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Ashkar A, Shah S, Yousuf F, Siddiqui FZ, Yousuf H. Case report: Elective management of a bicornuate uterus with hematometra, incidentally found submucosal fibroids, rectus sheath hematoma, and hydronephrosis in a resource limited setting. Int J Surg Case Rep 2024; 120:109889. [PMID: 38852567 DOI: 10.1016/j.ijscr.2024.109889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Bicornuate uterus is a rare type of congenital mullerian anomaly, presenting as a diagnostic challenge. Metroplasty either via an open approach or laparoscopically can be performed to definitively diagnose and treat the defect. CASE PRESENTATION A 26-year-old female, with no known comorbids and past surgical history of endometriotic cyst excision presented with acute symptoms of left lower abdominal pain, burning micturition, and relative constipation. After clinical and radiologic investigations, the diagnosis of bicornuate was suspected. An elective exploratory laparotomy was then performed due to limited resources and skilled surgical techniques. Intra-operatively it was found that she had a bicornuate uterus with a single cervix and vagina, with the left cornuate being non-communicating with fluid suggesting hematometra. Dense adhesions were reported with drainage of 150-200 ml of free fluid upon opening the rectus sheath. Postoperatively she remained vitally stable and was discharged home. CLINICAL DISCUSSION We report a rare case of a bicornuate uterus with double horns along with submucosal fibroids, rectus sheath hematoma, and left sided hydronephrosis. Diagnosis of bicornuate uterus is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation. CONCLUSION Although bicornuate is rare, it may result in complications if not attended to timely. Early diagnosis and management are necessary to minimize associated morbidity and mortality that can occur as a consequence of associated unattended pressure symptoms.
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Affiliation(s)
- Anusha Ashkar
- Dow University of Health Sciences, Karachi, Pakistan.
| | - Saba Shah
- Dow University of Health Sciences, Karachi, Pakistan
| | - Fizza Yousuf
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Hamza Yousuf
- Dow University of Health Sciences, Karachi, Pakistan
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Areys HM, Omer NH, Osman OA. Second Trimester Spontaneous Fundal Rupture of Unscarred Bicornuate Uterus in Primipara: A Case Report and Literature Review; Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia. Int Med Case Rep J 2024; 17:181-185. [PMID: 38524802 PMCID: PMC10960533 DOI: 10.2147/imcrj.s446718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
Background Primary rupture of an unscarred uterus is rare. Spontaneous rupture of an unscarred bicornuate uterus is a life-threatening obstetric emergency with high morbidity and mortality in the mother and fetus; however, it most commonly occurs in the first trimester of pregnancy. Case A 20-year-old primigravid woman at 22 weeks of gestation, with no prior surgery, presented with severe abdominal pain, anemia, and hemodynamic instability. With a preoperative diagnosis of uterine rupture, she was transfused with three units of cross-matched whole blood and underwent emergency laparotomy. Intraoperative findings showed a ruptured bicornuate uterus and a dead fetus in the abdomen with huge hemoperitoneum. Postoperative recovery was smooth, and the patient was discharged after being counselled on family planning and subsequent pregnancy. Conclusion A bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid women at any stage of pregnancy. Each obstetrician should have a high index of suspicion for a rare condition like ruptured bicornuate uterus, especially for a pregnant woman presenting with acute abdominal pain and hemodynamic instability. Early ultrasonography plays a key role in the evaluation, follow-up, and management of these patients.
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Affiliation(s)
- Hassen Mohammed Areys
- Department of Gynecology and Obstetrics, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Nour Hies Omer
- Department of Gynecology and Obstetrics, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Osman Ali Osman
- College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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Sgayer I, Dabbah S, Farah RK, Wolf M, Ashkar N, Lowenstein L, Odeh M. Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature. Obstet Gynecol Surv 2023; 78:759-765. [PMID: 38134341 DOI: 10.1097/ogx.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes. Objective To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus. Evidence Acquisition PubMed was searched for the phrases "uterine rupture," "unscarred," and "spontaneous." Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included. Results We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries. Conclusions and relevance Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.
