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.
{"title":"Atypical Eclampsia in a Pregnant Woman Infected by COVID-19","authors":"M. A. Odeh, Yousef S. Abuzneid, Omar Badareen, Khaled Masarweh","doi":"10.1155/2022/9952355","DOIUrl":"https://doi.org/10.1155/2022/9952355","url":null,"abstract":"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.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91066783","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}
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.
{"title":"A Case of Markedly Elevated Isolated Alkaline Phosphatase in the Third Trimester of Pregnancy","authors":"Courtney T Connolly, Olivia Grubman, Zainab Al-ibraheemi, Tatyana Kushner","doi":"10.1155/2022/1611304","DOIUrl":"https://doi.org/10.1155/2022/1611304","url":null,"abstract":"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.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88062125","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}
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.
{"title":"Challenging Obstetrical Management in Generalized Peritonitis during Pregnancy","authors":"S. Oliveira, A. Sousa, N. N. Martins","doi":"10.1155/2022/1249676","DOIUrl":"https://doi.org/10.1155/2022/1249676","url":null,"abstract":"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.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73134580","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}
Catatonia during pregnancy is rare and presents unique challenges due to the potential ramifications to mom and baby of the overall disease state and of potential treatment options. The purpose of this case report is to highlight the complexities in the workup and management of a catatonic patient with concurrent acute obstetric concerns requiring urgent intervention. We report a case of acute catatonia due to underlying major depressive disorder in a patient who presented in spontaneous preterm labor, with a twin pregnancy of unknown chorionicity with no known prenatal care. She underwent an extensive workup with no significant findings on lumbar puncture, brain MRI, metabolic labs, and EEG. After exclusion of several acute underlying conditions, a presumptive diagnosis of catatonia secondary to exacerbation of underlying major depressive disorder was made. She was transferred to an inpatient psychiatric facility postdelivery and treated with a course of lorazepam, aripiprazole, and escitalopram with good effect.
{"title":"Perinatal Catatonia in a Patient with a Twin Pregnancy of Unknown Chorionicity and Gestational Age Presenting in Spontaneous Preterm Labor","authors":"Ryan Farias, J. Hartnett","doi":"10.1155/2022/3143601","DOIUrl":"https://doi.org/10.1155/2022/3143601","url":null,"abstract":"Catatonia during pregnancy is rare and presents unique challenges due to the potential ramifications to mom and baby of the overall disease state and of potential treatment options. The purpose of this case report is to highlight the complexities in the workup and management of a catatonic patient with concurrent acute obstetric concerns requiring urgent intervention. We report a case of acute catatonia due to underlying major depressive disorder in a patient who presented in spontaneous preterm labor, with a twin pregnancy of unknown chorionicity with no known prenatal care. She underwent an extensive workup with no significant findings on lumbar puncture, brain MRI, metabolic labs, and EEG. After exclusion of several acute underlying conditions, a presumptive diagnosis of catatonia secondary to exacerbation of underlying major depressive disorder was made. She was transferred to an inpatient psychiatric facility postdelivery and treated with a course of lorazepam, aripiprazole, and escitalopram with good effect.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90833222","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}
Kaçar Serife, S. Karampelas, N. Hottat, C. Devalck, K. Vanden Houte
Ovarian Sertoli-Leydig cell tumors (SLCTs) are extremely rare ovarian sex-cord stromal tumors. Alpha-fetoprotein (AFP) production by SLCTs is a rare event generally linked to the presence of hepatocytes or intestinal mucinous epithelium as heterologous elements. We report here a case of a 15-year-old female complaining about abdominal pain, constipation, and spaniomenorrhea with high level of serum AFP leading to a clinical suspicion of malignant germ cell tumor. Final histopathological diagnosis was a moderately differentiated Sertoli-Leydig cell tumor of the ovary with alpha-fetoprotein-producing cells without hepatocytic or intestinal epithelium differentiation. NGS analysis showed mutation in DICER1 gene. SLCTs occur in patients at any age with a mean age of 25 years. The presence of alpha-fetoprotein-producing cells is an important tool in the differential diagnosis of germ cell tumors and challenging in this case of SLCT because of its rarity in this context. An adequate sampling and exhaustive immunohistochemical analyses are mandatory to make the correct differential diagnosis and confirm the presence of alpha-fetoprotein-producing cells and also define the differentiation because of therapeutic strategies between conservative surgery and/or chemotherapy.
