Case Reports in Obstetrics and Gynecology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Bilateral Tubal Pregnancy without Known Risk Factor Wed, 18 Oct 2017 00:00:00 +0000 Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy. Hyacinthe Zamané, Barnabé Yameogo, Paul Dantola Kain, François Gueswendé Xavier Kaboré, Yobi Alexis Sawadogo, Sibraogo Kiemtoré, Sidbewenné Yacinthe Kaboré, and Blandine Bonané Thiéba Copyright © 2017 Hyacinthe Zamané et al. All rights reserved. Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion Wed, 18 Oct 2017 00:00:00 +0000 Background. The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes. Jaimin Shah, Eduardo Matta, Fernando Acosta, Natalia Golardi, and Cristina Wallace-Huff Copyright © 2017 Jaimin Shah et al. All rights reserved. 21-Year-Old Pregnant Woman with MODY-5 Diabetes Sun, 15 Oct 2017 00:00:00 +0000 The term “Maturity-Onset Diabetes of the Young” (MODY) was first described in 1976 and is currently referred to as monogenic diabetes. There are 14 known entities accounting for 1-2% of diabetes and they are frequently misdiagnosed as either type 1 or type 2 diabetes. MODY-5 is an entity of monogenic diabetes that is associated with genitourinary malformations and should be considered by obstetricians in pregnant women with a screen positive for diabetes, genitourinary malformations, and fetal renal anomalies. Correct diagnosis of monogenic diabetes has implications on managing patients and their families. We are reporting a case of a 21-year-old pregnant woman with a bicornuate uterus, fetal renal anomalies, and a family history of diabetes that were suggestive of a MODY-5 diabetes. Anastasia Mikuscheva, Elliot McKenzie, and Adel Mekhail Copyright © 2017 Anastasia Mikuscheva et al. All rights reserved. Ectopic Breast Tissue of the Vulva in a Postmenopausal Woman Thu, 12 Oct 2017 00:00:00 +0000 Ectopic breast tissue is a rare condition caused by remnants of the mammary ridges that fail to involute during embryologic development. To date, only 39 cases have been reported in the literature worldwide. Here, we report the 40th case of a 69-year-old G3P2 postmenopausal Caucasian woman who presented with complaint of vulvar swelling. Biopsy of the mass revealed the presence of a benign mammary gland-like adenoma which was completely excised shortly thereafter. Clinical presentation of vulvar breast tissue is highly variable depending on the amount of breast tissue developed and its functionality. Diagnosis is ultimately made by tissue biopsy and histopathologic examination. Due to the scarce evidence that exists pertaining to supernumerary breast tissue located on the vulva, specific management guidelines are lacking. Since this ectopic tissue serves no function, but rather may provide a source for future malignancy, surgical excision is recommended. Sasha Mikhael, Wesley Nilsson, Kruti Patel, and Sherri Graf Copyright © 2017 Sasha Mikhael et al. All rights reserved. Atypical Distant Metastasis of Breast Malignant Phyllodes Tumors: A Case Report and Literature Review Wed, 11 Oct 2017 00:00:00 +0000 Malignant phyllodes tumors (MPT) are rare breast neoplasms. Preoperative diagnosis is often challenging due to the unspecific clinical, radiological, and histological characteristics of the tumor. Dissemination pathways are local with chest wall invasion, regional with lymph nodes metastasis, and distant, hematogenous, mostly to the lungs, bones, and brain. Distant metastasis (DM) can be synchronous or appear months to years after the diagnosis and initial management. The current report describes the case of a 57-year-old woman presenting with a giant/neglected MPT of the breast, with no DM at initial staging, treated by radical modified mastectomy. Motor disorders due to medullar compression by a paravertebral mass appeared at short follow-up, also treated surgically. The patient died from several DM of rapid evolution. To our knowledge, this is the only case described of MPT with metastases to soft tissue causing medullar compression. We present a literature review on unusual metastatic localizations of MPT. Tiphaine de Foucher, Hélène