Case Reports in Women's Health最新文献_第4页

Heterotopic pregnancy following ovulation induction with clomiphene citrate therapy: A case report 柠檬酸克罗米芬促排卵后异位妊娠一例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-10-15 DOI: 10.1016/j.crwh.2025.e00757

Amanda Almeida , Adrianna Zambrano , Elizette Rodriguez , Vidhi Raval , Judith Vinod , Laura Molina , Heather Gabai Hernandez , Adrian Abreu

A heterotopic pregnancy is a rare, life-threatening condition in which an intrauterine and ectopic pregnancy occur simultaneously. The incidence of these pregnancies is increasing as the use of assisted reproductive technology and ovulation-inducing agents becomes more common and accessible. A 31-year-old woman with polycystic ovarian syndrome conceived following clomiphene citrate-induced ovulation and was later diagnosed with a heterotopic pregnancy at 10 weeks 2 days of intrauterine gestation and 9 weeks 2 days of ectopic gestation by transvaginal ultrasound following painless vaginal bleeding and rectal pain. The ectopic pregnancy was managed surgically, and the intrauterine pregnancy progressed to a full-term vaginal delivery. This case calls attention to the importance of physicians maintaining a high index of suspicion for heterotopic pregnancy in patients undergoing ovulation induction, despite reassuring imaging and nonspecific symptoms.

异位妊娠是一种罕见的危及生命的情况，其中宫内妊娠和异位妊娠同时发生。随着辅助生殖技术和促排卵剂的使用越来越普遍和容易获得，这种怀孕的发生率正在增加。一名31岁多囊卵巢综合征妇女在枸橼酸克罗米芬诱导排卵后怀孕，后来在子宫内妊娠10周2天和异位妊娠9周2天，阴道无痛出血和直肠疼痛经阴道超声诊断为异位妊娠。异位妊娠经手术处理，宫内妊娠进展为足月阴道分娩。本病例提醒我们，尽管有可靠的影像学表现和非特异性症状，但医生对促排卵患者异位妊娠保持高度怀疑的重要性。

引用次数: 0

Ultrasound-guided caesarean section as a safer intraoperative strategy for vasa previa type III: A case report 超声引导下剖宫产术中治疗III型前置血管更为安全：1例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-30 DOI: 10.1016/j.crwh.2025.e00755

Stefania Carlucci , Guglielmo Stabile , Teresa Silvestris , Letizia Iagnemma , Davide Maizzi , Antongiulio Del Bianco , Stefano Bettocchi

Vasa previa refers to the presence of chorionic vessels (arterial or venous) unprotected by Wharton's jelly, traversing the membranes over or near the internal cervical orifice. If diagnosed prenatally, the condition has a survival rate of up to 97 %. Ultrasound has proven to be a useful diagnostic tool, although its use for general population screening remains a topic of debate. In addition to its diagnostic applications, ultrasound may serve as a valuable intraoperative aid during complex caesarean sections, particularly in high-risk cases such as pregnancies complicated by vasa previa, by contributing to safer and more precise surgical management. The present report concerns a case of type III vasa previa in a patient with three previous caesarean sections, where mapping of the fetal vessels was challenging due to the cephalic presentation during labor. During the caesarean section, ultrasound evaluation of the anterior uterine wall allowed the surgeon to select the best approach for the hysterotomy. Standardizing the intraoperative transuterine ultrasound approach could provide valuable guidance in selecting the most appropriate uterine incision, thereby enhancing surgical safety and promoting both maternal and fetal well-being.

