Ruptured interstitial ectopic pregnancy: A case report and review of the literature.

Introduction: Interstitial pregnancy is a rare type of ectopic pregnancy. The aim of our publication is to describe the diagnosis and treatment of this entity. Case report: We report the case of a ruptured interstitial pregnancy diagnosed in a 32 years old patient admitted for acute abdominal pain. Discussion: The main symptom was severe pelvic pain in a context of amenorrhea. The ultrasound found the ectopic pregnancy in the form of an eccentric gestational sac with an empty uterine cavity as well as intraperitoneal effusion. A ruptured ectopic pregnancy was suspected and the patient was admitted immediately for emergency laparotomy with cornusotomy and salpingectomy. Conclusion: Interstitial ectopic pregnancy is associated with high morbidity. Its diagnosis and management should be early and adequate in order to avoid complications and preserve fertility.

Awareness of toxoplasmosis among postpartum women: a cross-sectional study in Morocco.

Introduction: awareness and knowledge of toxoplasmosis are particularly important, as an intervention point for the management of the disease. The aim of this study was to evaluate the awareness and knowledge regarding toxoplasmosis in a sample of postpartum Moroccan women. Methods: this was a cross-sectional descriptive survey carried out among 320 parturient at the National Reference Center for Neonatology and Nutrition at the Children's Hospital of Rabat. Results: of 320 parturient women responding to the survey, 227 (71%) had never heard about toxoplasmosis. While 18.1% of parturient stated knowing the transmission routes for toxoplasmosis. Regarding the transmission route, 53 (16.6%) women pointed at a domestic cat and 31 (9.7%) at eating raw or undercooked meat. Out of all participants, 60 (18.8%) women said they had received prevention advice during their pregnancy. The great majority (90%) of participants were unaware of the severity of the congenital infection. None of the participants showed a high level of knowledge about transmission routes, measures of prevention, and severity of CT. Conclusion: according to our survey, we observed that the majority of participants had never heard any information about toxoplasmosis. It is, therefore, necessary to educate women of childbearing age and pregnant women about the disease, especially concerning the transmission route and the prevention of infection and primary infection in non-immune women.

Benckiser's hemorrhage: about an uncommon case report.

BACKGROUND: Benckiser's hemorrhage is a serious obstetric emergency caused by rupture of one or more umbilical vessels of velamentous insertion, putting the fetus in distress and leading to rapid fetal death through exsanguination in utero. It is an uncommon condition associated with a neonatal mortality rate of 75-100%. This hemorrhage of fetal origin happens most often when the membranes rupture, whether spontaneously or artificially. This is why prenatal diagnosis via ultrasound can only be beneficial and make it possible to schedule a prophylactic caesarean section before the onset of fetal death as well as other adverse perinatal outcomes. CASE PRESENTATION: We hereby present an uncommon case of a 27-year-old female patient, with no antenatal check-ups, who presented to the emergency department for labor-like pain at a gestational age of 32 weeks. On examination, blood pressure was 140/89mmhg. Shortly after her hospitalization, the patient was experiencing steady vaginal bleeding as well as spontaneous rupture of the membranes. Retroplacental hematoma was suspected. It was then quickly decided to do an emergency caesarean section. It was only at the examination of the placenta that the diagnosis was corrected with the visualization of torn velamentous vessels, allowing immediate resuscitation of the newborn and admission in neonatal intensive care unit for blood transfusions. CONCLUSIONS: Detailed prenatal ultrasonography screening for vasa previa in high risk pregnancies prevent the onset of complications related to their rupture. An elective caesarean section should be carried out prior to the onset of labor, most often at 35 weeks of amenorrhea, avoiding rupture of membranes and fetal exsanguination, while taking into consideration the impact of iatrogenic prematurity.

Interstitial pregnancy is one of the most serious and uncommon ectopic pregnancies: Case report.