Roussel, Mikael Hivelin, Léa Rossi, Caroline Cornou, Anne-Sophie Bats, Myriam Deloménie, Fabrice Lécuru, and Charlotte Ngô Copyright © 2017 Tiphaine de Foucher et al. All rights reserved. Incidental Laparoscopic Discovery of an Intraperitoneal Plastic Catheter 16 Years after an Unsafe Abortion: A Case Report from the Gynecologic, Obstetric, and Pediatric Hospital of Yaoundé (Cameroon) Mon, 09 Oct 2017 00:00:00 +0000 In many developing countries like Cameroon, unsafe abortion is a major public health problem. It can be responsible for severe complications including damage to the digestive and/or urinary tract, sepsis, and uterine perforation. Uterine perforation could be caused by most of the instruments that are used to evacuate the uterus. We report a case of apparent uterine perforation and subsequent migration of the plastic or rubber catheter into the peritoneal cavity during an abortion procedure performed in a setting that may have been unsafe. The discovery was made during a diagnostic laparoscopy indicated for secondary infertility of tubal origin 16 years after the abortion procedure. This is a rare clinical finding which is of therapeutic and diagnostic importance. To the best of our knowledge, a single similar case has been reported so far in the literature. Ngandji Andre, Ngo Um Meka Esther Juliette, Fokom Joel, Wandji Brigitte, and Foumane Pascal Copyright © 2017 Ngandji Andre et al. All rights reserved. A Case of Haematometra Secondary to Cervical Stenosis after Vesicle Vaginal Fistula Surgical Repair Sun, 08 Oct 2017 00:00:00 +0000 Background. Haematometra is a rare postobstetrics fistula surgical repair outcome complication; however the condition can be misinterpreted especially in limited resource areas that lack routine ultrasound guidance and with a slowly progressed increase in size of abdomen accompanied with a history of amenorrhoea together with a history of having unprotective sexual intercourse which may increase the possibility of being controversial to full-term gravid uterus. The causes of haematometra might be either due to congenital abnormality of the vaginal canal or acquired iatrogenically. However, any other cause that involved vaginal canal can be a predisposing factor of haematometra. We present a case of a 32-year-old female patient, who had obstetric fistula which was successfully repaired over the past two years. She presented with one-year-and-two-month history of an amenorrhoea that was progressive accompanied with distended abdomen to the extent of looking typically as the gravid uterus. Explorative laparotomy was performed successfully and surgical incision managed by hysterotomy and salpingotomy, whereby approximately ten liters of serosanguinous blood fluid mixed with blood clots was completely suctioned. Despite being a rare condition after vesicle vaginal fistula repair complication outcome, haematometra remains to be relatively common gynaecological condition among female adolescence during postpubertal period. Athanase Lilungulu, Willy Mwibea, Mzee Nassoro, and Balthazar Gumodoka Copyright © 2017 Athanase Lilungulu et al. All rights reserved. Medical First-Trimester Termination of Pregnancy with Massive Fibroid Uterus Mon, 02 Oct 2017 09:50:52 +0000 First-trimester termination of pregnancy by medical or surgical route is highly effective with a low complication rate. Uterine abnormalities can complicate a procedure due to distortion of normal anatomy. In this case presentation, medical termination of pregnancy is performed using fetal intracardiac potassium chloride injection and intramuscular methotrexate. Michael Saad-Naguib, Karla Maguire, Christine Curry, and Usha Verma Copyright © 2017 Michael Saad-Naguib et al. All rights reserved. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy Wed, 27 Sep 2017 08:02:20 +0000 Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation. Victoria Sampson, Oluremi Mogekwu, Ammar Ahmed, and Farida Bano Copyright © 2017 Victoria Sampson et al. All rights reserved. Undetected Severe Fetal Myelosuppression following Administration of High-Dose Cytarabine for Acute Myeloid Leukemia: Is More Frequent Surveillance Necessary? Sun, 17 Sep 2017 09:22:45 +0000 Background. Cytarabine use during pregnancy carries a 5–7% risk of neonatal cytopenia. We report two cases of fetal myelosuppression following high-dose cytarabine administration for acute myeloid leukemia (AML). Case 1. A 36-year-old G9P6 diagnosed with AML at 21 weeks was monitored for fetal anemia weekly and growth monthly. At 33 weeks (after 2 cycles), BPP was 2/10 and MCA PSV was elevated at 1.51 MoM. Urgent cesarean section was performed. The infant had an initial pH of 6.78 and pancytopenia (hematocrit 13.3%, platelets 3 K/UL, and white blood cell count 2.0 K/UL). Initially transfusion dependent, the neonate had count recovery by 3 weeks. Case 2. A 30-year-old G4P3 with AML at 26 weeks was monitored for fetal anemia twice weekly and growth monthly. At 34 weeks (after cycle 1), she was admitted with neutropenic fever. The fetal MCA PSV was borderline at 1.48 MoM. It improved to 1.38 MoM at 35 weeks but the fetal tracing worsened. At delivery the fetus was found to have a hematocrit of 30%, but with normal platelet and WBC. The fetus did not require any transfusions. Conclusion. Cytarabine use during pregnancy may cause neonatal myelosuppression. We recommend monitoring for fetal anemia with MCA Dopplers twice weekly. Jessica Parrott and Marium Holland Copyright © 2017 Jessica Parrott and Marium Holland. All rights reserved. Uterine Tumors Resembling Ovarian Sex Cord Tumors: Case Report of Rare Pathological and Clinical Entity Mon, 11 Sep 2017 10:04:52 +0000 Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are rare uterine neoplasms. These tumors are usually benign, displaying a nodular or polypoid growth pattern; common occurrence is observed at the 4th to 6th decade of life. This entity is divided according to clinical behavior and pathological typical findings including different immunohistochemical staining. Traditionally type I tumors show a predominant endometrial stromal pattern with less than 50% ovarian sex cord component. This type has been shown to behave more aggressively with a decreased disease free survival period. Type II tumors, the classical UTROSCT, are less invasive but have the tendency to recur. We report a case of a 57-year-old patient presenting with postmenopausal bleeding. Hysteroscopic polypectomy showed the diagnosis of UTROSCT. This case presents a less morbid minimally invasive treatment plan and exemplifies that in patients where low malignant potential exists and their will is taken into consideration such management is both crucial and correct. Rotem Sadeh, Yakir Segev, Meirav Schmidt, Jacob Schendler, Tamar Baruch, and Ofer Lavie Copyright © 2017 Rotem Sadeh et al. All rights reserved. Group A Streptococcus Septic Shock after Surgical Abortion: A Case Report and Review of the Literature Mon, 11 Sep 2017 09:00:20 +0000 Group A Streptococcus (GAS) causing puerperal sepsis is a leading cause of maternal mortality worldwide. Although rare, GAS infection is a relatively significant public health concern because of its propensity to evolve rapidly into septic shock, streptococcal toxic shock syndrome, and death. We report the case of a 27-year-old patient who presented with GAS septic shock after undergoing a surgical termination of pregnancy and was treated successfully and recovered without sequelae. GAS septic shock should always be included in the differential diagnosis of any patient who develops sepsis after a surgical abortion. Patients with GAS septic shock have a rapid clinical decline and need aggressive fluid management, early initiation of broad-spectrum antibiotics, and rapid surgical intervention. Stephanie C. Tardieu and Elizabeth Schmidt Copyright © 2017 Stephanie C. Tardieu and Elizabeth Schmidt. All rights reserved. Ovarian Adenomatoid Tumor Coexisting with Mature Cystic Teratoma: A Rare Case Report Mon, 11 Sep 2017 00:00:00 +0000 Adenomatoid tumor of the ovary is rare, and so are collision tumors in this location. The most common histological combination of ovarian collision tumors is the coexistence of mature cystic teratoma with ovarian