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Zhu T, Zhan G, Shang Z, Ying Z. Causal relationship between systemic lupus erythematosus and adverse pregnancy outcomes: A two-sample Mendelian randomized study. Heliyon 2024; 10:e35401. [PMID: 39170286 PMCID: PMC11336611 DOI: 10.1016/j.heliyon.2024.e35401] [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: 12/08/2023] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
Background Systemic lupus erythematosus (SLE) is associated with adverse pregnancy outcome (APO). However, the genetic causality of this association remains unclear. In this study, Mendelian randomization (MR) was used to explore the potential causal relationship between SLE and APO risk. Methods We selected 45 single nucleotide polymorphisms (SNPs) associated with SLE from published genome-wide association studies (GWAS). APO's statistics are obtained from the GWAS database. MR estimates were performed using the inverse variance-weighted (IVW) method, the MR-Egger method, and the weighted median (WM) method. Sensitivity analysis was performed using Cochran's Q test, MR-Egger intercept, MR-pleiotropic residual and outlier method, stay-one analysis and funnel plot. Results The results showed a causal relationship between SLE and pre-eclampsia (OR = 1.036, 95 % confidence interval 1.006 to 1.068, P = 0.019), and no significant causal relationship was found between SLE and other adverse pregnancy outcomes, including postpartum hemorrhage, placental abruption, spontaneous abortion, premature rupture of membranes, fetal distress, gestational diabetes mellitus. These findings were robust in several sensitivity analyses. Conclusion This MR study demonstrated the causal effect of SLE on preeclampsia. It provides important clues for identifying and early predicting risk factors for preeclampsia.
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Affiliation(s)
- Tao Zhu
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Gao Zhan
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Zheng Shang
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Zhao Ying
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
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Shibahara M, Hoshino K, Harada H, Ueda T, Kurita T, Yoshino K. A combined laparoscopic and vaginal approach with a novel method to reconstructing the uterine cervix in Herlyn-Werner-Wunderlich syndrome with cervical obstruction: A case report. Int J Surg Case Rep 2024; 121:110029. [PMID: 39013247 PMCID: PMC11304052 DOI: 10.1016/j.ijscr.2024.110029] [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: 05/29/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Herlyn-Werner-Wunderlich syndrome (HWWS) is characterized by uterine didelphys, unilateral cervical obstruction, and ipsilateral renal defects. Owing to its rarity, no standard surgical approach exists. PRESENTATION OF CASE An 11-year-old girl with severe dysmenorrhea had a duplicated uterus, a right cervical hemorrhagic cyst, and right ipsilateral kidney agenesis, indicative of HWWS. As transvaginal surgery was challenging, we turned to laparoscopic surgery for abdominal cavity inspection and surgical assistance. A longitudinal incision was made on the right uterus, followed by inserting a catheter tube fixed to an intrauterine device (IUD) into the right cervical canal from the anterior wall of the right uterine horn. Subsequently, the right external cervical os was inverted to prevent restenosis. Postoperatively, the hemorrhagic cyst at the right cervix disappeared. The patient had no symptom recurrence 24 months after the surgery. DISCUSSION The preoperative diagnosis for female genital malformations is complicated, and transvaginal manipulation is often difficult in adolescent girls. Laparoscopy is a valuable tool for evaluating female genital malformations, allowing for a thorough diagnosis and safe surgical treatment. In cases of female genital malformation with cervical obstruction, as in this case, reconstruction of the uterine cervix is important to prevent restenosis after surgery. CONCLUSION In female genital malformations, laparoscopy provides a comprehensive evaluation of the malformation, assisting in a precise diagnosis and safe surgical treatment. Insertion of the catheter tube with IUD into the uterus and reconstruction of the cervix contribute to preventing restenosis.
