Case Reports in Women's Health最新文献

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Laparoscopic surgery for left ovarian hemorrhage in a patient with an implantable left ventricular assist device on antithrombotic therapy and a history of right salpingo-oophorectomy open surgery for right ovarian bleeding: A case report 经植入式左心室辅助装置抗血栓治疗并有右侧输卵管卵巢切除术开放手术治疗右侧卵巢出血病史的患者行腹腔镜手术治疗左卵巢出血1例

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-12-01 DOI: 10.1016/j.crwh.2024.e00669

Yasuto Kinose, Aasa Shimizu, Mamoru Kakuda, Satoshi Nakagawa, Tsuyoshi Takiuchi, Tadashi Iwamiya, Michiko Kodama, Eiji Kobayashi, Yutaka Ueda, Kenjiro Sawada, Tadashi Kimura

Ovarian hemorrhage during antithrombotic therapy is sometimes difficult to manage. A 38-year-old woman, diagnosed with Marfan syndrome and implanted with a left ventricular assist device (LVAD) and taking aspirin and warfarin potassium, had a history of right adnexal oophorectomy via open surgery for a right ovarian hemorrhage at the age of 35 years. Thereafer, she had been treated with dienogest to suppress ovulation as much as possible. The patient was admitted to a local hospital with lower abdominal pain, and computed tomography showed a 10 cm left adnexal mass with suspected ovarian hemorrhage. Two days after the initiation of careful conservative treatment, with the cessation of antithrombotic therapy and monitoring of hemostasis, the patient was referred to a tertiary hospital. As the left ovarian hemorrhage continued 3 days after the transfer, emergency laparoscopic left salpingo-oophorectomy was performed due to the difficulty in conserving the left normal ovary. Although coagulopathy caused continuous oozing of blood from the pelvis after the removal of the left ovarian mass, hemostasis was successfully achieved laparoscopically. No postoperative bleeding was noted, and anticoagulant therapy was resumed on postoperative day 1 to prevent life-threatening thrombotic events associated with the LVAD. Postoperative pathological examination of the left ovary revealed an endometriotic cyst. To manage surgical menopause, complementary therapy using Japanese traditional herbal medicine was administered, as hormone replacement therapy was not recommended, to avoid the risk of fatal LVAD-associated thrombosis. Less invasive laparoscopic surgery for ovarian hemorrhage during anticoagulant therapy can be considered for reducing bleeding during and after surgery.

抗栓治疗期间卵巢出血有时难以控制。38岁女性，诊断为马凡氏综合征，植入左心室辅助装置（LVAD）并服用阿司匹林和华法林钾，35岁时因右卵巢出血行开放手术右附件卵巢切除术。因此，她一直在治疗dienogest尽可能抑制排卵。患者因下腹部疼痛入住当地医院，计算机断层扫描显示左侧附件肿块10cm，疑似卵巢出血。在开始谨慎保守治疗两天后，停止抗血栓治疗并监测止血，患者被转介到三级医院。由于移植后3天左侧卵巢持续出血，因左侧正常卵巢保存困难，行急诊腹腔镜左侧输卵管卵巢切除术。虽然凝血功能障碍导致左侧卵巢肿块切除后骨盆持续渗出血液，但腹腔镜下成功止血。术后未发现出血，术后第1天恢复抗凝治疗，以防止与LVAD相关的危及生命的血栓事件。术后左卵巢病理检查发现子宫内膜异位囊肿。由于不推荐激素替代疗法，为了避免致死性左心室辅助装置相关血栓形成的风险，为了治疗手术绝经，使用日本传统草药进行补充治疗。抗凝治疗期间卵巢出血的微创腹腔镜手术可以考虑减少术中及术后出血。

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引用次数: 0

Gynaecological Emergencies

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-12-01 DOI: 10.1016/j.crwh.2024.e00672

Annabelle Huguenin

引用次数: 0

Successful management of intraoperative cesarean section bleeding due to cervical arteriovenous malformation: A case report 成功处理宫颈动静脉畸形导致的剖宫产术中出血：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-19 DOI: 10.1016/j.crwh.2024.e00667