cystadenoma or cystadenocarcinoma. Presented herein is a rare case of ovarian adenomatoid tumor found incidentally and coexisting with mature cystic teratoma. A 44-year-old woman presented with a one-year history of intermittent right-sided pelvic pain. Ultrasound evaluation revealed a heterogeneous cystic mass in the right ovary, and a clinical diagnosis of teratoma was made. The patient subsequently underwent a right salpingo-oophorectomy. Pathological examination revealed a mature cystic teratoma and coexistent adenomatoid tumor. The two tumors were separate and no transitional features were recognized histologically. To our knowledge, no previous report of coexistence of these two tumors has been reported. Both tumors are benign and completely excised; therefore no adverse consequences are expected. Mingxia Shi, Firas Al-Delfi, Majd Al Shaarani, Kurt Knowles, and James Cotelingam Copyright © 2017 Mingxia Shi et al. All rights reserved. The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management Mon, 11 Sep 2017 00:00:00 +0000 Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant) in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options. Meher Tabassum and Kiran Atmuri Copyright © 2017 Meher Tabassum and Kiran Atmuri. All rights reserved. Expectant Management Leading to Successful Vaginal Delivery following Intrauterine Fetal Death in a Woman with an Incarcerated Uterus Sun, 10 Sep 2017 00:00:00 +0000 Expectant management leads to successful vaginal delivery following intrauterine fetal death in a woman with an incarcerated uterus. Management of intrauterine fetal death in the second or third trimester of pregnancy in women with an incarcerated uterus is challenging. We report a case of successful vaginal delivery following intrauterine fetal death by expectant management in a woman with an incarcerated uterus. In cases of intrauterine fetal death in women with an incarcerated uterus, vaginal delivery may be possible if the incarceration is successfully reduced. If the reduction is impossible, expectant management can reduce uterine retroversion, thereby leading to spontaneous reduction of the incarcerated uterus. Thereafter, vaginal delivery may be possible. Masafumi Yamamoto, Mio Takami, Ryosuke Shindo, Michi Kasai, and Shigeru Aoki Copyright © 2017 Masafumi Yamamoto et al. All rights reserved. Chronic Pelvic Pain and Infertility Resulting from Unrecognized Retained Laminaria Mon, 28 Aug 2017 09:51:17 +0000 Background. In 2013, the abortion rate in the United States was found to be 200 abortions per 1,000 live births. Of these, the CDC estimates that nearly 49% were performed using unsafe measures. Even when these procedures are safely performed, patients are at risk for immediate or delayed complications. In second-trimester terminations, mechanical dilation with an osmotic dilator is common to allow for delivery of the fetus. The Japanese seaweed Laminaria japonica is used to achieve this purpose. Case. A 28-year-old primigravida presented with chronic pelvic pain and infertility. She had irregular menstrual cycles and reported scant yellow discharge. A transvaginal ultrasound revealed an abnormally appearing endometrium with an elongated structure suspicious for a foreign body. The patient reported a voluntary termination of pregnancy twelve years earlier, for which laminaria were placed prior to the dilation and extraction. She underwent an operative hysteroscopy confirming our suspicion for retained laminaria. The pathology report demonstrated chronic severe endometritis and plant based material. Conclusion. Retained laminaria are associated with chronic pelvic pain and chronic infertility. Since they can be difficult to detect on conventional imaging, proper counting prior to insertion and after removal is an essential physician responsibility. Wesley Nilsson, Sasha Mikhael, and Jennifer Kaplan Copyright © 2017 Wesley Nilsson et al. All rights reserved. Pneumocystis Pneumonia in Non-HIV Pregnant Women Receiving Chemotherapy for Malignant Lymphoma: Two Case Reports Mon, 28 Aug 2017 00:00:00 +0000 Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection that sometimes occurs in immunocompromised patients with human immunodeficiency virus (HIV). Here, we report two extremely rare cases of PCP in non-HIV pregnant women who underwent chemotherapy for malignant lymphoma. Case  1 is a 34-year-old primigravida who was diagnosed with Hodgkin’s lymphoma. She received ABVD chemotherapy and developed PCP at 37 weeks of gestation. After the onset of PCP, emergent cesarean section was performed due to a nonreassuring fetal status. Case  2 is a 31-year-old multigravida with diffuse large B-cell lymphoma who was administered R-CHOP chemotherapy. At 34 weeks of gestation, she complained of dyspnea and developed PCP. She delivered her baby vaginally immediately after the onset of symptoms. Both patients were treated with sulfamethoxazole-trimethoprim (ST) and recovered shortly thereafter. The babies’ courses were also uneventful. PCP remains a serious cause of death, especially in non-HIV patients, and, therefore, appropriate prophylaxis and a prompt diagnosis are imperative. Yuki Fukutani, Yoshitsugu Chigusa, Eiji Kondoh, Kaoru Kawasaki, Shingo Io, and Noriomi Matsumura Copyright © 2017 Yuki Fukutani et al. All rights reserved. Successful Vaginal Delivery of Naturally Conceived Dicavitary Twin in Didelphys Uterus: A Rare Reported Case Sun, 27 Aug 2017 07:58:28 +0000 Didelphys uterus, or double uterus, is an embryological developmental malformation of the müllerian ducts with the incidence of approximately 8.3% of all müllerian duct abnormalities (MDAs). Didelphys uterus accompanying dicavitary twin gestation is encountered as a very rare entity with overall incidence of about 1 in 1,000,000. We report a rare case of didelphys uterus, diagnosed since her first pregnancy, and during her fourth pregnancy she conceived dicavitary twin naturally without any infertility treatment. Though, the pregnancy course was complicated by preterm labour at 34-week gestation and she delivered simultaneously both fetuses with the cephalic presentation by spontaneous vaginal delivery with good maternal and neonatal outcomes. Houda Nasser Al Yaqoubi and Nishat Fatema Copyright © 2017 Houda Nasser Al Yaqoubi and Nishat Fatema. All rights reserved. Acquired Vitamin K Deficiency as Unusual Cause of Bleeding Tendency in Adults: A Case Report of a Nonhospitalized Student Presenting with Severe Menorrhagia Sun, 27 Aug 2017 00:00:00 +0000 We report a rare case of acquired vitamin K deficiency presenting with severe menorrhagia and without any gynecological problem. Partial thromboplastin time (59.2 seconds) and prothrombin time (33.1 seconds, INR: 5.97) were considerably prolonged in laboratory evaluations. A complete coagulation factor assay test was performed for the patient: factor IX, 24%; factor II, 41%; factor VII, 3%; and factor X, 52%. She had been taking many high-energy drinks and she had inadequate dietary intake for the past 6 months. Given that she had vitamin K deficiency (VKD), a course of vitamin K therapy was started for her in the hospital. This case showed the potential for menorrhagia due to VKD with use of high-energy drinks and the value of a complete and detailed history in early diagnosis. Omid Reza Zekavat, Gholamreza Fathpour, Sezaneh Haghpanah, Seyed Javad Dehghani, Maryam Zekavat, and Nader Shakibazad Copyright © 2017 Omid Reza Zekavat et al. All rights reserved. Triple Synchronous Primary Neoplasms of the Cervix, Endometrium, and Ovary: A Rare Case Report and Summary of All the English PubMed-Indexed Literature Wed, 23 Aug 2017 00:00:00 +0000 The incidence rate of triple or more synchronous primary neoplasms of the female genital system is exceedingly uncommon. To the best of our knowledge, only 13 such cases have been reported in the PubMed-indexed English literature. Herein, we report a single case of triple synchronous primary neoplasms of the cervix, endometrium, and left ovary with three distinct histological patterns that were not reported previously. Moreover, we briefly present a summary table of all the English PubMed-indexed cases of triple or more synchronous primary neoplasms of the female genital system (). Ahmed Abu-Zaid, Mohannad Alsabban, Mohammed Abuzaid, Osama Alomar, Hany Salem, and Ismail A. Al-Badawi Copyright © 2017 Ahmed Abu-Zaid et al. All rights reserved. Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence Tue, 22 Aug 2017 00:00:00 +0000 Background. Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case. A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions. When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered. Kara M. Griffiths, Geoffrey D. Towers, and Jerome L. Yaklic Copyright © 2017 Kara M. Griffiths et al. All rights reserved. Recurrent HELLP Syndrome at 22 Weeks of Gestation Tue, 08 Aug 2017 06:22:08 +0000 We describe a case of a woman who presented with HELLP syndrome in two subsequent pregnancies (age 36 and 40), at gestational age of 22 weeks in both pregnancies with a rapid onset and progression. She presented with characteristic clinical symptoms and laboratory findings. Both pregnancies were delivered by caesarean sections due to deterioration in the mother’s condition, although neither pregnancy progressed into the 1st stage of the syndrome according to Mississippi classification. This case highlights the admittedly rare but serious condition of recurring HELLP syndrome at a gestational age before the limit of viability of the fetus. In such situations, pregnancy termination should be considered to minimise risk to the mother’s life and health. Peter Kascak, Milos Paskala, Peter Antal, and Radovan Gajdosik Copyright © 2017 Peter Kascak et al. All rights reserved. Complete Laparoscopic Extirpation of a Giant Ovarian Cyst in an Adolescent Thu, 03 Aug 2017 08:19:51 +0000 The giant ovarian serous cystadenoma is a rare finding and often benign. The use of the laparoscopic approach versus open approach for the management of huge ovarian cysts is controversial. We report a case of a 27-year-old woman with a history of increasing abdominal girth over a period of two years along with radiological investigations revealed a large tumor arising from the right ovary treated by complete laparoscopic extirpation of a giant ovarian cyst. The complete laparoscopic approach for huge cyst is a feasible treatment when having a normal tumor marker profile and benign imaging appearance. In addition to the advantages of laparoscopic surgery, it is less invasive, with perfect cosmetic outcome and shorter hospital stay, which are particularly important for young women. Saeed Baradwan, Feras Sendy, and Sameer Sendy Copyright © 2017 Saeed Baradwan et al. All rights reserved. Uterine Rupture at 21 Weeks in Twin Pregnancy with TTTS and Previous C-Section Thu, 03 Aug 2017 08:02:54 +0000 Uterine rupture is a health problem in every country. The diagnosis is not always obvious and fetal and maternal morbidity and mortality can be high. Gieta Bhikha-kori, Marieke Sueters, and Johanna M. Middeldorp Copyright © 2017 Gieta Bhikha-kori et al. All rights reserved. Pitfall in the Diagnosis of Diabetes Insipidus and Pregnancy Thu, 27 Jul 2017 07:36:48 +0000 Diabetes insipidus (DI) during pregnancy and the perinatal period is an uncommon medical problem characterized by polyuria and excessive thirst. Diagnosis of DI may be overlooked in the setting of pregnancy, a time when increased water intake and urine output are commonly reported. We report two cases: one of transient DI in a young woman during her third trimester of twin pregnancy in association with acute fatty liver and hypertension and one of postpartum DI secondary to Sheehan syndrome from rupture of a splenic artery aneurysm. These cases illustrate the spectrum with which DI related to pregnancy and delivery can present and highlight the difficulty in making the diagnosis since the symptoms are often initially overlooked. Melissa Sum, Jessica B. Fleischer, Alexander G. Khandji, and Sharon L. Wardlaw Copyright © 2017 Melissa Sum et al. All rights reserved. Corrigendum to “Prenatal Diagnosis of Cardiac Diverticulum with Pericardial Effusion in the First Trimester of Pregnancy with Resolution after Early Pericardiocentesis” Mon, 24 Jul 2017 00:00:00 +0000 Raquel Garcia Rodriguez, Azahara Rodriguez Guedes, Raquel Garcia