Case Reports in Obstetrics and Gynecology最新文献

英文中文

Bilateral Ovarian Serous Borderline Tumor with Non-Invasive Endometrial Implants. 双侧卵巢浆液性交界性肿瘤伴无创子宫内膜植入物。

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2023-01-01 DOI: 10.1155/2023/4845887

Melissa Bou Malham, Jordy Mehawej, Andreas Filippaios, Christina Kushnir, Paulette Mhawech-Fauceglia

Herein, we are presenting a case of a 33-year-old woman who presented to the emergency department complaining of persistent lower abdominal pain of one-day duration. Physical examination revealed abdominal tenderness with right lower quadrant rebound tenderness. Computed tomography abdomen/pelvis showed a 6 cm possible necrotic mass of the left ovary with moderate amount of complex ascites. A laparoscopic left oophorectomy with bilateral salpingectomy, right ovarian biopsy, and appendectomy were performed without complications. The cut surface of the left ovary showed a 9.7 cm × 8 cm × 4 cm ovarian mass, and the cut surface revealed multiple gray-tan friable papillary excrescence. Microscopic evaluation showed findings consistent with left and right ovarian serous borderline tumor (SBT). Subsequently, a tumor staging was conducted with total laparoscopic hysterectomy, pelvic and periaortic lymph node dissection, and omentectomy. The endometrium sections showed several small foci of SBT within the endometrial stroma, consistent with non-invasive implants of the endometrium. The omentum and lymph nodes were all negative for malignancy. SBTs associated with endometrial implants are very rare with only one case reported in the literature. Their existence can cause diagnostic challenges, and they should be acknowledged for early diagnosis and to plan for patient's treatment and outcome.

在此，我们提出的情况下，一个33岁的妇女谁提出了急诊科抱怨持续的下腹部疼痛一天的时间。体格检查发现腹部压痛并右下腹反跳痛。腹部/骨盆计算机断层扫描显示左侧卵巢可能有6厘米坏死肿块，伴中度复杂腹水。腹腔镜左卵巢切除术合并双侧输卵管切除术、右卵巢活检和阑尾切除术均无并发症。左侧卵巢切面可见9.7 cm × 8 cm × 4 cm卵巢肿块，切面可见多发灰褐色易碎乳头状赘生物。镜检显示左、右卵巢浆液交界性肿瘤(SBT)。随后，通过全腹腔镜子宫切除术、盆腔和腹主动脉周围淋巴结清扫和网膜切除术对肿瘤进行分期。子宫内膜切片显示子宫内膜间质内有几个小的SBT灶，与子宫内膜非侵入性植入一致。网膜及淋巴结均为阴性。与子宫内膜植入相关的sbt是非常罕见的，文献中只有一例报道。它们的存在可能会导致诊断上的挑战，它们应该在早期诊断中得到承认，并为患者的治疗和结果制定计划。

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引用次数: 0

Meckel's Diverticulum: The “Great Mimic” but Often a Forgotten Cause of Acute Abdomen during Pregnancy 梅克尔憩室:“伟大的模仿者”，但经常被遗忘的原因急性腹部在怀孕期间

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-06-07 DOI: 10.1155/2022/2383075

Beatriz Féria, M. Trindade, M. J. Palma, J. Figueiredo, F. Passos

Meckel's diverticulitis is an extremely rare event during pregnancy. Its diagnosis is often difficult and can result in higher maternal and fetal morbimortality. We describe a case of a 40-year-old healthy pregnant woman at 33 weeks of gestation who presented with abdominal pain and tender abdomen, leukocytosis, and elevated PCR. The imagiological exams were not conclusive. After an urgent caesarean section due to worsening of clinical status and nonreassuring fetal well-being, a laparotomy revealed a distended, necrotic, and perforated Meckel's diverticulum.

