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INTRODUCTION: Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. CASE PRESENTATION: We report a rare case of spontaneous heterotopic pregnancy of a 28-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. DISCUSSION: Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The most common functional signs are abdominal pain, vaginal bleeding, pelvic mass and peritoneal irritation. The first-line paraclinical examination is suprapubic and transvaginal pelvic ultrasound. Therapeutic management of heterotopic pregnancies involves rapid intervention on the ectopic pregnancy, while respecting the intrauterine pregnancy if it has progressed, in order to preserve the patient's fertility. CONCLUSION: Diagnosis of heterotopic pregnancy is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.
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INTRODUCTION AND IMPORTANCE: OEIS complex is a rare and complex anomaly of the genitourinary and intestinal tract. It includes Omphalocele, Exstrophy of cloaca, Imperforate anus and Spinal defects. PRESENTATION OF CASE: We are reporting a case of OEIS complex. CLINICAL DISCUSSION: Cloacal exstrophy is considered the most severe ventral abdominal wall defect. Diagnosis is primarily antenatal based on the presenting features on ultrasonography. Management requires initial resuscitation and stabilization followed by either single staged closure or multistage procedures by multi-disciplinary surgical team. CONCLUSION: The introduction of better diagnostic techniques and the detection of fetal malformations during pregnancy is it's the cornerstone of care.
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Fetal biometry and amniotic fluid volume assessments are two essential yet repetitive tasks in fetal ultrasound screening scans, aiding in the detection of potentially life-threatening conditions. However, these assessment methods can occasionally yield unreliable results. Advances in deep learning have opened up new avenues for automated measurements in fetal ultrasound, demonstrating human-level performance in various fetal ultrasound tasks. Nevertheless, the majority of these studies are retrospective in silico studies, with a limited number including African patients in their datasets. In this study we developed and prospectively assessed the performance of deep learning models for end-to-end automation of fetal biometry and amniotic fluid volume measurements. These models were trained using a newly constructed database of 172,293 de-identified Moroccan fetal ultrasound images, supplemented with publicly available datasets. the models were then tested on prospectively acquired video clips from 172 pregnant people forming a consecutive series gathered at four healthcare centers in Morocco. Our results demonstrate that the 95% limits of agreement between the models and practitioners for the studied measurements were narrower than the reported intra- and inter-observer variability among expert human sonographers for all the parameters under study. This means that these models could be deployed in clinical conditions, to alleviate time-consuming, repetitive tasks, and make fetal ultrasound more accessible in limited-resource environments.
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Líquido Amniótico , Aprendizaje Profundo , Embarazo , Femenino , Humanos , Líquido Amniótico/diagnóstico por imagen , Estudios Retrospectivos , Automatización , Biometría/métodosRESUMEN
INTRODUCTION: Collodion baby "CB" is an extremely rare dermatological condition. Approximately 1 in 100,000 births are identified as infants with CB syndrome, including stillbirths (Dyer et al., 2013). A cornified substance replaces the newborn's skin, giving the body a varnished or parchment-like appearance. CASE PRESENTATION: Patient aged 30 years, third gesture, third pare, admitted for premature delivery of 8 months. After labor management, she gave birth 2 h after admission to the maternity ward of a living newborn female weighing 2400 g. The initial physical examination revealed large, thick scales all over the body. Examination of the head and neck revealed an abnormal parchment-like membrane covering the head and sparse hairs. Excessive scaling around the mouth gives a typical fish-like appearance. No other obvious abnormalities were observed. CLINICAL DISCUSSION: CB is an extremely rare dermatological condition. This is a disorder secondary to cornification. These children are generally born prematurely, and are not diagnosed until after birth. Due to the presence of a tight membrane, these babies develop numerous complications such as eclabium, ectropion, limited movement of the extremities and fingers. Treatment consists mainly of support, such as the use of intravenous fluids, incubators, tube feeding and emollients. CONCLUSION: The collodion baby is a newborn characterized by an altered skin barrier, exposing him or her to numerous complications. Fortunately, the mortality rate has fallen thanks to improved neonatal care.
