Background:The incidence of cesarean section increased worldwide with subsequent increase in the risk of cesarean section scar dehiscence (CSSD). The clinical significance and the management of the CSSD are still unclear.Case Reports:Here, we report two cases of CSSD. A 35-year-old woman, gravida 2, previous CS, due to preterm premature rupture of membranes (PPROM) and breech presentation at 30 weeks, was admitted for elective CS at 38+3d weeks’ gestation. During the second elective CS, it was seen that the site of the previous CS scar was very thin along its whole length and the anterior uterine wall was completely deficient, leaving visible bulging fetal membranes and moving baby underneath. A 32-year-old woman, previous three CSs, was admitted as unbooked case without any antenatal records at 29+4d weeks’ gestation, triplet pregnancy with preterm labor. She received betamethasone and magnesium sulfate (MgSO4) for fetal lung and fetal brain protection, respectively, followed by emergency CS. During the CS, the previous CSs scars were dehiscent over more than half of its length and the anterior uterine wall was missing leaving visible fetal membranes. The uterine incision of the studied women was repaired in two layers using vicryl 0 interrupted simple stitches for the first layer, followed by interrupted mattress stitches for the second layer. The studied women had uneventful postoperative recovery and were discharged from the hospital after counseling regarding intraoperative findings, uterine incisions repair, and future pregnancies.Conclusion:It is useful to assess the lower uterine segment of women with previous CS using the available ultrasound facilities. If the CSSD is diagnosed before the elective CS, the surgeon should prepare himself with the safest uterine incision with least possible complications and the best way of repair of the defective or dehiscent uterine wall.
Epignathus or enigmatic teratoma is rare congenital tumor, arising from the sphenoid region of the palate or pharynx. A 30-year-old pregnant woman presented at 34 weeks + 2 days’ gestation with a well-defined solid mass measuring 6.47 cm × 5.7 cm arising from the fetal oral cavity. The color flow mapping showed that the mass was well vascularized, especially in its center, and its blood supply was originated from the fetal oral cavity. The newborn has no chromosomal abnormalities or other associated anomalies and/or intracranial extension immediately and successfully managed after delivery to highlight the importance of prenatal diagnosis and the importance of multidisciplinary team management.
A 27-year-old cesarean section scar pregnancy (CSSP) case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with β-hCG 15,373 mIU/ml in September 2017 was managed by intramuscular (IM) multidose methotrexate (MTX). The studied woman discharged home when the β-hCG decreased to 11,630 mIU/ml on the 1st week after the first MTX dose. On the 5th week after the first dose of IM-MTX, the β-hCG dropped to zero and the gestational sac completely disappeared. She was counseled about the risk of pregnancy in the first 6 months after the MTX and the possibility of the CSSP recurrence. She presented on December 16, 2018, with preterm delivery at 35 weeks' gestation. After delivery, her neonate admitted to the neonatal intensive care unit (NICU) due to mild respiratory distress and discharged from the NICU on the 4th day in good condition. Multi-dose MTX regimen for the treatment of CSSP supported by many authors with follow-up by β-hCG and vaginal ultrasound. This report highlights the successful outcome immediately after the proper management of CSSP cases.
Objective To assess the effectiveness of the current cervical cancer screening tools in Western Kazakhstan. Methods Smears taken through (i) conventional cytology using azur-eosin staining and (ii) liquid-based cytology (LBC) ‘Cell Scan’ in the general female population and in women first diagnosed with cervical cancer were collected throughout the region. ROC-analysis with curve construction and weighted Cohen's κ calculation were applied. A total of 494 cytological pairs were collected, including 94 sets with histology findings. Results The conventional (azur-eosin staining) technique contained 0.2% non-informative material and LBC ‘Cell Scan’ had 5.9%. Area under the curve was 0.95 for the conventional technique and 0.92 for ‘Cell Scan’ ( p > 0.05). The conventional smears showed κ 0.62, sensitivity 90.4% at specificity 90.0% for CIN2+, while LBC ‘Cell Scan’ smears showed κ 0.47, sensitivity 83.3% at specificity 92.5%. Conclusions In this analysis it was not possible to prove that the LBC ‘Cell Scan’ technique was superior to its predecessor, azur-eosin staining. These findings highlight the need to modify the current screening programme according to updated international scientific evidence on effective screening design, such as the use of HPV DNA testing with Pap smear triage in women aged 30 or older. Further research, and a Health Technology Assessment, are necessary if we wish to establish a national standardized screening programme using the available technology appropriately.
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