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Affiliation(s)
- Inshirah Sgayer
- Head of Maternal and Fetal Clinic, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Clinical Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Shirin Dabbah
- Medical Student, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Rola Khamisy Farah
- Clalit Health Service, Akko, Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Maya Wolf
- Head of Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Senior Lecturer, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Nadine Ashkar
- Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Galilee Medical Center
| | - Lior Lowenstein
- Head of Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya; Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed
| | - Marwan Odeh
- Associate Clinical Professor, Azrieli Faculty of Medicine, Bar Ilan University, Safed; Head of Obstetrical Ultrasound Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Saleem HA, Edweidar Y, Salim MA, Mahfouz IA. Mid-trimester spontaneous rupture of a bicornuate uterus: A case report. Case Rep Womens Health 2023; 39:e00524. [PMID: 37954229 PMCID: PMC10636261 DOI: 10.1016/j.crwh.2023.e00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 11/14/2023] Open
Abstract
Bicornuate uterus (BU) is a rare congenital anomaly that may present with various obstetric complications, and very rarely may be a risk factor for uterine rupture, even of an unscarred uterus. A 21-year-old primigravida woman, at 19 weeks and 5 days of gestation, presented with severe abdominal pain and features of hypovolemic shock. Urgent laparotomy showed a large hemoperitoneum, a ruptured left horn of a BU and a dead fetus in the abdominal cavity. Excision of the ruptured left horn was performed and the uterine defect was sutured. Postoperative recovery was uneventful. Bicornuate uterus is a rare uterine anomaly and is associated with various obstetric complications at different gestational ages. Ruptured uterus should be considered in the differential diagnoses of acute abdominal pain and a picture of hypovolemia in women with mid-trimester pregnancies.
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Hussein AI, Omar AA, Hassan HA, Kassim MM, Yusuf AA, Osman AA. Spontaneous Rupture of Unscarred Uterus in a Term Primagravida with Lethal Skeletal Dysplasia Fetus (Thanatophoric dysplasia). A Case Report and Review of the Literature. Int Med Case Rep J 2022; 15:551-556. [PMID: 36225974 PMCID: PMC9549793 DOI: 10.2147/imcrj.s383195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Importance Spontaneous uterine rupture, especially in an unscarred uterus, is a rare pregnancy complication that can cause severe morbidity and mortality in both the mother and the fetus. The vast majority of uterine ruptures occur in the presence of a previous uterine scar, most commonly from a previous cesarean delivery. To our knowledge, here we reported the first case of spontaneous rupture of unscarred uterus in a term primigravida secondary to lethal skeletal dysplasia fetus (Type 1 Thanatophoric dysplasia) faced by a practicing clinician in an underdeveloped country (Somalia) with a successful outcome. Case Presentation The patient was 24 yrs. Old Primagravida, at 40 weeks gestation by LMP, presented with abdominal pain and active vaginal bleeding; she did not receive antenatal care during pregnancy; after initial abdominal ultrasonography and vaginal examination, laparotomy was performed due to high suspicion of uterine rupture. After dead fresh fetal extraction, the uterine defect was repaired successfully, and the patient was discharged home in good condition after several days. Conclusion Through this case, we would like to highlight the urgent need to focus on and recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives lost each year can be reduced.
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Affiliation(s)
- Ahmed Issak Hussein
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia,Correspondence: Ahmed Issak Hussein, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252615597479, Email
| | - Abdikarim Ali Omar
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Hodan Abdi Hassan
- Obstetrics and Gynecology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Mukhtar Kassim
- Pediatric Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Ahmed Adam Osman
- Radiology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Yim S, Yeo I, Lee M, Kyeong KS, Cho HY, Kang JB, Kyung MS. Case Report: Spontaneous perforation of a bicornuate uterus with concomitant sarcoma. F1000Res 2020; 9:1143. [PMID: 33447379 PMCID: PMC7783531 DOI: 10.12688/f1000research.25961.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
A 47-year-old nulliparous, virginal woman presented to the emergency department with acute abdominal pain. Emergency pelvic ultrasound and abdominal CT were taken, which showed a significant amount of hemoperitoneum and a bicornuate uterus with about 18cm x 10cm mass on left uterus. Since the mass had increased vascularity and irregular margins, we thought that the mass could be a uterine sarcoma. MRI and PET/CT were taken additionally for oncologic evaluation before surgery. Intra operative findings showed a ruptured bicornuate uterus with a large mass within the left uterine horn. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathologic analysis confirmed an undifferentiated uterine sarcoma. She was treated with 6 cycles of chemotherapy(etoposide, ifosfamide, cisplatin) postoperatively. Chest and abdomen CT for follow up after chemotherapy showed no sign of cancer recurrence. We suggest a bicornuate uterus with concomitant sarcoma should be concerned as a possible cause of uterine rupture by reviewing this case.