梅克尔氏憩室炎在怀孕期间极为罕见。它的诊断通常很困难，并可能导致更高的孕产妇和胎儿死亡率。我们描述了一例40岁的健康孕妇在妊娠33周谁提出腹痛和腹部压痛，白细胞增多，和PCR升高。影像学检查没有结论。由于临床状况恶化和胎儿健康状况不稳定，在紧急剖腹产后，剖腹检查发现梅克尔憩室膨胀、坏死和穿孔。

引用次数: 2

Association of Beta-Thalassaemia and Hypogonadotropic Hypogonadism 地中海贫血与促性腺功能减退症的关系

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-05-19 DOI: 10.1155/2022/4655249

A. Vidal, C. Dhakal

Thalassaemic syndromes are among the most common haemoglobinopathies and are associated with high morbidity and mortality. Because of the various treatments, a secondary endocrinopathy due to iron overload—haemosiderosis—can occur, causing hypopituitarism leading to hypogonadotropic hypogonadism (HH) and infertility. We present a case of secondary amenorrhoea in a patient with beta-thalassaemia and a history of multiple therapies in her adolescence, such as multiple transfusions, chemotherapy, and allogeneic bone marrow transplantation, who presented with HH and premature ovarian insufficiency.

地中海贫血综合征是最常见的血红蛋白病之一，与高发病率和高死亡率有关。由于不同的治疗方法，可发生由铁超载引起的继发性内分泌病变- - -血红素沉着病，引起垂体功能减退，导致促性腺功能减退(HH)和不孕。我们报告了一个继发性闭经的病例，该患者患有-地中海贫血，并在其青春期有多种治疗史，如多次输血，化疗和异基因骨髓移植，她表现为HH和卵巢早衰。

引用次数: 2

Rotational Thromboelastometry-Guided Venoarterial Extracorporeal Membrane Oxygenation in the Treatment of Amniotic Fluid Embolism. 旋转血栓弹力仪引导静脉动脉体外膜肺氧合治疗羊水栓塞。

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-05-18 eCollection Date: 2022-01-01 DOI: 10.1155/2022/9658708

Jillian K Wothe, Elizabeth Elfstrand, Michael R Mooney, Donald D Wothe

Amniotic fluid embolism (AFE) is a rare and often fatal complication of pregnancy that occurs during the puerperium. The low incidence of AFE has resulted in few large studies, which makes evidence-based management of AFE challenging. The use of extracorporeal membrane oxygenation (ECMO) has been reported but is limited by availability and challenges managing anticoagulation. In this report, we detail the case of a 29-year-old female who suffered from an AFE leading to cardiac arrest and disseminated intravascular coagulopathy. She was treated with protocolized A-OK (adenosine, ondansetron, and ketorolac), emergency c-section, cardiopulmonary resuscitation, massive blood transfusion, and rotational thromboelastometry-guided ECMO, allowing her to forgo initial anticoagulation. After a prolonged rehabilitation with initial poor neurological status, she made a complete recovery. In this report, we describe the protocols that contributed to her recovery and detail management of complicated AFE for other clinicians.

羊水栓塞（AFE）是发生在产褥期的一种罕见且经常致命的妊娠并发症。AFE的低发病率导致很少有大型研究，这使得AFE的循证管理具有挑战性。体外膜肺氧合（ECMO）的使用已有报道，但受到抗凝治疗的可用性和挑战的限制。在本报告中，我们详细介绍了一名29岁女性的病例，她患有AFE，导致心脏骤停和弥漫性血管内凝血病。她接受了原协议A-OK（腺苷、昂丹司琼和酮咯酸）、紧急剖腹产、心肺复苏、大量输血和旋转血栓弹性测量术指导的ECMO治疗，从而放弃了最初的抗凝治疗。经过长期的康复和最初的神经系统状况不佳，她完全康复了。在本报告中，我们描述了有助于她的康复的方案，并为其他临床医生详细管理复杂的AFE。

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引用次数: 1

A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage 子宫动脉栓塞治疗产后出血后子痫前期合并子宫坏死1例

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-05-17 DOI: 10.1155/2022/2859766

Midori Yoshikawa, T. Seyama, T. Iriyama, S. Sayama, T. Fujii, Masatake Toshimitsu, Moto Nakaya, R. Kurokawa, Eisuke Shibata, T. Watadani, K. Kumasawa, T. Nagamatsu, K. Koga, Y. Osuga

