Case Reports in Obstetrics and Gynecology最新文献

Background: Growing teratoma syndrome (GTS) is a rare condition characterized by the enlargement of metastatic masses during or after chemotherapy for malignant germ cell tumors (GCTs), despite normalized tumor marker levels. It is defined by three criteria: (1) enlarging or new masses during or after chemotherapy, (2) normal tumor marker levels, and (3) histological presence of only mature teratoma elements. Differentiating GTS from recurrent immature teratoma is challenging, as both conditions may present similarly in imaging and tumor marker profiles.

Case presentation: We report the case of a 20-year-old woman diagnosed with a mixed ovarian GCT, consisting of grade 2 immature teratoma and yolk sac tumor. After undergoing right salpingo-oophorectomy and chemotherapy, she remained in remission for 4 years. Follow-up imaging revealed enlarged para-aortic lymph nodes. Due to normal tumor markers and a lack of response to chemotherapy, the condition was initially diagnosed as GTS, prompting surgical resection of the lymph nodes. Histopathological analysis, however, revealed immature neuroepithelial elements consistent with grade 3 immature teratoma, contradicting the GTS diagnosis. The final diagnosis was revised to recurrent immature teratoma.

Conclusion: This case highlights the diagnostic challenges in distinguishing between GTS and recurrent immature teratoma. While normal tumor markers and tumor growth following chemotherapy may suggest GTS, histopathological confirmation is essential. Clinicians should maintain a high index of suspicion for recurrent immature teratoma in cases mimicking GTS and consider surgical resection for definitive diagnosis. Multidisciplinary evaluation remains crucial in the management of ovarian GCTs.

Background: Although a nuchal cord is a common observation, multiple nuchal cord loops are rare. A few reports suggest that multiple nuchal cords are associated with adverse perinatal outcomes, such as cesarean or operative vaginal deliveries for fetal distress and neonatal asphyxia. However, there are controversies regarding antenatal detection and perinatal management of multiple nuchal cord loops. Herein, we report a case of live vaginal birth with septuple nuchal cords demonstrating a distinct pattern of fetal heart rate evolution during labor.

Case presentation: A 31-year-old primigravida was referred to our facility at 34 weeks of gestation with multiple nuchal cords. Transabdominal ultrasonography revealed a three-vessel cord with extreme loops around the fetal neck. The antenatal course was uneventful with appropriate fetal growth, amniotic fluid index, and reactive nonstress testing until the last checkup. The patient underwent labor at 38 weeks of gestation. The admission test on the fetal heart rate tracing indicated nonrecurrent but mild variable decelerations with an "atypical" feature. Subsequently, there were recurrent, severe decelerations and an elevation of the baseline rate during the second stage of labor. The patient delivered a male infant, weighing 2455 g (10.5 percentile of normal weight) vaginally via vacuum extraction. The umbilical arterial gas analysis at birth showed a pH of 7.31, a partial pressure of oxygen of 23.4 mmHg, a base excess of -6.4, and 1/5-min Apgar scores of 8/9. The cord was 112 cm long with septuple nuchal cords.

Conclusions: As umbilical cord abnormalities have a risk of fetal heart rate compromise in the prelabor or first stage of labor, prenatal detection of umbilical cord pathology may be beneficial for the early recognition of potential fetal compromise and prompt decision-making for operative intervention.

Vaginal evisceration is a very rare complication after a hysterectomy, and it can have extremely dire health consequences. We present a case of a 65-year-old female with a past medical history significant for obesity, pelvic organ prolapse, and rheumatoid arthritis-treated with chronic oral steroids-who presented with transvaginal small bowel evisceration more than 20 years after a total vaginal hysterectomy. The patient underwent emergent exploratory laparotomy with reduction of the bowel and reclosure of her vaginal cuff. The patient's postoperative course was complicated by bowel ischemia and subsequent bowel resection. We report this case to bring awareness to risk factors associated with vaginal evisceration; early diagnosis of this dangerous hysterectomy sequelae is vital to prevent life-threatening bowel ischemia.

[This corrects the article DOI: 10.1155/crog/1329744.].

Background: Postpartum hemorrhage (PPH) complicates 3%-5% of deliveries. Uterine atony is the most common cause of PPH, and there are several interventions that can be used to improve atony, including uterine massage, uterotonics, and intrauterine balloons. The intrauterine vacuum-induced hemorrhage-control device is a suction device that is placed in the lower uterine segment, which creates negative pressure on the myometrium to induce myometrial contraction. Case: The patient was a 37-year-old G3P1011 female with chronic hypertension who presented for induction of labor at term. Spontaneous rupture of membranes occurred several hours later with simultaneous placental abruption leading to DIC. Urgent cesarean section was performed for fetal distress remote from delivery. Massive transfusion protocol was initiated, and an intrauterine vacuum-induced hemorrhage-control device was placed intravaginally in an attempt to control blood loss. However, rather than acting as a tamponade, the device appeared to draw out a great blood loss with its suction. The patient underwent bilateral uterine artery embolization, and the device was replaced with an intrauterine balloon. Patient was transferred to the ICU, and blood products were transfused until the patient was stabilized. Conclusion: While a preliminary study appeared to show the safety and efficacy of the intrauterine vacuum-induced hemorrhage-control device, its use was limited to uterine hemorrhage secondary to uterine atony. It should be avoided in cases of hemorrhage where coagulopathy is suspected.

