Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a 34-year-old gravida 6 para 4 female who experienced POVL following an uncomplicated laparoscopic hysterectomy. Operating time was 174 minutes, and EBL was 75&#x2009;mL. After surgery, she complained of complete vision loss with no light perception. No cerebral hemorrhage or ischemia was detected on imaging. Funduscopic exam revealed no structural abnormalities. On postoperative day 7, she received an IV methylprednisolone taper. The following morning, she reported mild light perception. Later that night, she reported a partial return of visual acuity and was discharged home. At her 2-week postoperative visit, her vision had returned to baseline. POVL is an emergency and prompt evaluation should be initiated to optimize outcome.

Steven Radtke

Elizabeth Florence

Alexander Clavijo

Linh Do

Isabel Lopez

Complete Vision Loss after Laparoscopic Hysterectomy

The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman with a history of termination of pregnancy in the second trimester, was referred to the outpatients of the Gynecologic Department of the General Hospital of Trikala, reporting vaginal bleeding, accompanied by a deep, mild pain in the abdomen for a few days. The urine pregnancy test was positive. The transvaginal ultrasound in combination with the <i>&#x03B2;</i>-chorionic gonadotropin level was indicative of an ectopic pregnancy, and the surgical treatment of the patient was decided. Intraoperatively, the presence of an ovarian ectopic pregnancy was detected, and a wedge resection of the affected ovary was performed. The patient was discharged from our clinic on the third postoperative day, with instructions for weekly follow-up of the <i>&#x03B2;</i>-chorionic gonadotropin level until it returns to normal values.

Efthymia Thanasa

Ioannis Thanasas

Nikoleta Koutalia

Maria Mousia

Surgical Treatment of Ovarian Pregnancy

Though prepubertal vaginal bleeding is rare, it can create a dilemma for both physicians and parents. Prepubertal vaginal bleeding due to leech bite is even rarer and very difficult to diagnose without proper history. We report a case of a six-year-old girl presenting with vaginal bleeding and ultimately diagnosed as a case of vaginal bleeding due to leech bite. We described how focused history helped us in diagnosis and management of such case in rural areas with limited healthcare resources. A detailed history with a high index of suspicion and a thorough examination is essential to diagnose leech bite in the vagina.

S. M. Tajdit Rahman

Tasnim Shahriar

Adiba Tarannum

Md Abul Kasem

Tasnuva Akter

A Case Report on Prepubertal Vaginal Bleeding due to Leech Bite: History Is Very Important

Mitsuhiro Nakamura

Ryusuke Murakami

Kaoru Abiko

Taito Miyamoto

Yoshimi Kitawaki

Ken Yamaguchi

Akihito Horie

Junzo Hamanishi

Eiji Kondoh

Tsukasa Baba

Aki Kido

Sachiko Minamiguchi

Noriomi Matsumura

Masaki Mandai

Corrigendum to &#x201C;Low-Grade Endometrial Stromal Sarcoma with a Nodule-in-Nodule Appearance in Preoperative Magnetic Resonance Images&#x201D;

In this retrospective report, we present five cases of critically ill pregnant or newly delivered women positive for Covid-19 admitted to our obstetrical departments at Karolinska University Hospital. They compose 6% of eighty-three pregnant women that tested positive for SARS-CoV-2 during the period March 25 to May 4, 2020. Three patients were at the time of admission in gestational week between <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="23.017pt" style="vertical-align:-0.3499298pt" id="M1" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 23.017 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,15.386,0)"><path id="g117-36" d="M535 230V280H323V490H265V280H52V230H265V-3H323V230H535Z"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.438pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="25.872183800000002 -8.34882 6.438 8.69875"><g transform="matrix(.013,0,0,-0.013,25.922,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg></span> and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="23.017pt" style="vertical-align:-0.3499298pt" id="M2" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 23.017 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,15.386,0)"><use xlink:href="#g117-36"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.438pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="25.872183800000002 -8.34882 6.438 8.69875"><g transform="matrix(.013,0,0,-0.013,25.922,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span> and treated during their antenatal period; meanwhile, the other two were admitted within 1 week postpartum. All of them were in need of intensive care: one was treated with high flow oxygen therapy, the other four with invasive mechanical ventilation (three with endotracheal intubation and one with extracorporeal membrane oxygenation). Age above thirty, overweight, and gestational diabetes are notable factors in the cases presented. At the time of admission, they all presented with symptoms such as fever, cough, and dyspnea. Chest imaging with computer tomography scan was performed in each case and demonstrated multifocal pneumonic infiltrates in all of them, but no pulmonary embolism was confirmed in any. Neither did the echocardiogram indicate any cardiomyopathy. Four of the patients have been discharged from the hospital, with an average of 20 hospital days. One antenatal pregnant woman needed prolonged ECMO therapy; in gestational week <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="23.019pt" style="vertical-align:-0.3499298pt" id="M3" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 23.019 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,15.388,0)"><use xlink:href="#g117-36"/></g></svg><span class="ibiop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="6.436pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="25.8741838 -8.34882 6.436 8.69875"><g transform="matrix(.013,0,0,-0.013,25.924,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g></svg>,</span></span> she went into cardiac arrest, resulting in an urgent C-section on maternal indication. At the time of writing, she is still hospitalized. In coherence with other published reports, our cases indicate that critically ill pregnant women infected by SARS-Cov-2 may develop severe respiratory distress syndrome requiring prolonged intensive care. The material is limited for conclusions to be made; more detailed information on symptoms, treatment, and outcomes for pregnant and postpartum women managed in intensive care is therefore needed.

