Prenatal diagnosis of lipomyelomeningocele by ultrasound and magnetic resonance imaging (MRI).

OBJECTIVE: The authors report a case of a lipomyelomengocele with tethered cord, revealed on prenatal ultrasonography and confirmed by fetal magnetic resonance imaging (MRI). MATERIALS AND METHODS: A 32-year-old woman, gravida 1 para 1 underwent the routine second trimester prenatal ultrasound scan at 22(+5) weeks of gestation at the present hospital. RESULTS: The scan indicated an echoic semisolid subcutaneous mass covered by skin, posterior to the lumbosacral spinal canal of the fetus. Based on the findings indicating occult dysraphism, a fetal MRI examination was conducted, revealing that the mass was extending to the spinal cord, tethering the cauda equina. The diagnosis of lipomyelomeningocele was established. CONCLUSION: Lipomyelomeningocele is a form of closed neural tube defect with unclear predisposing factors. Its prevalence ranges between 0.3 and 0.6 per 10,000 live births. It leads to progressive conus tethering with associated neurological, urinary, and gastrointestinal deficits, demonstrating the importance of prenatal diagnosis.

Complicated abdominal hysterectomy subsequent to uterine embolization for large fibroids.

Uterine artery embolization (UAE) has increasingly been offered as a safe alternative method for treating uterine fibroids with major symptoms. By this technique patients could avoid surgical cure or definite treatment such as hysterectomy. UAE decreases the uterine blood supply to the tissues and this might predispose to intraabdominal adhesion formation as a result of tissue necrosis. A case of a complicated routine hysterectomy due to strong adhesions found intraabdominally during surgery is reported. Our patient had no predisposing factors for adhesions, but she had undergone UAE one year earlier for large fibroids and decided to proceed to surgical therapy when symptoms returned.

Microarray analysis in gynaecology and its findings: a systematic review.

Microarray technology is a promising method for investigating gynaecological benign pathology. This systematic review examined various parameters of the design of these studies, the methods used and the gene outcome in these diseases. Electronic searches were performed in Medline (up to April 2009). An overall representation of important genes for each disease detected was performed. The results showed genes were up-regulated or down-regulated. However, studies suffer from several flaws in their design, the sample size employed and the reporting method. In conclusion, a significant amount of work has been performed on benign gynaecological diseases using microarray technology. New trial designs need to be employed that incorporate microarray reporting standards. New research directions should evolve based on these results.

Ovarian artery clamp: initial experience with a new clamp to reduce bleeding at open myomectomy.

We studied the effect of novel ovarian artery clamps on intraoperative bleeding in 46 women undergoing open myomectomy for large fibroids. The clamps were applied medial to the ovaries to occlude uterine blood flow from the ovarian arteries without compressing the fallopian tubes, and were used in conjunction with a pericervical tourniquet. Myomectomy was completed successfully in all patients, and an average of 10 fibroids weighing 588 g were removed per patient. The clamps could be applied bilaterally in all but three cases. In the 45 women when at least one ovarian artery clamp was used, the intraoperative blood loss averaged 500 ml, which was comparable with historic data with conventional tourniquets. Ovarian artery clamps appear to be as effective as tourniquets applied to the infundibulopelvic ligaments in reducing bleeding at open myomectomy but have the advantage that they do not occlude ovarian perfusion or crush the fallopian tubes.

Adenoid cystic carcinoma of the Bartholin's gland in a young patient: eight-year follow-up.

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is one of the rarest neoplasms of the female genital tract. Including this report there are 65 cases mentioned in the literature. We report a case of a 36-year-old woman who presented at our hospital after excision of the right Bartholin gland elsewhere which proved to be ACC. The therapy of this rare tumor has many controversial questions and dilemmas, especially in young patients. Our patient underwent surgical treatment only (hemivulvectomy and lymph node dissection) without radiotherapy and is free of disease eight years after.

Mild ovarian hyperstimulation syndrome coexisting with ectopic pregnancy after in vitro fertilization.