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Affiliation(s)
- Mami Shibahara
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kaori Hoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Hiroshi Harada
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taeko Ueda
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomoko Kurita
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abe J, Nasu T, Noro A, Tsubaki J. An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report. J Med Case Rep 2024; 18:209. [PMID: 38664817 PMCID: PMC11046871 DOI: 10.1186/s13256-024-04524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. It has been reported that congenital uterine anomalies latently affect the fetal position. The clinical pitfalls in childbirth with uterine anomalies are discussed here on the basis of clinical evidence. CASE PRESENTATION At a perinatal medical center in Japan, a 29-year-old Japanese mother who had a history of bicornuate uterus, received tocolysis to prolong her pregnancy for 5 days during the late preterm period after preterm-premature rupture of the membrane. She gave birth to a 2304 g male neonate of the gestational age of 35 weeks and 5 days with severe asphyxia by means of crash cesarean section for fetal sustained bradycardia after sudden termination of tocolysis. We found the fetal position to reverse from cephalic to breech position during early labor. He ended up having severe cerebral palsy after brain cooling against hypoxic-ischemic encephalopathy for 3 days. The mechanism of inversion from cephalic to breech position without amnionic fluid remains unclear, although women with a known diagnosis of a uterine anomaly have higher risk of adverse outcomes such as malpresentation. CONCLUSIONS When considering the clinical course of this case on the basis of the medical reports, we suspected that uterine anomalies and changes in intrauterine pressure could cause fetal malpresentation and adverse neonatal outcomes.
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Affiliation(s)
- Jiro Abe
- Department of Pediatrics, JCHO Hokkaido Hospital, 3-18, Nakanoshima 1 Jyou 8 Tyoume, Sapporo, Japan.
- Department of Pediatrics, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan.
- Mitochondrial Redox Biology, Medical Research Council Mitochondrial Biology Unit and Department of Medicine, University of Cambridge, The Keith Peters Building, Cambridge Biomedical Campus Hills Road, Cambridge, CB2 0XY, UK.
| | - Takashi Nasu
- Department of Pediatrics, JCHO Hokkaido Hospital, 3-18, Nakanoshima 1 Jyou 8 Tyoume, Sapporo, Japan
| | - Ayumu Noro
- Department of Pediatrics, JCHO Hokkaido Hospital, 3-18, Nakanoshima 1 Jyou 8 Tyoume, Sapporo, Japan
| | - Junko Tsubaki
- Department of Pediatrics, JCHO Hokkaido Hospital, 3-18, Nakanoshima 1 Jyou 8 Tyoume, Sapporo, Japan
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Moltot T, Lemma T, Silesh M, Sisay M, Tsegaw B. Successful post-term pregnancy in scared bicornuate uterus: case report. BMC Pregnancy Childbirth 2023; 23:559. [PMID: 37533012 PMCID: PMC10394870 DOI: 10.1186/s12884-023-05875-0] [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: 09/23/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
Pregnancies in the bicornuate uterus are usually considered high-risk because of their association with poor reproductive outcomes such as recurrent pregnancy loss, cervical insufficiency, low birthweight, preterm birth, malpresentation, cesarean delivery, and uterine rupture. The objective of the report was to show that patients with a scared bicornuate uterus at post-term could have successful pregnancy outcomes. We are presenting a 28-year-old gravida III para II lady with a bicornuate scared uterus at post-term. She has a history of early third-trimester pregnancy loss, and her second pregnancy was delivered via cesarean section. In her first pregnancy, the patient's uterus was not identified as bicornuate. However, an ultrasound during her second pregnancy revealed that she had a bicornuate uterus, which led to the diagnosis. At term, the lady had a successful cesarean section. Lastly, for the current post-term pregnancy she had no prenatal check-up. Even though this, she was coming at the latent first stage of labor and an emergency cesarean section was done.Conclusion Successful outcomes could be achieved in patients with the bicornuate uterus at post-term gestation.
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Affiliation(s)
- Tebabere Moltot
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Tesfanesh Lemma
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulualem Silesh
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Moges Sisay
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhan Tsegaw
- Department of Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Gao Q, Xiong J, Zhu Y. Uterine torsion in twin pregnancy with complete bicorporeal uterus, double cervix, longitudinal non-obstructing vaginal septum - a case report. Front Surg 2023; 10:1082955. [PMID: 37035568 PMCID: PMC10076668 DOI: 10.3389/fsurg.2023.1082955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Even though uterine torsion is a rare obstetric complication in humans, it has been linked to severe complications like placental abruption, uterine rupture, foetal bradycardia, or even death. Here, we present a rare case of maternal shortening and prolonged foetal bradycardia. The patient suffered from congenital malformations of the female genital tract, which were classified as a complete bicorporeal uterus, a double "normal" cervix, and a longitudinal non-obstructing vaginal septum (U3b/C2/V1). The patient had an emergency caesarean section due to suspected placental abruption. Uterine torsion was found during the surgery, and the postoperative recovery was good. Obstetricians should be aware of the possibility of uterine torsion as a complication of pregnancy to avoid a delayed diagnosis of uterine torsion, especially in patients with genital malformations. During the surgery, there could be serious damage to blood vessels and tissues around the uterus due to an unclear surgical field, and difficulties in exposing the uterine body should be considered.