Vitcha Poonyakanok , Kridtin Jarutatsanangkoon , Pattarawalai Talungchit

Cervical arteriovenous malformation is an exceedingly rare condition that can lead to antepartum hemorrhage, posing risks for both maternal and perinatal morbidity. We report the case of a 30-year-old primigravida, at a gestational age of 31⁺² weeks, who presented to hospital with antepartum hemorrhage. A speculum examination revealed a 500 mL blood clot. Despite a thorough examination, the cause of the antepartum hemorrhage remained elusive. An emergency cesarean section was done due to hypovolemic shock and a fetal NICHD category III assessment. Following the delivery of the fetus, a pulsatile tubular structure was identified at the endocervix and biopsied. Suture ligation followed by insertion of a Bakri balloon, effectively controlled the bleeding with blood loss of 1200 mL. Histopathology confirmed the diagnosis of arteriovenous malformation. This case underscores the importance of recognizing cervical arteriovenous malformation and demonstrates the effectiveness of suture ligation and balloon tamponade in managing associated hemorrhage, offering insights for similar cases.

宫颈动静脉畸形是一种极为罕见的疾病，可导致产前大出血，给产妇和围产期带来风险。我们报告了一例 30 岁的初产妇，孕龄 31+2 周，因产前出血入院。窥器检查发现了 500 毫升的血块。尽管进行了全面检查，但仍无法确定产前出血的原因。由于低血容量性休克和胎儿 NICHD 评估为 III 类，医生紧急实施了剖宫产手术。胎儿娩出后，在宫颈内口发现了一个搏动性管状结构，并进行了活检。缝合结扎后插入巴克里球囊，有效控制了出血，出血量为 1200 毫升。组织病理学确诊为动静脉畸形。本病例强调了识别宫颈动静脉畸形的重要性，并展示了缝合结扎和球囊填塞在控制相关出血方面的有效性，为类似病例提供了启示。

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引用次数: 0

Postpartum multiple vertebral fractures in a patient with osteogenesis imperfecta type I: A case report and literature review 一名 I 型成骨不全症患者产后多发性脊椎骨折：病例报告和文献综述

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-16 DOI: 10.1016/j.crwh.2024.e00666

Yumiko Miyazaki, Mizuki Hosokawa, Sho Kudo, Toshimichi Onuma, Makoto Orisaka, Yoshio Yoshida

A 39-year-old woman with type I osteogenesis imperfecta reported experiencing back pain at 35 weeks of gestation. Two days following an elective cesarean section, the patient developed a Th12 vertebral compression fracture; 3 weeks postoperatively, she sustained an L3 vertebral compression fracture. The patient displayed a lumbar spine Z-score of −1.7; she subsequently discontinued breastfeeding, and treatment with active vitamin D was initiated. Genetic testing confirmed a diagnosis of osteogenesis imperfecta.

一名患有 I 型成骨不全症的 39 岁女性报告说，她在妊娠 35 周时感到背部疼痛。在选择性剖宫产术后两天，患者发生了 Th12 椎体压缩性骨折；术后 3 周，她又发生了 L3 椎体压缩性骨折。患者的腰椎 Z 评分为-1.7；随后她停止了母乳喂养，并开始接受活性维生素 D 治疗。基因检测确诊为成骨不全症。

引用次数: 0

Caesarean scar pregnancy complicated by partial rupture in the second trimester: A case report 剖腹产瘢痕妊娠并发第二孕期部分破裂：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-12 DOI: 10.1016/j.crwh.2024.e00665

Prakriti Garkhail , Astrid S.M. Vinkesteijn , Sabina de Weerd

This case report examines caesarean scar pregnancy, a rare but significant complication associated with increasing global caesarean rates. It explores diagnostic challenges, therapeutic interventions, and the importance of a multidisciplinary approach. This report details the case of a patient at 13 + 4 weeks of amenorrhea presenting with severe abdominal pain, diagnosed with caesarean scar pregnancy and scar dehiscence causing major haemorrhage. Emergency surgery and interventional radiology were employed for pregnancy evacuation and haemorrhage control. This report emphasizes niche pregnancy complexities and underscores the need for evidence-based practices to mitigate maternal morbidity and mortality. Additionally, it emphasizes the need for training in niche detection by transvaginal ultrasound for all clinicians encountering patients with early pregnancies.

