Necrotizing fasciitis after total abdominal hysterectomy: A case report.

RATIONALE: Necrotizing fasciitis is rapidly progressive infection with high mortality rate. This study aimed to summarize the clinical and pathological presentation of this case. PATIENT CONCERNS: A 46-year-old woman patient presented to our emergency department of an obstetric and gynecology clinic on the 8th day after total abdominal hysterectomy. The abdominal wall showed pronounced signs of inflammation. Abundant purulent content was oozing from the abdominal wound. DIAGNOSES: The patient underwent surgery. Areas of necrosis were observed on the skin around the wound, the subcutaneous fatty tissue was necrotic around the incision site, and the fascia was completely dehisced. INTERVENTIONS: Wound debridement and flap cutting of the anterior abdominal wall were performed. Metronidazole, ceftriaxone, and vancomycin were administered intravenously. A plastic surgeon suggested daily debridement and toileting of the wound in the operating room. Swabs of the abdominal cavity, abscess cavity, and abdominal wound were obtained, and Enterococcus faecalis was isolated. After the negativism of microbiological swabs, excochleation of granulation tissue was performed by a plastic surgeon. OUTCOMES: Nineteen days after the relaparotomy, the patient was discharged in good general condition with advice for further monitoring and therapy. LESSONS: Successful treatment of necrotizing fasciitis can be achieved through an initial diagnosis, adequate debridement, empirical broad-spectrum antibiotic coverage, and multidisciplinary treatment.

Corrected evaluation of the breech presentation outcome based on etiology of this presentation in congenitally malformed uterus.

Background: Breech presentation (BP) results from at random filling of the intrauterine cavity, with an equal probability for a BP or cephalic presentation (CP). Each fetus in BP has its "pair" in CP randomly assumed CP. Direct comparison of BP and CP makes bias to less expressed differences between these two groups. It is therefore necessary to subtract the number of fetuses/newborns from the CP set that are identical to the number of fetuses/newborns in the BP set, with identical characteristics, and add this group to the BP set before comparing them to the rest of the CP fetuses/newborns in the matching process. Methods: The procedure encompasses nine variables in pregnancies with a congenitally malformed uterus (CMU) identified at the Department of Obstetrics (1985-2014): gestational age, birth mass, birth length, head circumference, shoulders circumference, umbilical length, placental weight, newborn mass/newborn length ratio, and newborn mass/placental mass ratio. Firstly, the probability of BP was determined and its relation to gestational age, physical characteristics, and previous presentations. Then direct comparison as well as case-control matching of the CP and BP were performed. Case-control matching was based on either a single specific variable (M1) or all combined variables (M2). Findings: 462 deliveries were identified with CMU. In 81 cases of multiparity, a fetal presentation was found to be an independent event regardless of the previous presentation, gestational age, and newborn physical characteristics. In four types of CMU with 337 deliveries (Bicornuate, Didelphys, Unicornuate, Arcuate), 9 variables with 36 instances of comparison were observed. M1 in 10 instances and M2 in 6 instances showed a statistically significant lower value of breech/random presentation compared with CP. CP have lower value in 2 instances in M1 and 1 in M2. Statistically significant differences were absent without the matching process. Interpretations: The study confirms the maximum probability for the BP is 50%. The case-control matching procedure shows that it is able to detect the difference between the breech/random presentation and CP, while the classic method of direct comparison was unable to detect any differences. The outcome of the breech/random presentation in CMU should be evaluated with the described case-control matching procedure.

The effect of continuous positive airway pressure treatment on hypertensive disorder in pregnant women with obstructive sleep apnea.

PURPOSE: Our study aimed to determine the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on the incidence and severity of hypertensive syndrome in pregnancy. METHODS: The study included women with high-risk pregnancies and the Epworth Sleepiness Scale score ≥ of 10. Polygraphic testing was done between 18 and 20 weeks. Participants were divided into three groups: pregnant women with OSA starting treatment with CPAP for 4 weeks between 24 and 28 gestational weeks, women with OSA treated conservatively, and women without OSA as the control group. Participants were followed up regularly for 4 weeks until the delivery and 1 week after for the occurrence of hypertensive syndrome and other maternal complications. RESULTS: Among the 110 women enrolled in the study, the prevalence of hypertensive syndrome in 41 pregnant women with OSA treated conservatively was 39%, 50 women with OSA treated with CPAP 26%, and 19 women in the control group 21%, p = 0.1. The group treated with CPAP when compared with the conservatively treated group had a significantly lower incidence of severe forms of hypertensive syndrome (8% vs. 24%, p = 0.02.), and after 1 month of treatment had higher night oxygen saturation (92%, vs. 87%, p = 0.003) and lower Epworth Sleepiness Scale score (respectively, 4.2 ± 2.3 vs. 9.4 ± 4.1, p < 0001). The respiratory event index was significantly associated with hypertension severity (patients with preeclampsia 9.5 ± 4.9 vs. without hypertension 6.9 ± 4.5, p = 0.04). CONCLUSION: CPAP therapy significantly reduced the incidence of severe forms of hypertensive syndrome in pregnant women with OSA.