A twin pregnancy in a bicornuate uterus]

A case of twin pregnancy in bicornuate uterus with a fetus in each horn is presented. During the second trimester, the rudimentary horn ruptured. This horn was extirpated and two non viable fetus were delivered by cesarean section. Later on, the patient had another pregnancy in the unicornuate uterus. She was delivered at 36th week of pregnancy by cesarean section. The baby was in good condition.     

Massive Uterustonisierung unklarer Ursache

This case report describes a patient who was admitted for treatment to a hospital in Zambia exhibiting the clinical picture of early placental abruption. She presented with severe abdominal pain and constant contraction of the uterus that was sensitive on palpation. The ultrasound examination was relatively unremarkable except for thinning of the portio. Fetal cardiography revealed borderline pathological findings. The diagnosis was reached by taking a meticulous patient history: instead of drug prophylaxis against malaria, the patient had taken misoprostol which she had already received during pregnancy but was intended for use after birth to prevent postpartum hemorrhage. The patient responded well to tocolysis with nifedipine and could be discharged a few days later.     

Ectopic pregnancy--still a live clinical issue --a case report

We report a case of a 23-year old patient with extrauterine (tubal) pregnancy at 14 weeks gestational age. The patient was admitted to the Clinic with growing abdominal pain lasting few hours, with worsening general condition with no previous symptoms. In ultrasound examination a normal size uterus was described. On the right and behind the uterus the structures of an alive fetus, 13 weeks gestational age according to biometry (BPD, FL) and a large amount of blood clots were seen. Laparotomy was performed and 1500 ml of blood with clots were evacuated from the peritoneal cavity. The right fallopian tube, bulged in isthmal region (close to its intramural part) was ruptured about 2 cm from the uterine corn. The 10 cm long fetus and afterbirth were born into the peritoneal cavity. Right salpingectomy was performed with no complications in the postoperative period.     

Confusing presentation in a retroflexed septate uterus at term

This case report presents a full-term pregnancy in a retroflexed uterus. Although the fetus presented at first as a cephalic presentation, the longitudinal lie appeared to be breech. Further diagnostic procedures revealed a uterus subseptus. No explanation could be found for this persisting retroflexion during pregnancy.     

Ultrasound diagnosis of coexisting molar pregnancy following referral for abnormal serum screen

Complete hydatidiform mole and coexistent fetus is a rare occurrence. We report a case of a patient referred for abnormal serum screen and vaginal bleeding in the second trimester of pregnancy. Ultrasound revealed a cystic and solid mass along the posterior uterine wall with multiple hypoechoic (honeycomb) areas noted, consistent with molar degeneration of the placenta. Separate from this mass was a coexisting viable fetus with normal fetal anatomy and distinct anterior placenta. At delivery, a large cystic mass of placental tissue appeared to be implanted separately from a normal-appearing fetus and placenta. The mass weighed 184 g and contained multiple 1- to 1.5-cm cysts throughout. Microscopic sections revealed hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia, compatible with complete hydatidiform mole. This case illustrates that the diagnosis of coexisting molar pregnancy after referral for abnormal serum screen should be considered, especially if maternal serum beta-human chorionic gonadotropin is high and the patient has vaginal bleeding.     

Endometrial aspiration in fertility control. A report of 500 cases.

Outpatient endometrial aspiration was offered to patients who suspected that they were pregnant, but were within 5 to 21 days after failure of expected menstruation and had a uterus of normal size on pelvic examination. This is a report of 500 consecutive cases treated between September, 1973, and April, 1975. Histologic examination of the aspirated tissue was obtained on all 500 cases (100 per cent). Follow-up examination and urine pregnancy was obtained on 407 patients (81.4 per cent). Histologic evidence of pregnancy was obtained in 323 patients (64.6 per cent). Complications were limited to five infections (1 per cent), only one of which led to hospitalization of the patient, and failure to completely evacuate the pregnant uterus in 39 patients (12.1 per cetn of the 323 pregnant). Thirty-four of these had the uterus emptied by a second outpatient procedure and five patients were hospitalized to complete their abortion.     

Cornual heterotopic pregnancy: conservative treatment with transvaginal embryo reduction

Objective The objective was to discuss a case of heterotopic cornual pregnancy managed with transvaginal embryo reduction.Methods A 22-year-old woman with heterotopic cornual pregnancy was treated with ultrasonographically guided transvaginal injection of potassium chloride into the thorax of ectopic fetus.Results Sixteen days after the procedure, the patient presented with pelvic pain and miscarriage ensued. Control examination 1 month and 3 months later revealed normal uterine cavity and partially resorbed ectopic material.Conclusion This minimally invasive approach in a hemodynamically stable patient can be considered in the management of a first trimester heterotopic cornual pregnancy. However the patient must be informed for the risk of abortion related to the procedure. Nevertheless this approach can be a treatment option in cornual pregnancies without a simultaneous intrauterine gestation.     

