Uterine torsion in the second trimester of pregnancy.

OBJECTIVES: Torsion of the pregnant uterus is a very rare complication. It may occur at any gestational age. The treatment depends on the intensity of symptoms, intraoperative ischemic signs and the gestational age. MATERIAL AND METHODS: We present a case report of 33-year-old primipara accidentally diagnosed with uterine torsion during appedectomy. CASE DESCRIPTION: The patient underwent surgery at 19th week of gestation due to severe pain in the right iliac fossa and increased levels of inflammation markers. Intraoperatively acute appendicitis and levorotation of the uterus by about 100 degrees were found. As the signs of ischemia were absent, the uterus was returned into its normal position. Intraoperative and postoperative period was uncomplicated. Close outpatient monitoring was introduced and the pregnancy continued without further complications. The patient underwent cesarean section at 36 weeks of pregnancy due to early leakage of amniotic fluid and failure to progress during first stage of labor. CONCLUSIONS: Uterine torsion may present with non-specific symptoms or be asymptomatic. Urgent laparotomy and rotation of the uterus into its normal anatomical position gives chance for normal course of pregnancy. Subsequent close outpatient care is obligatory to asses viability of the fetus and early detection of possible pregnancy complications.

Hemoperitoneum in a patient with spontaneous rupture of the posterior wall of an unscarred uterus in the second trimester of pregnancy.

BACKGROUND: Hemoperitoneum resulting from a rupture of an unscarred uterus is a rare condition. Uterine rupture in patients without evident risk factors is associated with non-specific signs and symptoms that can delay the diagnosis. This is a report of spontaneous rupture of posterior wall of the uterus in the second trimester of pregnancy presented as intra-abdominal bleeding. CASE PRESENTATION: Here, we report the case of a 31-year-old Caucasian multiparous female (gravida 3, para 1) who had a sudden onset of abdominal pain at 28 weeks of gestation. The patient had no history of caesarean section. Exploratory laparotomy was performed due to deterioration of the patient's clinical condition, and ultrasound results were suspicious for hemoperitoneum. Uterine rupture in the posterior wall with active bleeding from the defect was confirmed. A caesarean section was performed, and a live female infant weighing 1000 g, with an Apgar score of three, was delivered. A hysterectomy was performed during the caesarean section. CONCLUSION: Diagnostic difficulties arise from the rarity of the disease, a nonspecific clinical picture and the absence of the main risk factors. Uterine rupture should be considered in the differential diagnosis of hemoperitoneum in patients with an unscarred uterus.

[Frequency and layout of congenital defects in infants born from 1991 to 1995 and from 2000 to 2004 at the Obstetrics and Gynecology Department of Wolomin District Hospital]. / Czkstosc wystkpowania i rozklad wad wrodzonych u noworodków urodzonych w latach 1991-1995 i 2000-2004 w Oddziale Poloznictwa i Ginekologii Szpitala Powiatowego w Wolominie.

OBJECTIVE: The aim of the study was an evaluation of the frequency and distribution of congenital malformations in infants born at the Obstetrics and Gynecology Department of Wolomin District Hospital in the years 1991-95 and 2000-2004 and a comparison of occurrence frequency of defects' types in the analyzed periods. METHODS: The study comprises an evaluation of documentations of 5649 infants born in the years 1991-1995 and 6049 infants born in the years 200-2004, 11698 infants in total. In the study groups of infants, the frequency of congenital malformation occurrence was analyzed. RESULTS: The majority of congenital malformation diagnosis in the years 1991-1995 were CNS defects with 21% and the second most frequent group were facial skeleton defects with 16% The majority of congenital malformation diagnosis in the years 2000-2004 were osteoarticular system defects (25%) and the second most frequent group were organic heart diseases with 14%. CONCLUSIONS: The frequency and distribution of congenital defects was comparable with data provided by other authors. The most frequent defects were osteoarticular system defects, congenital hart dsefects and CNS. An increase in number of defects of the osteoarticular system was observed.