Uterine necrosis is a rare complication in uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Preeclampsia (PE) is a condition characterized with systemic endothelial damage and intravascular volume depletion. Whether a patient with PE is at high risk for uterine necrosis after UAE for PPH has been unknown. A 30-year-old primipara woman was diagnosed with PE based on hypertension and proteinuria during delivery. UAE was performed for PPH after forceps delivery. After UAE, the patient presented with pleural effusion and massive ascites as well as persistent fever unresponsive to antibiotics. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) led to the diagnosis of uterine necrosis, for which we performed total laparoscopic hysterectomy. It should be kept in mind that patients with PE associated with massive ascites may be at high risk for uterine necrosis after UAE due to decreased uterine perfusion. Therefore, it is important to pay attention to persistent symptoms such as fever and abdominal pain after UAE to diagnose uterine necrosis.

子宫坏死是子宫动脉栓塞治疗产后出血(PPH)的一种罕见并发症。先兆子痫(PE)是一种以全身内皮损伤和血管内容量减少为特征的疾病。PE患者在PPH UAE后是否有子宫坏死的高风险尚不清楚。一位30岁初产妇在分娩时因高血压和蛋白尿被诊断为PE。产钳分娩后PPH行UAE。UAE后，患者出现胸腔积液和大量腹水以及持续发热，对抗生素无反应。超声检查和增强磁共振成像(MRI)导致子宫坏死的诊断，为此我们进行了全腹腔镜子宫切除术。需要注意的是，PE合并大量腹水的患者，由于子宫灌注减少，UAE后子宫坏死的风险较高。因此，要注意UAE后持续出现发热、腹痛等症状，以诊断子宫坏死。

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引用次数: 1

More than an Incidentaloma: The Nonreportable NIPT 不只是偶发瘤:不可报告的NIPT

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-04-30 DOI: 10.1155/2022/2496057

Allison M Jay, Brian Mason, D. Lebovic, P. Chuba

Noninvasive prenatal testing (NIPT), which utilizes a maternal blood sample to detect fetal gender and screen for fetal aneuploidy (abnormal chromosomes), is widely used in obstetrics to screen for Trisomies 21, 18, and 13. Per the literature, approximately 0.3% of pregnant woman's results are nonreportable. Reasons include low fetal fraction, insufficient DNA, vanishing twin, twin pregnancy, clonal mosaicism, and maternal neoplasia. Here, we describe a 25-year-old G2P1 pregnant woman who had two nonreportable NIPT results and subsequently was diagnosed with lymphoma. We discuss the importance of clinical exam in correlation with the results to offer comprehensive evaluation of the patient with a nonreportable finding, given malignancy occurs in 1/1000 pregnant women. This report overviews proposed management guidelines for pregnant women with a nonreportable result and helps to address discomfort the treating physician may feel in discussing this result with their patient.

无创产前检测(NIPT)利用母体血液样本检测胎儿性别并筛查胎儿非整倍体(异常染色体)，广泛用于产科筛查21、18和13三体。根据文献，大约0.3%的孕妇的结果是不可报告的。原因包括胎儿分数低、DNA不足、双胞胎消失、双胎妊娠、克隆嵌合和母体肿瘤。在这里，我们描述了一位25岁的G2P1孕妇，她有两个不可报告的NIPT结果，随后被诊断为淋巴瘤。鉴于恶性肿瘤发生率为1/1000孕妇，我们讨论了临床检查的重要性与结果的相关性，以提供对未报告发现的患者的全面评估。本报告概述了未报告结果的孕妇的建议管理指南，并有助于解决治疗医生在与患者讨论这一结果时可能感到的不适。

引用次数: 0

Appearances Are Deceptive: Two Case Reports in Teenagers on the Conservative Laparoscopic Surgery for Adnexal Torsion with Apparent Infarction 外表具有欺骗性:两例青少年保守腹腔镜手术治疗伴有明显梗死的附件扭转

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-04-27 DOI: 10.1155/2022/1798599

A. Jayawardane, M. Patabendige, C. Gunathilaka

Introduction. Torsion of the ovary, tube, or both is estimated to be responsible for 2-7% of all gynaecological emergencies. Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. Case Presentations. We report two cases of teenage girls presented with adnexal torsion describing their laparoscopy features. Detorsion without additional surgical intervention could save their ovaries. Discussion. Detorsion is a more conservative surgical approach that should be considered in all younger women with ovarian torsion.

