Acute presentation of a heterotopic pregnancy following spontaneous conception: a case report

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We present the case of a 40 year old patient who was treated for a heterotopic pregnancy. She had a transvaginal ultrasound because of a previous ectopic pregnancy and an intrauterine gestational sac was seen with false reassurances. The patient presented acutely with a ruptured tubal pregnancy and this was managed laparoscopically. The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation

Negative pressure wound therapy aids recovery following surgical debridement due to severe bacterial cellulitis with abdominal abscess post-cesarean: a case report (CARE-Compliant).

Open accessBacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate—used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and “ad-hoc” solutions to improve efficacy and patient experience. A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community. NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm2 per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully healed with no additional scarring beyond the boundaries of the origi

Whole body magnetic resonance imaging of healthy newborn infants demonstrates increased central adiposity in Asian Indians

Abdominal adiposity and metabolic ill health in Asian Indians are a growing public health concern. Causal pathways are unknown. Preventive measures in adults have had limited success. The aim of this observational case-control study was to compare adipose tissue partitioning in 69 healthy full term Asian Indian and white European newborns born in Pune, India and London, UK, respectively. The main outcome measures were total and regional adipose tissue content measured by whole body magnetic resonance imaging. Although smaller in weight (95% CI for difference −0.757 to −0.385 kg, p < 0.001), head circumference (−2.15 to −0.9 cm, p < 0.001), and length (−2.9 to −1.1 cm p < 0.001), the Asian Indian neonates had significantly greater absolute adiposity in all three abdominal compartments, internal (visceral) (0.012–0.023 L, p < 0.001), deep s.c. (0.003–0.017 L, p = 0.006) and superficial s.c. (0.006–0.043 L, p = 0.011) and a significant reduction in nonabdominal superficial s.c. adipose tissue (−0.184 to −0.029 L, p = 0.008) in comparison to the white European babies despite similar whole body adipose tissue content (−0.175 to 0.034 L, p = 0.2). We conclude that differences in adipose tissue partitioning exist at birth. Investigative, screening, and preventive measures must involve maternal health, intrauterine life, and infancy

BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy

Key content: Hysteroscopy is a common surgical procedure in gynaecology. Fluid distension media is needed to undertake the procedure. The common fluid distension media available are discussed, along with their properties and role in undertaking operative hysteroscopic procedures. Some inherent complications can occur when there is excessive fluid absorption during hysteroscopic procedures. The monitoring of the fluid distension medium used and how to avoid complications is discussed. / Learning objectives: To gain a better understanding of the fluid media are available for hysteroscopic surgery. To understand the risks associated with the use of different distension fluid media. To understand the difference between the various fluid distension media and their effect when excessive absorption occurs. To recognise, manage and prevent complications associated with excessive fluid absorption. To understand the different monitoring systems available during surgery