Uncommon obstetric and gynecologic emergencies associated with pregnancy: ultrasound diagnosis

Are Cesarean Section and Appendectomy in Pregnancy and Puerperium Interrelated? A Cohort Study

Introduction

It is not known whether appendectomy for acute appendicitis (AA) increases the Cesarean section (CS) rate and whether CS increases the likelihood of AA and appendectomy in the early puerperium. In this study, delivery type and delivery outcomes and appendectomy during pregnancy and puerperium were analyzed.

Methods

This cross-sectional retrospective study was performed on 11,513 women, delivered during 2015–2020. Inclusion criteria were patients undergoing appendectomy for AA during pregnancy and the first 6 weeks after delivery. Evaluating parameters were age, parity, gestational week at birth, delivery type, and babies' birth weight.

Results

Thirty-two patients underwent appendectomy: 12 during pregnancy (2 in the first trimester, 6 in the second trimester, 4 in the third trimester) and 20 women during puerperium. 58.2% of pregnant women and 65% of puerperal women were submitted to CS.

Discussion

Half of the women who underwent appendectomy for AA during pregnancy may require urgent CS. The cause of acute abdomen in the postpartum period, especially in the first week, could be AA, especially in women delivered by CS.

MRI in Pregnancy and Precision Medicine: A Review from Literature

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.

Postpartum left ovarian vein thrombosis

Left ovarian vein thrombosis is a very rare and infrequent thrombotic condition that mainly occurs in the postpartum or postoperative period. We report a case of a 25-year-old para-1 woman who presented with 2 weeks of postpartum fever and dull aching abdominal pain more on the left side. Before operation, the diagnosis was left adnexal mass secondary to questionable ovarian cyst torsion and she underwent laparotomy. Her intraoperative findings revealed a firm left broad ligament mass with extension to retroperitoneum and it was difficult to demarcate the proximal end. Moreover, on the second day of postoperation, abdominal Doppler ultrasound indicated enlargement of the left ovarian vein that was filled with thrombi having hypoechoic and intermediate echogenicity. After the confirmation of left ovarian vein thrombosis, the case was treated with anticoagulants and broad-spectrum antibiotics and then well improved. Our case climaxes an instant diagnosis and therapeutic significance concerning ovarian vein thrombosis to early manage/avert complications. Besides, the ovarian vein thrombosis diagnosis requires a high index of suspicion for a case presented with fever and abdominal pain.

To Evaluate and Explain the Occurrence of Recurrent Ectopic Pregnancy after Ipsilateral Salpingectomy, Using the Ultrasound

The current case report evaluated a female patient with a history of right salpingectomy subsequent to right tubal ectopic pregnancy that was presented with amenorrhea followed by vaginal bleeding and lower abdominal severe pain. The transvaginal ultrasound examination revealed the presence of ipsilateral right interstitial ectopic pregnancy. The patient was subjected to cornual wedge resection and uterine repair. The pathology report of the excised specimen revealed decidua, chorionic villi, and blood. Recurrent interstitial ectopic pregnancy after previous ipsilateral tubal ectopic pregnancy managed with salpingectomy is very rare, with only a few cases described in the literature. The current study was to evaluate and explain the occurrence of recurrent ectopic pregnancy after ipsilateral salpingectomy using the ultrasound.