BACKGROUND: Ectopic pregnancies are a dreaded and common cause of first-trimester metrorrhagia. They refer to the implantation and development of the embryo outside the uterine cavity. Interstitial localization is uncommon and corresponds to implantation of the embryo in the intramural part of the uterine tube. It has an unforeseen evolution with a risk of cataclysmic hemorrhage by uterine rupture in the absence of early diagnosis and management. CASE PRESENTATION: We herein present the uncommon case of a 26-year-old female patient, second gestation, nulliparous, who underwent a pelvic ultrasonography in the emergency department for pelvic pain associated with a two-month amenorrhea. A past history of left salpingectomy for a ruptured tubal ectopic pregnancy 3 years ago was found. Pelvic ultrasound allowed us to detect a ruptured ectopic interstitial pregnancy at 7 weeks of amenorrhea. Significant hemoperitoneum and hemodynamic instability required emergency laparotomy. The condition was confirmed preoperatively and the patient underwent a corneal resection. The postoperative course was uneventful and the patient was discharged on day 4 postoperatively. CONCLUSIONS: The interstitial ectopic pregnancy is an uncommon and life-threatening condition. The importance of early ultrasound detection is of paramount importance to allow conservative treatment with methotrexate injections. Delayed diagnosis requires cornual uterine resection with all the complications that it implies.

Lactococcus lactis cremoris intra-uterine infection: About an uncommon case report.

BACKGROUND: When intra-uterine infection (IUI) is suspected or confirmed, intravenous antibiotic therapy providing coverage against common organisms (S. agalactiae and E. coli) is recommended to be administered immediately in order to reduce the risk of maternal and neonatal infectious complications. Nevertheless, it happens that some infections are due to uncommon microorganisms that do not respond to probabilistic treatment. Therefore, samples with bacteriological examination remain systematic. Moreover, the extraperitoneal cesarean section avoids the opening of the peritoneal cavity used in the Pfannenstiel technique and thus reduces the risk of infectious dissemination. CASE PRESENTATION: We hereby present the uncommon case of a 19-year-old primigravida woman who was referred to our facility for acute gastroenteritis at 34 weeks of gestation. The hospital course was complicated by premature rupture of the membranes followed by the development of fever, chills and deterioration of the fetal heart rate (FHR), imposing an urgent extraperitoneal cesarean section for suspected IUI with fetal impact. Bacteriological examination of a placental sample subsequently yielded growth of Lactococcus lactis cremoris which makes it to our knowledge the second case reported to date of an IUI due to this bacterium. CLINICAL DISCUSSION AND CONCLUSION: IUI predominantly occurs by ascending bacterial invasion from the lower genital tract to the typically sterile amniotic cavity in the setting of membrane rupture. Extraperitoneal cesarean section serves as a viable alternative to classic transperitoneal delivery in the presence of uterine infection by controlling bacterial spread. Our case serves as a reminder that IUI can arise from multiple pathogens, including Lactococcus lactis cremoris which is known as a harmless bacterium.

Placenta percreta as a cause of uterine rupture in the second trimester: Case report.

INTRODUCTION: Placenta accreta spectrum is a very life-threatening obstetrical condition whose rate increased significantly the past years due to the increase of caesarean deliveries. In some rare cases, it can cause uterine rupture which needs to be diagnosed and managed quickly to avoid catastrophic outcomes. CASE REPORT: We present a case of a 33-year-old patient who was admitted to the emergency room for signs of shock at 29 weeks of a poorly supervised pregnancy, secondary to a spontaneous uterine rupture on a previously scarred uterus by a caesarean delivery two years prior to the events. She presented with massive haemoperitoneum with no vaginal bleeding. Foetus was in bradycardia. Quick total hysterectomy allowed favorable maternal and foetal outcome. DISCUSSION: Placenta accreta spectrum (PAS) occurs when the placenta becomes abnormally adherent to the myometrium and serosa rather than the uterine decidua. Its most important complication is hemorrhage after delivery of the placenta. In rare cases it can lead to spontaneous uterine rupture at any trimester, as it was the case of our patient. Antepartum diagnosis by ultrasound examination is recommended to avoid complications and improve management. It should be carefully done in high-risk patients of PAS. PAS is associated with high maternal and foetal morbidity and mortality. Definitive diagnosis is obtained after pathology examination of the specimen. CONCLUSION: Uterine rupture should be considered a differential diagnosis for abdominal pain in any trimester, in case of shock even in the absence of vaginal bleeding, especially when associated to abnormal placentation. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity.

