Case Reports in Obstetrics and Gynecology最新文献

Introduction: Intrauterine devices (IUDs), both hormonal and nonhormonal, are widely used contraceptive methods, with approximately 20% of reproductive-aged women worldwide utilizing them. Although IUDs are generally considered safe and effective, complications such as displacement and migration can occur. We report a rare case of copper IUD migration into a cesarean section scar niche.

Case presentation: A 28-year-old woman presented to the emergency department with complaints of lower abdominal pain and abnormal vaginal bleeding. She had received a T-shaped copper IUD 2 years prior. Transvaginal ultrasound revealed an inverted IUD within the endometrial cavity, with one arm embedded in the cesarean scar defect. The device was successfully removed via hysteroscopy without complication.

Conclusion: This case highlights the importance of imaging evaluation in symptomatic IUD users with a history of cesarean delivery.

Cesarean scar isthmocele (CSI) is a defect in the anterior myometrial wall of the uterine isthmus, at the site of a previous cesarean scar, and can be associated with menorrhagia in the form of prolonged menstrual bleeding or spotting, dysmenorrhea, and/or secondary subfertility. We report a case of hysteroscopic morcellation of CSI with a subsequent successful pregnancy. A 37-year-old female with menorrhagia since cesarean delivery and secondary subfertility, with midcycle transvaginal sonogram (TVS) showing a CSI with associated endometrial cavity fluid (ECF) as well as a small endometrial polyp, underwent hysteroscopic revision of the CSI and polypectomy via a tissue removal system. Postoperatively, menorrhagia had resolved, and follow-up midcycle TVS imaging showed no ECF. The patient spontaneously conceived 3 months after surgery and achieved a successful pregnancy. The use of a hysteroscopic tissue removal system is a feasible approach to the revision of CSI. Larger studies are necessary in order to determine efficacy for fertility patients.

Introduction: Müllerian agenesis, also known as vaginal agenesis, Müllerian aplasia, or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is a rare developmental disorder affecting one in 5000 female births, resulting from an error in Müllerian duct fusion during fetal development.

Case report: We present a clinical case of a 46-year-old female patient, virgo intacta, with Müllerian agenesis and a leiomyoma arising from remnant uterine buds. The patient presented with primary amenorrhoea, continuous lower abdominal pain, and abdominal distension. We describe the diagnostic process and treatment strategy.

Discussion: MRKH syndrome is the leading cause of vaginal agenesis, often accompanied by uterine and cervical aplasia. It is categorized into Type 1, which involves symmetric underdevelopment of the Müllerian ducts, and Type 2, characterized by asymmetric malformations of the genital tract and other congenital anomalies. Leiomyomas arising from remnant uterine tissue in MRKH patients are extremely rare. Accurate diagnosis and a carefully planned treatment strategy are essential for managing patients with MRKH syndrome complicated by rare tumors.

Conclusion: In this case, total tumor extirpation with bilateral adnexectomy was the preferred treatment, based on the patient's clinical presentation and diagnosis.

Introduction: Mullerian anomalies alone are not an indication for prophylactic and history indicated cerclage (HIC). Data on the use of cerclage for patients with mullerian anomalies is therefore limited to case reports of ultrasound indicated cerclage (UIC) and physical exam indicated cerclage (PIC). Given these limitations, there is a hesitancy towards cerclage use in this subset of patients. This case report aims to highlight that HIC is a safe and effective intervention for patients with mullerian anomalies and a history of cervical insufficiency (CI).

Case: We present a case of a patient with uterine didelphys and a history of CI that underwent a successful McDonald HIC in a subsequent pregnancy. Surveillance throughout pregnancy was reassuring and the patient delivered preterm at 32 weeks and 0 days' gestation with a favorable final outcome.

Conclusion: Although data is limited regarding cerclage use in patients with mullerian anomalies, this case suggests that a HIC is a low risk and effective intervention that should not be withheld from this subgroup of patients.

