Fetal hydrops and middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for therapy.

PURPOSE: To determine the role of fetal multiples of the median of middle cerebral artery peak systolic velocity (MoM MCA-PSV), in predicting the degree of fetal anemia for determination of the best timing for the second intrauterine intravascular transfusion (IUIVT) in hydropic fetuses with Rh alloimmunization. MATERIALS AND METHODS: Prospective study of 30 monofetal pregnancies with maternal Rh D alloimmunization and hydrops fetalis, from 2005 to 2012 that underwent first and second IUIVT were assessed. RESULTS: Thirty IUIVT were performed at 26.9 weeks (standard deviation, SD 4.3). Mean interval to the second procedure was 11.23 (SD 6.21) days and average hematocrit decline rate was 1.45%/day. The study did not demonstrated statistical significance between MCA-MoM-3 before the second IUIVT, and the mean decline rate in fetal hematocrit levels (expressed in percentage/day) r = 0.220; p = 0.242, and between MCA-MoM-3 and the time interval between both procedures (T) r = -0.157; p = 0.408. CONCLUSION: The measurements fetal MoM-MCA before every IUIVT cannot be useful as predictor for the best timing for the next IUIVT, but it can be useful in predicting severity of fetal anemia.

Management of cervical dysplasia in patient with Müllerian anomaly: diagnostic and therapeutic challenges.

PURPOSE: The study aim was to report diagnostic and therapeutic challenges in treatment of a patient with cervical dysplasia and con- genital uterine anomaly. CASE REPORT: A 53-year-old women with Müllerian anomaly - uterus duplex (bicorporal septate uterus) and Y-shaped endocervical canal was referred due to repeated abnormal Pap smears. She underwent endocervical curettage of both canals and the endocervical septum biopsy which revealed presence of cervical intraepithelial neoplasia (CIN) III. Cervical conization was considered technically unfeasible because of abnormal cervical anatomy (lesions deep in the cervical canal on the cervical bifurcation where the cervical wall is the thickest). Classical open abdominal hysterectomy was performed. Patient had two almost equally-sized, symmetrical uterine bodies connected in the isthmico-cervical region, with normal left and obstructed right hemi-vagina. Postoperative histopathological findings confirmed that dysplasia was located in the region where two endocervical canals conjoined. CONCLUSION: Diagnostic and therapeutic approach to patients with uterine anomalies has to be individualized, based on anomaly type, patient's age, reproductive history, and patient's preferences.

Predictive value of transvaginal ultrasound score for detection of endometrial malignancy.

PURPOSE: The aim of this study was to assess the accuracy of transvaginal ultrasound in detecting endometrial malignancy in peri-menopausal women. MATERIAL AND METHODS: The cross-sectional study included 100 perimenopausal women who had changes on the endometrium discovered through a regular ultrasound check-up and were referred to Clinic of Gynecology and Obstetrics "Narodni Front" in Belgrade during the period from September 1, 2012 to September 1, 2013. Transvaginal ultrasound was performed on each participant in the study. Parameters of the ultrasound examination composed a score system. RESULT: The results of regression analysis showed that this transvaginal ultrasound score have independent prognostic value for detection of endometrial malignancy. Score system showed that the value 8 had the best validity for the detection of endometrial malignity, with the sensitivity of 0.857 ind specificity of 0.785. CONCLUSION: The collected transvaginal ultrasound sample had high predictive value for the discovery of malign changes on endometrium.

Asymptomatic isthmico-cervical uterine perforation with IUD - our experience and literature review.

PURPOSE: The study aim was to report an unusual case of a misplaced IUD in isthmico-cervical region causing partial uterine perforation and discuss literature data regarding such a condition. CASE REPORT: A 50-year-old women was referred to the present institution for IUD extraction. She was diagnosed with spontaneously misplaced IUD located in isthmico-cervical region of the uterus causing partial perforation. The time of dislocation was unknown, as she was completely asymptomatic for ten years after IUD application. More-over, she had no risk factors for device misplacement. The removal of IUD was uneventful. CONCLUSION: Isthmico-cervical misplacement of IUD, although rare, can occur at any time and can be asymptomatic. Thus, women with IUD should be annually checked-up in order to prevent possible IUD complications.

