Clinical and Experimental Obstetrics & Gynecology

Can ACGME Milestones predict surgical specialty board passage: an example in Obstetrics and Gynecology
Ottum S, Chao C, Tamakuwala S, Dean J, Shafi A, Kramer KJ, Kaur S and Recanati MA
Multiple tools including Accreditation Council for Graduate Medical Education (ACGME) standardized milestones can be utilized to assess trainee and residency program performance. However, little is known regarding the objective validation of these tools in predicting written board passage.
Which patients on a gynecologic oncology service will require perioperative transfusion? A single-center retrospective cohort study
Kirschen GW, Dayton SM, Blakey-Cheung S and Pearl ML
The purpose of this study was to determine which patient- or surgery-related factors are predictive of need for perioperative transfusion to avoid obtaining unnecessary pre-operative type and screens (T&S). We conducted an observational retrospective cohort study of 1200 women ≥ 18 years old undergoing gynecologic surgery for benign, possibly benign, or malignant indications on a gynecologic oncology service at a university medical center from 2009-2016. A logistic regression model was used to examine patient-related and surgery-related variables predictive of outcome of transfusion. Independent variables included patient demographics, comorbidities, and surgical indication surgical route, and surgical type. Dependent variable was transfusion outcome (T&S only, conversion to type and cross (T&C), or transfusion). Eight hundred ninety-nine (74.9%) women underwent pre-operative T&S, of which 118 (9.8%) were converted to T&C, and 80 (6.7%) received a transfusion of blood or blood products. Cancer indication, major surgery, and preoperative hematocrit less than 36% were significantly associated with need for transfusion ( = 0.002, < 0.0001, < 0.0001, respectively). Patients with a benign indication undergoing minor procedures and with normal preoperative hematocrit are least likely to require transfusion.
Successful live birth in a patient who underwent cranial radiotherapy and systemic chemotherapy by implantation of a cryopreserved blastocyst on day 7
Hayashi C, Chishima F, Matsumoto K, Kato E, Shinya K, Nakao T, Nakamura A and Yamamoto T
Preservation of fertility has been recommended for cancer-bearing patients of reproductive age before undergoing cancer treatment. However, there are many considerations and it is difficult to preserve fertility for all patients undergoing therapy for malignancies. Female cancer survivors had lower pregnancy and live birth rates compared with others that underwent assisted reproductive technologies (ARTs). We should continue to consider the issue of infertility in patients who underwent therapies for malignancies. This is the first report of a successful live birth in a patient with a cranial tumor who underwent radiotherapy and chemotherapy after implantation of an autologous embryo. The patient was a 27-year-old Japanese woman. She was diagnosed with suprasellar germinoma at 13 years of age, and she developed panhypopituitarism after radiotherapy and chemotherapy. At 27 years of age, she began infertility treatment with in-vitro fertilization (IVF). The level of anti-Mallerian hormone (AMH) was 4.29 ng/ml. After ovarian stimulation by high purified human menopausal gonadotropin (HP-hMG), she obtained two blastocysts and became pregnant by implantation of a cryopre- served blastocyst. At 37 gestational weeks, she delivered a healthy female baby by cesarean section.
Mature ovarian cystic teratoma containing well-differentiated cerebellar tissue
Cavide Sonmez F, Yildiz P, Kiran T, Sema Arici D and Dansuk R
A 38-year-old female patient experienced groin pain; ultrasound imaging revealed a dermoid cystic mass in the right ovary and a cystectomy was then performed. Unusually, a mature cerebellum is found in the cyst wall. The pathological diagnosis was 'mature cystic teratoma with well-differentiated cerebral and cerebellar tissue'. Glial tissue is a common neural component of teratomas, but a cerebellum is extremely rare in mature ovarian cystic teratomas. The authors report the case because of its rare component; they acknowledge that a cystic teratoma is the most common neoplasm of ovarian germ cells.
Bladder stone formation on permanent suture material ten years after laparoscopic high uterosacral ligament suspension
Jang H, Park EK, Han DS, Kim CJ and Lee YS
The present authors describe an uncommon case of iatrogenic bladder stone formation in a patient who underwent surgery for pelvic organ prolapse. A female patient who underwent high uterosacral ligament suspension ten years ago presented with pyuria and irritable bladder symptoms that did not respond to treatment. She had not experienced any specific urinary symptoms during the previous ten years. Patient evaluation revealed bladder stone formation on the non-absorbable suture material used during the previous operation. Cystoscopy during the previous operation did not find the suture material, and the suture knot that was tied extravesically during the operation was found inside the bladder. These strongly suggest delayed migration and rotation of the'suture knot after surgery rather than direct penetration of the bladder during operation. Delayed suture migration is a long-term complication that clinicians should consider in a patient who suffers from recurrent urinary symptoms after pelvic surgery around the bladder.
