Pub Date : 2020-05-29DOI: 10.31487/j.crogr.2020.01.06
Lourdes Sala Climent, D. Borniquel Agulló, F. Xavier González Tallada, I. Llordella Sarmiento, Javier Medrano Juárez, M.J. Pelegay Escartín, N. Redondo López
Case Report: We present the case of a diamniotic-dichorionic twin pregnancy of 14+4 weeks with obstetric history of cervical incompetence. The premature delivery of the first twin took place, with unfortunate outcome. The second twin was left in utero. The management, at first, included combination of expectant attitude with a close monitoring of maternal constants and analysis, and administration of antibiotics; in a second step, after discarding intraamniotic infection, a McDonald cerclage was performed with success. At 37 weeks the cerclage was removed and after Oxytocin induction, a healthy baby was born. Conclusion: Delayed delivery of the second fetus in a twin pregnancy is an effective management choice. The use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. The behaviour in these unusual cases should be assessed individually, due to the scarce literature on the matter and the lack of unanimous protocols. But, always considering the maternal and fetal status, trying to improve perinatal results with a strict maternal surveillance to discard the appearance of a possible intraamniotic infection.
{"title":"Beating the Record: 157 Days of Delayed Delivery of The Second Fetus in a Twin Pregnancy","authors":"Lourdes Sala Climent, D. Borniquel Agulló, F. Xavier González Tallada, I. Llordella Sarmiento, Javier Medrano Juárez, M.J. Pelegay Escartín, N. Redondo López","doi":"10.31487/j.crogr.2020.01.06","DOIUrl":"https://doi.org/10.31487/j.crogr.2020.01.06","url":null,"abstract":"Case Report: We present the case of a diamniotic-dichorionic twin pregnancy of 14+4 weeks with obstetric\u0000history of cervical incompetence. The premature delivery of the first twin took place, with unfortunate\u0000outcome. The second twin was left in utero. The management, at first, included combination of expectant\u0000attitude with a close monitoring of maternal constants and analysis, and administration of antibiotics; in a\u0000second step, after discarding intraamniotic infection, a McDonald cerclage was performed with success. At\u000037 weeks the cerclage was removed and after Oxytocin induction, a healthy baby was born.\u0000Conclusion: Delayed delivery of the second fetus in a twin pregnancy is an effective management choice.\u0000The use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. The\u0000behaviour in these unusual cases should be assessed individually, due to the scarce literature on the matter\u0000and the lack of unanimous protocols. But, always considering the maternal and fetal status, trying to improve\u0000perinatal results with a strict maternal surveillance to discard the appearance of a possible intraamniotic\u0000infection.","PeriodicalId":416165,"journal":{"name":"Case Reports in Obstetrics Gynecology and Reproductive","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131831461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-06DOI: 10.31487/j.crogr.2020.01.04
A. Lee-Winn, Charlotte V. Farewell, Claire Ulrickson, Grace Undis, J. Leiferman, J. Huberty
Objective: Pilot data was collected to examine providers’ beliefs, knowledge, self-efficacy, barriers, and practices related to perinatal depression and how they may differ across provider types. Background: High prevalence and detrimental impact of depression during pregnancy and the first year postpartum (i.e. perinatal period) on maternal and child health outcomes highlights the need for improving diagnosis and treatment during this critical period. Healthcare providers play a significant role in helping to identify and manage perinatal depression. Methods: Ninety-nine providers (e.g. physicians, nurses, mental health workers, public health practitioners) who provide care to pregnant women in Colorado completed a 64-item online survey. Results: Although 94% of providers reported it was their responsibility to recognize perinatal depression, variations across specialties with regards to responsibility to treat were found. Most providers (91%) reported use of a screening tool for depression, 60% of providers provide counseling on perinatal depression, and 80% of providers refer patients for treatment of perinatal depression on at least a monthly basis. Significant differences in knowledge, self-efficacy, current practices, and perceived patient barriers were found across provider specialties. Conclusion: These findings highlight the need for expansion of online training programs to increase awareness of mental health resources in the community, improve confidence related to diagnosis and treatment of perinatal mood disorders, and to enhance communication between mental health specialists and healthcare providers in order to effectively identify and manage maternal depression.