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Affiliation(s)
- Soobin Yim
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Inji Yeo
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Myunghwa Lee
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Kyu-Sang Kyeong
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Hye-Yon Cho
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jung Bae Kang
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Min Sun Kyung
- Department of Obstetrics & Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Sun Y, Huang J, Kong HF. Spontaneous rupture of unscarred uterus in the third trimester after in vitro fertilization-embryo transfer because of bilateral salpingectomy: A case report. Medicine (Baltimore) 2019; 98:e18182. [PMID: 31770271 PMCID: PMC6890355 DOI: 10.1097/md.0000000000018182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.
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Zhao B, Wang Y, Zhang Y. Uterine rupture in patients with a history of laparoscopy or hysteroscopy procedures: Three case reports. Medicine (Baltimore) 2019; 98:e15491. [PMID: 31096449 PMCID: PMC6531272 DOI: 10.1097/md.0000000000015491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Uterine rupture is a rare incidence but can lead to catastrophic maternal and fetal consequences. We still need to place a high premium on these cases. PATIENT CONCERNS The patients all showed hemodynamic shock with complaints of serious pain in the abdomen. They all had a history of laparoscopy or hysteroscopy procedures. DIAGNOSES Case 1 and 2 were diagnosed during surgery. Case 3 was diagnosed by an urgent abdominal ultrasonogram before surgery. INTERVENTIONS We performed emergency surgeries for the 3 cases. OUTCOMES Three patients all recovered well. But only the child in case 2 survived. LESSONS It must be emphasized that pregnant women with a history of such surgeries should be aware of uterine rupture during pregnancy.
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Affiliation(s)
- Baojing Zhao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University
- Anhui Province Key Laboratory of Reproductive Health and Genetics
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Yanling Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University
- Anhui Province Key Laboratory of Reproductive Health and Genetics
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University
- Anhui Province Key Laboratory of Reproductive Health and Genetics
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui Province, China
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Sugiyama M, Takahashi H, Baba Y, Taneichi A, Suzuki H, Usui R, Takei Y, Ohkuchi A, Fujiwara H, Matsubara S. Perinatal outcome of pregnancy after adenomyomectomy: summary of 10 cases with a brief literature review. J Matern Fetal Neonatal Med 2019; 33:4145-4149. [PMID: 30889999 DOI: 10.1080/14767058.2019.1597845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The purpose of this study was the perinatal outcomes of patients who became pregnant after adenomyomectomy.Study design: The retrospective cohort study was performed involving pregnant women with a history of adenomyomectomy between 1 January 2011 and 31 December 2018. At 24-26 weeks, the patients were admitted even without symptoms or signs. When regular uterine contractions were observed, tocolysis was performed.Results: Ten patients were included. Elective and emergent cesarean section (CS) was performed in seven and three patients, respectively. Emergent CS was performed due to onset of labor (tocolytic failure) at 28, 24, and 32 weeks. Although no patients suffered uterine rupture, myometrial thinning was observed at the site corresponding to that of adenomyomectomy in three patients. Of these three patients, two required emergent CS due to tocolytic failure with cervical length (CL) shortening. In contrast, CLs were stable in the other seven patients with elective CS.Conclusions: Three patients after adenomyomectomy showed preterm delivery, and three had a very thin uterus to the extent that the fetus could be observed through the uterine wall. A short CL should be paid special attention in pregnant women with a history of adenomyomectomy.
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Affiliation(s)
- Mizuho Sugiyama
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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