本病例报告探讨了剖腹产瘢痕妊娠，这是一种罕见但严重的并发症，与全球日益增长的剖腹产率有关。报告探讨了诊断难题、治疗干预以及多学科方法的重要性。本报告详细介绍了一名停经 13+4 周的患者因剧烈腹痛被诊断为剖腹产瘢痕妊娠和瘢痕开裂导致大出血的病例。急诊手术和介入放射学用于妊娠排空和出血控制。这份报告强调了龛位妊娠的复杂性，并强调有必要采取循证做法，以降低孕产妇发病率和死亡率。此外，报告还强调需要对所有遇到早孕患者的临床医生进行经阴道超声检测壁龛的培训。

引用次数: 0

Posterior uterine wall rupture in an unscarred uterus in a term pregnancy; a case report 足月妊娠未受疤痕子宫的子宫后壁破裂；病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-09 DOI: 10.1016/j.crwh.2024.e00664

Mesfin Ayalew Tsegaye , Alemayehu Nigusssie Adugna , Rebecca Haile Tesfay , Elias Gashaw Endegnanew , Kidist Nega Aragaw

Uterine rupture is a catastrophic separation of the uterine walls due to several risk factors. It is a common complication of scarred uterus during labor and delivery. Early detection is associated with better maternal and fetal outcomes. Due to nonspecific presentation, a high level of suspicion especially on pregnancies with risk factors could help pick uterine rupture early. This report presents a gravida 11 para 10 mother who presented with vaginal bleeding and severe abdominal pain after laboring for 24 h at home. Intra-op findings were approximately 1000 ml of hemoperitoneum with the fetus and the placenta floating on the peritoneal cavity and a 13 cm posterior uterine rupture with vaginal extension. A subtotal hysterectomy and left salpingo-oophorectomy were done She was discharged well after several blood transfusions. The objective is to present a rare case of posterior wall uterine rupture and to emphasize the importance of early detection of posterior wall uterine ruptures.

子宫破裂是由于多种风险因素造成的子宫壁分离的灾难性后果。它是瘢痕子宫在分娩过程中常见的并发症。早期发现可改善产妇和胎儿的预后。由于子宫破裂的表现并无特异性，因此高度怀疑尤其是有风险因素的孕妇，有助于及早发现子宫破裂。本报告介绍了一位 11 para 10 的孕产妇，她在家中分娩 24 小时后出现阴道出血和剧烈腹痛。术中发现腹腔积血约 1000 毫升，胎儿和胎盘漂浮在腹腔上，子宫后位破裂 13 厘米，并有阴道延伸。医生为她进行了子宫次全切除术和左侧输卵管切除术，经过多次输血后，她康复出院。本文旨在介绍一例罕见的子宫后壁破裂病例，并强调早期发现子宫后壁破裂的重要性。

引用次数: 0

Septic shock after a saline infusion hysterosalpingosonogram in a woman with stage IV endometriosis and infertility: A case report 一名患有 IV 期子宫内膜异位症和不孕症的妇女在接受生理盐水输注子宫输卵管造影术后发生脓毒性休克：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-07 DOI: 10.1016/j.crwh.2024.e00663

Mariah Colussi , Geneviève Horwood , Jenn McCall , Jenna Gale , Sukhbir Singh

Saline infusion sonohysterography/hysterosalpingo-contrast sonography is commonly used in the work-up of infertility. Overall, pelvic infection following these investigations is rare, but risk may be increased in patients with deep infiltrating endometriosis. Antibiotic prophylaxis is not professionally recommended in patients with advanced endometriosis, a point that requires reconsideration. A 29-year-old woman with stage IV endometriosis presented with pelvic inflammatory disease and sepsis following a saline hysterosalpingo-contrast sonogram for investigation of infertility. Her infection was resistant to antibiotic treatment and she required extensive surgical intervention for source control, which impacted her fertility. The immunodeficient pelvic microenvironment in patients with endometriosis and endometrioma can increase the risk and severity of pelvic infection. Antibiotic prophylaxis should always be utilized in those with stage IV endometriosis who are due to undergo saline infusion sonohysterography or hysterosalpingo-sonography.

