SACROCOCCYGEAL TERATOMA, CASE REPORT

Sacrococcygeal teratoma (SCT) is the most common tumor presenting at birth. Commonly seen in female fetuses; this case presented, more or less with the whole feature of typical sacrococcygeal teratoma

LEOPOLDOVI HVATOVI: KOLIKO SU ČESTI U NAŠOJ SVAKODNEVNOJ PRAKSI

Objective. To determine how frequent obstetricians use Leopold’s maneuvers in their practice. Subjects and Methods. A questionnaire with numerical scale was distributed among practicing obstetricians. They examined how ­frequent the symphyseal fundal height (SFH) measurement, Leopold’s maneuvers and ultrasound examination for fetal orientation were performed. Results. A total of 165 obstetricians completed the questionnaire. Only 56 (33.9%) respondents indicated that they use SFH. The first and third Leopold’s maneuver were the most frequent abdominal grips ­performed. Only 36 (21.8%) respondents regularly perform all four maneuvers. Seventy seven (46.7%) respondents use ultrasound to determine fetal orientation. The use of ultrasound was significantly higher (p=0.02) in those practicing for less than 10 years (62.6%) compared to those practicing for 10 years or more (43.3%). Conclusion. Leopold’s maneuvers are still common in daily obstetrics practice. Abdominal palpation remains a common method to estimate the uterine size. The first and third Leopold’s maneuver were the most frequent abdominal grips performed. Ultrasound examination is commonly used to determine fetal orientation.Cilj rada je ustanoviti koliko često opstetričari u svojoj praksi rabe Leopold-Pavlikove hvatove. Materijal i metode. Upitnik s brojčanim podatcima je podijeljen opstetričarima iz prakse. Oni su pokazali koliko često izvode ­mjerenje udaljenosti fundus simfiza, Leoplodove hvatove i pregled ultrazvukom za prosudbu fetalnog položaja i stava. Rezultati. Ukupno je 165 opstetričara ispunilo upitnik. Samo 56 (33,9%) njih mjere udaljenost fundus simfiza. Prvi i treći Leopoldov hvat su najčešće rabljeni hvatovi. Samo 36 (21,8%) ispitanika redovito izvode sva četiri hvata. Sedamdeset ­sedam (47,7%) rabe ultrazvučni pregled da odrede položaj i stav djeteta. Uporaba ultrazvuka je bila signifikantno češća (p=0,02) u onih koji rade manje od 10 godina (62,6%) od onih koji rade dulje od 10 godina (43,3%). Zaključak. Leopoldovi hvatovi su još uvijek uobičajeni u svakodnevnoj opstetričnoj praksi. Palpacija trbuha trudnice je uobičajena metoda za prosudbu veličine maternice. Prvi i treći Leopoldov hvat su najčešće rabljeni hvatovi. Pregled ultrazvukom se obično rabi za prosudbu položaja i stava fetusa

Interventional Ultrasound for Ovarian Cyst Aspiration During Pregnancy; A Case Report and Literature Review

Abstract: Herewith we present perinatal outcome in pregnancies with ovarian cysts after fine needle aspiration in the second trimester and excision during c-section at term. Outcome was satisfactory for both maternal and fetal. 28 years primigravida presented with huge ovarian cyst, size 18 X 16 cm in her second trimester of pregnancy. The procedure was performed without anaesthesia under ultrasound guidance. Three litres were aspirated within two hours while the patient was on her right lateral position. Cytology of the aspirated fluid revealed a simple ovarian cyst and no evidence of malignancy. The pregnancy continued uneventfully. C-section was done at 37 weeks gestational age.  Ovarian cystectomy was performed. The result of histopathology was benign cystadenoma. We concluded that ovarian cyst aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign ovarian cysts. We advocate using this procedure in similar situation and same characteristics