For patients with ectopic ovaries undergoing in vitro fertilization-embryo transfer, transabdominal ovarian puncture remains necessary for selected cases. Despite advancements in the procedure, transabdominal oocyte retrieval demands higher operational skills compared to transvaginal retrieval. In this study, a retrospective analysis was conducted on the clinical data and treatment process of a patient with a unilateral ectopic ovary, undetectable by vaginal ultrasound, who underwent transabdominal ovarian puncture for oocyte retrieval under the guidance of a vaginal ultrasound probe. By employing a towel clip to grasp and indent the abdominal skin, simulating a vaginal fornix-like structure, the vaginal ultrasound probe was flexibly positioned on the smooth abdominal wall, facilitating the oocyte retrieval process and ensuring its smooth execution. A significant number of oocytes were successfully retrieved, resulting in a successful pregnancy and term live birth. This modified technique, which further optimizes the operational process, is an efficient and reliable method for transabdominal oocyte retrieval.

Introduction: This article describes a case of asymptomatic uterine torsion in the setting of macrosomia and polyhydramnios. While other causes have been reported in the literature, there are no existing cases of uterine torsion associated with fetal macrosomia and polyhydramnios.

Case: This patient had an asymptomatic uterine torsion discovered incidentally during a scheduled repeat cesarean section. A congested vascular lower uterine segment was noticed on entrance into the abdomen. After exteriorization of the uterus, 180° torsion was discovered. If torsion is identified prior to hysterotomy, an attempt can be made to perform detorsion. If unsuccessful, a posterior hysterotomy can be performed to avoid the bilateral uterine vessels. In our case, the torsion was not discovered until after exteriorization of the uterus, so an unintended posterior classical (vertical) uterine hysterotomy was performed to avoid the bilateral uterine vessels.

Conclusion: While prior cases of uterine torsion have had other etiologies for increased size of the gravid uterus, including large fibroids, twins, and malpresentation, the likely cause in this case was fetal macrosomia and polyhydramnios. Uterine torsion should be considered as part of the differential diagnosis for abdominal and pelvic pain in pregnancy, especially with any risk factors, although it may be asymptomatic. Ultrasound, MRI, and, in select cases, CT (outside of pregnancy) can be helpful imaging modalities to evaluate for uterine torsion, but it is often not detected. The finding of a congested vascular lower uterine segment should raise the surgeon's index of suspicion for uterine torsion. Surgical management of uterine torsion in pregnancy includes reducing the torsion when possible or performing a posterior hysterotomy when attempts at reduction are not successful. Prophylactic shortening of the round ligament after delivery may be considered to prevent recurrence, but this technique is not yet validated.

Background: The hydatidiform mole presents as either a complete or partial mole. They are differentiated by morphology, histopathology, karyotype, and the risk of malignancy. Partial hydatidiform moles are the only type of trophoblastic gestational disease associated with the presence of a fetus (with or without positive cardiac response). However, early intrauterine fetal death often occurs with triploidy. Therefore, a partial hydatidiform mole is often misdiagnosed as an incomplete abortion. This case is unique due to the rare occurrence of a partial hydatidiform mole complicated by severe pregnancy-associated cardiomyopathy. To date, only five similar cases have been reported, all describing cardiorespiratory symptoms from left ventricular dysfunction in previously healthy women around abortion induction.

Case report: We present the case of a 19-year-old 1 gravida, 0 para with partial hydatidiform mole and late miscarriage in the 18th week of pregnancy. Abortion induction occurred, followed by severe maternal cardiac complications. The patient developed a pregnancy-associated cardiomyopathy with acute heart failure on the basis of a newly severely restricted biventricular function with dilatation and secondary mitral valve insufficiency, congestion and forward failure led to congestive pneumonia, acute renal failure, and metabolic acidosis. After histological examination of the fetal tissue, a partial mole can be assumed on the basis of the histological findings, immunohistochemistry, and the trisomy of the X chromosome detected by fluorescence in situ hybridization.