在不孕症的检查中，盐水灌注超声造影/子宫输卵管造影是常用的检查方法。总体而言，在这些检查后发生盆腔感染的情况很少见，但对于深部浸润性子宫内膜异位症患者来说，风险可能会增加。专业人士并不建议晚期子宫内膜异位症患者使用抗生素预防，这一点需要重新考虑。一名患有 IV 期子宫内膜异位症的 29 岁女性因不孕症接受盐水子宫输卵管造影检查后，出现盆腔炎和败血症。她的感染对抗生素治疗产生了耐药性，需要进行广泛的手术治疗以控制感染源，这影响了她的生育能力。子宫内膜异位症和子宫内膜瘤患者盆腔微环境的免疫缺陷会增加盆腔感染的风险和严重程度。IV期子宫内膜异位症患者在接受生理盐水输注超声造影或子宫输卵管造影检查时，应始终使用抗生素预防。

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引用次数: 0

Recurrent adnexal torsion in a teenager with hypermobile Ehlers-Danlos syndrome: A case report 一名患有艾勒斯-丹洛斯综合征（Ehlers-Danlos syndrome）活动过度症的青少年复发性附件扭转：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-06 DOI: 10.1016/j.crwh.2024.e00661

Michail Panagiotopoulos, Maria Tsiriva, Lito Vogiatzi-Vokotopoulou, Konstantinos Koukoumpanis, Nikolaos Kathopoulis, Athanasios Douligeris, Athanasios Protopapas, Lina Michala

Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common type of EDS, characterized by joint hypermobility, frequent dislocations, and chronic pain. Genetic markers are not typically used in diagnosis.

A 17-year-old clinically diagnosed with hEDS presented with recurrent lower abdominal pain, later attributed to intermittent partial adnexal torsion. Whole-genome sequencing revealed a missense mutation c.1691G > A (p.Arg564His) in the COL1A1 gene. She had undergone two exploratory laparotomies at ages 8 and 10 due to acute pain, resulting in a left adnexectomy and right detorsion with hydrosalpinx drainage. It was suspected that the recurrent adnexal torsion was linked to hEDS-related tissue elasticity, and so a laparoscopic right oophoropexy by shortening the utero-ovarian ligament was performed. At one-year follow-up, she was asymptomatic.

This case highlights the potential connection between hEDS and adnexal torsion, which may contribute to chronic abdominal pain, often misattributed to other conditions, such as irritable bowel syndrome.

活动过度埃勒斯-丹洛斯综合征（hEDS）是 EDS 中最常见的类型，以关节活动过度、频繁脱位和慢性疼痛为特征。一名临床诊断为hEDS的17岁患者出现反复下腹痛，后被归因于间歇性部分附件扭转。全基因组测序发现，COL1A1 基因中存在一个错义突变 c.1691G > A (p.Arg564His)。她在8岁和10岁时曾因急性疼痛接受过两次探查性开腹手术，结果是进行了左侧附件切除术和右侧附件切除术，并进行了肾积水引流。医生怀疑复发性附件扭转与 hEDS 相关的组织弹性有关，因此在腹腔镜下通过缩短子宫卵巢韧带进行了右侧输卵管切除术。本病例强调了 hEDS 与附件扭转之间的潜在联系，附件扭转可能导致慢性腹痛，而慢性腹痛往往被误认为是肠易激综合征等其他疾病引起的。

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引用次数: 0

Diagnosis and management challenges of recurrent lupus pericarditis in pregnancy: A case report 妊娠期复发性狼疮性心包炎的诊断和治疗难题：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-06 DOI: 10.1016/j.crwh.2024.e00662