前置血管是指未受沃顿氏胶质保护的绒毛膜血管（动脉或静脉）的存在，穿过膜或靠近颈内口。如果在产前诊断，这种情况的存活率高达97%。超声已被证明是一种有用的诊断工具，尽管它用于普通人群筛查仍然是一个有争议的话题。除了诊断应用外，超声还可以作为复杂剖宫产术中有价值的辅助手段，特别是在高危情况下，如妊娠合并前置血管，有助于更安全、更精确的手术处理。本报告涉及一例III型前置血管，患者有三次剖宫产，其中胎儿血管的测绘是具有挑战性的，因为在分娩时头侧的表现。在剖宫产术中，超声对子宫前壁的评估使外科医生能够选择最佳的剖宫产入路。规范术中经子宫超声入路可为选择最合适的子宫切口提供有价值的指导，从而提高手术安全性，促进母胎健康。

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引用次数: 0

Desmoid tumor in pregnancy complicated by deep vein thrombosis: A case report 妊娠硬纤维瘤合并深静脉血栓1例

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-30 DOI: 10.1016/j.crwh.2025.e00754

Monchai Suntipap , Potsanop Kassayanan , Kasidis Nontaprom

Desmoid tumor is a rare, locally aggressive soft-tissue neoplasm that primarily arises from the abdominal wall. Deep vein thrombosis is more common in pregnancy due to hypercoagulability. The coexistence of desmoid tumor and pregnancy complicated by deep vein thrombosis is extremely rare and poses unique diagnostic and therapeutic challenges.

A 29-year-old woman, gravida 2 para 1, with obesity, presented at 28 + 6 weeks of gestation for routine antenatal care. She had a history of left lower limb deep vein thrombosis and presented with progressive leg swelling. Ultrasonography revealed a 10.7 × 6.5 × 10.6 cm abdominal wall mass arising from the left rectus abdominis compressing the left external iliac vein consistent with chronic deep vein thrombosis. Because of financial constraints, warfarin was prescribed temporarily instead of low-molecular-weight heparin. At 38 + 5 weeks of gestation, elective cesarean delivery was performed with a modified surgical approach to avoid damage to the tumor. Resection was deferred due to the high risk of hemorrhage while on anticoagulation. A healthy female newborn was delivered. Postpartum biopsy confirmed desmoid-type fibromatosis with extension into adjacent muscles and iliac vessels. Radiotherapy was planned but delayed, again owing to financial constraints. Lifelong anticoagulation with warfarin and surveillance were planned for the patient.

The case highlights the importance of considering abdominal wall tumors as a potential cause of pregnancy-related deep vein thrombosis. It also demonstrates how financial considerations can shape clinical decisions and underscores the role of multidisciplinary planning in optimizing maternal and fetal outcomes.

硬纤维瘤是一种罕见的局部侵袭性软组织肿瘤，主要起源于腹壁。由于高凝性，深静脉血栓在妊娠期更为常见。硬纤维瘤合并妊娠并发深静脉血栓极为罕见，对诊断和治疗提出了独特的挑战。29岁女性，妊娠2期1，肥胖，妊娠28 + 6周时出现常规产前护理。她有左下肢深静脉血栓形成史，并表现为进行性腿部肿胀。超声示左侧腹直肌压迫左侧髂外静脉，腹壁肿块10.7 × 6.5 × 10.6 cm，表现为慢性深静脉血栓形成。由于财政限制，华法林暂时代替了低分子肝素。妊娠38 + 5周时，择期剖宫产采用改良手术入路，避免肿瘤损伤。由于抗凝期间出血的高风险，手术被推迟。产下一名健康的女婴。产后活检证实硬纤维瘤病已扩展到邻近肌肉和髂血管。放射治疗曾计划过，但再次由于财政限制而推迟。患者计划终身使用华法林抗凝并进行监测。该病例强调考虑腹壁肿瘤作为妊娠相关深静脉血栓形成的潜在原因的重要性。它还展示了财务考虑如何影响临床决策，并强调了多学科规划在优化孕产妇和胎儿结局中的作用。

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引用次数: 0

Interstitial pregnancy after frozen embryo transfer in a woman with prior bilateral salpingectomy: A case report and literature review 双侧输卵管切除术后冷冻胚胎移植后间质性妊娠一例报告及文献复习

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-21 DOI: 10.1016/j.crwh.2025.e00753

Caterina Iaquinta, Ginevra Guarrera, Caterina De Luca, Carmela Votino, Alessandro Svelato, Fulvio Zullo, Roberta Venturella

