Retroperitoneal ectopic pregnancy (REP) is a rare obstetric condition caused by the mislocalization of the gestational mass. The unexpected location often results in missed or delayed diagnoses, which can complicate the treatment process. We report the case of a 34-year-old Asian woman who presented to the hospital 31 days after embryo transfer with mild vaginal bleeding. A history of bilateral salpingectomies was established. Two operations were performed before we were able to successfully remove the gestational sac from the retroperitoneal cavity. The histologic finding suggested an interesting migration pathway for the pregnancy. REP should be considered when a visible gestational sac cannot be detected on ultrasound in the expected locations, particularly among patients who undergo treatment using assisted reproductive techniques (ART), and have a history of bilateral salpingectomies. Magnetic resonance imaging (MRI) plays a vital role in diagnosing REP and guiding surgical interventions. A multidisciplinary team is necessary to treat REP, and monitoring beta-human chorionic gonadotropin (βHCG) levels and histologic findings remain essential during follow-up.
Objective: The study aims to evaluate long-term ovarian reserve change by serum anti-Mullerian hormone (AMH) level and determine the factors that affect the changes after laparoscopic endometrioma cystectomy. Methods: In a prospective longitudinal study, 104 patients with unilateral (n=77) and bilateral (n=27) endometrioma underwent laparoscopic endometrioma cystectomy. AMH levels were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Multivariate linear regression analysis was performed to determine factors related to AMH level changes. Results: Median preoperative AMH levels significantly declined from 3.77 ng/mL to 1.60 ng/mL ( P <0.001), 1.66 ng/mL ( P <0.001), 1.67 ng/mL ( P <0.001), and 1.72 ng/mL ( P <0.001) at 1, 3, 6, and 12 months postoperatively, respectively. The rate of decrease in AMH was unchanged six months after surgery, 52.2%, 53.7%, 54.8% at 1, 3, 6 months, respectively, and declined to 43.2% at 12 months. Although most factors were associated with AMH level changes in monovariant linear regression, multivariant linear regression analysis showed only three factors that reached the statistical significance, including bilateral endometriomas, mean size of the endometrioma, and preoperative AMH levels. Conclusions: Serum AMH levels decline significantly after laparoscopic cystectomy of endometriomas but recovered at 12 months compared with the first 6 months with unilateral endometrioma. Bilateral endometriomas, size of the cyst, and preoperative AMH levels might independently affect AMH levels at 12 months after surgery.
Background: Induction of labor (IOL) is a technique to establish vaginal delivery when the risks for continuing the pregnancy for mother or baby are higher than the risks of delivery. It is usually performed in high-risk pregnancies, but can also be beneficial in low-risk populations, as shown in the ARRIVE trial. Objective: To evaluate the effectiveness and safety of slow-release vaginal dinoprostone (prostaglandin E2 10 mg) for labor induction in women with low-risk pregnancies. Methods: A prospective study was performed at Hanoi Obstetrics and Gynecology Hospital, Vietnam. We recruited women with low-risk pregnancies from 39 weeks + 0 days to 40 weeks + 6 days of gestation and an unfavorable cervix. Women who participated received 10 mg intravaginal slow-release dinoprostone (Propess) for induction of labor. Labor, deliveries, and post-partum management were performed according to the local protocol. Results: From September 2020 to March 2021, 102 low-risk women were eligible to participate in the study. Among these women, 67.6% had vaginal deliveries, 6.9% had postpartum bleeding, and 3.9% experienced tachysystole. All newborns were healthy, with good APGAR scores. None of the women needed respiratory support or intensive care unit admission. All other maternal or fetal complications were explored. The rate of cesarean section was 3.8 higher in nulliparous than multiparous women and 2.2 times higher in women who did not receive epidural analgesia than in those who did. The risk of cesarean section increased if the time between labor induction and active labor was greater than 12.5 hours. Conclusion: Slow-release dinoprostone insert is safe and effective for the induction of labor in low-risk pregnant women. The risk of cesarean section was elevated in nulliparous patients and those who did not receive epidural analgesia during labor. As the time from labor induction to active labor increased, the risk of cesarean section increased.
Background The newborn and child death associated with inadequate post-natal health checks continued to be a significant issue across the world. This study aimed to assess the socioeconomic inequalities in post-natal health checks for the newborn in Vietnam in 2014. Methods We used the secondary data from the Multiple Indicator Cluster Survey in 2014. We included women aged 15–49 years who had a live birth within two years of the time of the interview. We estimated the concentration index to measure socioeconomic inequalities post-natal health checks for the newborn. We conducted multiple logistic regression analysis to identify factors associated with post-natal health checks for the newborn. Results Overall, the proportion of post-natal health checks for the newborn in Vietnam was 89.1%. The concentration index of post-natal health checks for the newborn was positive at 0.06. It indicated that the newborns in the rich households were more likely to get post-natal health checks as compared to in the poor households. The common factors significantly associated with the higher percentage of post-natal health checks for the newborn were women belonging to the Kinh and Hoa ethnic, higher education, and wealthier groups. Conclusion Socioeconomic inequalities in post-natal health checks for the newborn in Vietnam were not strong, but it still existed. Thus, we recommended that policy efforts to increase access to post-natal health services for poor women. In addition, there is a need to improve access to post-natal health services for women belonging to minor ethnic group and low education.
Objective To evaluate the surgery outcomes of fetoscopic laser ablation (FLA) for selective umbilical cord in treating twin-twin transfusion syndrome (TTTS) with special conditions and neonatal outcomes post-operation. Methods A prospective study, 21 monochorionic diamniotic (MCDA) twins diagnosed with TTTS stage II–IV according to Quintero classification from 16 to 26 weeks of gestation, among that, 12 cases of TTTS stage II with selective intrauterine growth restriction (sIUGR), 6 cases of TTTS stage II with proximate cord insertions, 3 cases of TTTS stage IV underwent fetoscopic laser ablation for the selective fetal reduction at Hanoi Obstetrics and Gynecology Hospital from September 2019 to July 2021. Complications and surgical outcomes were noted. Prenatal care was carried out every 2 weeks post operation until birth. Newborn neurologic complications were assessed at birth, three months, and six months after birth using Denver II test and magnetic resonance imaging (MRI). Results The mean gestational age at operation was 20.30 weeks. The average operation duration was 39.52 minutes. No complications of operation, such as bleeding or infection, were recorded. The mean gestational age at birth was 34.70 ± 4.33 weeks, with a mean duration of 12.97 ± 6.87 weeks between intervention and delivery. The survival rate of newborns after the operation was 90.48%. There were two stillbirths (9.52%) within seven days after the operation. No short-term neurological complications have been reported with follow-up of the newborn to 6 months after birth. Conclusion Our study showed that fetoscopic laser ablation of selected fetal reduction surgery for treatment of special conditions of TTTS had no complications of operation, high neonatal survival result (90.48%), no short-term neurological complications. This should be considered for TTTS in cases of indication.
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