Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for congenital cystic adenomatoid malformation of the lung

BACKGROUND: Spontaneous monochorionic triamniotic pregnancy is rare and is at increased risk for pregnancy complications. The presence of an anomalous fetus further complicates the management. CASE PRESENTATION: We present a case of monochorionic triamniotic triplet pregnancy diagnosed at 15 weeks of gestation with one fetus having developed a multicystic lung lesion, suggestive of congenital cystic adenomatoid malformation (CCAM). At 24 weeks, the largest cyst measured 10 mm in diameter. We managed the pregnancy conservatively and delivered three live male fetuses with birth weights 1560 g, 1580 g and 1590 g at 35 weeks of gestation. Two newborns were admitted to the neonatal intensive care unit with respiratory distress, the third one died due to sepsis 7 days postpartum. One of the newborns was discharged healthy at 24 days postpartum. The newborn with CCAM developed a pneumothorax on the right side, recovered after treatment, and was discharged after one month. Computerized tomography (CT) of the infant at 3 months demonstrated two cystic lesions in the middle lobe of the right lung measuring 25 mm and 15 mm. A repeat CT of the infant at 6 months showed a 30 mm solitary cystic mass. CONCLUSION: Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for CCAM, present rarely and can be managed conservatively. These findings may help in decision making and counselling of parents

Prospective randomized trial of iliohypogastric-ilioinguinal nerve block on post-operative morphine use after inpatient surgery of the female reproductive tract

<p>Abstract</p> <p>Objective</p> <p>To determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS).</p> <p>Methods</p> <p>We conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB) on post-operative morphine consumption in female study patients (<it>n </it>= 60). Patients undergoing laparotomy via Pfannenstiel incision received injection of either 0.5% bupivacaine + 5 mcg/ml epinephrine for IINB (Group I, <it>n </it>= 28) or saline of equivalent volume given to the same site (Group II, <it>n </it>= 32). All injections were placed before the skin incision and after closure of rectus fascia via direct infiltration. Measured outcomes were post-operative morphine consumption (and associated side-effects), visual analogue pain scores, and hospital length of stay (LOS).</p> <p>Results</p> <p>No difference in morphine use was observed between the two groups (47.3 mg in Group I vs. 45.9 mg in Group II; <it>p </it>= 0.85). There was a trend toward lower pain scores after surgery in Group I, but this was not statistically significant. The mean time to initiate oral narcotics was also similar, 23.3 h in Group I and 22.8 h in Group II (<it>p </it>= 0.7). LOS was somewhat shorter in Group I compared to Group II, but this difference was not statistically significant (<it>p </it>= 0.8). Side-effects occurred with similar frequency in both study groups.</p> <p>Conclusion</p> <p>In this population of patients undergoing inpatient surgery of the female reproductive tract, utilization of post-operative narcotics was not significantly influenced by IINB. Pain scores and LOS were also apparently unaffected by IINB, indicating a need for additional properly controlled prospective studies to identify alternative methods to optimize post-surgical pain management and reduce LOS.</p

The 2011 Survey on Hypertensive Disorders of Pregnancy (HDP) in China:Prevalence, Risk Factors, Complications, Pregnancy and Perinatal Outcomes

Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP

Vaginoscopic resection of vaginal septum

We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect

Episiotomy: history, present and future - a review

Childbirth has always carried traumatic stress to the woman's body. To deliver with less perineal trauma, obstetricians have used episiotomies. Episiotomy is still a common practice despite the controversy regarding its use. Weighing the risks and benefits, the scientific literature supports its selective use. With the worldwide trend to reduce the rate of episiotomy, several techniques have been proposed to achieve that. However, further research is still needed to prove their efficacy. This review will shed light on the historical background of episiotomy, its different techniques, indications, and the future of its practice

Factors that affect women's choice of their obstetrician and gynecologist: a survey of Lebanese women

