Intrapartal uterine avulsion with posterior cervical rupture

In this case study we describe an obstetric emergency of complete intrapartum left-lateral uterine avulsion, with posterior cervical rupture in a 31-year-old secundipara, following vacuum extraction. To the best of our knowledge, a similar case has not been previously reported in the literature. A live macrosomic male neonate was delivered by two tractions, with lateral episiotomy, and with shoulder dystocia that was relieved by McRoberts’ and Resnik’s maneuvers (Apgar score 7.8, birth weight/length 4640/57). In our patient, the risk factors for avulsion and concomitant posterior cervical rupture included prolonged second stage of labor, delivering a macrosomic neonate in a secundipara with deflexion (parietal) in a cephalic presentation along the distended and thinned posterior uterine wall. Urgent total hysterectomy was performed in dramatical circumstances due to complete unilateral avulsion and cervical rupture, with continuous aortal compression, volume replacement and intact coagulation, which certainly contributed to the good final maternal outcome

Spontana heterotopična, ektopična cervikalna i ektopična tubarna trudnoća - uvijek prisutna dijagnostička poteškoća: prikaz triju slučajeva

The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.Incidencija heterotopičnih/ektopičnih trudnoća se u posljednje vrijeme povećava između ostalog i zbog sve veće upotrebe metoda pomognute oplodnje, ali ovi slučajevi, a naročito cervikalna trudnoća, iznimno su rijetki u spontanim zanošenjima. Prikazujemo tri bolesnice koje su se javile u našu Kliniku u tjedan dana: bolesnica sa spontanom heterotopičnom trudnoćom, druga s cervikalnom i treća s tubarnom trudnoćom. Sve su spontano zanijele, pravodobno dijagnosticirane i izliječene, ali naglašavamo da je osobita pozornost potrebna u dijagnozi i liječenju potencijalno fatalnih posljedica izvanmaterničnih trudnoća ako nisu prepoznate i liječene dovoljno rano, unatoč tako iznimno rijetkoj pojavnosti

Učinak pentadekapeptida BPC 157 i uloga sustava dušikova oksida na oštećenje stijenke maternice cisteaminom

Cysteamine induces damages of endometrium and penatadecapeptide BPC 157 counteracts those lesions as well as interacts with NO-system. Cysteamine was applied directly in each of the uterus horns (40mg/0.5ml/uterus horn), in the total dose of the 400 mg/kg. Effect was evaluated by macroscopic and microscopic examination after 2h, 3days and 7 days. Medication was given after cysteamine, either immediately or 2h later, including pentadecapeptide BPC 157 10μg/kg or 10ng/kg per day, intraperitoneally (5ml/kg), or perorally (12ml/rat/day, 0.16ug/ml, 0.16ng/ml), L-NAME (5mg/kg/day intraperitoneally), Larginine (100mg/kg/day intraperitoneally), given alone and/or in combinations, while controls received saline (5ml/kg) intraperitoneally or drinking water (12ml/rat/day). We demonstrated a strong damaging effect of cysteamine on the endometrium. BPC 157 given intraperioneally or per-orally prevented lesions development and counteracted already extensive lesions. We proved interaction between the tested pentadecapeptide BPC 157 in conditions of modulation of the NO-synthetase inhibitor L-NAME or NO-synthetase substrate L-arginine. These suggest NO-system related regeneration of the endometrium and beneficial effect of BPC 157 connected with NO-system. In conclusion, significant protective effect to the uterus of pentadecapetide BPC 157 may have a particular therapeutical potential