We describe a rare case of interstitial pregnancy following frozen embryo transfer in a woman with previous bilateral salpingectomy. The 33-year-old patient with a history of recurrent early pregnancy loss conceived after in vitro fertilization. Transvaginal ultrasound revealed a gestational sac with cardiac activity implanted in the interstitial portion of the left uterine cornua, surrounded by a thin myometrial mantle. Medical management with methotrexate was unsuccessful, and serum human chorionic gonadotropin levels continued to rise. The patient underwent laparoscopic cornual wedge resection using local infiltration, monopolar resection, and double-layer closure. The procedure was completed with minimal blood loss, an uneventful postoperative course, and preservation of uterine integrity and future fertility potential. The patient was discharged on the second postoperative day, and follow-up confirmed a steady decline in human chorionic gonadotropin levels. This case highlights that interstitial pregnancy may occur even after bilateral salpingectomy, underlining the importance of early ultrasound surveillance, timely surgical management, and preventive strategies such as complete cornual excision at salpingectomy and single embryo transfer to reduce risks and optimize reproductive outcomes.

我们描述了一个罕见的病例间质妊娠后冷冻胚胎移植的妇女与以前的双侧输卵管切除术。患者33岁，有体外受精后复发性早孕流产史。经阴道超声显示左侧子宫角间质部植入有心脏活动的妊娠囊，被薄的子宫肌层包裹。甲氨蝶呤治疗不成功，血清人绒毛膜促性腺激素水平继续升高。患者行腹腔镜角膜楔形切除术，采用局部浸润、单极切除和双层闭合。手术以最小的失血完成，术后过程平稳，保留了子宫的完整性和未来的生育潜力。患者术后第二天出院，随访证实人绒毛膜促性腺激素水平稳步下降。本病例强调了双侧输卵管切除术后间质性妊娠也可能发生，强调了早期超声监测、及时手术治疗和预防策略（如输卵管切除术时完全切除子宫角和单胚胎移植）的重要性，以降低风险和优化生殖结果。

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引用次数: 0

Discordant phenotypic outcomes in monozygotic twins conceived via IVF: A case report involving Hirschsprung's disease, tricuspid and pulmonary atresia, and orofacial clefts without detectable genetic mutation 通过体外受精怀孕的同卵双胞胎的不一致表型结果：一例报告涉及先天性巨尖症候群病，三尖瓣和肺闭锁，以及没有可检测到的基因突变的口面部裂

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-20 DOI: 10.1016/j.crwh.2025.e00752

Sonia Gayete-Lafuente , Umar Mian , Elizabeth Choong , David H. Barad , Norbert Gleicher

This report concerns the incidental finding of discordant congenital anomalies in twins diagnosed as monozygotic in a private, academically-affiliated fertility center in the United States. A 40-year-old woman conceived monozygotic dichorionic twins via in vitro fertilization (IVF). One twin presented with multiple congenital anomalies, including tricuspid and pulmonary atresia, cleft lip/palate, Hirschsprung's disease, facial skin tags, and a benign ocular tumor, while the other twin presented none of those abnormalities and appeared entirely healthy. Genetic testing, including amniocentesis and whole-exome sequencing, confirmed no identifiable mutations. This case emphasizes the potential role of postzygotic mosaicism, epigenetic dysregulation, and/or environmental disruption of neural crest-derived development, highlighting the complexity of embryologic development.

本报告涉及在美国一家私立学术附属生育中心偶然发现的诊断为同卵双胞胎的不一致先天性异常。一名40岁的妇女通过体外受精（IVF）怀孕了单卵双绒毛膜双胞胎。其中一个双胞胎表现出多种先天性异常，包括三尖瓣和肺闭锁、唇腭裂、先天性巨结肠病、面部皮赘和良性眼部肿瘤，而另一个双胞胎没有出现这些异常，看起来完全健康。基因检测，包括羊膜穿刺术和全外显子组测序，证实没有可识别的突变。该病例强调了受精卵后嵌合、表观遗传失调和/或环境破坏对神经嵴源性发育的潜在作用，突出了胚胎发育的复杂性。

引用次数: 0

Female genital tuberculosis in an infertility patient resulting in destruction of ovarian tissue: A case report 不孕患者的女性生殖器结核导致卵巢组织破坏：一例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-15 DOI: 10.1016/j.crwh.2025.e00749

Rachel Watkin , Kalen Hubbs , Michael Clark , Shannon Wood

Female genital tuberculosis is an important cause of infertility in endemic regions; it most often affects the fallopian tubes and uterine endometrium, though involvement of the ovaries, cervix, and vagina/vulva have also been reported.