Maternal hemodynamic influence on uteroplacental oxygen distribution during cesarean section.

This study investigated maternal hemodynamic influence on uteroplacental oxygen distribution and neonatal outcome during cesarean section (CS). CS was performed on 80 parturients using two anaesthetic techniques: spinal anaesthesia (SA) and general balanced anaesthesia (GBA). Indications for CS were exclusively obstetric related. Monitored maternal parameters were: ECG, heart rate (HR), non-invasive blood pressure (NIBP), saturation (SaO2). Gas parameters in umbilical artery, vein, and neonatal capillary blood were sampled. Vitality was assessed by the Apgar scoring, first breath-taking time and the first breastfeeding attempt. Hypotension was the most common finding after SA induction. GBA group presented changes such as QT inversion (12.5%), tachycardia (55%), and bradycardia (2.5%). SA group experienced higher rates of sinus tachycardia (45%) and ventricular dysrhythmias (2.5%). Neonatal oxygenation was significantly higher in SA group. Higher quality of early neonatal adaptation in the SA group confirms it as the technique with the least neonatal risk during CS.

Herlyn-Werner-Wunderlich syndrome--a case report.

This is a case report of Herlyn-Werner-Wunderlich syndrome in a 28-year-old patient. She was admitted to hospital for surgical treatment of the pelvic mass accompanied by painful menstruation periods. This syndrome was diagnosed by US and MRI and it was treated by hemi-hysterectomy with vaginectomy. After the surgery, the patient has had regular and painless menstruation.

Cesarean section scar pregnancy treatment--case report.

This is a case report of a 36-year-old patient with an ectopic pregnancy located in the previous cesarean section scar following in vitro fertilization (IVF). The patient was treated by 50 mg of intrasacular methotrexate locally under ultrasound guidance. Transvaginal ultrasound (TVUS) confirmed that the pregnancy was no longer vital within 24 hours, dilatation and aspiration of the ovular tissue were performed after seven days and it was sent for pathohistological analysis. Eight hours after the procedure, the patient began bleeding abundantly and was consequently treated locally by 1 ml of Beriplast P Combi set, human fibrinogen, and human thrombin set (CSL Behring). After the treatment, the patient was discharged in good health, with normal laboratory values. Her menstrual period resumed 35 days after the procedure.

Atypical polypoid adenomyoma mixed with endometrioid carcinoma: a case report.

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

Carney complex and teratoma maturum ovarii--a case report.

This is a case report of an extremely rare Carney complex (CNC) syndrome in a 17-year-old patient. After the decision made by a team of cancer specialists, the patient was admitted to the hospital for surgery because of adnexal tumor associated with ascites and increased Ca 125 tumor marker level. The patient underwent cardiac surgery twice. Adnexal mass and ascites, revealed by transvaginal ultrasound (TVUS) and confirmed by magnetic resonance imagings (MRI), indicated the malignant alteration. Surgery was performed and surgical pathological staging was refined according to the FIGO guideline and included a staging laparotomy. After surgery, general condition of the patient was good, without ascites and pain, with Ca 125 marker levels within reference ranges.

[Creation of a new vagina using a part of the rectosigmoid colon]. / Formiranje nove vagine od dela rektosigmoidnog kolona.

The paper shows the indications, preoperative and intraoperative evaluation as well as the way to make a new vagina. The authors advise to use part of colon sigmoideum to make a new vagina, this vagina is very much like the real one and the function is unlimited. During the operation the shortest possible part of colon sigmoideum should be taken in order to avoid oversecretion (mucorrhoea). After taking the segment and making termino-terminal anastomosis the tunnel should be made between the bladder and rectum and the segment should be stitched to the introitus of the vagina. For three weeks after the operation the patient should keep a tampon in the [figures: see text] new vagina and we suggest the dilatation of the introitus for three months. After the three months period we advise the sexual intercourse. The number of postoperative complications was minimal and the sexual intercourse was normal.