Delgado, Lourdes Roldan Gutierrez, Margarita Medina Castellano, and Jose Angel Garcia Hernandez Copyright © 2017 Raquel Garcia Rodriguez et al. All rights reserved. Delayed Presentation of Suture Erosion following Burch Colposuspension Thu, 13 Jul 2017 00:00:00 +0000 Background. Synthetic mid-urethral mesh slings are the most common primary surgical treatment for stress urinary incontinence (SUI) and have been designated as the standard of care by the American Urogynecologic Society. In recent years, synthetic mesh has come under increased scrutiny by the Federal Drug Administration (FDA) due to concerns over patient safety. This has led to more surgeons and patients preferring Burch colposuspension to treat SUI. Case. We discuss two cases of suture erosion into the urethra and bladder. They presented with irritative voiding symptoms and recurrent urinary tract infections. Both were discovered years after a Burch colposuspension. Conclusion. As reported in the literature as early as 1999, erosion is a complication associated with many types of incontinence surgery and not unique to mesh based sling operations. Burch colposuspension should not be favored solely to avoid erosion and patients should be counseled accordingly. Teaching Point. Cystourethroscopy performed intraoperatively or postoperatively is essential for early diagnosis and treatment of complications related to incontinence surgery. Robert Shapiro, Ali Hajiran, and Stanley Zaslau Copyright © 2017 Robert Shapiro et al. All rights reserved. Preservative Monitoring of a Greek Woman with Hydrops Fetalis due to Parvovirus B19 Infection Wed, 12 Jul 2017 00:00:00 +0000 Primate erythroparvovirus 1 (parvovirus B19) is a member of the Erythrovirus genus of the Parvoviridae family and it is one of the few members of the family known to be pathogenic in human. B19 infection is common and widespread with the virus being associated with numerous rheumatologic and haematologic manifestations. More specifically, maternal infection with parvovirus B19 during pregnancy can cause severe anemia which may lead to nonimmune hydrops or fetal demise, as a result of fetal erythroid progenitor cells infection with shortened half-life of erythrocytes. We present a rare case reported in the Greek population, of subclinical transient reticulocytopenia due to B19 parvovirus infection, in an asymptomatic pregnant woman, without medical history of hemoglobinopathy, and with the presence of hydrops fetalis during the third trimester of her pregnancy. Zacharias Fasoulakis, Panagiotis Antsaklis, and Emmanuel N. Kontomanolis Copyright © 2017 Zacharias Fasoulakis et al. All rights reserved. A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF Mon, 10 Jul 2017 09:26:46 +0000 We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax. Negjyp Sopa, Elisabeth Clare Larsen, and Anders Nyboe Andersen Copyright © 2017 Negjyp Sopa et al. All rights reserved. Previable Preeclampsia Diagnosed by Renal Biopsy in Setting of Novel Diagnosis of C4 Glomerulopathy Tue, 04 Jul 2017 00:00:00 +0000 Background. Preeclampsia diagnosed before 20 weeks’ gestational age is a rare entity, particularly without any predisposing factors. We report a case of preeclampsia occurring prior to 20 weeks’ gestational age in the setting of a novel diagnosis of C4 glomerulopathy. Case. A G3P0020 at 18 weeks presented with new onset hypertension and proteinuria, requiring multiple antihypertensive agents to maintain control. Renal biopsy demonstrated thrombotic microangiopathic lesions and glomerular endotheliosis. C4-dominant staining and numerous subendothelial and mesangial electron dense deposits were found within the glomerulus. With no other definable etiologies, preeclampsia was diagnosed. She developed posterior reversible encephalopathic syndrome and pregnancy termination was recommended. Conclusion. The lectin complement pathway may play a role in the pathophysiology of severe, early onset preeclampsia. Renal biopsy may play an integral role in diagnosis. Jessica Parrott, Timothy A. Fields, and Marc Parrish Copyright © 2017 Jessica Parrott et al. All rights reserved.