Conclusion: In case of a hydatidiform mole, an early diagnosis is essential to prevent serious complications during medical course. Particularly, if cardiac symptoms occur, early diagnosis should be carried out. Close cardiological and gynecological follow-up must be carried out to prevent late complications.

Parasitic myomas (PMs) are rare uterine leiomyomas that exist independently of the uterus. They can result from tissue fragments left behind during laparoscopic uterine procedures or, less commonly, develop spontaneously from pedunculated subserosal leiomyomas that detach and revascularize on extrauterine structures. We present a case of a 37-year-old woman with a history of pedunculated subserosal leiomyoma who presented in the emergency department with acute pelvic pain. Imaging revealed a large pelvic mass separated from the uterus and significant hemoperitoneum. Emergency laparotomy was performed, identifying a large left adnexal mass causing adnexal torsion, with partial pedicle rupture as the bleeding source. Histopathology confirmed a benign leiomyoma in the ovarian parenchyma. This case underscores the importance of considering PMs in the differential diagnosis of acute pelvic pain and provides more insight about the etiology of spontaneous PMs, which are rare entities.

Background: Parasitic fibroids are rare extrauterine leiomyomas that can arise spontaneously or following prior uterine surgery, particularly with morcellation. Their coexistence with ectopic pregnancy is exceptionally rare and presents a unique surgical challenge. We report a rare case of concurrent right tubal ectopic pregnancy, broad ligament fibroid and anterior abdominal wall parasitic fibroid.

Case presentation: A 30-year-old woman (P0 + 2) presented with acute right iliac fossa pain and a serum β-hCG level > 9000 IU/L. She had a history of two prior laparoscopic myomectomies. Transvaginal ultrasound suggested a right adnexal ectopic pregnancy with a large posterior uterine fibroid and free pelvic fluid. Laparoscopy revealed an unruptured right tubal ectopic pregnancy, a fibroid in the broad ligament and a separate parasitic fibroid attached to the anterior abdominal wall. A laparoscopic right salpingectomy, excision of the parasitic fibroid and adhesiolysis were performed. Histology confirmed ectopic pregnancy and parasitic leiomyoma. The patient had an uneventful recovery.

Discussion: The simultaneous occurrence of ectopic pregnancy and parasitic fibroids is highly unusual. Prior myomectomies, especially those involving morcellation, may predispose patients to parasitic fibroid formation through iatrogenic tissue implantation. In this case, distorted pelvic anatomy due to adhesions and fibroids may have contributed to tubal implantation of the embryo. This case highlights the rarity of parasitic fibroids and emphasises the importance of preventive measures during myomectomies, such as contained morcellation to avoid implantation of parasitic fibroids. While intraoperative mindfulness is important, parasitic fibroids are an uncommon finding and are not a routine consideration during common gynaecological presentations, such as ectopic pregnancy.

Conclusion: This case illustrates a rare but significant intersection of fibroid pathology and ectopic pregnancy. Awareness of parasitic fibroids in patients with prior fibroid surgery is essential for surgical planning and optimising reproductive outcomes. Further investigation into the pathophysiological mechanisms linking fibroid surgery to altered fertility and ectopic gestation is warranted.

Fetal goitrous hypothyroidism is associated with important obstetrical complications including preterm birth, polyhydramnios, respiratory disorders, and neurodevelopmental impairments. There are currently no standard treatment guidelines for fetal goitrous hypothyroidism, and further studies are needed to help establish treatment guidelines. We report a case of a healthy 41-year-old female whose fetus was diagnosed with fetal goiter at 20 weeks gestation. The patient underwent weekly intra-amniotic infusions of levothyroxine, and the fetal goiter resolved by 30 weeks gestation. The infant was delivered vaginally at 36 weeks with no evidence of goiter on physical exam and diagnosed with congenital hypothyroidism upon follow-up with pediatric endocrinology. Both mother and infant are doing well today with the infant showing no signs of neurodevelopmental impairment. This case demonstrates that intra-amniotic infusion of levothyroxine for fetal goiter may improve perinatal outcomes.