Prevention of spontaneous preterm delivery–an update on where we are today

Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide with a great disparity between low, middle and high income countries. It has been estimated that the cost of neonatal care for preterm babies is more than 4 times that of a term neonate admitted into the neonatal care. Furthermore, there are high costs associated with long-term morbidity in those who survive the neonatal period. Interventions to stop delivery once preterm labor starts are largely ineffective hence the best approach to reducing the rate and consequences is prevention. This is either primary (reducing or minimizing factors associated with preterm birth prior to and during pregnancy) or secondary - identification and amelioration (if possible) of factors in pregnancy that are associated with preterm labor. In the first category are optimizing maternal weight, promoting healthy nutrition, smoking cessation, birth spacing, avoidance of adolescent pregnancies and screening for and controlling various medical disorders as well as infections prior to pregnancy. Strategies in pregnancy, include early booking for prenatal care, screening and managing medical disorders and their complications, and identifying predisposing factors to preterm labor such as shortening of the cervix and timely instituting progesterone prophylaxis or cervical cerclage where appropriate. The use of biomarkers such as oncofetal fibronectin, placental alpha-macroglobulin-1 and IGFBP-1 where cervical screening is not available or to diagnosis PPROM would identify those that require close monitoring and allow the institution of antibiotics especially where infection is considered a predisposing factor. Irrespective of the approach to prevention, timing the administration of corticosteroids and where necessary tocolysis and magnesium sulfate are associated with an improved outcome. The role of genetics, infections and probiotics and how these emerging dimensions help in the diagnosis of preterm birth and consequently prevention are exciting and hopefully may identify sub-populations for targeted strategies.Open Access funding provided by the Qatar National Library

Immunisation against COVID-19 in Pregnancy and of Women Planning Pregnancy

Following reports of the first human SARS-CoV2 infection in December 2019 from Wuhan Province, China, there was such rapid spread that by March 2021, the World Health Organization (WHO) had declared a pandemic. Over 6.5 million people have died from this infection worldwide, although this is most likely an underestimate. Until vaccines became available, mortality and severe morbidity were costly in terms of life lost as well as the cost of supporting the severely and acutely ill. Vaccination changed the landscape, and following worldwide adoption, life has gradually been returning to normal. The speed of production of the vaccines was unprecedented and undoubtedly ushered in a new era in the science of fighting infections. The developed vaccines were on the already known platforms for vaccine delivery: inactivated virus, virus vector, virus-like particles (VLP) subunit, DNA and mRNA. The mRNA platform was used for the first time to deliver vaccines to humans. An understanding of these platforms and the pros and cons of each are important for clinicians who are often challenged by the recipients on the advantages and risks of these vaccines. These vaccines have so far and reassuringly been shown to be safe in reproduction (with no effect on gametes) and pregnancy (not associated with congenital malformations). However, safety remains paramount and continuing vigilance is critical, especially against rare fatal complications such as vaccine-induced thrombocytopenia and myocarditis. Finally, the waning immunity months after vaccination means repeated immunisation is likely to be ongoing, but just how often and how many such revaccinations should be recommended remains uncertain. Research into other vaccines and alternate delivery methods should continue as this infection is likely to be around for a long time

SELEKTIVNI FETICID – NAUČENE LEKCIJE I BUDUĆI IZAZOV

The paper reviews cases of fetal reduction done for high order multi-fetal pregnancies, over a course of four years (2004 – 2008) at Hamad Medical Corporation, in Doha, Qatar. The aim is to find out the success of the procedure, its outcome, any related complications to both the mother or the fetuses and wheather or not it has any relation to the method of the procedure or the gestational age at which it was done. Material. There were seven cases done out of which five were successful. The other two cases declined to have another trial of reduction. Our results have shown that fetal reduction is a successful procedure with minimal affection of the fetus and the mother. It also decreases the rate of high order multiple gestation complications and prolongs the pregnancy to near maturity. Conclusion. Based on the results of the study the procedure should be offered to all high order gestations.Članak prikazuje slučajeve fetalnih redukcija u mnogoplodovih trudnoća, učinjene u četverogodišnjem razdoblju (2004–2008) u Hamad Medical Corporation, Doha, Qatar. Cilj rada je prikazati uspjeh postupka, njegov ishod, komplikacije nastale u majke i fetusa, te povezanost postupka s načinom zahvata i ovisnost o dobi trudnoće, u kojoj je zahvat rađen. Materijal. Ukupno je feticid učinjen u sedam trudnoća. Postupak je u pet bio uspješan; daljnje dvije trudnice su odustale od ponovljenog zahvata. Rezultati. Fetalna redukcija je uspješan postupak, koji neznatno šteti fetusu ili majci. Postupkom se smanjuju mnogoplodne trudnoće te produljuje trudnoća do njene zrelosti za porod. Zaključak. Na temelju rezultata studije, postupak bi trebalo ponuditi svim trudnicama s mnogoplodnim trudnoćama

