We report a case of spontaneous uterine rupture at 17+6 week's gestation in a nulliparous 32 year old patient with no history of myometrial surgery. She had presented with lower abdominal discomfort, progressing to severe pain with hypotension and tachycardia. An urgent ultrasound pelvis showed a live fetus with fetal tachycardia, free intra-peritoneal fluid with blood clots and myometrial defects on the uterine fundus. An emergency laparotomy performed revealed 1.7 liters of hemoperitoneum, with the fetus intact in the amniotic sac free floating in the peritoneal cavity. The uterine fundal rupture was successfully repaired. Placenta histology revealed placenta accreta. This case report demonstrates that a high index of suspicion, rapid diagnosis aided by imaging modalities and immediate surgical intervention are crucial steps in successful management. A postulated etiology in our patient is that of an upper scar from a previous uterine curettage with abnormal placentation predisposing to spontaneous rupture.
Introduction: Obesity is a major risk factor in the development
of endometrial cancer (EC) in young patients of reproductive age.
Fertility sparing treatment is a viable option for a select group of
patients with early EC, and involves systemic and intra-uterine hormonal
therapy. Weight loss has been associated with improved outcomes in this
group. Bariatric surgery (BS) has been shown to be the most efficient
and durable method of weight loss in obese patients. However, there is a
paucity of data studying the benefit of BS as part of fertility sparing
treatment. Methods: We present a retrospective case series of
five patients who are undergoing fertility sparing treatment for early
EC, who also underwent BS for treatment of obesity and related
comorbidities. We aim to show early regression of EC for all the
patients and also report on the other health benefits of BS.
Results: All five patients in the series achieved regression of
EC within six months of undergoing BS. They also achieved significant
weight loss consistent with previous studies, and three patients who had
comorbidities related to obesity had remission of these conditions. One
of the patients with EC regression also managed to conceive with IVF.
Conclusion: Patients on fertility sparing treatment for early
EC who underwent BS was associated with early regression within 6
months, significant weight loss and resolution of comorbidities. BS
could be a promising component of fertility sparing treatment. Long
term, prospective studies are required to confirm the benefits reported
in this case series.
Background: Residency selection panels commonly use time consuming manual voting processes which are easily subjected to bias and influence of others to select successful candidates. We explored the use of an electronic audience response system (ARS) or 'clickers' in obstetrics and gynaecology resident selection; studying the voting process and examiner feedback on confidentiality and efficiency. Methods: All 10 interviewers were provided with clickers to vote for each of the 25 candidates at the end of the residency selection interview. Votes were cast using a 5-point Likert scale. The number of clickers provided to each interviewer was weighted according to the rank of the interviewer. Voting scores and time for each candidate was recorded by the ARS and interviewers completed a questionnaire evaluating their experience of using clickers for resident selection. Results: The 10 successful candidates scored a mean of 4.28 (SD 0.27, range 3.86-4.73), compared to 2.99 (SD 0.71, 1.50-3.79) for the 15 unsuccessful candidates (p<0.001). Average voting time was 26 seconds per candidate. Total voting time for all candidates was 650 seconds. All interviewers favoured the use of clickers, for its confidentiality, instantaneous results, and more discerning graduated response. Conclusion: Clickers provide a rapid and anonymous method of collating interviewer decisions following a rigorous selection process. It was well-received by interviewers and highly recommended for use by other residencies in their selection process.
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