Spontaneous uterine rupture revealing vascular Ehlers-Danlos syndrome: An uncommon case report.

INTRODUCTION AND IMPORTANCE: Vascular Ehlers-Danlos syndrome also referred to as Ehlers-Danlos Type IV is an uncommon autosomal dominant genetic disorder linked to connective tissue abnormality. Its evolution is marked by the occurrence of severe vascular, digestive and obstetrical complications. The current case highlights the importance of early diagnosis and physician awareness about this disorder as it can improve the patient's prognosis. CASE PRESENTATION: We present the case of a 34-year-old woman, who presented at 36 weeks of amenorrhea with labor pain. The labor evolution was marked by an increased fluctuating abdominal pain, a sudden loss of the fetal station detected during cervical examination and decelerations to 60 beats per min, leading to an emergency caesarean section. During the laparotomy, the patient presented a spontaneous bilateral extension of the cutaneous incision requiring the realization of stopping stitches. The fetus and placenta had been expelled via a 9 cm long uterine wall rupture also known as an open book uterine rupture. A live male infant weighting 2890 g was promptly delivered and transported to NICU for respiratory distress. Physical features typical of EDS-IV allowed us to suspect this disorder and genetic analysis identified the presence of COL3A1 gene mutation, confirming the diagnosis. CLINICAL DISCUSSION AND CONCLUSIONS: Early recognition of Vascular Ehlers-Danlos syndrome is of paramount importance to improve the prognosis of affected patients, who often present themselves with life-threatening situations. Clinicians should maintain a high index of suspicion for the clinical signs of this inherited connective tissue disorder that is characterized by distinctive features.

Adnexal torsion caused by tuberculous pyosalpinx: An uncommon case report of urogenital tuberculosis.

BACKGROUND: According to the World Health Organization, TB is a global public health problem and it remains in 2020 the deadliest infectious disease in the world, ahead of Covid19 (Global Tuberculosis Report 2020, 2020). Morocco is an endemic area with more than 30,000 new cases of all forms of tuberculosis each year (Plan stratégique national 2018-2021 de lutte antituberculeuse, 2018). UGTB is the second most frequent localization after lymph node involvement and is responsible for 30 to 40% of all extrapulmonary cases. CASE PRESENTATION: We hereby present the uncommon case of a 27-year-old virgin woman with unremarkable medical and surgical histories, who presented at the emergency department for left-sided pelvic pain of acute installation. An exploratory laparotomy using a Pfannenstiel incision, demonstrated a peritoneal effusion of low abundance with a twisted left ovary and a huge pyosalpinx. Detorsion was then carefully performed, with improvement in color of the ovary and decrease in edema within 10 min. Histopathological study of the Fallopian tube biopsy revealed granulomatous abscessificated salpingitis with genital tuberculosis. Thus, the patient received her anti-tuberculosis treatment with a course of 6 months of 2HRZE/4HR. CONCLUSIONS: In view of the resurgence of cases of tuberculosis of all forms, the importance of prevention and screening should not be underestimated, especially in endemic areas. In fact, only BCG at birth and the correct treatment of any primary tuberculosis infection, whatever its location, will make it possible to reduce the consequences of this affection and avoid the tragedy of the home without children.

[Ballantyne syndrome associated with fetal cardiac rhabdomyoma: a case report]. / Syndrome de Ballantyne associée à un rhabdomyome cardiaque fœtal: à propos d´un cas.

Ballantyne syndrome or mirror syndrome was first described in 1892. It is a disorder affecting pregnant women describing the association of fetal anasarca complicated by more or less generalized maternal edema and albuminuria (and sometimes anemia). It is a rare clinical entity. Diagnosis is based on a triad consisting of fetal hydrops, generalized maternal edema and placentomegaly. It can be associated with fetal hydrops from any cause. Diagnostic should be suspected in patients with maternal edema syndrome associated with fetal anasarca. Guarded fetal prognosis can be associated with high maternal morbidity; hence the need for early diagnosis, resting on a clear determination of its cause, and aimed to implement antenatal treatment improving maternal and fetal prognosis. We here report a unique case of Ballantyne syndrome which has never been described in the literature. The study involved a 32-year-old female patient with fetal hydrops caused by fetal cardiac rhabdomyoma.

