Antenatal myomectomy of huge pedunculated fibroid.

A female patient in her 20s presented at 10 weeks of pregnancy with abdominal pain. She was known to have a 17-cm fibroid a year ago, which, on repeat imaging, was found to have increased in size to 29 cm. A 12-cm increase in size over a year therefore led to concerns that it would increase in pregnancy, causing risk of thrombosis, decrease in venous return, miscarriage, fibroid torsion, fibroid necrosis, preterm labour and uterine rupture. Following a multidisciplinary team review with obstetricians, neonatologists, gynaecologists and radiologists, the patient opted to proceed with an open myomectomy at 14 weeks gestation, which was performed successfully. The pregnancy continued uneventfully until term when she delivered a healthy girl infant at 38+2 weeks via an elective caesarean section.

Unusual presentation of a septate hymen leading to a retained vaginal tampon in the urinary bladder.

There is a wide range of hymenal variants which exist and usually become apparent to women during puberty. Our case describes a 16-year-old woman with a previously undiagnosed hymenal septum who presented with a retained tampon within the urinary bladder. This case report discusses a rare presentation of a hymenal variant and highlights the importance of understanding the difference in pelvic examinations in children and adolescents when compared with adults and awareness of the different hymenal variants.

Acute upper gastrointestinal bleed in the puerperium following weight reduction surgery.

Bariatric surgery is often a definitive treatment for obesity and is increasingly being performed on women of childbearing age. While bariatric surgery may reduce the risk of obesity in pregnancy, there are new complications which can develop following these procedures. Our case describes a 31-year-old women who presented in the puerperium with a life-threatening upper gastrointestinal bleed secondary to marginal ulceration following a Roux-en-Y procedure. This case report discusses a rare case of acute upper gastrointestinal bleed in the postnatal period and highlights the risk factors and complications which may present in the obstetrical patient following bariatric surgery. With the increasing use of weight loss surgery in obese women and the associated improvement in fertility following, we must remain aware of the risks and these women should be identified at booking so that their antenatal and postnatal care can be tailored accordingly.