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INTRODUCTION: Paratubal cysts are frequent lesions, and may be responsible for complications such as adnexal torsion, which is rare and difficult to diagnose. Management requires emergency surgery in an attempt to preserve the adnexa. PRESENTATION OF CASE: We report a rare case of a young patient admitted with a Torsion of paratubal cyst mimicking ovarian torsion, the positive diagnosis was difficult. DISCUSSION: Paratubal cysts are lesions that constitute around 10 % of adnexal masses, and may have their embryological origin in Wolfian remnants. Morgagni's hydatid is by far the most common form. Torsion of a para-tubal cyst may manifest as sudden, continuous, or rapidly worsening pain in the iliac fossa. Ultrasound should systematically seek to identify the ovaries outside the lesion. Isolated tubal torsion can only be treated surgically. Laparoscopy is the gold standard. CONCLUSION: Paratubal cyst torsion is rare and very difficult to diagnose, but should be systematically considered in the case of an adolescent presenting with acute pelvic pain.
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INTRODUCTION AND IMPORTANCE: Atypical pre-eclampsia cases are those that develop before 20 weeks of gestation and after 48 h after delivery and or have some of the signs and symptoms of preeclampsia without the usual hypertension or proteinuria which make them difficult to diagnose. CASE PRESENTATION: Our aim is to report a case of atypical preeclampsia (before week 20 of gestation) associated with a HELLP syndrome and analyze the clinical features of atypical forms, assess differential diagnosis and highlight the progress in biochemical and biophysical markers that may help with diagnosis. CLINICAL DISCUSSION: Severe early pre-eclampsia (before 32 weeks of pregnancy) is associated with a risk of maternal mortality 20 times higher than after 37 weeks, and a higher risk of perinatal complications. Its symptoms are variable and reflect multisystem dysfunction. CONCLUSION: Despite the refinement of diagnostic tools available to clinicians, there are still clinical presentations that fall outside the definitions. Any good clinician must be aware of the atypical forms in order to initiate correct management without delay and thus avoid increasing maternal and perinatal morbidity and mortality.
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INTRODUCTION: Massive vulvar edema is an unusual complication of pregnancy that may be due to underlying systemic pathology but has also been associated with preeclampsia. It is likely to interfere with vaginal delivery. It has been associated with maternal mortality in the postpartum period. OBSERVATION: A 34 years old female patient, having already delivered a child by vaginal route, without any other particular pathological history, admitted for severe pre-eclampsia on an unattended pregnancy estimated at 36 weeks of amenorrhea. The examination on admission showed a blood pressure of 170/110 mmHg, a proteinuria of three crosses on the urine dipstick. Examination of the vulva showed massive vulvar edema. The massive vulvar edema was explained by hypoprotidemia secondary to renal damage in the context of severe pre-eclampsia. The evolution was marked by the rapid normalization of the tentional figures and a spectacular regression of the vulvar edema, and its complete disappearance in fifteen days. DISCUSSION: Edema may be seen in 80 % of pregnant women, but isolated massive vulvar edema is rare in pregnancy. Massive vulvar edema has been reported in the literature after tocolysis, vulvovaginitis, Crohn's disease and pre-eclampsia. Treatment of vulvar edema is necessary because it can be alarming to the patient and may lead to occlusion of the vulvar orifices. The patient with vulvar edema deserves special attention, and identification and treatment of the associated factors are essential to its management. CONCLUSION: Massive vulvar edema is rare in pregnancy but requires special attention because it can be associated with maternal and fetal complications. Treatment is symptomatic and etiologic whenever an underlying cause is found and the evolution is often favorable with proper treatment.
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INTRODUCTION: Uterine rupture due to placenta percreta is very rare. It often occurs in patients with a history of Cesarean section. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity. OBSERVATION: Patient, 36 years old, mother of three children delivered by cesarean section, admitted for acute abdominal pain in the context of a poorly monitored pregnancy estimated at 25 weeks of amenorrhea. Pelvic ultrasound showed a large peritoneal effusion with the presence of an evolving intrauterine pregnancy with cardiac activity present, the placenta was with anterior coverage. An emergency laparotomy revealed uterine rupture with active hemorrhage localized on the anterior uterine scar with placental protrusion was noted. A cesarean section was quickly performed to save the fetus. The placenta was left in place and a difficult hysterectomy was then undertaken. DISCUSSION: Uterine rupture in second trimester caused by placental percreta is a rare event that can be life threatening for both mother and fetus. Placenta percreta should be considered when diagnosing internal bleeding in a patient during the first trimester of pregnancy. CONCLUSION: Placenta percreta is a rare but severe obstetric complication that is potentially life threatening for both the mother and fetus. It is important to maintain a high level of clinical suspicion for this disease in pregnant women with acute abdomen, especially those with specific risk factors.
