IntroductionA supernumerary ovary was found attached to the mesentery of the descending colon. The patient had a very long history of pelvic pain and numerous operations. Thirty-four cases found in the literature are listed.
Guillain-Barré syndrome (GBS) is rare in pregnancy with an incidence estimated to be between 1.2 and 1.9 cases per 100,000 people annually, and it is generally accepted that it carries a high maternal risk. Delayed diagnosis is common because the initial non-specific symptoms may mimic changes in pregnancy. GBS should be considered in any pregnant patient complaining of muscle weakness, general malaise, tingling of the fingers and respiratory discomfort. This case aims to highlight the importance of early diagnosis, allowing prompt initiation of the immunomodulatory treatments which have been shown to improve outcome alongside multidisciplinary care.
In this study we assessed the effectiveness of the NovaSure Impedance Controlled Endometrial Ablation System for the treatment of menorrhagia in pre-menopausal women. A total of 125 pre-menopausal women with menorrhagia, which was secondary to dysfunctional uterine bleeding and unresponsive to medical therapy, had endometrial ablation using the NovaSure system between June 2004 and October 2005. A postal questionnaire was sent to all patients and the response rate was 80% (110 patients). The clinical data were analysed in 105 case notes (84%). The mean age was 43.91 +/- 5.45 SD, and mean parity was 2.09 +/- 0.65. The median treatment time was 71.00 s, ranging between 45.00 and 105.00 s. Results from a period of 18 months demonstrated that the NovaSure system was effective in reducing excessive uterine blood loss in 90.5% of patients and there were no intraoperative adverse events reported. Some 87% of patients were satisfied with the procedure and 90% of patients would be happy to recommend the treatment. We conclude that the NovaSure system is effective and safe in the treatment of symptomatic menorrhagia.
Endometriosis is defined as the presence of endometrial tissue outside the uterus, which induces a chronic inflammatory response. Its prevalence remains unknown, but it has been estimated to affect up to 10% of women of reproductive age. Although it is a benign oestrogen-dependent gynaecological condition, women may describe painful symptoms such as cyclical pelvic pain, dysmenorrhoea and dyschezia. Intestinal endometriosis may affect the ileum, appendix, sigmoid colon and rectum. It may present with a myriad of symptoms such as abdominal pain, vomiting, diarrhoea, constipation and haematochezia. Caecal endometriosis can present as an acute appendicitis, making the diagnosis challenging to establish in pregnancy. Transmural involvement and acute occlusion are very rare events. The gold standard for diagnosis remains laparoscopy with tissue sampling for histological confirmation. Although endometriosis improves during pregnancy under the effect of progesterone, the ectopic endometrium becomes decidualised with a progressive reduction in size. The authors present the case of a multiparous woman in her mid-30s with acute onset of right-sided abdominal pain at 35 weeks gestation. Physical examination was suggestive of an acute appendicitis and MRI showed an inflamed caecum. She became acutely unwell requiring an emergency caesarean section. A mass in the caecum was observed with impending perforation at the caecal pole. A right hemicolectomy was performed. Histopathological examination confirmed the diagnosis of endometriosis with decidualisation. Although endometriosis improves during pregnancy, this case shows the unexpected complications of the disease and demonstrates the importance of considering endometriosis in the differential diagnosis of an acute abdomen in women of childbearing age to prevent maternal morbidity and fetal loss.
Introduction Fetal macrosomia is increasing in prevalence and is associated with increased maternal and neonatal morbidity. Challenges include varying definitions, difficulties in accurate antenatal diagnosis and lack of consensus on ideal management in non-diabetic patients. We examined the management of large-for-gestational-age (LGA) pregnancies in our unit and compared obstetric outcomes of infants weighing 4250–4500 g and >4500 g respectively. Methods We conducted a cross-sectional survey investigating detection and management of LGA pregnancies. We compared obstetric outcomes of 100 babies weighing >4500 g (mean weight 4720 g, SD 198.5) and 4250–4500 g (mean weight 4347 g, SD 75.3). Data was collected via retrospective case note review. Comparison was made between ultrasound estimated-fetal-weight (EFW) and actual birthweight. Results The two groups were matched for maternal age, BMI and parity. There was no statistically significant difference between rate of LSCS, instrumental delivery or shoulder dystocia in the two groups (p=0.837,0.944). In the >4500 g group, 41% were LGA antenatally, 81% were managed expectantly and 77% delivered vaginally with a major complication rate of 2.6%. Ultrasound correctly predicted macrosomia in 6/16 cases (sensitivity 63%, specificity 40%) Abdominal circumference measurement alone and EFW estimation were equivalent in accuracy. Conclusion Management of LGA pregnancy is often influenced by concerns about increased obstetric intervention and complication rates. However, we found no difference between vaginal delivery and shoulder dystocia rates in 4250–4500 g and >4500 g infants, supporting the available literature in advocating spontaneous vaginal delivery in LGA pregnancies. Comparison of EFW with actual birthweight highlights the poor sensitivity and specificity of ultrasound to correctly predict LGA pregnancy.
An ectopic pregnancy (EP) occurs when the fertilised ovum implants outside the endometrial cavity. An EP has an incidence of 1%, with the majority occurring in the fallopian tube. It has a maternal mortality of 0.2 per 1000, with about two-thirds of these deaths associated with substandard care. An interstitial pregnancy occurs when the EP implants in the interstitial part of the fallopian tube. An interstitial ectopic pregnancy (IEP) shows few early clinical symptoms, hence it is associated with serious or fatal bleeding and a mortality rate up to 2.5%. With the advent of transvaginal ultrasound scan (TV USS), correlated with serum beta human chorionic gonadotropin (BHCG) assay, earlier diagnosis of an EP can be established. An EP is often diagnosed in women who are trying to conceive; therefore, the prognosis of future fertility is one of the main concerns associated with this diagnosis. Management can be surgical, expectant or medical with methotrexate (MTX). However, the best approach is tailored to the woman’s individual case. The authors present the case of a primigravida woman presenting with abdominal pain and vaginal bleeding at 6 weeks gestation following assisted reproduction. Her BHCG showed a suboptimal rise. Her TV USS showed no evidence of an intrauterine pregnancy. There was no evidence of an adnexal mass or free fluid. As her BHCG remained static, she underwent a diagnostic laparoscopy. A right sided IEP was identified. Due to the high risk of bleeding requiring transfusion or hysterectomy and her desire to preserve her fertility, she received medical management with MTX. Indeed, research has shown that women successfully managed expectantly achieve better reproductive outcomes, with the shortest time to achieve a subsequent intrauterine pregnancy. This case acts as a cautionary reminder of the challenges associated with identifying an IEP on TV USS. A high index of clinical suspicion is required to prevent maternal morbidity and mortality.
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