{"title":"Identification and Management of Perinatal Depression: Differences between Healthcare Providers","authors":"A. Lee-Winn, Charlotte V. Farewell, Claire Ulrickson, Grace Undis, J. Leiferman, J. Huberty","doi":"10.31487/j.crogr.2020.01.04","DOIUrl":"https://doi.org/10.31487/j.crogr.2020.01.04","url":null,"abstract":"Objective: Pilot data was collected to examine providers’ beliefs, knowledge, self-efficacy, barriers, and\u0000practices related to perinatal depression and how they may differ across provider types.\u0000Background: High prevalence and detrimental impact of depression during pregnancy and the first year\u0000postpartum (i.e. perinatal period) on maternal and child health outcomes highlights the need for improving\u0000diagnosis and treatment during this critical period. Healthcare providers play a significant role in helping to\u0000identify and manage perinatal depression.\u0000Methods: Ninety-nine providers (e.g. physicians, nurses, mental health workers, public health practitioners)\u0000who provide care to pregnant women in Colorado completed a 64-item online survey.\u0000Results: Although 94% of providers reported it was their responsibility to recognize perinatal depression,\u0000variations across specialties with regards to responsibility to treat were found. Most providers (91%)\u0000reported use of a screening tool for depression, 60% of providers provide counseling on perinatal depression,\u0000and 80% of providers refer patients for treatment of perinatal depression on at least a monthly basis.\u0000Significant differences in knowledge, self-efficacy, current practices, and perceived patient barriers were\u0000found across provider specialties.\u0000Conclusion: These findings highlight the need for expansion of online training programs to increase\u0000awareness of mental health resources in the community, improve confidence related to diagnosis and\u0000treatment of perinatal mood disorders, and to enhance communication between mental health specialists and\u0000healthcare providers in order to effectively identify and manage maternal depression.","PeriodicalId":416165,"journal":{"name":"Case Reports in Obstetrics Gynecology and Reproductive","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129769838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-22DOI: 10.31487/j.crogr.2020.01.02
Fang Yang, Xiaoqiu Chen, Yu Zhu, Shubin Wang
Ovarian cancer is the most lethal gynecological malignancy. Because of the lack of specific clinical symptoms, approximately 70% of women diagnosed with the disease have metastases beyond the regional lymph nodes. The most common metastatic sites of ovarian cancer are peritoneum, liver and lung, while brain metastasis that indicates a worse prognosis is rarely seen. This is a case report of a 73-year-old woman who was initially diagnosed with stage IIIC ovarian cancer and developed brain metastasis 10 years later. After surgical treatment and chemotherapy, the quality of life of the patient was significantly improved, and the survival time was prolonged.
{"title":"A Case of Brain Metastasis of Ovarian Cancer in the Elderly","authors":"Fang Yang, Xiaoqiu Chen, Yu Zhu, Shubin Wang","doi":"10.31487/j.crogr.2020.01.02","DOIUrl":"https://doi.org/10.31487/j.crogr.2020.01.02","url":null,"abstract":"Ovarian cancer is the most lethal gynecological malignancy. Because of the lack of specific clinical\u0000symptoms, approximately 70% of women diagnosed with the disease have metastases beyond the regional\u0000lymph nodes. The most common metastatic sites of ovarian cancer are peritoneum, liver and lung, while\u0000brain metastasis that indicates a worse prognosis is rarely seen. This is a case report of a 73-year-old woman\u0000who was initially diagnosed with stage IIIC ovarian cancer and developed brain metastasis 10 years later.\u0000After surgical treatment and chemotherapy, the quality of life of the patient was significantly improved, and\u0000the survival time was prolonged.","PeriodicalId":416165,"journal":{"name":"Case Reports in Obstetrics Gynecology and Reproductive","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131689947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-31DOI: 10.31487/j.crogr.2019.01.04
A. Dua, Arzoo Amin, Z. Amin
Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This life-threatening condition has been historically managed in various ways as no single modality is reliable enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but requiring Surgical management later on. Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP. HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman required surgical management 10 weeks after the initial management, but the blood loss was minimal. Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be considered even with high HCG levels. Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is crucial. Medical management can be considered in most cases even with high HCG, but management has to be tailored according to the patient. Close follow up of patient after Medical treatment is important as they may require further intervention.
{"title":"Live Cesarean Scar Pregnancy: A Case Report","authors":"A. Dua, Arzoo Amin, Z. Amin","doi":"10.31487/j.crogr.2019.01.04","DOIUrl":"https://doi.org/10.31487/j.crogr.2019.01.04","url":null,"abstract":"Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This\u0000life-threatening condition has been historically managed in various ways as no single modality is reliable\u0000enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but\u0000requiring Surgical management later on.\u0000Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP.\u0000HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The\u0000treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman\u0000required surgical management 10 weeks after the initial management, but the blood loss was minimal.\u0000Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial\u0000misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally\u0000invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be\u0000considered even with high HCG levels.\u0000Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is\u0000crucial. Medical management can be considered in most cases even with high HCG, but management has\u0000to be tailored according to the patient. Close follow up of patient after Medical treatment is important as\u0000they may require further intervention.","PeriodicalId":416165,"journal":{"name":"Case Reports in Obstetrics Gynecology and Reproductive","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134574479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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