Rasha El-ahmad Polcer

Elin Jones

Karin Pettersson

A Case Series on Critically Ill Pregnant or Newly Delivered Patients with Covid-19, Treated at Karolinska University Hospital, Stockholm

The aim of this paper is to present a case of a cesarean section ectopic pregnancy (CSP) diagnosed in the second trimester and perform a literature review of current guidelines for the management of CSP in the second trimester. This was exempt from the Mount Sinai IRB. This is a case is of a 35-year-old P1122 at 13w4d who presented to our hospital with vaginal spotting and abdominal pain. The patient was found to have a cesarean section ectopic pregnancy with placenta increta. There are no management guidelines for second trimester CSP, and the published material is minimal. A literature review was completed and demonstrated two cases and one case series published on management of existing literature on management of second trimester CSP. Our patient underwent an uncomplicated total laparoscopic hysterectomy with bilateral salpingectomy, bilateral ureterolysis, and cystoscopy. She had an uncomplicated postoperative course and was discharged on postoperative day three with an unremarkable recovery at her two-week postoperative visit.

Sharonne Holtzman

Mary Louise Kiernan

Jaimie Huntly

Valentin Kolev

Konstatin Zakashansky

Cesarean Section Scar Ectopic Pregnancy in the Second Trimester: An Underrecognized Complication of Cesarean Deliveries

Although the incidence of preeclampsia complicated by hyponatremia is reportedly rare, the effects on the maternal outcome are severe and life-threatening. Here, we describe a case of a patient with preeclampsia who coded postpartum and was discovered to have hypervolemic hyponatremia and subsequently recovered after fluid diuresis and resolution of hyponatremia. While hyponatremia in preeclampsia is rare, it is even more unique for it to lead to cardiopulmonary arrest consequently. Therefore, sodium levels and fluid status should be monitored closely and promptly corrected without delay to prevent cardiopulmonary arrest in patients with preeclampsia.

Richard Hsu

Anna Tong

Chaur-Dong Hsu

Hypervolemic Hyponatremia as a Reversible Cause of Cardiopulmonary Arrest in a Postpartum Patient with Preeclampsia

Pregnancy in the rudimentary horn is rare and a life-threatening. Rupture of pregnant rudimentary horn in the second trimester is a usual presentation. Early diagnosis and fast management are necessary to decrease the mortality and the morbidity of this pathological entity. This report confirms the diagnostic and therapeutic difficulties of the pregnant rudimentary horn. An emergency laparotomy was taken, and ruptured right rudimentary horn was diagnosed. A hemi-hysterectomy was carried out. The patient&#x2019;s postoperative follow-up was uneventful, and she left the hospital 5 days after.

Hanane Houmaid

Abderraouf Hilali

Rupture of Rudimentary Horn Pregnancy at 16 Weeks of Gestation

About this journal

<p><em>Case Reports in Obstetrics and Gynecology</em> publishes case reports and case series related to obstetrics, maternal-fetal medicine, gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, and reproductive endocrinology.</p>


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Case Reports in Obstetrics and Gynecology