Background: Previous studies in the Western world and some Arab countries have shown that women seeking healthcare consider a variety of factors such as physician bedside manner, hospital affiliation, experience, competency, gender, and recommendations from friends among others. The objective of this study is to evaluate factors that affect Lebanese women's choice of their obstetrician and gynecologist (ob-gyn). Materials and Methods: Quantitative data were collected from 199 respondents after administering a self-completion questionnaire created on "LimeSurvey" and sent via email to a random sample (n=848) of female employees at the American University of Beirut (AUB). SPSS was used to code and analyze the data. Results: Lebanese women value consultation quality (median score (MS) = 92%), convenience (MS = 80%), physician's educational background (MS = 73.34%) and reputation (MS = 52%), more than physical qualities (MS = 40%), and physician's gender (MS = 20%). Multivariate analysis showed that younger females care more about consultation quality (p = 0.01), Muslim women and village residents prefer a female physician (p = 0.02 and p = 0.01, respectively), and the woman's level of education directly relates to the physician's educational background (p = 0.01). Conclusion: These findings will help medical graduates, program directors, current practitioners, and hospital human resources managers to better understand and cater to the needs of the population they are serving

The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease

This study aimed to determine the usefulness of MR cholangiopancreatography (MRCP) in the evaluation of pregnant patients with acute pancreaticobiliary disease and its additional value over ultrasound. MRI studies of pregnant patients who were referred because of acute pancreaticobiliary disease were included. MR images and patient charts were reviewed retrospectively to determine clinical outcome and the results of other imaging studies. 18 pregnant patients underwent MRCP because of right upper quadrant pain (n=6), pancreatitis (n=9), cholangitis (n = 1) or jaundice (n=2). 15 patients were also evaluated with ultrasound. Biliary dilatation was detected in eight patients by ultrasound, but the cause of biliary dilatation could not be determined by ultrasound in seven patients. MRCP demonstrated the aetiology in four of these patients (choledocholithiasis (n=1), Mirizzi syndrome (n=1), choledochal cyst (n=1) and intrahepatic biliary stones (n=1)) and excluded obstructive pathology in the other four patients. MRCP was unremarkable in the seven patients who had no biliary dilatation on ultrasound. Three patients underwent only MRCP; two had choledocholithiasis and one cholelithiasis and pancreatitis. Choledocholithiasis diagnosed with MRCP (n=3) was confirmed by endoscopic retrograde cholangiopancreatography. Mirizzi syndrome (n=1) and a choledochal cyst (n=1) were confirmed by surgery. The patients with normal MRCP (n=12) and one patient with intrahepatic stones improved with medical treatment. MRCP appears to be a valuable and safe technique for the evaluation of pregnant patients with acute pancreaticobiliary disease. Especially when ultrasound shows biliary dilatation, MRCP can determine the aetiology and save the patient from unnecessary endoscopic retrograde cholangiopancreatography by excluding a biliary pathology

Intraumbilical vein injection of oxytocin and the third stage of labor: randomized double-blind placebo trial

The objective of this study was to determine whether intraumbilical injection of oxytocin shortens the third stage of labor. A randomized, double-blind, placebo-controlled trial was used to assess the effectiveness of an intraumbilical injection of oxytocin on the duration of the third stage. Following randomization, each of 79 women received 30 mL of saline ( N = 40) or 20 U of oxytocin in 30 mL of saline ( N = 39). The primary outcome of interest was the effect on the duration of the third stage. Secondary outcomes examined were change in hemoglobin and percentage of undelivered placenta after 15 minutes. There was no difference in the duration of the third stage between the two groups (7.8 +/- 6.1 min in the saline-only group versus 5.9 +/- 2.6 min in the oxytocin group). The change in hemoglobin was significantly lower in the oxytocin group (1.3 +/- 0.9 g/dL in the oxytocin group versus 1.8 +/- 0.9 g/dL in the saline-only group). The percentage of undelivered placentas beyond 15 minutes was significantly lower in the oxytocin group (0% in the oxytocin group versus 12.5% in the saline-only group). The study concluded that intraumbilical vein injection of oxytocin reduced the rate of placentas remaining undelivered beyond 15 minutes and subsequent blood loss