{"title":"15-Year-Old Patient with an Unusual Alpha-Fetoprotein-Producing Sertoli-Leydig Cell Tumor of Ovary","authors":"Kaçar Serife, S. Karampelas, N. Hottat, C. Devalck, K. Vanden Houte","doi":"10.1155/2022/4759826","DOIUrl":"https://doi.org/10.1155/2022/4759826","url":null,"abstract":"Ovarian Sertoli-Leydig cell tumors (SLCTs) are extremely rare ovarian sex-cord stromal tumors. Alpha-fetoprotein (AFP) production by SLCTs is a rare event generally linked to the presence of hepatocytes or intestinal mucinous epithelium as heterologous elements. We report here a case of a 15-year-old female complaining about abdominal pain, constipation, and spaniomenorrhea with high level of serum AFP leading to a clinical suspicion of malignant germ cell tumor. Final histopathological diagnosis was a moderately differentiated Sertoli-Leydig cell tumor of the ovary with alpha-fetoprotein-producing cells without hepatocytic or intestinal epithelium differentiation. NGS analysis showed mutation in DICER1 gene. SLCTs occur in patients at any age with a mean age of 25 years. The presence of alpha-fetoprotein-producing cells is an important tool in the differential diagnosis of germ cell tumors and challenging in this case of SLCT because of its rarity in this context. An adequate sampling and exhaustive immunohistochemical analyses are mandatory to make the correct differential diagnosis and confirm the presence of alpha-fetoprotein-producing cells and also define the differentiation because of therapeutic strategies between conservative surgery and/or chemotherapy.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79491730","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}
Misa Kobayashi, Y. Otsuki, Hiroharu Kobayashi, Takashi Suzuki, S. Nakayama, H. Adachi
We report a case of gastrointestinal stromal tumor (GIST) with repeated multiple cerebral infarctions mimicking ovarian cancer. A 79-year-old postmenopausal woman had multiple cerebral infarctions with a giant pelvic tumor detected by computed tomography. Ovarian cancer with Trousseau's syndrome was suspected. Through laparoscopic biopsy on the tumor surface, she was diagnosed with left ovarian fibrosarcoma; although, the abdominal cavity could not be observed appropriately. Ovarian fibrosarcoma is an extremely rare tumor and still has no adequate treatment strategy. Complete resection was planned. The tumor was extremely fragile, and gelatinous that it easily bled. Meanwhile, the uterus and bilateral ovaries and fallopian tubes were all normal. The tumor invaded only the peritoneum near the left sacral uterine ligament and sigmoid colon, with no peritoneal dissemination. To completely remove the tumor, we performed total hysterectomy with bilateral salpingo-oophorectomy and omentectomy and sigmoidal and rectal resection with colostomy. Despite resuming her anticoagulant therapy on postoperative day 4, she had recurrent multiple strokes. On histopathological examination, tumor showed spindle cell proliferation with severe atypia, increased mitotic activity, and widespread necrosis. Immunohistochemical studies showed positive staining for c-kit, CD34, and DOG1. Thus, she was diagnosed with GIST. This case was rare and highly malignant, with a high risk of recurrence of GIST because of a giant ruptured tumor that had a mitotic activity of 36/10 high-power fields from the sigmoid colon. Multiple cerebral infarctions mimicking ovarian cancer recurred. Therefore, preoperative diagnosis of an atypical GIST was extremely difficult.
