Cerclage in complete placenta previa preventing preterm labor: A rare case report

Placenta previa often leads to antepartum hemorrhage, which warrants the patient for emergency room admission. The bleeding occurs mainly due to cervical dilation, which could be caused by cervical incompetence. Cervical cerclage has been considered as the primary treatment for cervical incompetence. However, evidence is lacking for its application in placenta previa. Here, we present a case of a 30-year-old pregnant woman diagnosed with complete placenta previa where a good obstetrical outcome could be achieved. The patient had antepartum hemorrhage during the 21st week of gestational age due to cervical dilation in a complete placenta previa case. An emergency cerclage using McDonald's technique was then performed, which prolonged the pregnancy to the 34th week of gestation. The patient had cesarean section and delivered a healthy baby girl weighing 2190 g. The mother and the baby had an uneventful recovery and were discharged after 2 days of hospitalization.

Case report: Unpredictable nature of tubal cancer

Introduction

Primary tubal cancer is very rare, most are diagnosed intra and post operatively. Histopathology is vital in determining the cancer origin. Here we present a case of fallopian tube cancer with clinical presentation mimicking endometrial origin.

Case description

A 74-year old patient came with complaints of intermittent post-menopausal bleeding and pelvic pain. The patient had several investigations using Ultrasonography, Hysteroscopy-guided biopsy, and Magnetic Resonance Imaging. Pre-operative diagnosis was endometrial cancer based on histopathology of endometrial biopsy during hysteroscopy. Explorative laparotomy, total abdominal hysterectomy, bilateral salphingo-oophorectomy, pelvic and para-aortic lymph node dissection were then performed, and the tumor samples were sent to the histopathology laboratory. It was found that the post-operative diagnosis was in fact primary fallopian tube cancer stage IIB.

Conclusion

For patients with gynecological malignancies, rare cases such as fallopian tube cancer should never be overlooked as a differential diagnosis.

Discrepancy in perception of infertility and attitude towards treatment options: Indonesian urban and rural area

Background

In Indonesia infertility affects 10–15% of reproductive-age couples. In addition to medical problem, infertility in Indonesia poses significant social problem. Childlessness is often stigmatized as a failure which victimizes couples, moreover the females. Despite the high prevalence, there is no fertility awareness education which further passes down the common myth, misperception, and negative attitude towards infertility treatment in Indonesian society.

Objective

This study aims to reveal the knowledge, myth, and attitude towards infertility, likewise acceptance towards infertility treatment options.

Method

Cross-sectional study using standardized questionnaire was done to 272 individuals consisted of two parallel groups: Jakarta and Sumba representing urban and rural population respectively. Participants were all outpatients above 18 years old who visited the healthcare centers from February 2017 to June 2017.

Results

Knowledge on biological and lifestyle risk factors of infertility among Jakarta and Sumba groups were comparable. However, belief in supernatural causes of infertility is remarkable in Sumba population. There is a common misconception on the use of contraception as risk factors of infertility in both groups.

Half respondents from both groups think infertility is a disease. In Jakarta 93.4% respondents consider both female and male should be investigated for infertility; in Sumba only 55.4% agree while 33.1% consider only female should be investigated. Infertility is an acceptable reason for polygamy for 41.3% respondents in Sumba, with 34.7% blaming maternal side for childlessness.

Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options.

Conclusion

Lack of understanding, misleading myths, and negative attitude towards infertility have been illustrated in the sample population.

Investigation of Each Society for Fertility Preservation in Asia

Fertility preservation (FP) remains a future direction for reproductive medicine. FP development is needed to keep up with advancements in other areas of medicine, such as cancer research that has successfully prolonged patients' survival. The demand for optimum FP is sought by both patients and practitioners alike. The American Society of Clinical Oncology has published and updated several FP guidelines. However, these guidelines need to be optimized for each country due to the nature of FP that interacts with the local policy, social decorum, and economic factors. Furthermore, the availability and success rate for each procedure might differ since there is a requirement for advanced and innovative technologies involved in FP. These guidelines should ideally be supported by the FP society to overcome unique barriers that may arise in each country. Here we try to illustrate the most recent update on the condition of FP practice in several countries in Asia. This hopefully will encourage future FP development and might become a useful reference for other countries, especially in Asia.