +/- 129 vs. 220.7 +/- 67; P < 0.0001) and glucose (87.5 +/- 17.1 vs. 79.6 +/- 10.4; P = 0.0009) were higher in hypertensive group. The proportions of the women with a positive result for each of the components were significantly higher in the group of PIH. The percentage of the cases having 2 (35.2 vs. 8.2%; P = 0.0002) and 3 or more (27 vs. 4.1%; P = 0.0003) components of MS was higher in the hypertensive group and the percentage of the cases with none of these factors was high in the normotensive group (10.8 vs. 56.7%; P < 0.0001). CONCLUSION: The presence of multiple components of MS may be a risk factor in the development of PIH. New scoring systems according to the gestational age might be useful in analyzing the risk of PIH.

Sonographic findings in adnexal torsion: a report of 34 cases.

OBJECTIVE: The aim of this study was to correlate the preoperative sonographic findings and operation type in cases with surgically proven adnexal torsion in our clinic. STUDY DESIGN: This retrospective study included 34 postmenarchal patients with adnexal torsion who were examined with ultrasound and then operated between November 2003 and October 2007. Surgical procedures performed were divided into two groups: (1) detorsion followed by aspiration or detorsion combined with resection of the adnexal cyst, (2) resection of the whole adnexa. Patients with additional adnexal pathologies as a cause of adnexal torsion were excluded from the study. RESULTS: Twenty-four out of 34 patients (71%) were treated with ovarian conservation and 10 (29%) with resection of the adnexa. Echogenic features of lesions identified in both patient subgroups were similar in appearance. The lowest resection rate was in the group with multicystic appearance (14%), and the highest in solid-cystic group (44.4%). The average mass size was not significantly different between resection (69.3 vs 86.1 mm) and conservation groups. The risk of adnexal resection was higher in cases with an adnexal mass larger than 60 mm (sensitivity 90%, specificity 54.1%) (P = 0.031). The blood flow was present in six of the 21 cases (28.5%). The number of cases who were treated with adnexal resection were significantly more in the group with absent blood flow (P = 0.045). CONCLUSION: Determination of preoperative sonographic appearance of the mass may be valuable, but it is not specific in the prediction of the operation type of the cases with adnexal torsion. The measurement of the diameter and assessment of blood flow in the adnexal mass might be helpful in detection of the cases who have high risk of adnexal resection.

Ultrasound screening for fetal major abnormalities at 11-14 weeks.

BACKGROUND: This study was planned to evaluate the efficiency of the 11-14 week scan in detecting fetuses with major fetal structural abnormalities. METHODS: Some 1,290 pregnant women were submitted to a routine ultrasound scan between the 11th and 14th week after the detection of the fetal viability. The fetal anatomy was examined transabdominally, and in suspected cases transvaginally. Following the scans, the patients were examined in the second or third trimester of pregnancy. Fetal structural abnormalities classified as major and early onset were noted. Isolated choroid plexus cysts, cardiac defects not requiring treatment, mild ventriculomegaly, and mild renal pelviectasis in second trimester were not included. RESULTS: Twenty-four (1.86%) fetuses with various defects were identified, and 17 of these were diagnosed at the 11-14 week scan. The antenatal ultrasound detection rate of the fetuses with major anomalies was 95%, and 70% were detected in the first-trimester assessment. Four cardiac defects associated with genetic syndromes or requiring operation were included (0.31%) in this series. Two of the fetuses with cardiac defects (50%) had an increased nuchal translucency thickness. In this group, none of the fetuses with karyotype anomalies was born alive. CONCLUSIONS: The first-trimester scan is important in routine antenatal care for early detection of fetal defects, and determination of the fetuses at risk of cardiac anomalies and genetic syndromes.