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Affiliation(s)
- Qianqian Gao
- Departments of Obstetrics, Weifang People’s Hospital, Weifang, China
| | - Jinqiu Xiong
- Departments of General Surgery, Weifang People’s Hospital, Weifang, China
- Correspondence: Jinqiu Xiong
| | - Yuchun Zhu
- Departments of Obstetrics, Weifang People’s Hospital, Weifang, China
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Preliminary application of three-dimensional printing in congenital uterine anomalies based on three-dimensional transvaginal ultrasonographic data. BMC Womens Health 2022; 22:290. [PMID: 35836228 PMCID: PMC9284698 DOI: 10.1186/s12905-022-01873-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The three-dimensional (3D) printing technology has remarkable potential as an auxiliary tool for representing anatomical structures, facilitating diagnosis and therapy, and enhancing training and teaching in the medical field. As the most available diagnostic tool and it is routinely used as the first approach in diagnosis of the uterine anomalies, 3D transvaginal ultrasonography (3D-TVS) has been proposed as non-invasive “gold standard” approach for these malformations due to high diagnostic accuracy. Despite holding promise of manufacturing 3D printed models based on 3D-TVS data, relevant reports about 3D-TVS derived gynecological 3D printing haven’t been reported to the best of our knowledge. We found an opportunity to explore the feasibility of building 3D printed models for the abnormal uterus based on the data acquired by 3D-TVS. Methods The women suspected with congenital uterine anomalies (CUAs) were enrolled in the study. The diagnose of CUAs were made by 3D-TVS scanning and further confirmed under the hysteroscopy examination. One volunteer with normal uterus was enrolled as control. All subjects underwent 3D-TVS scanning for 3D printing data collection. Acquired images were stored and extracted as DICOM files, then processed by professional software to portray and model the boundary of the uterine inner and outer walls separately. After the computer 3D models were constructed, the data were saved and output as STL files for further surface restoration and smoothing. The colors of endometrium and uterine body were specified, respectively, in the print preview mode. Then the uncured photosensitive resin was cleaned and polished to obtain a smooth and transparent solid model after printed models were cooled down. Results 3D printing models of normal uterus, incomplete septate uterus, complete septate uterus, uterus didelphys and unicornuate uterus were produced on ultrasonographic data of 3D-TVS. Conclusions Our research and practice made the first try in modeling CUAs successfully based on ultrasonographic data entirely, verifying that it’s a feasible way to build 3D printed models of high-quality through 3D-TVS scanning.
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Lin Y, Liu M, He S, Yang M, Wu Q. The effectiveness of uterine parametrics measured by three-dimensional transvaginal sonography in the diagnosis of uterine cavity distortions. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1486. [PMID: 33313231 PMCID: PMC7729365 DOI: 10.21037/atm-20-6755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To analyze the application values of quantitative parametrics measured by three-dimensional transvaginal sonography (3D-TVS) in the diagnosis of uterine cavity distortions. Methods A retrospective analysis was performed on consecutive 113 patients with septate uteruses, as diagnosed consistently by both 3D-TVS and hysteroscopic surgery, between Jan 2016 and Jan 2018. The intrauterine quantitative parametrics were compared between an infertility group and a miscarriage group. Receiver operating characteristic (ROC) curve analysis and evaluation indicators of diagnostic tests were plotted to analyze the relationships between parametrics and uterine cavity distortions. Results There were no significant differences in septum width, septum length, uterine angle, remaining uterine cavity length, and distortion rate between the infertility and miscarriage groups (P>0.05). The distortion rate was positively correlated with septum length, but showed a negative correlation with uterine angle and remaining uterine cavity length (all P<0.05). The area under the curve (AUC) of septum length for predicting a distortion rate higher than 50% was 0.969; with a cutoff value of 2.15 cm, and a diagnostic accuracy of 97.14%, sensitivity was 81.80% and specificity was 98.90%, respectively. Patients with lower septum length coupled with a higher remaining uterine cavity length had a lower risk of uterine cavity distortion. Conclusions Septum length was shown to have the most important effect on uterine cavity distortion of all the uterine parametrics measured by 3D-TVS. Patients with septum lengths higher than 2.15 cm indicated a distortion rate of more than 50%, and tend to experience adverse pregnancy outcomes.
