RESUMO
Cesarean scar pregnancies are a rare complication of pregnancy, with an incidence rate of approximately 1 in 2000 pregnancies. Numerous treatment alternatives have been proposed and published for cesarean scar pregnancies (CSPs), including medical management with local or systemic methotrexate injection, resection through hysteroscopic, vaginal, abdominal or laparoscopic approach, and dilation and curettage. Concomitant strategies for achieving hemostasis/bleeding control have been attempted, including uterine artery embolization, the placement of a Foley balloon catheter, injection of vasopressin, and less commonly reported, the use of vascular clamps. We describe a case of failed medical management of a CSP, followed by laparoscopic resection with the use of vascular clamps to minimize bleeding. This approach can be considered for minimizing blood loss in the laparoscopic management of cesarean ectopic pregnancies.
RESUMO
RESUMEN El síndrome de teratoma creciente (STC) es una condición infrecuente en la que se evidencia aumento de tamaño de los tumores de células germinales o la aparición de nuevas lesiones, durante o después del tratamiento con quimioterapia. Lo más característico de este tumor es la presencia exclusiva de componentes de teratoma maduro, así como valores de marcadores tumorales que negativizan durante la quimioterapia, y se mantienen negativos durante el seguimiento. Se presenta el caso de una mujer de 28 años con un tumor de ovario de células germinales mixtas sometida a cirugía y luego quimioterapia. Durante el seguimiento, desarrolló múltiples tumores pélvicos que correspondieron a teratomas maduros. En esta paciente, fue crucial identificar el síndrome de teratoma creciente para evitar tratamiento adicional con quimioterapia.
ABSTRACT The growing teratoma syndrome (GTS) is a rare condition in which patients with germ cell tumors present an increase in tumor size or the appearance of new lesions, during or after chemotherapy. The hallmark of this tumor is the unique presence of mature teratoma components, as well as tumor marker values that become negative with chemotherapy, and remain low thereafter. We report the case of a 28-yearold female who presented a mixed germ cell tumor of the ovary, for which she underwent surgery and subsequent chemotherapy. Later, she developed multiple pelvic tumors that corresponded to mature teratoma. It was crucial in this patient to identify the syndrome to avoid additional treatment with chemotherapy.
RESUMO
There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. KEY POINTS: · We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory support.. · This is a case of positive RT-PCR in first day of life, suggesting possible vertical transmission.. · There were no detectable maternal antibodies for COVID-19 until after delivery..