Ovarian torsion is a gynecological emergency caused by the rotation of an ovary on its supporting ligaments, which can obstruct blood flow and lead to ovarian necrosis if untreated. Typically, torsion is associated with ovaries enlarged by cysts or masses, which increase the likelihood of rotation around the supporting ligaments. Although torsion can also occur in normal ovaries, especially in premenarchal girls with elongated infundibulopelvic ligaments, literature on this occurrence in reproductive-aged women is limited. This report presents two cases of ovarian torsion in normal ovaries, highlighting diagnostic and management challenges. The first case involves a 19-year-old who presented with acute right iliac fossa pain. Ultrasound showed a normal ovary with intact blood flow. However, due to ongoing pain, she underwent laparoscopy, which confirmed a 1.5-twist torsion at the utero-ovarian ligament. Right ovarian detorsion was performed successfully, and her postoperative recovery was uneventful, with follow-up ultrasound showing no abnormalities. The second case describes a 40-year-old woman with a prior hysterectomy, presenting with left iliac fossa pain. Ultrasound showed an enlarged, heterogeneous left ovary (5 × 3.2 × 4.2 cm) with poor blood flow and complex free pelvic fluid, raising suspicion for torsion. Emergency laparoscopy confirmed a 2-twist torsion on the infundibulopelvic ligament. Despite attempts at detorsion, the ovary remained nonviable, leading to left oophorectomy. These cases emphasize that ultrasound and Doppler findings may not reliably detect torsion in normal ovaries. Laparoscopy remains the definitive method for diagnosis and intervention, providing timely treatment that is essential to preserve ovarian function. Clinicians should maintain a high suspicion for torsion in reproductive-aged women with acute abdominal pain, even if imaging is inconclusive, to prevent severe complications. These cases highlight the need for heightened awareness of ovarian torsion in normal ovaries to optimize surgical outcomes and fertility preservation.

Background: Malaria and amoebic infections are considered risk factors for stillbirth and preterm labor, but their coexistence during pregnancy has not been previously reported. Case: We describe the first case of averted maternal mortality with fetal death in utero at 22 weeks' gestation, complicated by both falciparum malaria and hepatic amoebic abscess, in a rural hospital in Burundi. Conclusion: Amoebic liver abscesses are rarely described in pregnancy and, as far as we are aware, never in conjunction with severe malaria: two parasitic infections requiring completely different treatments. We successfully managed this difficult case in a rural context thanks to at least three main factors: staff skills, inventiveness, and advances in ultrasonographic technology.

Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube. While rare, ectopic pregnancies can also occur in atypical locations such as the ovary, cervix, abdominal cavity, or broad ligament, often posing significant diagnostic and therapeutic challenges. We report a highly unusual case of ectopic pregnancy implanted in the left labium majus, a site not previously documented in the literature. A 20-year-old woman presented with abdominal pain, vulvar swelling, and amenorrhea of approximately 4 months. Initial imaging and clinical evaluation did not reveal the ectopic implantation. Diagnosis was made intraoperatively during marsupialization of the vulvar swelling, which revealed a macerated fetus within the left labium majus. This case highlights the importance of maintaining a high index of suspicion for rare ectopic pregnancy sites in patients presenting with unexplained vulvar symptoms and a positive pregnancy test-particularly when imaging is inconclusive. It underscores the critical role of prompt surgical exploration in preventing life-threatening complications and contributes to expanding the clinical spectrum of ectopic pregnancy presentations.

Objective: Splenic ectopic pregnancy is an exceptionally rare and life-threatening form of abdominal ectopic pregnancy, often presenting significant diagnostic and management challenges. We report a case of ruptured splenic ectopic pregnancy initially suspected to be a tubal miscarriage. Case Report: A 36-year-old woman presented with mild left-sided pelvic pain, no vaginal bleeding and a positive pregnancy test. This was an unplanned pregnancy, and she was not sure of her LMP. This presentation in early pregnancy requires ruling out an ectopic pregnancy through clinical assessment and laboratory investigations. Clinical examination showed normal observations and generalized abdominal tenderness with no signs of peritonism. Initial investigations revealed a significantly elevated β-hCG of 24,076 IU/L, and transvaginal ultrasound showed an empty uterus. Given the findings, an ectopic pregnancy was suspected, and diagnostic laparoscopy was performed. During laparoscopy, no ectopic pregnancy was identified in the pelvis, both tubes looked normal, but a left fimbrial cyst was noted, and 300 mL of haemoperitoneum was observed, without active bleeding. A tubal miscarriage was presumed with the plan to follow up β-hCG to confirm resolution of the pregnancy. Postoperatively, the patient developed worsening pain and a significant haemoglobin drop to 97 g/L, inconsistent with the amount of intraoperative blood loss which raised the suspicion of extrapelvic ectopic pregnancy with active bleeding. A contrast-enhanced CT scan identified free blood surrounding the spleen and a 25-mm peripherally enhancing lesion with venous drainage into the splenic vein, consistent with a ruptured splenic ectopic pregnancy. An urgent multidisciplinary team discussion led to surgical management via midline laparotomy and splenectomy. The postoperative course was complicated by ileus, which resolved with conservative management. The patient's β-hCG levels progressively declined, confirming resolution. Conclusion: This case highlights the importance of considering splenic ectopic pregnancy when β-hCG is markedly elevated, and no pelvic ectopic pregnancy is identified. Prompt imaging and diagnosis are crucial to prevent morbidity associated with delayed management.

We report the case of a 57-year-old woman who presented to the gynecological emergency department with an enormous 18 cm submucosal leiomyoma pedunculated through the cervix. She was anemic due to bleeding over the past 2 months. The aim of this study was to highlight the challenges of managing such an unusual clinical scenario. We also describe the preoperative and intraoperative methods that can be used to minimize intraoperative blood loss and improve the safety and feasibility of this kind of surgical procedure. In our case, we decided to perform a vaginal myomectomy after a tourniquet on the pedicle to reduce bleeding.