Rationale:Holoprosencephaly is a structural malformation of the brain that results from the complete or incomplete noncleavage of the forebrain of the embryo into 2 hemispheres. We report a severe case of alobar holoprosencephaly diagnosed at 38 weeks, associated with cebocephaly, microcephaly, and craniosynostosis.Patient concern:The main knowledge added by this case is the late ultrasound diagnosis and chromosomal analysis that revealed a very rare abnormality (45X/46,XX/47,XX) with mosaicism at chromosome 18.Diagnoses:Investigation of the mother revealed nothing remarkable from clinical point of view and on laboratory tests. Ultrasonography identified a fetal biometry appropriate for gestational age, except for the head biometry and abdominal circumference, that were appropriate for less than the fifth percentile. Microcephaly, a large midline monoventricle, absent midlinestructures, cleft lip, cebocephaly (hypotelorism, single-nostril nose), ethmocephaly (hypotelorism, interorbital proboscis) and craniosynostosis, were also present. Fetal magnetic resonance imaging of fetus revealed an absent midline structure, a central monoventricle, abnormal corpus calosum, and abnormal gyri.Interventions:A cesarean section at 38 weeks was indicated for fetal bradycardia and a female baby was delivered, with Apgar score 6, weight 2290g. After birth, the diagnosis of the fetus confirmed holoprosencephaly with facial anomalies and demonstrated repeated tonic-clonic seizure, severe respiratory failure, cyanosis, decreased muscle tone, palor, and apnea. Laboratory examination of the newborn revealed acidosis and a prolonged of prothrombin time. The neonate was treated for severe respiratory distress syndrome, with immediate intubation and resuscitation. Vitamin K, fresh frozen plasma, and antibiotics were also administered.Outcomes:After delivery, exitus of the fetus occurred at 3 days and 18hours due to massive pulmonary hemorrhage.Lessons:We described a case of alobar holoprosencephaly diagnosed at 38 weeks of gestation and associated with a rare chromosomal abnormality (45X/46,XX/47,XX) with mosaicism at chromosome 18. Emotional implications could have been less severe if the patient underwent regular ultrasonography allowing a diagnosis in the first or early second trimester.
Leiomyomas (fibroids or myomas) are benign uterine tumors of unknown etiology. Fibroids are most common in women aged between 30 and 40 years, but they can occur at any age. At present, laparoscopic myomectomy is the most appropriate surgical technique for patients with fertility disturbances. We conducted a prospective study, in which a number of 72 patients diagnosed with uterine fibromatosis and infertility were investigated for the impact of laparoscopic myomectomy (i.e. intramural and subserosal fibroids), the fertility rate and the average time for the appearance of pregnancy. The patients were randomly divided into 2 groups: Group 1, consisted of 36 patients with infertility and uterine fibroids associated in which laparoscopic myomectomy it was practiced, and Group 2, consisted of 36 patients, having the same diagnosis who refused surgical ablation. From the 36 patients which were operated, 11 had intramural fibroids and 25 had presented one or more subserosal fibroids (Group 1). The fertility rate was 25% for patients with no surgery (Group 2) comparing with 86.5% for patients with laparoscopic myomectomy (Group 1, 54.5% for patients with intramural fibroids and 32% for
Women�s perception on childbirth experience is frequently related to pain struggle, regardless the type of birth. We aimed to present our Department�s experience on pharmacologically treating postpartum related pain. We developed a 6 months retrospective, descriptive study which included a number of 305 patients. Two sample patients were formed depending on the type of birth. In the sample of vaginal delivery a correlation between episiotomy and Paracetamol consumption was found (Pearson correlation of 0.238). In the sample of cesarean section births, for Acupan, Ketoprofen and Algifen the correlations with epidural anesthesia are negative and statistically significant at the 99.9% confidence level.
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