{"title":"Gastrointestinal Stromal Tumor with Repeated Multiple Cerebral Infarction Mimicking Ovarian Cancer with Trousseau's Syndrome","authors":"Misa Kobayashi, Y. Otsuki, Hiroharu Kobayashi, Takashi Suzuki, S. Nakayama, H. Adachi","doi":"10.1155/2022/5537990","DOIUrl":"https://doi.org/10.1155/2022/5537990","url":null,"abstract":"We report a case of gastrointestinal stromal tumor (GIST) with repeated multiple cerebral infarctions mimicking ovarian cancer. A 79-year-old postmenopausal woman had multiple cerebral infarctions with a giant pelvic tumor detected by computed tomography. Ovarian cancer with Trousseau's syndrome was suspected. Through laparoscopic biopsy on the tumor surface, she was diagnosed with left ovarian fibrosarcoma; although, the abdominal cavity could not be observed appropriately. Ovarian fibrosarcoma is an extremely rare tumor and still has no adequate treatment strategy. Complete resection was planned. The tumor was extremely fragile, and gelatinous that it easily bled. Meanwhile, the uterus and bilateral ovaries and fallopian tubes were all normal. The tumor invaded only the peritoneum near the left sacral uterine ligament and sigmoid colon, with no peritoneal dissemination. To completely remove the tumor, we performed total hysterectomy with bilateral salpingo-oophorectomy and omentectomy and sigmoidal and rectal resection with colostomy. Despite resuming her anticoagulant therapy on postoperative day 4, she had recurrent multiple strokes. On histopathological examination, tumor showed spindle cell proliferation with severe atypia, increased mitotic activity, and widespread necrosis. Immunohistochemical studies showed positive staining for c-kit, CD34, and DOG1. Thus, she was diagnosed with GIST. This case was rare and highly malignant, with a high risk of recurrence of GIST because of a giant ruptured tumor that had a mitotic activity of 36/10 high-power fields from the sigmoid colon. Multiple cerebral infarctions mimicking ovarian cancer recurred. Therefore, preoperative diagnosis of an atypical GIST was extremely difficult.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87103320","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}
Andi Kurniadi, A. Rinaldi, Herry Yulianti, A. Bazar, Rose Dita Prasetyawati, K. Tjandraprawira
Fibroepithelial polyps or acrochordons are benign skin tumors of mesenchymal and ectodermal origin. They are seen in 25% of the population, and their frequency increases with age. They are often found in areas with skin folds, such as the neck, axilla, submandibular, or inguinal region. However, they can also be located in the genital tract. Hormone imbalances may facilitate the development of fibroepithelial polyp s (e.g., high levels of estrogen and progesterone during pregnancy). Larger lesions are likely to arise from the proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower. Generally, their size does not exceed 5 millimeters. We present a 28-year-old patient with multiple giant fibroepithelial polyps with size of 20 × 12 × 8 cm and 9 × 4 × 2 cm, located on both sides of her vulva. Herein, we presented our patient along with the review of current literature pertaining to the diagnosis and the treatment of fibroepithelial polyps (FEPs) and the factors leading to excessive growth.
{"title":"Multiple Vulvar Giant Fibroepithelial Polyps: A Rare Case Occurrence","authors":"Andi Kurniadi, A. Rinaldi, Herry Yulianti, A. Bazar, Rose Dita Prasetyawati, K. Tjandraprawira","doi":"10.1155/2022/5712925","DOIUrl":"https://doi.org/10.1155/2022/5712925","url":null,"abstract":"Fibroepithelial polyps or acrochordons are benign skin tumors of mesenchymal and ectodermal origin. They are seen in 25% of the population, and their frequency increases with age. They are often found in areas with skin folds, such as the neck, axilla, submandibular, or inguinal region. However, they can also be located in the genital tract. Hormone imbalances may facilitate the development of fibroepithelial polyp s (e.g., high levels of estrogen and progesterone during pregnancy). Larger lesions are likely to arise from the proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower. Generally, their size does not exceed 5 millimeters. We present a 28-year-old patient with multiple giant fibroepithelial polyps with size of 20 × 12 × 8 cm and 9 × 4 × 2 cm, located on both sides of her vulva. Herein, we presented our patient along with the review of current literature pertaining to the diagnosis and the treatment of fibroepithelial polyps (FEPs) and the factors leading to excessive growth.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74745015","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}
S. Cohen, A. Kasi, N. Hook, Michael Krainock, G. Budde, A. Malashevich, J. Meltzer, R. Jelsema, P. Olshan, P. Billings, A. Aleshin, A. Poklepovic
The number of pregnant women with cancer is on the rise. These patients and their providers encounter complex medical management decisions. Standard-of-care systemic therapy and radiological imaging can impair fetal development and affect viability. Conversely, insufficient monitoring and treatment can lead to cancer progression, compromising the health of the patient. Personalized and tumor-informed circulating tumor DNA (ctDNA) testing (Signatera™, bespoke mPCR NGS assay) is a validated, noninvasive blood test that can accurately assess cancer progression and tumor response to treatment ahead of radiological imaging, across solid tumors. In this case series of four patients, we explore the clinical utility of longitudinal ctDNA testing in the medical management of pregnant patients with solid tumors, to aid in informed decision-making for patients and providers.
