Successful Pregnancy in a Patient with Previous Bladder Exstrophy

EDITORIAL COMMENT: Usually we do not accept anecdotal case reports for publication. Chambers twentieth century dictionary defines an anecdote as 'a short narrative of an incident of private life'. Readers can decide if this case is anecdotal. There appears to be a lot left unsaid about this woman's private life, if not her private pans. She was admitted to hospital as a nonbooked emergency case in labour. The symphyseal separation shown in figure 2 clinched our decision to accept the case for publication. The editor did not see such a case in 38 years of obstetrics practice.
Summary: Bladder exstrophy is an unusual congenital anomaly. Patients becoming pregnant with such anomaly after surgical repair are even rarer. The present case reports a lower segment Caesarean section delivery of a living healthy baby in a woman who had been operated on for bladder exstrophy at the age of 18 years. This is the first case of this type seen in our institution in 35 years.     

Five Successful Deliveries Following 9 Consecutive Spontaneous Abortions in a Patient with Wilson Disease

EDITORIAL COMMENT: We accepted this case for publication because it surely presents the ultimate evidence of an association between recurrent spontaneous abortion and untreated Wilson disease, in a woman with great reproductive stamina.     

Successful Pregnancy,Epidural Anaesthesia,Labour, and Delivery in a Woman With Sturge-Weber Syndrome and Previous Hemispherectomy

BackgroundThe outcomes of pregnancy and subsequent delivery of healthy neonates in women who have undergone previous near total hemispherectomy for Sturge-Weber syndrome (SWS) have rarely been reported.CaseA woman with SWS had two successful and uncomplicated pregnancies and deliveries under epidural anaesthesia after undergoing a near total hemispherectomy with subsequent unilateral cerebral palsy. Non-contrast MRI of the brain revealed post hemispherectomy changes with no residual meningeal angiomatosis.ConclusionAs more women who undergo surgical resection for underlying SWS grow into the child-bearing years, additional reports of pregnancy and delivery outcomes in this patient population can be expected and will be valuable.     

Spontaneous Uterine Rupture in the Second Trimester in a Patient With Previous Pelvic Radiotherapy in Childhood: A Case Report

BackgroundPelvic irradiation in childhood may result in abnormal uterine function. Poor obstetric outcomes have been reported in these patients.CaseA 30-year-old woman with a previous midtrimester miscarriage, G2, P0, presented at 23⁴ weeks gestation with acute abdominal pain and signs of hemodynamic instability. The patient was treated in childhood for Ewing sarcoma of the pelvis. Spontaneous uterine rupture was diagnosed. A supracervical hysterectomy with intrauterine fetus was performed.ConclusionA high index of suspicion is needed in primigravidas with risk factors for uterine rupture. Pelvic radiotherapy in childhood may be a risk factor.     

First and Third Trimester Uterine Scar Thickness in Women With Previous Caesarean: A Prospective Comparative Study

Background

Lower uterine segment (LUS) thickness in the third trimester of gestation is associated with the risk of uterine scar defect at delivery. It was suggested that first trimester residual myometrial thickness (RMT) could also predict uterine scar defect at delivery.

Recurrent Hydatidiform Mole: A Report of a Patient with 7 Consecutive Moles

A rare case of hydatidiform mole occurring 7 consecutive times in a Chinese woman is presented. She was first seen in 1979 at the age of 23 years, with a molar pregnancy and subsequently had 6 consecutive moles, the last being in July, 1986; at this visit the patient and her husband were very depressed, and convinced that a normal pregnancy was unlikely and requested a hysterectomy. They were warned earlier several times, of the possible long-term consequences of a recurrent mole and that their chance of having a normal baby was very remote. A total hysterectomy was performed at her last presentation as the patient requested one, instead of dilatation and curettage for a persistently high HCG and bulky uterus following suction evacuation. Histology revealed an invasive mole. The beta HCG level was less than 4IU/l by the end of September, 1986 and she is still being followed-up.     

Pregnancy Rates After Surgical Treatment of Deep Infiltrating Endometriosis in Infertile Patients With at Least 2 Previous In Vitro Fertilization or Intracytoplasmic Sperm Injection Failures

Study ObjectiveTo assess the postoperative probabilities of pregnancy in patients with deep infiltrating endometriosis (DIE) and ≥2 previous in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) failures.DesignRetrospective study using data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.SettingUniversity tertiary referral center.PatientsInfertile patients under the age of 43 years, having undergone ≥2 previous IVF or ICSI failures, who were surgically managed for DIE.InterventionsComplete excision of DIE.Measurements and Main ResultsThe pregnancy rate after surgery was assessed. One hundred and four infertile patients had surgery in 7 different centers participating in the database. Seventy-seven women intended to get pregnant postoperatively. Four patients who got pregnant by oocyte donation were excluded, resulting in a sample of 73 women. The mean patient age was 31.9 years (standard deviation [SD], 4.1), and the mean length of history of infertility was 48.4 months (SD, 26.5). Stage III and IV endometriosis were recorded in 83.6% of patients. The mean postoperative follow-up was 46.6 months (SD, 20.5). The postoperative pregnancy rate was 43.8% with a mean time from surgery to pregnancy of 11.1 months. 21.8% of pregnancies were spontaneous, 31.2% were obtained by IVF, 21.8% by frozen embryo transfer, 18.7% by IVF-ICSI, and 3.1% by intrauterine insemination. Multivariate analysis revealed that ovarian surgery, age ≥35 years old, and stage II endometriosis was associated with the probability of conception.ConclusionInfertile women with ≥2 IVF-ICSI failures may be referred for surgery as it appears related to reasonable postoperative pregnancy rates, particularly when endometriomas surgery is either not required or not performed. Surgery for DIE does not routinely delay conception, as it usually occurs during the year following surgery.     

Normal Term Intra-uterine Pregnancy in a Nulliparous Patient After 3 Consecutive Ectopic (Tubal) Pregnancies

Summary: A case of normal term intra-uterine pregnancy in a nulliparous patient after 3 consecutive ectopic (tubal) pregnancies is presented.