Background. Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a “double uterus,” is one of the least common amongst MDAs. This report discusses a case of didelphys uterus that successfully conceived, carried her pregnancy to term, and delivered vaginally without any significant complications. Case. Patient is a 29-year-old G2P0010 from Bangladesh, initially came a year prior in her first pregnancy, with spontaneous abortion (SAB). Pelvic Sonogram at that time showed a diagnosis of bicornuate versus didelphys uterus. There were no renal anomalies on subsequent abdominal CT scan. Patient presented with the second pregnancy and had uncomplicated prenatal care and did not have signs of preterm labor; fetus showed appropriate growth and the pregnancy was carried in the left uterus. Patient presented at 38 4/7 wks with Premature Rupture of Membrane and underwent induction of labor with Cytotec. Antibiotics were started for chorioamnionitis. Patient had a vaginal delivery with left mediolateral episiotomy and complete tear of vaginal septum. Third stage of labor was complicated with retained placenta, which was removed manually in the operating room with total EBL of 600 cc.

Background. The Essure device is a method of permanent sterilization widely used in the US that has proven to be safe and effective in most cases. However, there have been reports of device migration that have led to failed tubal occlusion as well as several other serious complications resulting from the presence of the device in the abdominal cavity. Case. This paper represents two cases of failed tubal occlusion by an appropriately placed Essure device without signs or symptoms of further complications related to device migration. Conclusion. Although there have only been 13 reported cases of abdominal device migration since November 2014, this case indicates that the actual number may be higher than reported since it is possible for migration to occur without additional complications. In the majority of reported cases of abdominal migration a major complication requiring surgical correction occurred, such as adhesions, small bowel obstruction, bowel perforation, or persistent pelvic pain. To avoid these complications it is recommended that migrating implants be removed; however, this case also represents an example of when a migrating device may remain in situ in an asymptomatic patient.

Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

INTRODUCTION: To evaluate the impact of a tertiary care vaginitis clinic with standardized protocols on health care utilization and prescription antifungal and antimicrobials for vaginitis-related concerns. METHODS: A retrospective analysis of electronic medical records of women with complaints of vaginitis attending a tertiary care vaginitis clinic (VC) in an integrated healthcare system. Women had vaginal microscopy, vaginal pH, an amine test, and vaginal mycology cultures at the index VC visit. Vulvovaginal candidiasis diagnoses required a positive mycology culture and bacterial vaginosis required 3 of 4 Amsel's criteria. Records were analyzed to compare the number of vaginitis-related encounters (clinic and telephone), fluconazole, and metronidazole (oral and vaginal) prescriptions in the 12 months before and the 12 months after the index VC visit. RESULTS:Out of 207 women identified over an 18 month time frame, age range 16-77 years (mean 38.5 years), 71.5% had at least 1 vaginitis-related encounter in the 12 months before the index VC visit; 47.3% in the 12 months after. The mean number of visits dropped from 2.06 to 0.98 (P,.0001, paired t test). The number of women with at least one fluconazole prescription and one metronidazole prescription decreased from 53.6% to 43.0% and 39.6%-18.8% respectively (P,.0001, paired t test).CONCLUSION: Attending a tertiary care vaginitis clinic resulted in a statistically significant reduction in vaginitis-related encounters and both fluconazole and metronidazole prescriptions for 12 months. A standardized vaginitis clinic may help reduce the burden of inappropriate diagnosis and treatment of vaginitis. INTRODUCTION:To examine the effect of maternal glucose variability on gestational weight gain in obese DM women according to the Institute of Medicine (IOM) guidelines and its impact on adverse maternal and neonatal outcomes.