Spontaneously closed gastrocutaneous fistula becomes symptomatic after 30 years with pregnancy
Beksac K, Konan A and Kaynaroglu V
Percutaneous endoscopic gastrostomy (PEG) is the standard procedure of choice for the provision of enteral nutrition in children who require long-term nutritional support. Removal of gastric tubes has a risk of causing gastrocutaneous fistula and this complication is dealt within childhood. The authors report a 34-year old woman who had a PEG procedure at the age of four years due to caustic esophageal injury and recovered without incident. Thirty years later she becomes pregnant and as her pregnancy progresses, her former fistula opening becomes more obvious and at the 34'h week of the pregnancy she' presents to the hospital with fistula. After a successful delivery, the fistula was evaluated and repaired surgically.
Effect of maternal pregnancy-induced hypertension on neonatal immunity
Lei N and Tian Z
To explore the effect of pregnancy-induced hypertension (PIH) on immune system of neonate. Materials and Methods Sixty neonates whose mothers suffered from PIH were selected and divided into preeclampsia group (n=28) and gestational hyperten sion (GH) group (n=32) according to severity of mother's condition. Thirty neonates having healthy mothers were enrolled as control group. The base clinical characteristics of neonates were collected and umbilical vein blood was drawn to detect the distribution of lymphocyte antigen, immune globulin, and complement level.
Successful management of complete placenta previa after intrauterine fetal death in a second-trimester pregnancy by uterine artery embolization: case report and literature review
Kaku S, Tsuji S, Ono T, Kimura F and Murakami T
A 27-year-old woman with complete placenta previa was referred at 22 weeks of gestation because of vaginal bleeding and fetal growth restriction. At 24 weeks, sudden fetal death occurred, but bleeding continued and transvaginal sonography revealed abundant periplacental blood flow in the uterine wall. To avoid cesarean section, the authors performed uterine artery embolization (UAE) be- fore vaginal delivery of the fetus. Subsequently, there was little bleeding when laminaria was inserted for cervical ripening and the fetus was delivered vaginally by using vaginal gemeprost. Total blood loss was only 149 ml. The present case suggests that UAE may be an option for patients with placenta previa who desire vaginal delivery after intrauterine fetal death (IUFD) in a second-trimester pregnancy.
Successful management of primary splenic pregnancy: a case report and review of literature
Lv B, Zhou ST, Peng HL, Ma HW, Wu Y and Zhao X
Ectopic pregnancy is defined as dislocation of a fertilized ovum anywhere other than in the cavity of uterus. Generally, the common site for dislocation is within fallopian tube, accounting for 95.5% of all ectopic gestations. Abdominal pregnancy is rare with a potentially life-threatening variation that resides within peritoneal cavity and the primary splenic pregnancy is even rarer. This report describes a patient with primary splenic pregnancy, who was successfully managed after splenectomy.
Should sexual intercourse be avoided during the embryo transfer cycle? Life-threatening ruptured heterotopic pregnancy after single thawed embryo transfer: case report and review of the literature
Aoki Y, Kumakiri J, Itakura A, Kikuchi I, Takahashi N and Satoru T
To report the life-threatening complication of a raptured heterotopic pregnancy occurring from thawed single embryo transfer.
Unusual twin pregnancy: complete hydatidiform mole with coexistent normal fetus
Rodriguez E, Zamora JO, Monfort IR, Rubert L, Fuster S, Diago V and Perales A
The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mole gestation caused a placenta previa; with a posterior preterm premature rupture of membranes (PPROM) and ending in the 28h week of gestation due to acute chorioamnionitis, obtaining a live preterm newborn.
Successful treatment of very PPROM caused by bipolar cord coagulation in acardiac twin
Fu J, Wang XD, Luo H, Liu XH and Yu HY
The authors report management of a woman with an acardiac twin pregnancy complicated by preterm premature rupture of the membrane (PPROM) for more than two months after intrauterine treatment with bipolar cord coagulation at 24 weeks of gestation.
A case report of fetal malignant immature mediastinal teratoma
Gong W, Liang L, Zheng DG, Zhong RS, Zhu YX and Wen YJ
Fetal immature mediastinal teratoma is a rare disease. The pressure generated by the tumor mass can cause hydrops fetalis, pulmonary hypoplasia, pleural and peritoneal effusion, and polyhydramnios which cause the death of the fetus. Routine prenatal ultrasound has enabled accurate diagnosis.