This report concerns the case of a 30-year-old nulligravid woman who presented for evaluation following discovery of a right adnexal mass in the setting of right-sided abdominal pain. On initial evaluation, the patient also reported a history of secondary amenorrhea and the inability to conceive for six months. Laparoscopic and hysteroscopic findings were concerning for extensive adhesive disease resulting in loss of normal fallopian tube and uterine architecture, as well as complete obliteration of the right ovary. Ultimately, the patient's history and surgical findings were highly suggestive of female genital tuberculosis with sequelae resulting in diffuse pelvic organ disease. An endometrial biopsy confirmed the diagnosis with a positive tuberculosis PCR and acid-fast bacillus culture.

This case highlights the importance in considering female genital tuberculosis in the workup of infertility, the obstacles to definitive diagnosis, and the detrimental impact longstanding disease can have on pelvic organ function. Additionally, the loss of normal ovarian tissue in this patient may provide a pathophysiologic basis for the previously established association between diminished ovarian reserve and female genital tuberculosis.

在流行地区，女性生殖器结核病是导致不孕症的一个重要原因；它最常影响输卵管和子宫内膜，尽管也有涉及卵巢、子宫颈和阴道/外阴的报道。本报告涉及一名30岁无孕妇女，在右侧腹痛的情况下发现右附件肿块后进行评估。在初步评估时，患者还报告了继发性闭经和6个月无法怀孕的历史。腹腔镜和宫腔镜检查结果涉及广泛的粘连性疾病，导致正常输卵管和子宫结构的丧失，以及右侧卵巢的完全闭塞。最终，患者的病史和手术结果高度提示女性生殖器结核伴弥漫性盆腔器官疾病的后遗症。子宫内膜活检证实结核PCR和抗酸杆菌培养阳性诊断。本病例强调了在不孕症的检查中考虑女性生殖器结核的重要性，明确诊断的障碍，以及长期疾病对盆腔器官功能的有害影响。此外，该患者正常卵巢组织的缺失可能为先前建立的卵巢储备能力下降与女性生殖器结核之间的关联提供了病理生理学基础。

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引用次数: 0

Acute non-puerperal uterine inversion caused by a giant uterine leiomyoma with angioleiomyomatous features: A case report 具有血管平滑肌瘤特征的巨大子宫平滑肌瘤致急性非产褥期子宫内翻1例

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-09-02 DOI: 10.1016/j.crwh.2025.e00747

Volkan Karatasli , Neslihan Bayramoglu , Ferhat Coskun

Non-puerperal uterine inversion is an extremely rare condition most often associated with uterine tumors. A 48-year-old woman presented with sudden vaginal bleeding and a large protruding mass. Emergency surgery revealed complete uterine inversion caused by a giant pedunculated mass arising from the uterine fundus. The tumor was excised vaginally, and the uterus was manually repositioned. Because multiple fibroids were also present and fertility was not desired, a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathological examination revealed a leiomyoma with prominent angioleiomyomatous features, characterized by spindle cells surrounding thick-walled vascular structures and immunopositivity for desmin, smooth muscle actin, and progesterone receptor. The postoperative course was uneventful, and no recurrence was observed during 60 months of follow-up. This case highlights a rare morphological variant of uterine leiomyoma presenting with acute non-puerperal inversion and emphasizes the importance of early recognition and prompt surgical management.

