Isolated breast parenchymal changes following COVID-19 vaccine booster

Ipsilateral transient axillary lymphadenopathy is well-documented following COVID-19 mRNA vaccine administration. Recently, rare mammographic findings of breast tissue changes with co-existing lymphadenopathy have been documented. Current literature on isolated ipsilateral true breast parenchymal changes on diagnostic mammography in symptomatic patients following COVID-19 mRNA vaccine administration is limited. This is one of the first case reports that demonstrates isolated ipsilateral focal asymmetry 5 days after administration of COVID-19 mRNA vaccine followed by complete resolution of symptoms and focal asymmetry confirmed on follow up magnetic resonance imaging. These findings warrant the development of guidelines to reduce unnecessary invasive procedures as part of the workup for possible malignancy.     

HIV testing in pregnancy: are we testing enough?

Objective  

The crucial first step in the prevention of mother-to-child transmission of HIV is awareness of pregnant women of their HIV status. The aim of this study was to define the percentage of patients who received HIV tests between 2001 and 2007 in a German city hospital.     

Acinetobacter baumannii infection during pregnancy and puerperium

Acinetobacter baumannii is a multidrug-resistant bacterium that is normally a commensal pathogen. This bacterium can lead to severe complications such as pneumonia, fever and septicaemia, because of limited treatment options. This case report describes a cervical A. baumannii infection during pregnancy and puerperium in a case of a patient treated in our hospital, because of insufficiency of cervix diagnosed in the 28 + 3 week of gestation. In spite of antibiotic treatment, the patient developed increasing contractions and chorioamnionitis, resulting in caesarean section in the 31st week of gestation. Moreover, although being treated with carbapenems, the patient presented postpartal with fever and septic symptoms, which could only be treated by escalation of the dosage of the given carbapenem. In conclusion, A. baumannii can lead to premature contractions and can be associated with chorioamnionitis during pregnancy. Moreover, it can also cause septic complications in the puerperium associated with long duration of hospitalisation. The management and therapy of this vaginal infection during pregnancy and puerperium is a real challenge to gynaecologists and obstetricians.     

Caesarean section for the second twin after vaginal delivery of first.

Although caesarean section of a second twin after vaginal birth of the first twin is rare, it nevertheless has clinical importance as an acute emergency situation with high perinatal morbidity and mortality. We therefore found it appropriate to describe the obstetric management of such cases, including an overview of the literature and our own data. According to reports in the literature, 113 deliveries of second twins (3.4%) were carried out by section in 3342 twin births. At our department in Tubingen there were 497 twin births (1.9%) in 26 095 births. Of these the second twin was delivered by section in 11 cases (2.2%). This represents a statistical frequency of 0.04% of all births. As shown by case histories and our own study, the indications for abdominal delivery of the second twin were predominantly the prolapse of the umbilical cord or of small parts due to transverse or breech presentation, with simultaneous retraction of the cervix. Of our 11 births with emergency section, one child died postpartum. Because of above-mentioned risks the twin delivery must always be performed in a fully equipped facility, including facilities for intensive neonatal care.