Repeated collection of conjoined oocytes from a patient with polycystic ovary syndrome,resulting in one successful live birth from frozen thawed blastocyst transfer: a case report

Few cases have been reported in which the aspiration of a single follicle led to the recovery of two conjoined oocytes surrounded by a single zona pellucida. This report describes a successful embryo transfer with subsequent live birth derived from conjoined oocytes, and a later pair of conjoined oocytes in the same patient. After oocyte retrieval from a patient with polycystic ovary syndrome, two pairs of conjoined oocytes were collected. One oocyte was fertilized using in vitro fertilization (IVF) and developed to the blastocyst stage. This blastocyst was cryopreserved and later transferred to the uterus after separating the unfertilized conjoined oocyte. A successful pregnancy and healthy live birth was achieved. Two years later, the patient returned for a second IVF; one pair of conjoined oocytes was detected. One of the pair was fertilized and developed to a blastocyst, but was not transferred. We demonstrate that selective fertilization of a mature oocyte from conjoined oocytes by IVF can lead to the development of a blastocyst and subsequent pregnancy and live birth. To our knowledge, this is the second case report of successful live birth from conjoined oocytes. It may be the first case of repeated fertile conjoined oocytes from the same patient.     

Chronic abdominal pregnancy following rupture from a bicornuate uterus

The authors report a rare occurrence of a chronic abdominal pregnancy secondary to a ruptured bicornuate uterus. It is unusual in that rupture of the uterine horn probably occurred 2 weeks prior to diagnosis. Management was laparotomy to remove the fetus with resection and repair of the uterus. Uterine anomalies, their imaging and diagnosis, as well as the patient’s subsequent reproductive prognosis are discussed.     

Twin pregnancy with a fetus in each half of a uterus didelphys.

A rare case of a twin pregnancy with a fetus in each half of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. A longitudinal vaginal septum and two portios were detected during the first labor of this patient. During her second pregnancy ultrasonography was performed in the 16th week, and pregnancy was detected in each half of the double uterus. Both fetuses were of similar size and corresponded to the gestational age. A completely separated double uterus was confirmed by ultrasonography. In the 38th week a female and a male infant were delivered by cesarean section. The follow-up of this pregnancy and the management of the labor are reported.     

Successful Pregnancy in an Adolescent Woman with a Communicating Double Uterine Anomaly

BACKGROUND: Women with communicating double uterine anomalies are at increased risk for obstetric complications, including early pregnancy loss, preterm delivery, and breech presentation. We present the pregnancy of a woman with a previously diagnosed communicating double uterine anomaly. CASE: An 18-yr-old white female with a previous diagnosis at age 11 of a communicating double uterus, double cervix, and obstructed left hemivagina was followed during the course of her pregnancy. She experienced no complications until 36 6/7 weeks, when she was found to have signs and symptoms of mild preeclampsia. The fetus was in a breech presentation and a cesarean section was performed. Two hemiuteri were identified intraoperatively. The communication was not visualized. A viable male infant was delivered without complications. CONCLUSION: This patient represents only the sixth report of successful pregnancy in a woman with a Toaff type 5A communicating uterine anomaly.     

Case report of uterine rupture after an automobile accident

The pregnant woman who is involved in an automobile accident carries the risk of injury to her uterus and fetus. The following is a case report of a woman in her third trimester of pregnancy who had extensive lacerations of the uterus that almost completely severed the fundus from the lower uterine segment. The fetus was stillborn as a result of complete separation from the placenta.     

Primary ovarian twin pregnancy with one fetus progressing to term: case report and review of literature

A case of primary ovarian twin pregnancy is presented. A 30-year-old woman, gravida 3 para 2, was admitted to Medical College Hospital, Jabalpur, for postdated pregnancy with intrauterine fetal demise. Ultrasonography showed a break in the continuity of the uterus suggestive of a ruptured uterus. On laparotomy, twin ovarian pregnancy was discovered. One fetus was postdated, showing signs of maceration. The bones of the other fetus were discovered in the sac, suggestive of an autolysed fetus of approximately 26 to 28 weeks of gestation.     

Term delivery after repair of a uterine rupture during the second trimester in a previously unscarred uterus: a case report

BACKGROUND: Rupture of the unscarred gravid uterus is very rare. The event occurs mostly during the intrapartum period and is potentially catastrophic for both mother and fetus. The management in general is prompt termination of pregnancy and hysterectomy. CASE: A successful term delivery followed spontaneous rupture of the uterus during the second trimester and surgical repair. The uterus ruptured with no apparent risk factors at 26 weeks of gestation. The rent, at the right side of the fundus, was repaired without damaging the amniotic membrane. After the operation, the patient received tocolysis for irregular uterine contractions until 37 weeks' gestation and delivered a healthy, male infant by cesarean section. CONCLUSION: Spontaneous rupture of a nonlaboring, unscarred uterus, especially in the second trimester, is extremely rare. This report suggests that conservative treatment for spontaneous rupture of the uterus before fetal maturity may be considered as an alternative to hysterectomy.     