Ovarian hyperstimulation syndrome (OHSS) is an entity arising in women undergoing assisted reproductive techniques (ART). The simultaneous presence of two different clinical complications such as OHSS and ectopic pregnancy (EP) is not frequent. The diagnosis of an extrauterine pregnancy can be obscured by the stimulated ovaries and ascites, and actually be missed, especially in women with increased body mass index. We report a case of a woman who presented with mild OHSS after in vitro fertilization (IVF), (intracytoplasmatic sperm injection (ICSI) and embryo transfer). The ectopic pregnancy was ascertained soon after by transvaginal ultrasound (TVS) and right salpingectomy was performed.

Pelvic retroperitoneal schwannoma presenting as a gynecologic mass: case report.

Schwannomas of the sacral plexus are retroperitoneal tumors, usually benign, that result from proliferation of perineural cells. They are rare, pelvic, well defined tumors that present infrequently as gynecologic masses. Misdiagnosis is not uncommon in these cases, since these masses are not often encountered in clinical practice and preoperative imaging methods can be only suggestive of the diagnosis. Furthermore, these masses are not often encountered in clinical practice. We report a case of a 28-year-old woman who presented with a pelvic mass and obscure clinical signs. Imaging methods suggested that this tumor was most probably an ovarian mass of embryonic origin. After dissection by laparotomy, the microscopic examination showed typical futures of a neurilemoma (ancient schwannoma). The goal of the operating intervention is to excise the tumor avoiding major trauma, thus cooperation between surgeons is indispensable. The patient has had no motor or sensory disturbances after surgery.

Ruptured heterotopic pregnancy with successful obstetrical outcome: a case report and review of the literature.

Emergency medicine has encountered in the last decades a gradual increase in cases of heterotopic pregnancy (HP) with rupture of the ectopic part. The rise of this entity is mainly due to ovulation induction performed in women undergoing assisted reproductive techniques (ART), but in natural cycles is still rare and unexpected. Diagnosis is often delayed especially in cases where no predisposing factors exist, causing life threatening situations. We report a case of a ruptured heterotopic pregnancy presenting at seven weeks of gestation that was treated with immediate laparotomy. The rest of the pregnancy course was uneventful with spontaneous vaginal delivery of a healthy infant at 39 weeks of gestation. A review of the diagnosis and management of heterotopic pregnancy is also given.

Hodgkin's disease during pregnancy: a case report and review of the literature.

The simultaneous presence of cancer and pregnancy is rare but occurs, creating extreme scenarios in clinical practice. Hodgkin's disease (HD), affects primarily young adults and therefore obstetricians may confront young women with this type of lymphoma during pregnancy. We report a case of a 27-year-old woman with HD who presented during the 28th week of gestation. After counseling the couple decided to continue with the pregnancy. The patient received conservative treatment with regression of the symptoms and rapid improvement of her general condition. At 36 weeks of gestation a healthy infant was born and the patient underwent chemotherapy after delivery with complete resolution of the disease.

Unicornuate uterus and uterus didelphys indications and techniques for surgical reconstruction: a review.

Unicornuate uterus and uterus didelphys consist of miscellaneous congenital malformations of the female genital system. These anomalies can cause many gynecological and obstetrical complications including infertility, ectopic pregnancy, recurrent abortions and preterm deliveries. Laparoscopy and hysteroscopy are two helpful operative procedures in establishing an accurate diagnosis and treating effectively. A case of a patient with unicornuate uterus and longitudinal vaginal septum, who presented at our hospital suffering from infertility, is reported.

Bacteriological cultures of removed intrauterine devices and pelvic inflammatory disease.