非产褥期子宫内翻是一种极其罕见的疾病，通常与子宫肿瘤有关。一名48岁的女性，因阴道突然出血和一大块突出的肿块而就诊。急诊手术发现完全子宫内翻是由子宫底部产生的巨大带蒂肿块引起的。经阴道切除肿瘤，手动复位子宫。由于多发性肌瘤也存在，不希望生育，我们进行了全腹子宫切除术和双侧输卵管卵巢切除术。组织病理学检查显示平滑肌瘤具有明显的血管平滑肌瘤特征，其特征是厚壁血管结构周围有梭形细胞，desmin、平滑肌肌动蛋白和黄体酮受体免疫阳性。术后过程平稳，随访60个月未见复发。本病例强调了一种罕见的形态变异的子宫平滑肌瘤表现为急性非产褥期倒置，并强调了早期识别和及时手术治疗的重要性。

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引用次数: 0

Multidisciplinary team management of caesarean scar ectopic pregnancy progressing to a live birth and caesarean hysterectomy at 34 weeks: A case report 多学科团队对剖宫产瘢痕异位妊娠进展到活产和34周剖宫产子宫切除术的处理：1例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-08-29 DOI: 10.1016/j.crwh.2025.e00746

Ruihong Xue , Wei Gu , Xiao Lang

Progression of a caesarean scar ectopic pregnancy (CSEP) to a live birth is exceptionally rare. Whether the placenta should be removed during a caesarean section for patients with a CSEP complicated by severe placenta accreta spectrum remains unclear. This report presents the case of a 42-year-old multigravida with two prior caesarean sections who presented with CSEP at 6 weeks. Despite recommendations for termination, the patient decided to continue the pregnancy. Serial imaging confirmed a progressive placenta accreta spectrum. At 34+ weeks of gestation, a caesarean hysterectomy was successfully performed under the management of a multidisciplinary team, with good maternal and infant outcomes. The management of a CSEP progressing to a live birth during the third trimester requires provider expertise and multidisciplinary treatment and should be individualized. In the present case, caesarean hysterectomy was performed without attempting placental removal, which might have significantly decreased blood loss. While the patient survived, the management remains controversial, and women with CSEP opting for expectant management should be informed about the lack of conclusive evidence on its safety and associated risks. Such options can be considered only in a highly equipped specialist centre with access to a multidisciplinary team.

剖宫产瘢痕异位妊娠（CSEP）进展到活产是非常罕见的。CSEP合并严重胎盘增生谱的患者剖宫产时是否应切除胎盘尚不清楚。本报告报告了一位42岁的多胎孕妇，曾两次剖腹产，在6周时出现CSEP。尽管建议终止妊娠，患者还是决定继续妊娠。连续影像证实进行性胎盘增生。在妊娠34周以上，在多学科团队的管理下，成功进行了剖宫产子宫切除术，母婴预后良好。在妊娠晚期，CSEP进展到活产的管理需要提供者的专业知识和多学科治疗，并应个体化。在本病例中，剖腹产子宫切除术没有尝试胎盘切除，这可能会显著减少失血。虽然患者存活了下来，但治疗方法仍然存在争议，选择保守治疗的CSEP妇女应了解其安全性和相关风险缺乏确凿证据。只有在装备精良的专家中心才能考虑这些选择，并有机会获得一个多学科小组。

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引用次数: 0

Laparoscopic management of a heterotopic cornual pregnancy following first-trimester miscarriage – A case report and literature review 早期妊娠流产后异位角妊娠的腹腔镜治疗- 1例报告及文献复习

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-08-22 DOI: 10.1016/j.crwh.2025.e00745

Vishal Bahall , Reiaz Mohammed , Lance De Barry

Heterotopic pregnancies, defined by the simultaneous occurrence of an intrauterine and ectopic pregnancy, present a rare but potentially life-threatening diagnostic and surgical challenge. Heterotopic pregnancy is rare in spontaneously conceived pregnancies; however, a dramatic rise in the incidence is observed in patients undergoing assisted reproductive technology procedures. Moreover, cornual localization comprises only a minority of ectopic cases yet bears the highest maternal mortality rate due to the risk of catastrophic hemorrhage.