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The association of ovarian malignancy with pregnancy is rare; accounting for 3-6% of ovarian masses of which malignant germ cell tumors represent the type most frequently associated with pregnancy, whereas the incidence of epithelial ovarian cancer is only 1/12,000 to 1/50,000 of pregnancies. The diagnosis and management of ovarian cancer in pregnancy remain poorly codified because of the rarity of cases and the limited data available on this pathology. We report here the case of a 45-year-old woman with a large ovarian mucinous adenocarcinoma diagnosed during pregnancy, identified by ultrasound and magnetic resonance imaging. The patient was treated by surgical resection followed by adjuvant chemotherapy with carboplatin and paclitaxel with a follow-up of 36 months, she is in complete remission.
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INTRODUCTION: Ovarian pregnancy is a rare form of ectopic pregnancy. Its incidence is 0.5% to 1% of all ectopic gestations, or 1 in 7000 to 40,000 live births. The diagnosis is intricate and based on surgical and histopathological observations. Traditional risk factors for ovarian ectopic pregnancy are similar to those for tubal pregnancy, but use of an IUD seems to be disproportionately associated. CASE REPORT: We report a rare case of spontaneous ectopic ovarian pregnancy of a 40-year-old woman, diagnosed with a ovarian pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. CLINICAL DISCUSSION: Ovarian ectopic pregnancies occur through fertilization of an egg retained in the peritoneal cavity leading to implantation on the surface of the ovary. The increased incidence of ovarian ectopic pregnancies is associated with the increased use of artificial reproductive technologies (ART) and intrauterine contraceptive devices (IUCDs). The diagnosis is difficult and a constant challenge for the gynecologist. Its management remains surgical therapy despite the progress in medical treatment. CONCLUSION: Ovarian pregnancy is a rare entity that has some special features. Its diagnosis is difficult and relies on criteria based on intraoperative findings. Its management remains surgical therapy despite the progress in medical treatment.
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INTRODUCTION: Spontaneous bladder rupture SBR is a rare condition and often missed diagnosis, especially after a nontraumatic vaginal delivery. CASE PRESENTATION: A 34-year-old patient who had a nontraumatic vaginal delivery presented to the emergency room 7 days later with acute abdomen and anuria. Computed tomography showed free fluid in the peritoneal cavity. An intraperitoneal rupture of the bladder dome was detected, showing extravasation of contrast into the peritoneal cavity. An exploratory laparotomy revealed a perforation on the bladder dome that was sutured. CLINICAL DISCUSSION: SBR following vaginal delivery is an extremely rare condition. It represents a surgical emergency. Due to the low incidence and the presence of non-specific symptoms, diagnosis was usually delayed with an increased morbidity and mortality. Clinicians should consider this diagnosis in the presence of an acute abdominal pain associated to anuria or dysuria. We therefore recommend that the bladder be catheterized or drained before labour. CONCLUSION: SBR is a rare and life-threatening condition in post-partum. Abdominal pain with elevated serum creatinine should be suspicious of urinary bladder rupture.
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In order to prepare for a validation study to compare percutaneous absorption through reconstructed human epidermis with ex vivo skin absorption through human and animal skin, nine test compounds, covering a wide range of physicochemical properties were selected, namely: benzoic acid; caffeine; clotrimazole; digoxin; flufenamic acid; ivermectin; mannitol; nicotine; and testosterone. The donor and receptor media for the test substances, the addition of a solubiliser for the lipophilic compounds, as well as the stability and solubility of the test substances in the vehicles, were systematically analysed. Hydrophilic molecules, being freely soluble in water, were applied in buffered saline solutions. In order to overcome solubility restrictions for lipophilic compounds, the non-ionic surfactant, Igepal CA-630, was added to the donor vehicle, and, in the case of clotrimazole and ivermectin, also to the receptor fluid. The model molecules showed a suitable solubility and stability in the selected donor and receptor media throughout the whole duration of the test.