{"title":"The Utility of Circulating Tumor DNA (ctDNA) Monitoring in Cancer Patients Who Are Pregnant or Planning to Become Pregnant","authors":"S. Cohen, A. Kasi, N. Hook, Michael Krainock, G. Budde, A. Malashevich, J. Meltzer, R. Jelsema, P. Olshan, P. Billings, A. Aleshin, A. Poklepovic","doi":"10.1155/2022/9412201","DOIUrl":"https://doi.org/10.1155/2022/9412201","url":null,"abstract":"The number of pregnant women with cancer is on the rise. These patients and their providers encounter complex medical management decisions. Standard-of-care systemic therapy and radiological imaging can impair fetal development and affect viability. Conversely, insufficient monitoring and treatment can lead to cancer progression, compromising the health of the patient. Personalized and tumor-informed circulating tumor DNA (ctDNA) testing (Signatera™, bespoke mPCR NGS assay) is a validated, noninvasive blood test that can accurately assess cancer progression and tumor response to treatment ahead of radiological imaging, across solid tumors. In this case series of four patients, we explore the clinical utility of longitudinal ctDNA testing in the medical management of pregnant patients with solid tumors, to aid in informed decision-making for patients and providers.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73698318","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}
Dereje Tegene, Sultan Nesha, Befikadu Gizaw, Tadele Befikadu
Background Abdominal pregnancy is the rarest and the most serious type of extrauterine pregnancy. The mainstay of treatment for advanced abdominal pregnancy is surgery. The fetus can be delivered easily, and there are two options for the management of the placenta: removal of the placenta and leave the placenta in situ. Case Presentation. This is a 26-year-old primigravida lady who does not recall her first day of last normal menstrual period (LNMP) but claimed to be amenorrhic for the past 9 months. She had antenatal care (ANC) follow-up at a private hospital and had obstetric ultrasound two times and told that the pregnancy was normal. Currently, she presented with absent fetal movement of one week and vaginal bleeding of 3 days duration. She had history of abdominal pain with fetal movement before one week. Upon examination, the abdomen was 34 weeks sized, with easily palpable fetal parts; fetal heartbeat was negative, with mild abdominal tenderness. The cervix was closed and uneffaced. She was investigated with ultrasound which reveals 3rd trimester abdominal ectopic pregnancy with negative fetal heartbeat. Laparotomy was done to deliver a 2000 gm female stillborn with GIII maceration from the peritoneal cavity. Placenta was removed after releasing adhesion from the bowel and omentum. She had smooth postoperative course and discharged on her 5th postoperative day. Conclusion Abdominal ectopic pregnancy could be missed despite having repeated ultrasound scanning and may continue to third trimester. High index of suspicion and correlation of patient's sign and symptom is very important to make early diagnosis.
{"title":"Laparotomy for Advanced Abdominal Ectopic Pregnancy","authors":"Dereje Tegene, Sultan Nesha, Befikadu Gizaw, Tadele Befikadu","doi":"10.1155/2022/3177810","DOIUrl":"https://doi.org/10.1155/2022/3177810","url":null,"abstract":"Background Abdominal pregnancy is the rarest and the most serious type of extrauterine pregnancy. The mainstay of treatment for advanced abdominal pregnancy is surgery. The fetus can be delivered easily, and there are two options for the management of the placenta: removal of the placenta and leave the placenta in situ. Case Presentation. This is a 26-year-old primigravida lady who does not recall her first day of last normal menstrual period (LNMP) but claimed to be amenorrhic for the past 9 months. She had antenatal care (ANC) follow-up at a private hospital and had obstetric ultrasound two times and told that the pregnancy was normal. Currently, she presented with absent fetal movement of one week and vaginal bleeding of 3 days duration. She had history of abdominal pain with fetal movement before one week. Upon examination, the abdomen was 34 weeks sized, with easily palpable fetal parts; fetal heartbeat was negative, with mild abdominal tenderness. The cervix was closed and uneffaced. She was investigated with ultrasound which reveals 3rd trimester abdominal ectopic pregnancy with negative fetal heartbeat. Laparotomy was done to deliver a 2000 gm female stillborn with GIII maceration from the peritoneal cavity. Placenta was removed after releasing adhesion from the bowel and omentum. She had smooth postoperative course and discharged on her 5th postoperative day. Conclusion Abdominal ectopic pregnancy could be missed despite having repeated ultrasound scanning and may continue to third trimester. High index of suspicion and correlation of patient's sign and symptom is very important to make early diagnosis.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2005 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76747758","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}
