Uterine torsion of 90 degrees: case report

Uterine torsion is defined as a rotation of uterus more than 45 degrees along its long axis. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice, authors report a case of torsion of the uterus by 90 degrees. The patient, a 30-year-old gravida 3 para 2 at 37 weeks’ gestation with a singleton pregnancy, her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation was admitted to the obstetrical unit  with  labour at 37 weeks 5 days ,on obstetric examination the patient was in labour with transversal presentation of the fetus so an emergency caesarean section (CS) was carried out for. At the time of CS, the diagnosis of uterine torsion of 90 degrees was made. After the delivery of the baby, uterus returned to anatomical position and the torsion corrected spontaneously. The patient recovered and was discharged home with her baby on the third postoperative day. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester

Partial hydatidiform mole evolving into metastatic trophoblastic tumor: case report

Partial hydatidiform mole can evolve into a metastatic trophoblastic tumor. A 36-year-old, multiparous woman, pregnant with a 22-week embryonic hydatidiform mole, having spontaneously expelled. Histopathological examination showed a non-invasive partial mole. During biological monitoring, a trophoblastic tumor was diagnosed with pulmonary metastasis on CT-scan and myometrial invasion by MRI. Authors opted for a monochemotherapy with a good evolution. The potential risk of malignant transformation of the partial hydatidiform mole requires an adequate therapeutic strategy with strict monitoring

Near death 18 weeks preeclampsia in molar pregnancy

Authors present a case of a molar pregnancy of 18 weeks with preeclampsia complicated with acute pulmonary oedema. A condition carrying a significant risk to mother, therefore, raising an important issue on preeclampsia symptoms on pregnancies before 20 weeks. A 31-year-old woman gravida 2, parity 1 presented with dyspnea at 18 weeks' gestation. Blood pressure was very high (180/110 mmHg) and there was markedly proteinuria (+4). She had severe dyspnea and her oxygen saturation level was 75%. Her chest X-ray graph showed massive acute pulmonary oedema. Ultrasonography shows endometrial cavity containing multiple small cystic spaces, creating a characteristic “snowstorm” and “cluster of grapes” appearance. Markedly elevated quantitative human chorionic gonadotropin (250.000 mIU/mL). The acute pulmonary oedema has been managed by diuretics (Furosemide) and oxygen. There was no cardiac abnormalities in the tranthoracic echocardiogram. Authors administered antihypertensive therapy (intravenous nicardipine and lmethyldopa in per os), and magnesium sulfate in prevention of eclamptic seizures. The pregnancy was terminated by uterine evacuation under oxytocin infusion by manual ultrasound aspiration. She was followed up intensive care unit for two days. Causes of secondary high blood pressure had been eliminated. The patient's blood pressure rapidly normalized two days after delivery. Dyspnea disappeared one day later. Pathologic and cytogenetic analyses revealed a complete hydatiform mole. Two days after delivery; the serum β-hCG level was 99000 mlU/ml. A control ultrasonography shows an empty uterus. Hydatidiform mole is classified into 2 different subtypes, complete hydatidiform mole and partial or incomplete hydatidiform mole development of preeclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. Ultrasonography and level of serum BHCG are the initial investigation of choice for the detection of hydatidiform mole. Aspiration is the treatment of reference

Gynandroblastoma: a rare case report of ovarian sex cord tumour

Gynandroblastoma is an extremely rare ovarian sex cord tumor with malignant potential. An 61-year-old woman, menopausic, consulted for an abdominal pelvic mass. a latero-uterine mass measuring 27.8 cm in diameter showed a predominantly cystic pattern with a partial solid component. A unilateral adnexectomy was performed. A histopathological examination showed gynandroblastoma composed of juvenile granulosa and Sertoli-Leydig cells, chirurgical treatment was completed by total hysterectomy with right adnexectomy, omentectomy with no proof of malignant cells. We opted for a close observation without adjuvanted chemotherapy. two years after surgery, no signs of recurrence have been noted. The present findings can help clinicians make an accurate preoperative imaging diagnosis of gynandroblastoma with a juvenile granulosa cell component and plan an adequate treatment strategy for this rare, potentially malignant neoplasm