Herlyn-Werner-Wunderlich syndrome and central placenta previa in a COVID-19 positive pregnant woman: a case reportHerlyn-Werner-Wunderlich syndrome and placenta previa

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A correct management of cesarean scar pregnancy (CSP) is mandatory to avoid further complications. There is no consensus for the standard therapy and the most frequent methods used are not free from failures and sequelae. A 38-year-old woman was admitted referring amenorrhea lasting 9 weeks, pelvic pain, and vaginal bleeding. She had three previous cesarean sections. Transvaginal ultrasound showed a gestational sac of 16 mm in the cervico-isthmic site and inside the thickness of the uterine wall, and the dosage of beta-human chorionic gonadotropin was 12,770 mU/mL. A diagnosis of CSP was done, and an ultrasound-guided removal after uterine artery cervical branch ligation was performed. The follow-up was uneventful. Even if not yet codified in the literature, our therapeutic procedure should be considered in other similar cases in the future, as it potentially limits the possible iatrogenic problems and reduces intraoperative and postoperative bleeding to a minimum.

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In hypoparathyroidism (HypoPT), calcium supplementation is virtually always required, although the disease is likely to be associated with an increased risk of nephrolithiasis. The use of calcium citrate (Ca‐Cit) theoretically could have a positive impact on the nephrolithiasis risk because citrate salts are used to reduce this risk. Our objective was to evaluate the potential therapeutic advantage of Ca‐Cit in comparison with calcium carbonate (CaCO3) in HypoPT, on nephrolithiasis risk factors, as well as to their ability to maintain desirable serum calcium levels. We also evaluated these preparations on quality of life (QOL). This randomized, double‐blind, crossover trial recruited 24 adults with postsurgical chronic hypoparathyroidism at Campus Bio‐Medico University of Rome. Participants were randomized 1:1 to Ca‐Cit or CaCO3 for 1 month and then crossed over to the other treatment for another month. The primary outcomes were changes in albumin‐adjusted serum calcium and in ion activity product of calcium oxalate levels (AP[CaOx] index). Secondary efficacy outcomes included changes in SF‐36 survey score, fatigue score, constipation, and adverse events. No difference in terms of AP(CaOx) index was observed between the two groups. However, Ca‐Cit was associated with a significant reduction in the oxalate/creatinine ratio compared with CaCO3 (−2.46 mmol/mol [SD 11.93] versus 7.42 mmol/mol [SD 17.63], p = 0.029). Serum calcium and phosphorus concentration was not different between the two calcium preparations. Ca‐Cit was associated with less constipation (p = 0.047). No difference was found in QOL scores. Although Ca‐Cit did not modify the AP(CaOx) index when compared with CaCO3, it was associated with a reduction in urinary oxalate excretion that could have a potential beneficial effect on nephrolithiasis risk. These results are likely to have clinical implications in HypoPT, particularly those who do not tolerate CaCO3 and those affected by nephrolithiasis. A longer‐term experience is needed to confirm these findings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Ovarian Hyperstimulation Syndrome (OHSS) is an uncommon but serious complication occurring in patients undergoing ovarian stimulation. It is characterized by ovarian enlargement, nausea, vomiting, abdominal pain/distension, and reduction in urine output. However, OHSS may rarely evolve into a life-threatening condition with ascites, hemoconcentration and hypercoagulability. Prevention of OHSS consists of an integrated approach that associates behavioral aspects with administration of pharmacological compounds. Among drugs used to manage OHSS, Letrozole has recently been proposed as an effective option for prevention of the syndrome. However, despite the promising findings reported by several studies, to date Letrozole is not yet officially mentioned in the guidelines for “Prevention and Treatment of moderate and severe ovarian hyperstimulation syndrome”. In this scenario, the current study discusses Letrozole approaches scientifically available to prevent OHSS.