Various symptoms, included in OHVIRA acronym, are a result of different morphologic variants included in this syndrome. Most likely, in our case, the absence of communication between the cervical canal/patent vagina and the obstructed hemivagina prevented formation of mucocolpos or hematocolpos. This rare clinical variant made our MRI diagnosis of obstructed hemivagina, as well of the entire OHVIRA syndrome, ineffective. We did not find OHVIRA cases in the literature with a single septate uterus and single cervix, associated with obstructed hemivagina diagnosed during and after labor and presented with intrapartal rupture of hemivagina. Because of lack of guidelines, the final decision about management of the labor in such rare cases of OHVIRA syndrome is difficult.
Annular placenta is an extremely rare morphological type of human placenta. It is
commonly related to placental vessel abnormalities frequently causing antenatal and
postnatal hemorrhage and operative delivery. Gravida 4 para 1 had an uneventful course of
pregnancy and normal vaginal delivery followed by moderate postpartum hemorrhage.
Hemorrhage was found to be local in origin but the placenta was annular in shape and the
newborn was delivered through one of the openings. Annular placenta was not recognized
before delivery. Its implantation site was in the lower uterine segment but high enough to
allow the passage of the fetus through its annular defect and vaginal birth. To our
knowledge, this is a first report of annular placenta ending in normal vaginal
delivery.
SUMMARY -Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the fi rst half of the 20 th century and was performed mediolaterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic fl oor from injuries. However, reports claiming that episiotomy had no such benefi ts were published. It was shown that routine mediolateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. Th e role of episiotomy in development of pelvic fl oor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. Th e origin of stress incontinence during pregnancy is controversial and not definitely scientifi cally proven. Pregnancy per se and older age at fi rst delivery may have impact on the onset of pelvic fl oor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic fl oor structures, limited denervation of the pelvic fl oor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this fi eld is needed.
We report a rare case of spontaneous intraperitoneal bladder rupture following normal vaginal delivery without concomitant uterine rupture. Key diagnostic clinical features were acute renal failure, new-onset ascites and bowel ileus with urosepsis. Laparotomy and bladder repair with omentum patch were performed with no adverse outcome reported.
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