Archana Ayyar, Rachel D. Seaman, K. Guntupalli, M. Tolcher
Background COPA syndrome is a rare autoimmune disease, demonstrating an autosomal dominant inheritance pattern with variable penetration that occurs more frequently in females than males. This disease manifests in childhood as pulmonary hemorrhage, arthritis, and renal disease. Case We present a case of obstetric management of a 20-year-old nulligravida patient with a diagnosis of COPA syndrome. Her case was further complicated by multiple antepartum admissions for hypoxemia and a complex psychosocial history of substance use. On her first antepartum admission, rheumatology recommended management with hydroxychloroquine, inhaled corticosteroids (budesonide), and bronchodilators (albuterol inhaler) as needed. On admission for induction of labor, she was again noted to have oxygen desaturations. A chronic thrombus was noted on computed tomography (CT), and a multidisciplinary team was recommended against Valsalva. Thus, she had a primary cesarean delivery. Her postpartum course was only remarkable for improved oxygenation status. Conclusion Management of COPA syndrome should be performed by a multidisciplinary team including maternal-fetal medicine, rheumatology, and pulmonology specialists. Traditionally, COPA syndrome is treated with immunomodulator therapy often used to treat autoimmune syndromes. However, many of these medications are not well studied or contraindicated in pregnancy. Preconception counseling is recommended both to ensure pregnancy safe medications being prescribed and to provide information on the genetic inheritance of this disease. At time of entry to care, patients should have a baseline work-up including a radiographic imaging, complete blood count, complete metabolic panel, lactate dehydrogenase, and a 24-hour urine protein collection for baseline. Although thought to be rare, COPA syndrome has an autosomal dominance pattern of inheritance with variable penetrance that is more common in females. Thus, incidence of COPA syndrome in pregnancy will likely increase in the future. Further case studies are warranted to optimize management of patients with COPA syndrome in pregnancy.
{"title":"Management of a Novel Autoimmune Disease, COPA Syndrome, in Pregnancy","authors":"Archana Ayyar, Rachel D. Seaman, K. Guntupalli, M. Tolcher","doi":"10.1155/2022/4865985","DOIUrl":"https://doi.org/10.1155/2022/4865985","url":null,"abstract":"Background COPA syndrome is a rare autoimmune disease, demonstrating an autosomal dominant inheritance pattern with variable penetration that occurs more frequently in females than males. This disease manifests in childhood as pulmonary hemorrhage, arthritis, and renal disease. Case We present a case of obstetric management of a 20-year-old nulligravida patient with a diagnosis of COPA syndrome. Her case was further complicated by multiple antepartum admissions for hypoxemia and a complex psychosocial history of substance use. On her first antepartum admission, rheumatology recommended management with hydroxychloroquine, inhaled corticosteroids (budesonide), and bronchodilators (albuterol inhaler) as needed. On admission for induction of labor, she was again noted to have oxygen desaturations. A chronic thrombus was noted on computed tomography (CT), and a multidisciplinary team was recommended against Valsalva. Thus, she had a primary cesarean delivery. Her postpartum course was only remarkable for improved oxygenation status. Conclusion Management of COPA syndrome should be performed by a multidisciplinary team including maternal-fetal medicine, rheumatology, and pulmonology specialists. Traditionally, COPA syndrome is treated with immunomodulator therapy often used to treat autoimmune syndromes. However, many of these medications are not well studied or contraindicated in pregnancy. Preconception counseling is recommended both to ensure pregnancy safe medications being prescribed and to provide information on the genetic inheritance of this disease. At time of entry to care, patients should have a baseline work-up including a radiographic imaging, complete blood count, complete metabolic panel, lactate dehydrogenase, and a 24-hour urine protein collection for baseline. Although thought to be rare, COPA syndrome has an autosomal dominance pattern of inheritance with variable penetrance that is more common in females. Thus, incidence of COPA syndrome in pregnancy will likely increase in the future. Further case studies are warranted to optimize management of patients with COPA syndrome in pregnancy.","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87564832","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：