Use of Foley\u27s catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section

Aim: To evaluate the effect of 2-way Foley\u27s catheter balloon tamponade on controlling immediate postpartum hemorrhage (PPH) in cases of major placenta previa during cesarean section (CS). Methods: We evaluated women with placenta previa from May to November 2015. Women with immediate PPH during CS due to major placenta previa were managed by 2-way Foley\u27s catheter balloon tamponade when medical treatment failed, and before any surgical intervention. Results: Twenty patients, had major placenta previa, were delivered by elective CS and complicated by immediate PPH. Three placenta accreta patients (15%) underwent hysterectomy, 17 (85%) were managed by the 2-way Foley\u27s catheter balloon tamponade. In two patients, Foley\u27s catheter balloon failed to control bleeding and hysterectomy was done immediately. However, Foley\u27s catheter balloon successfully treated the remaining 15 patients. The median bleeding during the operation was 1522.5 (± 619.29) ml. None of them presented complications related to this procedure or required any further invasive surgery. Conclusion: The 2-way Foley\u27s catheter tamponade could be an option to control immediate postpartum hemorrhage resulting from major placenta previa during the cesarean section. This method is simple, cheap, nearly non-invasive and should be considered to reduce the risk of peripartum hysterectomy

The unexpected presence of a huge cystic hygroma with thanatophoric dysplasia type I: a case report

Introduction: The presence of a thin-walled, multicystic structure posterior to the fetal head and neck with an intact vertebral column is known as a cystic hygroma. Thanatophoric dysplasia is the most lethal skeletal dysplasia. Thanatophoric dysplasia (TD) is an autosomal dominant disorder with two phenotypes. TD type I is characterized by a normal shaped skull with bowed femurs and micromelia, while TD type II is characterized by straight femurs with a clover-leaf deformity of the skull and micromelia. We report here a case of thanatophoric dysplasia type I associated with cystic hygroma, this association needs further evaluation. Case history: A 30 year old woman was referred at 26 weeks of gestation because of marked polyhydramnios. Ultrasonographic examination of the fetus revealed a narrow chest, protuberant abdomen, short curved femur, normal shaped skull with accidentally cystic hygroma were present. No other anomalies were detected. We explained to the patient the nature and severity of the anomaly and the patient preferred the termination of pregnancy. Induction of abortion was done successfully. Conclusion: This case report has highlighted the association between cystic hygroma and thanatophoric dysplasia type I. To our knowledge, this is the first report in the literature reporting the association of cystic hygroma and thanatophoric dysplasia type I. We believe that this case is useful for obstetricians and pediatricians. We also highly recommend the genetic evaluation of the fetus and parents

Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy

Objectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF). Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings. Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits. Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions

ICAR: endoscopic skull‐base surgery

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Arthrogryposis with cystic hygroma: A case report

Arthrogryposis, or arthrogryposis multiplex congenita (AMC), comprises non progressive conditions characterized by multiple joint contractures found throughout the body .Cystic hygroma are caused by a delay or absence of the communication between the jugular lymph sacs and the internal jugular veins during fetal development. Here is a case of 18 weeks pregnancy with Arthrogryposis, Cystic hygroma and other ultrasonagraphic findings suggestive Trisomy 18 (T18) like clenched hand, Strawberry head and Polydactyly

Torsion of para-ovarian cyst

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature. However, torsion of para ovarian cyst is rare. We report a rare case of twisted paraovarian cyst. Torsion of the fallopian tube and paraovarian cyst is usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain

Adnexal torsion in the first trimester of pregnancy: A case report

Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. It is uncommon for a normal-sized ovary to undergo torsion. Torsion of the ovary during pregnancy is common during third trimester. Adnexal torsion is rarely bilateral and is more common on the right side, perhaps because the sigmoid colon leaves a limited space for left adnexal mobility. Here we report a case of 23-year-old primigravida with 8 weeks pregnancy presented with sever left abdominal pain. Left abdominal tenderness was detected. Transabdominal ultrasound scan reported left adnexal torsion. Laparotomy and then left salpingo-oophorectomy were performed

A 32 weeks twin pregnancy in a non-communicating rudimentary horn: Case report

Introduction: Pregnancy in a rudimentary horn represents a serious implication of this rare uterine anomaly. In 90% of cases, rupture of the horn occurred in the second trimester. In this report, we present a rare case of intact twin pregnancy in a non-communicating rudimentary horn that reached 32 weeks of gestation. Case presentation: A 25 years old Caucasian woman pregnant for 32 weeks presented with shock, acute lower abdominal pain and considerable vaginal bleeding. The patient was shocked and the uterus was tender and tense. Trans-abdominal ultrasound scan revealed a twin intrauterine pregnancy with no cardiac activity in both fetuses, fetal biometry was equivalent to 32 weeks and there was a huge retroplacental hematoma. Urgent laparotomy was performed and a huge intact right sided rudimentary horn was identified. Vertical incision was done with extraction of the dead twins, and the horn was excised. Conclusion: Despite being rare, rudimentary horn pregnancy should be suspected regardless of the gestational age. Placental abruption should also be considered as an unusual presentation of this condition

Hydrops fetalis with cystic hygroma: A case report

Hydrops fetalis is an excess accumulation of fluid in the fetus. Depending on the severity and cause of hydrops, there may be edema of fetus and placenta, ascites, pleural effusions and/or pericardial effusions. In previous years, most cases of hydrops were caused by severe erythroblastosis fetalis secondary to Rh isoimmunization. Most cases of hydrops fetalis are now caused by other conditions and are known as nonimmune hydrops. Here is a case of an 18 week pregnancy with hydrops fetalis, cystic hygroma and other structural anomalies suggestive chromosomal abnormalities

Endometrial ablation for treatment of heavy menstrual bleeding: For whom it may not work?

Endometrial Ablation (EA) refers to a group of minimally invasive approach that produces irreversible destruction of the endometrium. These procedures provide a satisfactory alternative to hysterectomy when medical treatment is contraindicated or unsatisfactory. While EA has become longstanding in practice, variable failure rates were reported, that seem to relate, in part, to time since intervention. Identifi cation of predictors of long-term outcomes allows better patient selection and lowers the probability of reintervention.This review discusses determinants of EA failure and how to improve patient selection based on available evidence.</p