Nonpuerperal uterine inversion caused by an adenosarcoma: A case report.

INTRODUCTION: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. CASE PRESENTATION: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. CONCLUSIONS: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Low back pain in pregnant women: A necessary or an avoidable evil?

OBJECTIVES: The aim of this study was to determine the prevalence, the main features and the potential risk factors of LBP in pregnant women. METHODS: This cross-sectional study included 173 pregnant women in the third trimester. Non-inclusion criteria were severe mental disability and known previous history of musculoskeletal diseases. The participants were categorised into two groups: women with pregnancy-related LBP and pain-free women. Demographic, socio-professional, clinical and obstetrical data were compared between the two groups using the appropriate statistical tests. RESULTS: The mean age was 32.2 ± 5.4 years [17-45]. Among them, 108 (62.4%) reported one or more episodes of LBP during at least 7 days, mostly in the third semester (n = 71). The presence of LBP was significantly associated with history of LBP in previous pregnancies and jobs requiring prolonged standing. Active jobs and the presence of gestational complications were significantly more common in pain-free women. In the multivariate analysis, LBP was independently predicted by the history of LBP in previous pregnancies and the absence of gestational complications. CONCLUSIONS: The association of LBP with gestational complications as a protective factor has not yet been reported in previous studies. These complications are a common cause of hospitalisation, which represents a period of relative rest during pregnancy. Our results revealed that history of LBP in previous pregnancies, sedentary lifestyle prior to pregnancy and prolonged standing are the main risk factors of LBP. In contrast, rest and avoidance of physical overstrain during pregnancy may be protective factors.

Microbiological and molecular screening of Candida spp. isolated from genital tract of asymptomatic pregnant women.

Introduction. Candida spp. may cause opportunistic infections called vulvovaginal candidiasis (VVC), which is estimated to be the second most common cause of vaginitis worldwide.Gap Statement. Under various circumstances, VVC could compromise pregnancy outcomes. Emerging data suggests that VVC during pregnancy may be associated with increased risk of complications and congenital cutaneous candidiasis.Aim. To assess the prevalence of Candida spp. in asymptomatic pregnant women and determine the susceptibility of the isolates to antifungal drugs.Methodology. In a prospective cohort, 65 high vaginal swab samples of consented pregnant women. Candida isolates were identified using both microbiological and molecular tools and drug susceptibilities were profiled.Results. The prevalence of VVC among our study participants was 37 %, 24 of the 65 asymptomatic pregnant women show Candida spp. colonization. C. albicans was the most common species 61 %, followed by C. glabrata 39 %. In addition, a significant fraction of the isolated colonies showed resistance to Fluconazole, with a ratio of 63 % for C. albicans isolates and 16 % for Candida glabrata isolates. Moreover, relative quantification of genes related to resistance to fluconazole, CDR1, ERG11 as well as HWP1, showed a significant change compared to controls.Conclusion. Monitoring of vaginal Candida colonization before the third trimester of pregnancy, that could reduce congenital Candida colonization and risk of pregnancy complications.

[Psychological impact of COVID-19 on women's wellbeing during pregnancy: about 2 cases]. / Impact psychologique des femmes enceintes atteintes du COVID-19: à propos de 2 cas cliniques.

This study is based on a psychoanalytically inspired psychological investigation of two pregnant women with COVID-19 at different stages of pregnancy in the Department of Obstetrics and Gynaecology A at the Charles Nicolle Hospital. Our study was conducted between 2020 and 2021, until deliveries. Two young Tunisian women aged 28 and 30 years were tested positive for COVID-19 during pregnancy. They suffered from emotional shock. In this study, we discuss the different points of collision between life and death by describing, in detail, the experiences of these two women during their confinement.

[A case of neonatal gastrointestinal duplication]. / Duplication digestive: à propos d´un cas néonatal.

Gastrointestinal duplications are defined as tubular or cystic malformations of a segment of the digestive tract, from the oral cavity to the anus. They are rare. Prenatal diagnosis ca be made in patients with a voluminous cyst. We here report the case of a 33-year-old primiparous woman with no previous medical-surgical history who was poorly screened. She just underwent ultrasound scan at 8 weeks of amenorrhea (WA). During the third trimester of pregnancy ultrasound showed anechoic nonvascularized cyst measuring 3cm located in the upper pelvis. It was anteriorly located; the kidneys and the bladder were not involved. Then magnetic resonance imaging (MRI) of the fetus was performed to better interpret ultrasound results. This showed well-defined cyst in contact with the small bowel loops along the mesenteric side. The diagnosis of gastrointestinal duplication was strongly suspected. C-section was done at 39 weeks' gestation because the woman had a history of primary infertility (7 years). Delivery proceeded without complications. Postnatal ultrasound results reinforced the hypothesis of gastrointestinal duplication, showing a cystic mass with a multi-bulkhead-like structure at the level of the left hypochondrium, measuring 45 mm x 19 mm, which could be consistent with gastrointestinal duplication. The new-born was referred to the Paediatric Surgery for better management and surgery in the first 6 months of life. The discovery of fetal anechoic cyst poses a challenge in etiology and diagnosis on the one hand and of follow-up and postnatal management on the other hand.

The methylene blue test, a risky intervention: A case report.

Methylene blue is used to check tubal patency during laparoscopy. We report the case of a 28-year-old patient who presented a blue coloring of the skin, mucous membranes and nails after methylene blue test during laparoscopy for infertility.  The oxygen saturation was 82%. The patient was hospitalized for 48 hours in the intensive care unit and spectrophotometric analysis revealed a methemoglobin level of 8.9%, thus confirming the diagnosis of methemoglobinemia. The suites were simple with normalization of the saturation. It is important to know the complications of the injection of methylene blue in order to prevent them and ensure adequate monitoring for the patients.

[Parauterine solitary fibrous tumor: about a case]. / Tumeur fibreuse solitaire parautérine: à propos d'un cas.

Solitary fibrous tumors of the female genital tract are extremely rare. We report the case of a 78-year old patient presenting with a pelvic mass. Surgical exploration showed parauterine tumor. Anatomo-pathological examination confirmed the diagnosis of malignant solitary fibrous tumor. The evolution was marked by the death of the patient. It is important to be able to detect these tumors whose evolution can be poor. Long-term follow-up of patients with resectable tumor should be recommended.

Ultrasound diagnosis of fetal head engagement.

OBJECTIVE: To compare clinical data and transperineal ultrasound results for the diagnosis of fetal head engagement. METHODS: The present prospective longitudinal study enrolled 100 term women attending the Mongi Slim Hospital, La Marsa, Tunisia, between July and September 2012. The clinical assessment of fetal engagement was compared with ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was the distance between the perineum and external table of fetal skull. RESULTS: The ultrasound measures of the perineum to external table of fetal skull ranged from 13 to 75mm. The measures of the perineum to succedaneum bump ranged from 22 to 68mm. A threshold of 55mm was determined as the perineum to fetal head distance above which a diagnosis of engagement would be reversed. This proposed threshold had a positive predictive value of 98.6%, a sensitivity of 86.7%, and a specificity of 94.1%. CONCLUSION: Transperineal ultrasound is a simple, rapid, and reproducible method for the diagnosis of fetal head engagement. It can be used in the delivery room in addition to clinical examination and when the latter is hampered by a succedaneum bump.