Congenital vaginal atresia: about an uncommon case.

Congenital vaginal atresia is a rare congenital abnormality of the female reproductive tract due to a failure of canalisation in the urogenital sinus. We report the uncommon case of a 14-year-old girl with a primary amenorrhea associated to a cyclical pelvic pain, in whom examination objectified a vaginal cup that replaced the introitus. Ultrasound examination and magnetic resonance imaging (MRI) revealed atresia of the lower third of the vagina. The diagnosis of partial vaginal aplasia on functional uterus was retained, the patient had a perineal vaginoplasty. The evolution was satisfactory with regular cycles and improvement of pelvic pain. The decline is three years. Congenital vaginal atresia is a rare malformation classically and clinically pictured as a primary amenorrhea with chronic cyclic pelvic pain. Diagnosis is based on clinical examination and imaging. The MRI is designed to assess the importance of atresia and guide surgical management while the surgical technique aims to restore the integrity of the utero-vaginal tract and to increase the possibility of pregnancy for these patients.

Molecular Diagnosis of Pneumonia Using Multiplex Real-Time PCR Assay RespiFinder® SMART 22 FAST in a Group of Moroccan Infants.

BACKGROUND: In Morocco, pediatric pneumonia remains a serious public health problem, as it constitutes the first cause of mortality due to infectious diseases. The etiological diagnosis of acute respiratory tract infections is difficult. Therefore, it is necessary to use Multiplex real-time polymerase chain reaction assay tests in a routine setting for exact and fast identification. OBJECTIVES: In this paper, we present the clinical results of pediatric pneumonia and describe their etiology by using molecular diagnosis. Study design: Tracheal secretion was collected from infants presenting respiratory distress isolated or associated with systemic signs, attending the unit of Neonatology between December 1, 2016, and Mai 31, 2018. Samples were tested with the multiplex RespiFinder® SMART 22 FAST which potentially detects 18 viruses and 4 bacteria. RESULTS: Of the 86 infants considered in this study (mean age 31 ± 19 days) suspected of acute respiratory tract infections, 71 (83%) were positive for one or multiple viruses or/and bacteria. The majority of acute respiratory tract infections had a viral origin (95%): respiratory syncytial viruses (A and B) (49%), rhinovirus (21%), coronaviruses 229E (11%), humain metapneumovirus (5%), influenza A (3%), influenza H1N1 (1%), adenovirus (2%), and parainfluenza virus type 4 (2%). Among our patients, 6% had Mycoplasma pneumoniae. Coinfections were not associated with severe respiratory symptoms. CONCLUSION: The clinical spectrum of respiratory infections is complex and often nonspecific. Thus, the early and fast detection of related causative agents is crucial. The use of multiplex real time polymerase chain reaction may help choose an accurate treatment, reduce the overall use of unnecessary antibiotics, preserve intestinal flora, and decrease nosocomial infection by reducing the length of hospitalization.

[Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]. / Nécrose utérine suite à une combinaison de compressions utérines et de ligature vasculaire lors d'une hémorragie post-partum: à propos d'un cas.

Delivery hemorrhage is the leading cause of maternal mortality in Morocco. It is an obstetric emergency requiring early, effective and multidisciplinary management in patients with severe postpartum bleeding resistant to medical treatment. Advances in interventional radiology and especially, in surgical techniques have provided safe and effective alternatives to hemostasis hysterectomy . We here report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage based on B-Lynch uterine compression suture combined with Tsirulnikov triple vascular ligation. The patient had sepsis on day 4 after delivery associated with fever and pelvic pain and biological inflammatory syndrome which worsened 48 hours after the onset of abdominal contracture. Abdomopelvic scanner, showed gas bubbles in the uterine myometer suggestive of necrosis. Exploratory laparotomy was performed, which objectified complete necrosis of the uterus. Uterine compression sutures are surgical techniques which play a major role in the therapeutic armamentarium of postpartum hemorrhage during cesarean section. It allows, in addition to or as an alternative to vascular ligation, the preservation of patient's fertility, but it also requires maximum caution and monitoring of complications, the most serious of which is uterine necrosis.