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Affiliation(s)
- Yan Lin
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Min Liu
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Suhui He
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Minmin Yang
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
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Schaible B, Annie F, Seybold D, Calhoun BC. Ecological study of effects of industrial watershed on Müllerian anomalies in an obstetric population. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 202:110819. [PMID: 32590208 DOI: 10.1016/j.ecoenv.2020.110819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To ascertain the prevalence of Müllerian anomalies within an obstetrical population in relation to official hazardous waste sites designated by the Environmental Protection Agency (EPA) in West Virginia. METHODS Observational study of obstetric patients in a tertiary care center with uterine ultrasounds from January 2006 to June 2017. An Optimized Hot Spot analysis and Ripley's K- Function was constructed to ascertain if there is an association with environmental exposures. RESULTS The prevalence of Müllerian anomalies in our obstetric study sample was 0.9% (118/13,040). The most common were septate (47; 39.8%) and bicornuate (46; 39.0%). The distribution of Müllerian anomalies was non-random illustrated by Optimized Hot Spot Analysis locating several statistically significant zip codes of Müllerian anomalies in relation to zip codes that include EPA facilities. CONCLUSION The distribution of Müllerian anomalies was clustered in watershed areas along the Kanawha River in West Virginia that have been designated as EPA FRS Sites and Superfund Sites.
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Affiliation(s)
- Burk Schaible
- Charleston Area Medical Center Women and Children's Hospital, 800 Pennsylvania Ave, Charleston, WV, 25302, United States.
| | - Frank Annie
- Charleston Area Medical Center Health Education and Research Institute, 3211 McCorkle Ave, SE Charleston, WV, 25304, United States.
| | - Dara Seybold
- Charleston Area Medical Center Health Education and Research Institute, 3211 McCorkle Ave, SE Charleston, WV, 25304, United States.
| | - Byron C Calhoun
- West Virginia University/Charleston Area Medical Center Women and Children's Hospital, 800 Pennsylvania Ave, Charleston, WV, 25302, United States.
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Failed manual removal of the placenta after vaginal delivery. Arch Gynecol Obstet 2017; 297:323-332. [PMID: 29101608 DOI: 10.1007/s00404-017-4579-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A retained placenta after vaginal delivery where manual removal of placenta fails is a clinical challenge. We present six cases that illustrate the heterogeneity of the condition and discuss the etiology and terminology as well as the clinical management. METHODS Members of the European Working group on Abnormally Invasive Placenta (EW-AIP) were invited to report all recent cases of retained placenta that were not antenatally suspected to be abnormally adherent or invasive, but could not be removed manually despite several attempts. RESULTS The six cases from Denmark, The Netherlands and the UK provide examples of various treatment strategies such as ultrasound-guided vaginal removal, removal of the placenta through a hysterotomy and just leaving the placenta in situ. The placentas were all retained, but it was only possible to diagnose abnormal invasion in the one case, which had a histopathological diagnosis of increta. Based on these cases we present a flow chart to aid clinical management for future cases. CONCLUSION We need properly defined stringent terminology for the different types of retained placenta, as well as improved tools to predict and diagnose both abnormally invasive and abnormally adherent placenta. Clinicians need to be aware of the options available to them when confronted by the rare case of a retained placenta that cannot be removed manually in a hemodynamically stable patient.
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Ng'ang'a N, Ratzersdorfer J, Abdelhak Y. Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect. BMJ Case Rep 2017; 2017:bcr-2016-219149. [PMID: 28584004 PMCID: PMC5534647 DOI: 10.1136/bcr-2016-219149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/04/2022] Open
Abstract
Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications.
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Affiliation(s)
- Njoki Ng'ang'a
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jonathan Ratzersdorfer
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
| | - Yaakov Abdelhak
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
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