Evidence that estrogen may be a key factor in hyperprolactinemic anovulation: a case report

Although anovulation associated with hyperprolactinemia is not an uncommon cause of infertility, the precise mechanism of the pathogenic process that induces hyperactivity (hypertrophy with hyperplasia) of pituitary lactotropes is unknown. We have recently experienced a case of anovulation and hyperprolactinemia in a woman with ergot alkaloid intolerance in whom ovulation was restored by tamoxifen citrate administration. Since tamoxifen citrate administration also suppressed prolactin levels, it was suggested that a low but sustained serum level of estradiol and consequently continuous estrogenic stimulation may be an important causative factor in the development of hyperprolactinemic anovulation.     

Ruptured tuboovarian abscess in early gestation. A case report

A woman with a ruptured tuboovarian abscess was treated surgically at nine weeks' gestation. She subsequently had an uneventful pregnancy and delivery.     

Reduction in the severity of early onset severe preeclampsia during gestation may be associated with changes in endothelial cell activation: A pathological case report

Early severe preeclampsia with changes consistent with the Hemolysis elevated liver enzymes low platelet count (HELLP) variant and severe fetal growth restriction rarely resolves prior to delivery. Established clinical disease is preceded by endothelial dysfunction and inflammation. Endothelial activation is reported in vitro to be raised in the presence of necrotic trophoblastic debris which is deported into the maternal circulation in preeclampsia. We report on an early severe preeclamptic patient admitted at 24 weeks gestation. Maternal serum was taken at day 2, 16, 30 of admission and 45 days postpartum. 20% maternal serum or trophoblastic debris from first trimester placental explants that had been cultured with 10% maternal serum was exposed to endothelial cells. Endothelial cell activation was quantified by the cell surface ICAM-1 expression and U937 monocyte adhesion assay. The clinical condition of this patient improved including the blood pressure, liver function, and platelet count by the 3rd day after antihypertensive treatment and remained normal until delivery at 37 weeks. ICAM-1 expression and U937 moncyte adhesion assay of endothelial cells was significantly increased following exposure of the endothelial cells to the maternal serum or trophoblastic debris from placentae treated with maternal serum drawn on day 2. However, ICAM-1 expression and the monocyte adhesion assay were significantly reduced following exposure of endothelial cells to maternal serum or trophoblastic debris from placenta treated with maternal serum drawn on day 16 or 30. Our data suggest unknown factor(s) in the maternal serum triggered endothelial cell activation when the clinical symptoms were present. The improvement in the clinical condition occurred along with the changes in endothelial cell activation.     

Conjoined twins: historical perspective and report of a case.

In this article we review the historically important cases of conjoined twins (Biddenden Maids, Siamese twins, Blazek sisters) and contemporary knowledge regarding incidence, etiopathogenesis, antenatal diagnosis, antenatal management, and outcome of conjoined twins. We also present a case of male cephalothoracoomphalopagus, which is extremely rare.     

Tubal gestation and schistosomiasis: a case report

BACKGROUND: Schistosomal infections of the female reproductive tract are common in countries where the parasite is endemic. Serious complications, such as ectopic pregnancy and infertility, may arise in patients with gynecologic schistosomiasis. CASE: A primiparous, African woman presented with vaginal bleeding and was found to have an ectopic pregnancy. Laparoscopy revealed distorted pelvic anatomy due to dense adhesions. Pathologic examination confirmed an ectopic pregnancy and identified Schistosoma haematobium ova in the patient's fallopian tube. Urine examination was confirmatory, and the patient was treated and referred for fertility counseling. CONCLUSION: Clinicians should consider schistosomiasis as a possible etiology for gynecologic complaints, including serious complications such as ectopic pregnancy and infertility, in patients from endemic regions.     

Evidence of early placental vascular anastomosis during selective embryo reduction in monozygotic twins.

OBJECTIVE: To describe selective embryo reduction of two triplet pregnancies with a monozygotic twin. DESIGN: Case reports. SETTING: Infertility unit of a Department of Obstetrics and Gynecology. PATIENT(S): Two patients treated with IVF-ET who had triplet pregnancies. INTERVENTION(S): Selective embryo reduction of monozygotic twins. MAIN OUTCOME MEASURE(S): Fetal heart beat. RESULT(S): During intracardiac injection of potassium chloride plus midazolam in one of the monozygotic twin fetuses, we observed an immediate diminution of the cardiac pulse rate of the second twin. This phenomenon was observed in both patients. CONCLUSION(S): These observations clearly indicate the presence of vascular anastomosis between the two fetuses of these monozygotic twins. Thus, use of toxic substance to reduce one of the two fetuses of a monozygotic twin pregnancy is contraindicated. In cases of triplets that include a monozygotic twin, it is safest to interrupt the evolution of the twin if selective reduction is desired.     