介绍。卵巢、输卵管或两者的扭转估计占所有妇科急诊的2-7%。卵巢切除术通常用于附件扭转，可能对育龄妇女的生育能力产生负面影响。例演示。我们报告两例十几岁的女孩提出附件扭转描述他们的腹腔镜特征。不加手术干预的卵巢扭曲可以挽救卵巢。讨论。卵巢扭转是一种更保守的手术方法，应考虑所有卵巢扭转的年轻女性。

引用次数: 0

Atypical Eclampsia in a Pregnant Woman Infected by COVID-19 COVID-19感染孕妇的非典型子痫

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-04-27 DOI: 10.1155/2022/9952355

M. A. Odeh, Yousef S. Abuzneid, Omar Badareen, Khaled Masarweh

The coronavirus disease 2019, also called (COVID-19), is an infectious disease which is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first report was in December 2019, and on March 12, 2020, the World Health Organization (WHO) declared this disease a pandemic. COVID-19 targets many major organs causing life-threatening systemic complications. It can cause lung damage and respiratory failure in addition to systemic inflammation and immune dysregulation. Hypercoagulable state and numerous neurological abnormalities also have been reported due to this condition. Going through the literature review, we found some cases of pregnant women with novel coronavirus infection, being mostly mild illnesses, and most of these cases were focused on maternal-fetal transmission and neonatal outcomes. In this case report, we present the case of a COVID-19 positive woman who came to our emergency department at 34 weeks of gestation with tonic-clonic seizures. This case was a challenge for us because we faced a new an unknown manifestation of both COVID and eclampsia.

2019冠状病毒病，也被称为(COVID-19)，是一种由一种名为“严重急性呼吸综合征冠状病毒2”(SARS-CoV-2)的病毒引起的传染病。第一份报告于2019年12月发布，2020年3月12日，世界卫生组织(世卫组织)宣布该疾病为大流行。COVID-19针对许多主要器官，导致危及生命的系统性并发症。除了全身炎症和免疫失调外，它还会导致肺损伤和呼吸衰竭。高凝状态和许多神经异常也已报道，由于这种情况。通过文献查阅，我们发现一些孕妇感染新型冠状病毒的病例，多为轻症，且多集中在母婴传播和新生儿结局上。在本病例报告中，我们报告了一例COVID-19阳性妇女，她在妊娠34周时因强直阵挛发作来到我们的急诊科。这个病例对我们来说是一个挑战，因为我们面临着新冠肺炎和子痫的未知表现。

引用次数: 2

A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy 妊娠晚期分离性碱性磷酸酶显著升高1例

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-04-27 DOI: 10.1155/2022/1611304

Courtney T Connolly, Olivia Grubman, Zainab Al-ibraheemi, Tatyana Kushner

Background Alkaline phosphatase (ALP) is an enzyme produced by the liver, small intestine, bone, and kidneys as well as the placenta during pregnancy. ALP levels may increase up to twice the normal limit during pregnancy secondary to placental release and fetal bone growth. Rare case reports of extremely elevated levels of ALP during pregnancy have demonstrated possible association with adverse pregnancy outcomes. Case The patient is a 36-year-old G2P1001 who was found to have extremely elevated ALP levels during pregnancy after presenting with bilateral lower leg swelling and rash after receiving the Pfizer COVID-19 vaccine. She subsequently developed intrahepatic cholestasis of pregnancy and preeclampsia. ALP peaked at 2,601 U/L immediately prior to delivery at 36 weeks 1 day. She was followed postpartum, and her ALP levels had nearly normalized by 15 weeks postpartum. Conclusion Our case demonstrates a rare report of an extremely elevated level of ALP in the setting of multiple adverse pregnancy outcomes, including preterm delivery, preeclampsia without severe features, and intrahepatic cholestasis of pregnancy.