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidence of a direct association between IUD use and pelvic inflammatory disease (PID) is scarce, concerns about PID related to IUDs use has limited their use throughout the world. We designed this study to examine the effect of IUDs on PID. For the study, we recruited 200 participants from among women who requested an IUD as a means of contraception. The IUDs were removed 36 months later or in case of PID. No PID cases were recorded during the follow-up period. Prior to IUD insertion, 121 women (60.5%) had symptoms and/or signs of lower genital tract infection, whereas during the follow-up period 179 women (89.5%) had symptoms and/or signs of lower genital tract infection. The Papanicolaou smears were negative for Actinomyces throughout the study period. Also, cultures for sexualy transmitted disease microorganisms were negative throughout the study period. Following IUD removal, 189 IUD cultures (94.5%) were positive. The bacterial flora of the removed IUDs consisted of common aerobic and anaerobic microorganisms that do not account for PID. The most common microorganisms identified were Staphylococcus coagulase negative, Eschericia coli, and Enterococcus faecalis. IUDs are a very effective and safe method of contraception if potential recipients are selected carefully. Culture of the removed IUDs and therapeutic management of women with positive cultures are not recommended when women are asymptomatic for PID.

Polycystic ovarian syndrome and thrombophilia.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is associated with insulin-induced plasminogen activator inhibitor-1 (PAI-1) elevations. Since thrombophilic states correlate with high miscariage rates, as does PCOS, this study aimed at looking for thrombophilic predisposition in PCOS women compared with non-PCOS controls. METHODS: The prevalence of antithrombin III, protein S and protein C deficiencies, as well as factor V Leiden, prothrombin G20210A factor and methylene tetrahydrofolate reductase (MTHFR) mutations, was compared between two different groups of women, one with PCOS (n = 30) and one without PCOS (n = 45). RESULTS: Median proportions of activated protein C, S and antithrombin III as well as the activated protein C ratios were within normal ranges in both samples. There was no evidence that the genetic analysis for factor V Leiden or prothrombin factor differed between the two samples. The odds ratio (OR) of bearing a mutation on the MTHFR gene was 1.2-fold higher [95% confidence interval (CI) 0.470-3.065] in women with PCOS than in women without (P = 0.83). Although this difference is not statistically significant, it might indicate a slightly higher prevalence of heterozygous genotypes in women with PCOS (OR = 1.197, 95% CI 0.473-3.034). CONCLUSIONS: Molecular risk factors of hereditary thrombophilia do not show increased prevalence in women with PCOS in comparison with women in the general population. The existence of a possible trend towards higher prevalence of MTHFR mutation in women with PCOS needs further study, particularly regarding homocysteine levels.

Evaluation of fetal heart monitoring in the first stage of labor.

OBJECTIVE: To evaluate the usefulness of continuous electronic fetal heart rate (FHR) monitoring in the first stage of labor. METHODS: A total of 814 pregnant women in labor without identifiable risk factors was divided into two groups. In group A (468 cases), continuous FHR monitoring began in the earliest phase of the first stage of labor (cervical dilatation < or = 4 cm), while in group B (346 cases) it began when the cervical dilatation was > 4 cm. Initial FHR tracings were normal in all 814 cases. The fetal monitoring findings were analyzed at 10-min intervals, and comparisons were made between the two groups concerning FHR findings and their correlation with the state of the newborns. RESULTS: No significant difference was found between the two groups in the incidence of repetitive variable decelerations (1.9% and 1.7%, respectively); sporadic variable decelerations (9.2% and 8.7%, respectively); persistent repetitive late decelerations that resulted in Cesarean section (1.1% and 1.4%, respectively); or sporadic late decelerations (8.3% and 8.1%, respectively). One newborn from each group required intensive neonatal care. CONCLUSIONS: The same tracing sufficiency of fetal stress was observed in the two groups. However, the manner of labor supervision in group B seemed to be more beneficial, because of greater maternal comfort, a lower necessity for personnel, lower consumption of cardiotocographic materials and the possibility of labor induction for more women. Since fetal monitoring is widely used, it is preferable to start continuous FHR monitoring when the dilatation of the cervix approximates 4-5 cm (second phase of the first stage of labor) without risk of fetal loss.