Intra-amniotic injection of hypertonic solution as a method for termination of pregnancy

This study evaluated the efficacy of intraamniotic injection of hypertonic solution as a method of termination of pregnancy after 1st trimester. From 1964 to 1971 the Christian Medical College Hospital, South India, used this method to terminate pregnancy after 50 patients of 18-38 weeks gestation. 22 terminations were for medical reasons; in 27 intrauterine fetal death had occurred. In 1 patient 2 attempts at amniotic injection failed so separation of membranes was done. In 24 patients a 20% solution of sodium chloride was used; in 25 a 50% glucose solution. In 3 cases no amniotic fluid was obtained but hypertonic solution was injected. In 2 the procedure needed to be repeated 3-5 days later. In some patients penicillin and streptomycin were injected along with the glucose; in all others systemic antibiotics were given. Interval between intraamniotic injection and onset of uterine contractions ranged from 3 to 68 hours, average being 23 hours. In 6 patients iv syntocinon was given to shorten the latent period. Duration of labor averaged 10.8 hours. In 45 patients the fetus and placenta were expellec complete with membranes; in 2 evacuation was needed. 1 patient developed high fever which subsided with antibiotics. In 1 case a sudden fall in blood pressure required treatment. There were 2 deaths, both from causes unrelated to the abortions. In the 23 instances in which the fetus was alive at time of injection, 4 were born alive but died promptly. The method is considered safe and best for small hospitals with limited facilities.     

Acute fatty liver in the second trimester of pregnancy

Objective: Acute fatty liver of pregnancy (AFLP) is an uncommon, potentially fatal disorder that usually occurs in the late third trimester of pregnancy. We present the first reported case of acute fatty liver in the second trimester of pregnancy.Methods: We report the clinical and laboratory findings in a patient with AFLP who presented in the second trimester of pregnancy.Results: A 37-year-old G5P4 woman presented at 22 weeks gestation (by 18 weeks ultrasound) with nausea and vomiting. She was normotensive, had no proteinuria, had elevated SGOT and SGPT (266 and 261, respectively), negative hepatitis studies and a normal platelet count. She was managed conservatively for presumed cholelithiasis until 24 weeks gestation when she was transferred to our facility because of worsening SGPT and SGPT (368 and 505, respectively), jaundice (total bilirubin of 8.9 mg/dL), hypoglycemia, and laboratory evidence of disseminated intravascular coagulation (DIC) (PT = 18.6, PTT = 56, hypofibrinogenemia and presence of fibrin split products). Ultrasound showed singleton fetus (EFW 450 g) with total placenta previa. Computed tomography scan of the abdomen revealed decreased hepatic density consistent with AFLP. Delivery of a nonviable fetus was effected after transfusion of fresh frozen plasma. Postoperatively, the patient had rapid resolution of DIC, jaundice, and hypoglycemia; liver transaminases normalized 5 days postoperatively and the patient was discharged home in good condition 5 days later.Conclusion: It has been traditionally stated that AFLP occurs in the late third trimester of pregnancy. This case demonstrates that, even in the second trimester of pregnancy, the diagnosis of AFLP should be considered as a cause of deteriorating liver function, jaundice, and DIC.     

Advanced extrauterine pregnancy: description of 38 cases with literature survey

An analysis is presented of 38 patients with advanced extrauterine pregnancy. First three typical cases are described that emphasize the marked differentiation of clinical symptoms which these patients present to the doctor. The first patient was referred for induction because of a suspected intrauterine death. The second patient presented an intraligamentous pregnancy with a living fetus. In the third case, the patient was admitted to hospital after 32 weeks of pregnancy because of a persistent oblique lie. At 34 weeks, a normal living fetus was born. In all three cases, ultrasound examination was able to visualize the separate uterus. A literature survey is given with special attention to the specific "clinic" and the problems concerning diagnosis and treatment. It is obvious that sonography is the most important diagnostic technique at present. The decision to remove the placenta by means of a laparotomy is brought up for discussion.     

Laparoscopic treatment of profuse bleeding in Cesarean scar pregnancy

A case of profuse bleeding during dilation and curettage due to Cesarean scar pregnancy was treated with emergency laparoscopy. The gestational mass was removed and the perforated uterus was sutured in laparoscopy. The patient had persistent bleeding and 4 months later laparotomy was performed to explore a cystic mass in the isthmic area of the uterus. This necrotic tissue was removed and 6 months after the initial operation the patient was fully recovered with healed uterus in hysteroscopy.     

单角子宫IVF-ET助孕双胎妊娠分娩:1例病例报道

目的:报道1例单角子宫患者行IVF-ET助孕双胎妊娠成功分娩活产的病案。方法:对本院接受IVF-ET助孕的1例原发性不孕单角子宫患者进行回顾性总结与分析。结果:采用GnRHa长方案控制性超促排卵(COH),获优质胚胎13枚,移植8cⅡ级胚胎2枚,宫内双胎妊娠因严重子痫前期于34+3周行剖宫产,早产2名健康活婴。结论:对子宫肌层厚度及宫腔容积正常的单角子宫不孕患者行IVF-ET助孕治疗是可行的。但应尽量避免多胎妊娠,减少流产、早产等并发症的发生,争取良好的妊娠结局。     

Early spontaneous rupture of the post myomectomy gravid uterus

Rupture of a pregnant uterus is a serious threat to the mother's life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.