This report presents the case of a 33-year-old woman with a confirmed first-trimester miscarriage who remained asymptomatic but demonstrated persistently elevated β-hCG levels. Transvaginal ultrasonography identified a right cornual ectopic pregnancy. Laparoscopic wedge resection was performed with the preservation of uterine anatomy.

This case illustrates a critical vulnerability in the follow-up of early pregnancy loss, where residual or ectopic trophoblastic tissue may be misattributed to a slowly resolving miscarriage. It reinforces the value of repeat imaging and surveillance of β-hCG when clinical resolution is incomplete. This report presents one of the first documented cases of asymptomatic, spontaneously conceived heterotopic cornual pregnancy managed laparoscopically in the Caribbean; it contributes to the evolving literature on heterotopic pregnancies in low-risk women and supports early surgical intervention to preserve reproductive potential.

异位妊娠是指同时发生宫内和异位妊娠，是一种罕见但可能危及生命的诊断和手术挑战。异位妊娠在自然妊娠中是罕见的；然而，在接受辅助生殖技术手术的患者中，发病率急剧上升。此外，角定位仅占异位病例的一小部分，但由于灾难性出血的风险，产妇死亡率最高。本报告提出了一例33岁的妇女确诊早期妊娠流产谁仍然无症状，但表现出持续升高的β-hCG水平。经阴道超声检查发现右角异位妊娠。在保留子宫解剖结构的情况下，行腹腔镜楔形切除术。本病例说明了早期妊娠丢失随访中的一个关键脆弱性，其中残余或异位滋养细胞组织可能被错误地归因于缓慢解决的流产。当临床分辨率不完全时，它加强了重复成像和监测β-hCG的价值。本报告提出了第一例无症状的，自然受孕的异位角妊娠在腹腔镜下处理在加勒比地区；它有助于发展低风险妇女异位妊娠的文献，并支持早期手术干预以保持生殖潜力。

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引用次数: 0

Ovarian pregnancy following fresh embryo transfer: A case report and literature review 新鲜胚胎移植后卵巢妊娠：1例报告及文献复习

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-08-19 DOI: 10.1016/j.crwh.2025.e00744

Fombeno Kueta Pascal , Johnny El Hanna , Abdelilah Arsalane , Justin Lewis Denakpo

Ovarian pregnancy is a rare and potentially life-threatening form of ectopic pregnancy, accounting for only 1.6 % to 2 % of all ectopic gestations. While its association with assisted reproductive technology is increasingly recognized, diagnosis remains challenging due to its nonspecific clinical and imaging features.

This report concerns the case of a 29-year-old primigravida who presented with mild pelvic pain and vaginal spotting following a fresh embryo transfer. Transvaginal ultrasound revealed an empty uterus and a right ovarian mass. The patient had a serum β-hCG level of 3952 IU/L. Diagnostic laparoscopy indicated the presence of an ectopic pregnancy within the right ovary. Histopathological analysis of the excised mass confirmed the diagnosis. The patient recovered uneventfully following surgical management.

Ovarian pregnancy following embryo transfer is an uncommon but serious complication of the use of assisted reproductive technology. Early diagnosis is crucial to prevent complications and preserve fertility.

卵巢妊娠是一种罕见且可能危及生命的异位妊娠，仅占所有异位妊娠的1.6%至2%。虽然其与辅助生殖技术的关联日益得到认可，但由于其非特异性临床和影像学特征，诊断仍然具有挑战性。本报告涉及一例29岁的初产妇，在新鲜胚胎移植后出现轻度盆腔疼痛和阴道斑点。经阴道超声显示子宫空，右侧卵巢肿块。患者血清β-hCG水平3952 IU/L。诊断性腹腔镜检查显示右侧卵巢内存在异位妊娠。切除肿块的组织病理学分析证实了诊断。手术治疗后患者恢复平稳。胚胎移植后卵巢妊娠是使用辅助生殖技术的一种罕见但严重的并发症。早期诊断对于预防并发症和保持生育能力至关重要。

引用次数: 0