The outcomes of 41 patients with prolonged, premature rupture of membranes in the midtrimester (19.5 to 26 weeks) managed conservatively were retrospectively analyzed. The maternal obstetric history was notable for a high incidence of second trimester bleeding and a prior history of preterm delivery. The mean duration of ruptured membranes before delivery was 10.6 days and was unrelated to gestational age. Delivery occurred within 2 weeks in 75% of the cases. The major indication for delivery was chorioamnionitis in 71% of patients. The only major maternal morbidity was chorioamnionitis. The overall perinatal survival was 47%, but in infants exceeding 24 weeks' gestation or 500 gm weight, the survival increased to 75%. No significant limb abnormalities, facial anomalies, growth retardation, or pulmonary hypoplasia occurred in the study population. Long-term follow-up demonstrated that 28% of infants exhibited major neurologic or developmental deficits.
The rare specific association of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis has been increasingly recognized in recent years, although diagnosis of this syndrome is still often delayed.Clearly, early recognition of this condition allows for improved management and optimal patient outcome. Sonography has become the preferred diagnostic modality for delineating the precise nature of the abnormal anatomical relationships observed with this synd r~m e .~ We present a case in which sonography provided precise preoperative diagnosis, and also was utilized intraoperatively t o assist conservative surgical management of an affected patient.
CASEREPORTA 12-year-old girl presented t o the emergency department complaining of severe recurrent left lower abdominal pain. Her past medical history was unremarkable. She had menstruated regularly during the previous year, with secondary dysmenorrhea of increasing intensity during the 4 months prior to presentation. Physical examination revealed a healthy adolescent in no acute distress with appropriate secondary sexual characteristics. The abdomen was soft with significant tenderness overlying a left lower-quadrant mass. The introitus appeared normal. Rectal examination disclosed a tender pelvic mass.
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