Cantharidin is Superior to Trichloroacetic Acid for the Treatment of Non-mucosal Genital Warts: A Pilot Randomized Controlled Trial
Recanati MA, Kramer KJ, Maggio JJ and Chao CR
Condyloma Acuminatum is a sexually transmitted viral disease caused by the human papilloma virus (HPV). It is the most common viral sexually transmitted disease. In this randomized controlled trial, cantharidin was found to be more effective and better tolerated than trichloroacetic acid for the treatment of these lesions. Patients treated with cantharidin healed with less scarring than those treated with TCA (P<0.034), had less pain during treatment (P<0.01), and required fewer treatments to eradicate warts (P<0.01) when compared to Trichloroacetic acid.
Post-partum management of severe pubic diastasis
Mulchandani NB, Jauregui JJ, Abraham R, Seger E and Illica E
Pubic symphysis diastasis during pregnancy is a rare complication which can present as pain with ambulation, urinary dysfunction, and pelvic instability. A consensus treatment does not currently exist between surgical and conservative management. The authors present a case of severe pubic diastasis which was successfully treated using a conservative pelvic binder.
Placenta percreta with colon involvement in a twin pregnancy: case report and literature review
Chen HQ, Zou SH, Yang JB, Zhang Y, Cai J and Wang ZI
A case of a woman with twin pregnancy having placenta percreta involving the colon, showed hematochezia symptoms, experienced bleeding which caused the patient's mortality. Placenta percreta with bowel involvement is a very serious complication of pregnancy. Symptoms are very atypical and it is very difficult to diagnose.
Isolated left descended inguinal ovary with ipsilateral ectopic pelvic kidney: a case report and review of literature
Bawahab M, Alshumrani G, Al-Shraim M, Eskandar M and Shaamash A
Isolatd descended inguinal ovary is a rarity, but it should be considered as a differential diagnosis of an inguinal mass at any age; in particular during female infancy and up to adulthood. Herein the authors report a case of asymptomatic isolated left descended inguinal ovary, with ipsilateral left ectopic pelvic kidney that was accidentally discovered a few years after menarche.
Protective effect of curcumin on ovarian reserve in a rat ischemia model: an experimental study
Eser A, Hizli D, Namuslu M, Haltas H, Kosus N, Kosus A and Kafali H
To determine the protective effect of curcumin on ovarian reserve in a rat ischemia model.
Pericardial tumor and pregnancy - a case report study
Raspopovic S, Natalic D and Miketic V
Primary benign and malign pericardial ind heart tumors are very rare (0.002-0.03%). Benign tumors of heart and pericardium are more frequent (myxoma, rhabdomyoma, lipoma, and papillary fibroelastoma of endocardium: 70% of all primary tumors). Because of low frequency, clinicians rarely and hardly diagnose these types of tumors. The affected patients wander from one healthcare center to another, usually with misleading diagnosis, such as cardiomyopathy or mitral stenosis. Pericardial and cardiac tumors cause pressure to surrounding structures. Because of the specific anatomy and function, all heart tumors are "malign by localization". Presence of benign pericardial tumor leads to pericardial effusion, fibrinohemorrhagic pericarditis, and cardiac tamponade. In the present study, the authors report a case of a female patient with pericardial cyst which was diagnosed during the second trimester of pregnancy. After undergoing multiple diagnostic procedures in short time period, the authors had accurate set of definitive diagnosis. The patient had successful surgical treatment and the pregnancy was continued until term without any fetal consequences.
The importance of some angiogenic markers in spontaneous abortion
Ozturk N, Gozukara I, Kamalak Z, Gul MA, Bayraktutan Z, Baygutalp NK, Kiziltunc A, Bakan E and Karakilic E U
In this study, the authors aimed to determine the serum levels of vascular endothelial growth factor (VEGF), angiopoietin-l (ang-1) and angiopoietin-2 (ang-2) factors as indicators of placental angiogenesis and vasculogenesis in abortion cases. Materials and Meth- ods: This study was conducted in 40 women who were pregnant for 7-20 weeks and diagnosed with an incipient abortion and 40 pregnant healthy women with similar ages, gestational weeks, and body mass index (BMI) values. Serum VEGF, ang-1, and ang-2 levels were measured with ELISA methods.
Medical management of early pregnancy failure with misoprostol with rupture of the cesarean section scar pregnancy
Rouzi AA, Almarzouki A, Tallab F and Ashkar L
To report a case of ruptured uterus in the first trimester with the use of misoprostol for early pregnancy tailure in a woman with unrecognized cesarean section scar pregnancy.