Surveillance of pregnant women with potential exposure to Zika virus following travel.

AIM: To describe the experience of a single fetal medicine unit in evaluating pregnant women with potential exposure to Zika virus (ZIKV) following travel. METHOD: Between February 2016 and June 2017, a multidisciplinary team evaluated pregnant women by developing a local pathway based on Public Health England guidance. All pregnant women were offered serial fetal ultrasound scans (USS). If they presented with a history of clinical symptoms consistent with ZIKV infection during or within two weeks of travel or fetal USS was suggestive of microcephaly, reverse transcriptase polymerase chain reaction (RT PCR) and/or serology was used. RESULTS: 69 women were referred. Eight patients reported symptoms consistent with ZIKV infection (11.6%) and six (8.7%) patients reported mosquito bites. Maternal exposure was mainly during the preconception period and the first trimester in 35 (50.8%) and 19 (27.5%) women, respectively. Prenatally, there was no evidence of microcephaly in any of the 69 referrals. Sixty-two live births and seven miscarriages were reported. One patient had serology confirming ZIKV infection during pregnancy. At birth, 57 babies had normal head circumference (HC) measurements, including the baby born to the Zika positive mother. Two babies had small HC measurements but were not infected and were small for gestational age. CONCLUSIONS: One case of maternal ZIKV infection was detected but without any fetal congenital abnormalities postnatally. The number of potentially infected patients referred to our unit is a demonstration of the concern regarding perinatal ZIKV infection in the pregnant population.

Early fetal growth in progesterone-treated IVF pregnancies.

PURPOSE: The aim of this study was to compare fetal growth in the first and second trimesters of pregnancy and final birth weights between two groups of women: (a) spontaneous conceptions with reliable menstrual dates and (b) IVF pregnancies on progesterone supplementation during the first trimester. METHODS: We included in the study 73 singleton IVF pregnancies and 138 singleton spontaneous pregnancies. Exclusion criteria were: medications or presence of medical conditions affecting fetal growth. Fetal crown-rump length (CRL) at 10 + 1 to 13 + 6 weeks of gestation, and head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) at 18-24 weeks, were measured prospectively. The birth weights of the babies born were collected and compared. Independent sample t test was applied for comparing quantitative variables with normal distribution, and Wilcoxon-Mann-Whitney test was used for comparison of quantitative variables without normal distribution. RESULTS: IVF fetuses on progesterone supplementation had larger CRL measurements when compared to their counterparts from spontaneous pregnancies (p value = 0.045). Similarly, in the second trimester, the BPD was significantly larger but HC, AC and FL, although larger, did not reach statistical significance. The birthweights of babies between the two groups showed no statistically significant difference, although some IVF babies were born prematurely. CONCLUSIONS: Enhanced fetal growth during the first trimester has been observed with progesterone supplementation in IVF pregnancies. Aspects of enhanced fetal growth were observed in the second trimester but not at birth. The effect of progesterone supplementation on fetal growth needs further investigation.

Axillary lymph node metastases in adenoid cystic carcinoma of the breast. A rare finding.

Adenoid cystic carcinoma (ACC) of the breast is a rare malignant salivary-type neoplasm that has a good prognosis and represents less than 1% of all breast cancers. It is a triple negative carcinoma that presents as a painful mass. The mean age at the time of diagnosis is 50-60 years old. The solid variant of this type of tumour with basaloid features and presence of nodal metastases is very rare and considered to have a more aggressive clinical course. We present a case with presence of axillary lymph node metastases that was successfully treated with no evidence of recurrence one year after the diagnosis and review the literature.

Simultaneous Meckel's diverticulitis and appendicitis: a rare complication in puerperium.

We report a case of a 24-year-old woman who was delivered via cesarean section at 39 weeks and presented in the puerperium with symptoms of worsening abdominal pain and septicaemia. Preoperative ultrasonography suggested the presence of a pelvic collection. Explorative laparotomy revealed the simultaneous presence of Meckel's diverticulitis and appendicitis without bowel perforation. The patient made an uneventful recovery following small bowel resection with end to end reanastomosis and appendicectomy.