碱性磷酸酶(ALP)是一种由肝脏、小肠、骨骼、肾脏以及胎盘在妊娠期间产生的酶。妊娠期间，由于胎盘释放和胎儿骨骼生长，ALP水平可增加至正常限度的两倍。妊娠期间ALP水平极高的罕见病例报告已证明可能与不良妊娠结局有关。患者为36岁的G2P1001，在接受辉瑞COVID-19疫苗后出现双侧小腿肿胀和皮疹，妊娠期间发现ALP水平异常升高。随后出现妊娠期肝内胆汁淤积和子痫前期。分娩前36周1天的ALP峰值为2,601 U/L。产后随访，到产后15周时ALP水平基本恢复正常。结论:本病例是一例罕见的ALP水平极高的妊娠不良结局，包括早产、无严重特征的先兆子痫和妊娠肝内胆汁淤积。

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引用次数: 1

Challenging Obstetrical Management in Generalized Peritonitis during Pregnancy 妊娠期广泛性腹膜炎的产科管理挑战

Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Obstetrics and Gynecology

Pub Date : 2022-04-21 DOI: 10.1155/2022/1249676

S. Oliveira, A. Sousa, N. N. Martins

Acute abdomen in pregnancy represents a diagnostic and therapeutic challenge, despite the current advances in modern medicine, since the typical symptoms and altered laboratory parameters mimic normal pregnancy. Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy, with an incidence of 1 per 500-2000 pregnancies. Delayed diagnosis and reluctance to operate on a pregnant woman predispose to adverse maternal and fetal outcomes. The elective termination of pregnancy or interventions to prolong it in the presence of appendicitis is controversial. We present a case of a 38-year-old Caucasian woman, G2P0, admitted to the Obstetric Emergency Department at 13 4/7 weeks of gestation with a primary complaint of severe nausea and vomiting associated with progressive diffuse abdominal pain which had started 7 days before. After the difficulty of inherent differential diagnosis, she was diagnosed with generalized peritonitis due to acute perforated appendicitis. Prompt exploratory laparotomy with appendectomy and drainage of multiple abscesses were performed. Conservative obstetrical management was assumed, with subsequent periodic monitoring of the fetal focus. Due to abdominal compartment syndrome, the abdomen was left open for 4 days. After 7 days in the intensive care unit, recovery was favorable, pregnancy remained uneventful, and a healthy full-term baby was born 27 weeks later. This case represents a successful example of how the cooperation of the obstetrics and general surgery teams and the decision of conservative obstetrical management in the surgical environment contributed to optimizing maternal health, achieving the best obstetrical outcome.

尽管现代医学取得了进展，但妊娠期急腹症是一项诊断和治疗挑战，因为典型症状和改变的实验室参数与正常妊娠相似。急性阑尾炎是妊娠期间最常见的非产科外科急诊，发病率为每500-2000例妊娠中有1例。延迟诊断和不愿对孕妇进行手术易导致不良的母体和胎儿结局。选择性终止妊娠或干预延长它的存在阑尾炎是有争议的。我们报告一例38岁白人妇女，G2P0，于妊娠13 /7周入院产科急诊科，主要主诉为严重恶心和呕吐，并伴有7天前开始的进行性弥漫性腹痛。在固有鉴别诊断困难后，诊断为急性穿孔性阑尾炎所致全身性腹膜炎。及时行剖腹探查、阑尾切除及多发脓肿引流术。采取保守的产科治疗，随后定期监测胎儿病灶。由于腹膜间室综合征，腹部开放4天。在重症监护室呆了7天后，恢复良好，怀孕过程顺利，27周后，一个健康的足月婴儿出生了。本病例是一个成功的例子，说明产科和普外科团队的合作以及手术环境下保守产科管理的决定如何有助于优化产妇健康，实现最佳产科结果。

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