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) – age groups 11–20 and 41–50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV

RAK CERVIKSA U TRUDNOĆI: PRIKAZ BOLESNICE

The case of 29 years old pregnant III-para at 38 weeks of gestational age is presented. The patient was admitted complaining of vague abdominal pain. By speculum examination the large cervix with reddish ulcerative cervical canal was established and punch biopsy performed. The pathohistological diagnosis was well differentiated squamous cell carcinoma. No local metastases or lymph node or other signs of cancer spreading were present (stage 1a). The CS was done, born vital newborn of 2 kg weight, proceeded to total abdominal hysterectomy with bilateral salpingoophorectomy. The pathohistological finding was: Stromal invasion of 3 mm in depth and 6 mm in lateral spread (FIGO stage 1a1). Postoperative period was uneventfull, the patient was reffered to Institute of Nuclear Medicine for further management, where she received only 2 cycles of radiation and chemotherapy and thereafter stopped the treatement. Two years later the patient presented very ill and passed because of uremia.Prikazana je bolesnica dobi 29 godina, III-para, s oko 38 tjedana trudnoće. Primljena je zbog nejasnih boli u donjem trbuhu. Pregledom u spekulima nađen je krupni cerviks s ulceracijom u cervikalnom kanalu. Pod anestezijom je učinjena biopsija cerviksa i dobivena patohistološka dijagnoza: dobro diferencirani karcinom pločastih stanica. Nije bilo lokalnih metastaza, širenja u limfne čvorove ili drugih znakova širenja raka (stupanj 1a). Učinjen je carski rez i nastav¬ljena totalna histerektomija s obostranom salpingooforektomijom. Patohistološki nalaz je bio: stomalna invazija 3 mm u dubinu i postranična zahvaćenost 6 mm (FIGO stupanj 1a1). Postoperativni je tijek bio uredan, bolesnica je upućena u Zavod za nuklearnu medicinu radi zračenja i kemoterapije. Primila je samo dva ciklusa terapije i tada napustila liječenje. Nakon dvije godine pacijentica se pojavila vrlo bolesna, umrla je od uremije

EPIDEMIC OF RIFT VALLEY FEVER IN SUDAN, GEZIRA, 2007; GEZIRA EXPERIENCE

In the last 3 months of 2007, an acute episode of an ill-defined severe febrile illness presented to Medani hospital isolation words, with severe hemorrhagic manifestations. This initially did not harbor any attention as other possibilities were thought of like severe malaria , septicaemia but by the end of the same week the number of patients increased dramatically and the suspicion was put and the whole case was addressed officially in an epidemical paradigm. This study was conducted in Wad Medani Teaching Hospital. From the beginning of 41st week of the year 2007, the Gezira state in Sudan was tremendously affected by an epidemic of Rift valley fever as declared by the WHO authorities (11).all the districts of the estate were involved with a total number of patients was around 392. During the period of epidemic of RVF, (week 41.2007 - up to the 1st week of January 2008) total number of patients admitted were about 392 and total number of patients died were 158 patients .The main presenting symptoms were fever, epistaxsis, haematemesis and vaginal bleeding, and the main complication was acute renal failure and death

Best practice and research clinical obstetrics and gynaecology volume 92

Obesity is rising world-wide and has become the most common risk factor for non-communicable diseases. The increase is disproportionate, being higher in the low- and middle-income countries compared to high-income countries. In 2016, the WHO estimated that about 1.9 billion people world-wide were overweight and 650 million of these were obese. If current trends are not reversed, then it is estimated that by 2030, approximately 1:5 women (most of whom will be in the reproductive age groups) would be obese. The percentage of medical spending on obesity health-related complications varies from 3% to 21% depending on the country. Obesity is associated with severe morbidity and mortality including hypertension, diabetes and 13 cancers amongst which are ovarian, breast and endometrial. Several reasons have been advanced for the rise in obesity rates including genetic, epigenetic, environmental, cultural, political, and socioeconomic. Overall, obesity is now considered one of the most important threats to human health. It is within this context that this series on Obesity and Reproductive Health is timely and welcome. The series includes up-to-date coverage of key topics that address the reproductive consequences of obesity and the challenges in providing care to these women. The overview of the epidemiology puts into perspective the magnitude of the problem and the challenges posed by rising trends as well as how this may be arrested. Collective action from individuals, industry, national and international agencies, and governments is crucial to be successful