“Near miss” maternal morbidity following repeat rescue cerclage for twin pregnancy

Objective Repeat cervical cerclage is one of the treatment options described in the literature for when the primary cerclage suture fails. However, infectious complications of cerclage placement may be encountered which are more obvious for the newborn. In our presented case, severe acute maternal morbidity was encountered for the sake of prolonging pregnancy. Case(s) Twenty-seven year old nullipar patient at 23+5 gestational weeks with dichorionic diamniotic pregnancy was admitted to our emergency clinic with complaints of “pain” and “vaginal bleeding”. At 18 weeks of pregnancy she had a Shirodkar cerclage procedure indicated by a short cervical length (14 mm) at our hospital. She presented with “bulging of membranes” to a different institution and underwent a repeat cerclage at 23+3 weeks. Chorioamnionitis was suspected and the patient was counselled for a pregnancy termination. After termination of pregnancy, “cardiac arrest” developed. After 2 minutes of resuscitation sinus rythm was obtained. The patient was admitted to the ICU. Conclusion The role of repeat cerclage is controversial. Efforts should be maximized to rule out underlying intrauterine infection prior to placement of a cerclage suture for there to be a therapeutic benefit of prolonging the pregnancy

Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report

<div><p>Abstract Purpose Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported. Case Report A congested, multinodular myomectomy specimen was resected. Histologically, smoothmuscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the Ki-67 index was of 2-3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence. Conclusions Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant.</p></div