A Rare Case of Advanced-Stage Small Cell Carcinoma of the Ovary Identified During the Third Trimester of Pregnancy.

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare form of aggressive ovarian malignancy linked with mutations in the SMARCA4 gene. This disease predominantly affects young women within the first five decades of life and is associated with poor overall long-term survival, particularly when diagnosed in the advanced stage of the disease. Due to the low incidence of the condition and limited literature, current clinical decision-making is based on a small number of case series and case reports. We present an extremely rare case of SCCOHT diagnosed in a young female during her third trimester of pregnancy, requiring preterm delivery via cesarean section with simultaneous unilateral oophorectomy and salpingectomy.

Management of Fetal Supraventricular Tachycardia: Case Series from a Tertiary Perinatal Cardiac Center.

BACKGROUND: Fetal supraventricular tachycardia is a relatively uncommon cardiac rhythm abnormality which is often associated with adverse perinatal outcomes if untreated. Although there are several treatment modalities and protocols in use globally, there is no consensus as to the most effective antiarrhythmic to manage this condition. AIM: This study aimed to evaluate perinatal outcomes following prenatal maternal therapy for fetal supraventricular tachycardia. MATERIALS AND METHODS: This was a 20-year retrospective cohort study. Institutional records were reviewed for antenatal therapy choice and maternal and fetal outcomes. RESULTS: Sixty-nine cases met diagnostic criteria for fetal SVT, of which 56 (81%) received maternal antiarrhythmic therapy. Digoxin was the most common, but least effective, first-line therapy in 28 patients, achieving successful rate reversion in 35.7%. Thirty-one patients (55%) required second-line therapy, and this was most successful with digoxin and flecainide polytherapy achieving rate reversion in 17 of 18 cases (94.5%) at a median of 3 days (1.5-7). Hydrops was present in 23 (33%) cases at initial presentation, 16 of which achieved rate reversion. There was minimal difference in treatment efficacy comparing single- or multiple-agent treatment in the setting of hydrops (50% vs. 42.8%). Side effects occurred in 14/56 treated patients (25%) but were severe in only 8 (14.3%) women, most commonly with digoxin and flecainide polytherapy (6 of 8 cases). There were 3 (4%) fetal deaths amongst the study cohort. CONCLUSIONS: Digoxin and flecainide polytherapy were well tolerated and successfully achieved rhythm and rate control in fetuses with prenatally diagnosed supraventricular tachycardia. The presence of hydrops was a poor prognostic feature.

Maternal demographic and intrapartum antecedents of severe neonatal outcomes at term.

Objective: To determine key demographic and intrapartum antecedents predisposing to severe adverse neonatal outcome at term.Methods: This was a retrospective cohort study of severe adverse neonatal outcomes of nonanomalous singleton term births at an Australian tertiary maternity unit between January 2007 and April 2017. Serious neonatal outcome (SNO) was defined as any of the following: Apgar score ≤3 at 5 min, severe respiratory distress syndrome, severe acidosis, admission into neonatal intensive care unit (NICU), stillbirth, or neonatal death. Multivariable generalized estimating equations were used to identify key demographic and intrapartum risk factors predisposing to poor neonatal outcomes.Results: There were 77 888 births with SNO occurring in 7247 (9.3%) cases. Young maternal age, raised BMI, indigenous ethnicity, nulliparity, smoking, illicit drug use, and diabetes mellitus were more common in the SANO cohort. Instrumental birth (aOR 3.24, 95%CI 3.02-3.47, p < .001), emergency cesarean section (aOR 1.61, 95%CI 1.49-1.73, p < .001), emergency cesarean for nonreassuring fetal status (aOR 3.45, 95%CI 3.04-3.92, p < .001), cord accidents (aOR 4.98, 95%CI 2.81-8.83, p < .001) and intrapartum hemorrhage (aOR 1.42, 95%CI 1.08-1.87, p = .01) were major antecedents. Induction of labor (aOR 1.08, 95%CI 1.01-1.15, p = .03), prolonged second stage (aOR 1.76, 95%CI 1.55-2.00, p < .001) and use of intramuscular opioids/narcotics (aOR 1.41, 95%CI 1.30-1.52, p < .001) were also associated with adverse neonatal outcome. Low birth weight (< 5th and <10th centiles) and macrosomia (> 90th and >95th centiles) and delivery at 37 weeks and >41 weeks were additional risk factors.Conclusion: There are multiple maternal and intrapartum risk factors which can predispose to severe outcomes in the neonate.