Alexander Indra Humala, Manggala Pasca Wardhana

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease. Pericarditis in SLE can lead to severe effusion and cardiac tamponade, and is associated with significant morbidity and mortality. Therefore, early diagnosis and treatment are essential. A 32-year-old woman at 21 weeks of gestation with a history of lupus pericarditis two years previously presented to the emergency department with shortness of breath, fever, and weakness. Transthoracic echocardiography revealed a massive pericardial effusion, right ventricle failure, pulmonary hypertension, severe tricuspid regurgitation, and mild mitral regurgitation. A chest X-ray suggested pericardial effusion accompanied by pulmonary edema. Due to worsening of the patient's health, a joint decision was made with her and her family to terminate the pregnancy. Most cardiac manifestations of SLE worsen during pregnancy and can lead to life-threatening conditions such as cardiac tamponade or congestive heart failure. This is a rare case of recurrent lupus pericarditis in pregnancy accompanied by massive pericardial effusion, heart failure and pulmonary edema. Management is challenging because the most effective drugs are known to be harmful to the fetus.

系统性红斑狼疮（SLE）是一种自身免疫性多系统疾病。系统性红斑狼疮的心包炎可导致严重的积液和心脏填塞，并与严重的发病率和死亡率相关。因此，早期诊断和治疗至关重要。一名 32 岁、妊娠 21 周、两年前曾患狼疮性心包炎的妇女因气短、发热和乏力到急诊科就诊。经胸超声心动图检查发现大量心包积液、右心室衰竭、肺动脉高压、严重三尖瓣返流和轻度二尖瓣返流。胸部 X 光片显示心包积液并伴有肺水肿。由于患者的健康状况恶化，她和家人共同决定终止妊娠。大多数系统性红斑狼疮的心脏表现都会在妊娠期间恶化，并可能导致心脏填塞或充血性心力衰竭等危及生命的情况。这是一例罕见的妊娠期狼疮性心包炎复发病例，伴有大量心包积液、心力衰竭和肺水肿。治疗具有挑战性，因为已知最有效的药物对胎儿有害。

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引用次数: 0

Lithopedion – A rare complication of abdominal pregnancy: A case report 腹腔积液--腹腔妊娠的罕见并发症：病例报告

IF 0.7 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2024-11-01 DOI: 10.1016/j.crwh.2024.e00659

Champika Maggonage , Sibra Shihab , Chaminda Herath , Sulochana Wijetunga , Buddhika Dassanayake , Anura Abeysundara

Dead foetal remains retained within the abdomen following an ectopic pregnancy leads to the formation of lithopedion, a rare entity. A 44-year-old woman sub-fertile for 16 years presented with sub-acute abdominal pain. She had not sought medical help earlier, on account of her religious or cultural beliefs. Imaging revealed a calcified mass containing bones. The differential diagnoses were lithopedion or a fetiform teratoma. During laparotomy, cutting open the mass revealed multiple long, short and flat bones, which together formed an almost complete foetal skeleton. Histopathology revealed an old ectopic gestation sac. This confirmed the diagnosis of lithopedion, estimated to be 32–34 weeks old at the time of foetal demise. This rare case highlights the impact of limited health literacy, along with strong religious and cultural influences, in delaying timely diagnosis and intervention.

宫外孕后死胎残骸滞留在腹腔内会形成碎石，这是一种罕见的病症。一名 44 岁的妇女 16 年来一直未育，并伴有亚急性腹痛。由于宗教或文化信仰的原因，她之前没有寻求过医疗帮助。影像学检查发现了一个含有骨头的钙化肿块。鉴别诊断为碎石症或胎儿状畸胎瘤。在腹腔镜手术中，切开肿块后发现了多块长骨、短骨和扁平骨，它们共同构成了一个几乎完整的胎儿骨骼。组织病理学检查发现了一个陈旧的异位妊娠囊。这证实了碎石症的诊断，估计胎儿死亡时已经 32-34 周大。这一罕见病例凸显了有限的健康知识以及强烈的宗教和文化影响对延误及时诊断和干预的影响。

引用次数: 0

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