Successful treatment of placenta accreta spectrum disorder using management strategy of serial uterine artery embolization combined with standard weekly and a 8-day methotrexate/folinic acid regimens at 7 weeks of gestation.

OBJECTIVE: We describe our experience with serial uterine artery embolization (UAE) combined with standard weekly methotrexate and a eight-day methotrexate/folinic acid (MTX/FA) treatment regimen in the management of placenta accreta spectrum (PAS) disorder at 7 weeks of gestation. CASE REPORT: A 38-year-old woman, gravida 2 para 0, with a history of myomectomy, was referred for ultrasound (US) evaluation due to suspected cervico-isthmic pregnancy. Transvaginal US image showed a viable embryo with a disproportionately bigger placenta encircling the fetus and completely covering the internal os of the cervix at 7 weeks of gestation. Color Doppler imaging revealed diffuse intraplacental and periplacental vascularity. Patient chose to terminate the pregnancy but attempted to preserve the uterus for future fertility following counseling. Serial UAE procedures were performed using Gelfoam and metallic microcoils. Two courses of a standard weekly MTX and a eight-day MTX/FA treatment regimen were administered to accelerate placental regression. The beta-hCG gradually decreased to a normal level, and an ultimate resolution of the PAS disorder was observed at 110 days after treatment. CONCLUSION: Early diagnosis of the PAS disorder could result in better obstetric outcome through earlier intervention using serial UAE combined with standard weekly and a eight day MTX//FA regimen in the first trimester of pregnancy.

Recurrent severe placenta increta at 8 weeks of gestation in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum disorder.

OBJECTIVE: We describe herein our experience of employing a hysterectomy and prophylactic internal iliac artery balloon occlusion (IIABO) strategy for the management of recurrent severe placenta increta at 8 weeks in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum (PAS) disorder. CASE REPORT: A 40-year-old woman with a history of uterus-conserving surgery for PAS disorder underwent transvaginal ultrasound evaluation at 8 weeks of pregnancy, which showed a dichorionic/diamniotic pregnancy with viable embryos of a crown-rump length of 1.65 cm and 2.03 cm, respectively. Many irregularly-shaped grade 3+ lacunae were observed, and color Doppler imaging revealed diffuse intraplacental and perihypervascularity. A total abdominal hysterectomy was performed at 10 weeks, with an estimated blood loss of 1275 mL. Placenta increta was confirmed by histopathologic examination. CONCLUSION: The high rate of recurrence of PAS disorder in a subsequent pregnancy should be discussed following an antenatal diagnosis of PAS disorder with patients who may be considering uterine conservation in order to retain the option of a future pregnancy.

[Molecular epidemiology study on an acute gastroenteritis outbreak caused by a new GII. 4 norovirus recombinant strain].

OBJECTIVE: To analyze the epidemiological characteristics of an acute gastroenteritis outbreak in a nursing home caused by norovirus (NoV) and the genotype of the pathogen. METHODS: On January 29th 2013, a total of 26 acute gastroenteritis patients infected by norovirus were reported in the nursing home of Jinshan, Shanghai. A questionnaire was used to acquire information of patients involved in the outbreak, 9 stool or anal swab samples were collected from 9 patients without treatment by simple random sampling method, and 4 environmental samples from the surface of doorknobs or toilets were collected. The samples were detected by Real-time PCR for NoV, and positive samples were then amplified by routine RT-PCR. The PCR products were purified, sequenced, and aligned by comparing sequences in GenBank. Phylogenetic trees were constructed by using Clustal X, employing MEGA 5.1 program package. RESULTS: For the 26 patients, 7 were men and 19 were women.8 samples were found NoV positive among the 13 samples when detected by real-time PCR. The sequence alignment showed that the nucleotide sequence homology between Jinshan08 and Jinshan12 strain which obtained sequencing signal was 100%. The phylogenetic analysis revealed that Jinshan08, Jinshan12 and GII.e/NV2634/BCN/Spain/2008 strains in the RdRp region were on the the same branch of evolutionary tree, the confidence level was 99%, and in the N/S region of the Capsid, 2 other strains and Lordsdal strain were in the same branch, the confidence level was 97%. CONCLUSION: It was confirmed that the acute gastroenteritis outbreak was caused by the new GII.4 NoV recombinant.