Dichorionic twins discordant for thanatophoric dysplasia managed with selective reduction at 20 weeks' gestation: a case report

BACKGROUND: Thanatophoric dysplasia (TD) is a rare and lethal form of skeletal disorder. A MEDLINE search for 1965-2003 yielded only 3 reports of multiple pregnancies discordant for TD. This is the first case report of selective twin reduction for this diagnosis. CASE: A young woman was seen in consultation at 20 weeks' gestation. Ultrasound examination revealed a twin pregnancy, with ultrasound markers consistent with thanatophoric dysplasia, type II, in twin A. A thick dividing membrane and separated placentas were noted. After counseling, the patient opted for selective termination of twin A. Termination was performed by intracardiac injection of potassium chloride. The pregnancy continued uneventfully until 33 weeks, when spontaneous labor resulted in vaginal delivery of a vigorous female infant, and a mummified, macerated fetus. CONCLUSION: Selective termination for discordant lethal anomalies can be safely performed when the presence of the anomalous twin increases the risk of a poor perinatal outcome for the apparently normal cotwin.     

Multiple myeloma diagnosed during early pregnancy: a case report

Only five pregnant women with multiple myeloma have been reported in literature. We present the case of one woman with multiple myeloma diagnosed in early pregnancy, who decided to postpone therapy until after delivery. A cesarean section was performed at the 34th week due to the progression of the disease and a normal healthy baby was delivered.     

Rh isoimmunization complicating a triplet gestation. A case report

A case occurred of Rh isoimmunization complicating a triplet gestation. Management of that extremely rare situation required careful attention to the problems inherent in both multiple pregnancy and isoimmunization. Amniocentesis and frequent antepartum fetal monitoring were the cornerstones of therapy.     

Conjoined twins: Historical perspective and report of a case

In this article we review the historically important cases of conjoined twins (Biddenden Maids, Siamese twins, Blazek sisters) and contemporary knowledge regarding incidence, etiopathogenesis, antenatal diagnosis, antenatal management, and outcome of conjoined twins. We also present a case of male cephalothoracoomphalopagus, which is extremely rare.     

External hydrocephalus in discordant birth weight twins: a case report

The term “external hydrocephalus (EH)” is used to describe excessively rapid head growth in infants who are found to have enlarged subarachnoid spaces and little or no ventricular enlargement. EH has not yet been described in discordant birth weight twins.

We report the cases of two sets of discordant twins with normal neonatal course and normal neonatal brain ultrasound scans who developed an EH in the first months after birth and had a mild neurodevelopmental delay.

Our findings suggest that EH may be part of neurologic morbidity in discordant birth weight twins and represents one of the potential complications to look for in the follow-up of these infants.     

Twin gestation in a woman with a uterus didelphys. A case report

BACKGROUND: Twin gestation in a uterus didelphys is a rare condition, and the preferred labor course for these patients is unclear. CASE: A woman with a uterus didelphys presented at 14 weeks' gestational age. Serial ultrasound examinations demonstrated normally growing, diamniotic, dichorionic twins situated one in each uterine horn. The prenatal course was marked by intrauterine growth retardation, elevated liver functions and significant proteinuria. At 31 weeks' gestation, labor was induced; however, due to chorioamnionitis and arrest of cervical dilatation, cesarean section was performed 23 hours after rupture of membranes, and two viable female infants (1,480 and 1,421 g) were delivered. CONCLUSION: Twin gestation in a uterus didelphys is a rare condition, in which a trial of labor may be offered, with careful monitoring of both fetuses.     

Monochorionic dizygotic twins in a spontaneous pregnancy: a rare case report

Traditionally, monochorionicity in multiple pregnancies is associated with monozygocity. We present a case of a spontaneous, monochorionic dizygotic, sex-discordant twin pregnancy. The diagnosis of monochorionicity was initially done during first-trimester ultrasound evaluation and then confirmed by postnatal placental pathology. Furthermore, both twins were found to have blood chimerism. We also review the literature on dizygotic-monochorionic twins and blood-chimerism. We suggest that further prospective postnatal genetic studies are needed to define the reliability of prenatal diagnosis of identical twins in cases of monochorionicity.     

Asymptomatic uterine incarceration at term gestation: a case report

Uterine incarceration is a rare event complicating pregnancy. Herein, we present a unique case of an asymptomatic term pregnancy with uterine incarceration; this patient had had an anterior myomectomy 3 years earlier. She had an asymptomatic antenatal course and incidental identification of uterine incarceration during cesarean section. We also address the importance of early recognition and appropriate management regarding this circumstance.     

Antenatal diagnosis of meconium peritonitis in dichorionic twins: a case report

BACKGROUND: Meconium peritonitis (MP) is a chemical peritonitis, and little is known about its natural history. Below we report MP in both fetuses from a twin pregnancy, with identical clinical ultrasonographic findings but a delay in presentation. CASE: A 31-year-old woman with a twin pregnancy was referred to our institution due to fetal bowel dilatation and ascites. Serial ultrasonography demonstrated gradual but dynamic changes. Both infants were delivered at 29 weeks'gestation. The larger infant had type II MP and experienced more postoperative complications and longer ventilatory care, parenteral nutrition and hospital stay than the smaller one, who had type III MP. CONCLUSION: The type of MP at birth may be more important than birth weight in terms of neonatal morbidity. This case increases our understanding of the natural history and prognosis of MP.