Abdominal pregnancy with a healthy newborn: a new case.

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low-resource centers. We report a case of abdominal pregnancy with a healthy newborn. A 34-year-old Moroccan woman, G4P3 (3 alive children), presented with shortness of breath and progressive abdominal distension and pain at 37 weeks' gestation. An emergency laparotomy was performed with the impression of abdominal pregnancy. Intraoperatively, the fetus was seen in an intact amniotic sac in her abdomen, the placenta was strongly adhered to the fundus and enveloped the left adnexa. A total hysterectomy with a left adnexectomy was performed. The patient and neonate progressed well and were discharged. Term abdominal pregnancy is an extremely rare diagnosis. The life-threatening complication is bleeding from the detached placental site. High index of suspicion is vital in making prompt diagnosis in such situations.

Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature.

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.

Vitamin D status in Moroccan pregnant women and newborns: reports of 102 cases.

INTRODUCTION: Vitamin D insufficiency to pregnant women has been associated with a number of adverse consequences, and has been recognized as a public health concern. The aim of this study was to evaluate vitamin D status of Morrocan pregnant women and their newborns. Our study is being the first of its kind in Morocco, as it supports the program of systematic supplementation of pregnant women in the third quarter. Its results have established a new program for the fight against the deficit of various nutrients, thereby intake of vitamin D has become routine. So this work is a true example of action research. METHODS: It's an observational and a cross sectional study. The data was collected prospectively from the 1st January to 31 December 2012 in the labor room of the Souissi maternity hospital, at the Ibn Sina university center of Rabat in Morocco. Women included were consented to participate in the study. Data on epidemiological, sociodemographic and clinical characteristics was recolted by interview, physical exam and biochemistry parameters. Hypovitaminosis D is defined as serum level of vitamin D ≤ 50 nmol/l (20 ng/ml). RESULTS: Our study included 102 cases of mother-newborn pairs. The average age of mothers was 28.3 +/- 6.7 years (range 17-43 years), 90.1% of women enrolled had a hypovitaminosis D, the average weight of newborns was 3377.9 +/- 509g (2270 - 4880g). Hypovitaminosis D is not correlated with the origin, season, body mass index, birth interval and birth weight. It was positively correlated with maternal serum calcium (p=0.000). CONCLUSION: The maternal hypovitaminosis D is real public health problem. The prevention is necessary, by the systematic vitamin D supplementation for pregnant women.

Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco.

INTRODUCTION: Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. METHODS: This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. RESULTS: There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). CONCLUSION: The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications.

Prevalence of human papillomavirus genotype among Moroccan women during a local screening program.

INTRODUCTION: Many studies have indicated a causal relationship between genital human papillomavirus (HPV) infections and cervical cancer. This study aimed to determine the prevalence and genotypes of six high-risk oncogenic human papillomaviruses in cervical lesions from Moroccan women with normal and abnormal cytology. METHODOLOGY: The study included 938 women from the Children's and Mothers' Pathology Department of Ibn Sina Hospital, Rabat. Cytopathology examination was done by routine PAP smear testing. HPV DNA testing was conducted using DNA amplification by Polymerase Chain Reaction with subsequent typing by hybridization with specific probes for HPV types 16, 18, 31, 33, 35 and 45. RESULTS: Cytopathology testing showed that only 16.3 % had an abnormal cytology, with a predominance of atypical squamous cell of undetermined significance (ASCUS) cases. The overall HPV prevalence was 15.7%. According to the cytology results, HPV infection was detected in 15.8% of normal and 14.38% of abnormal cases. Specific HPV genotyping showed a predominance of HPV 16 and 18. Double infection (HPV 16 + 18) was found in two cases whereas multiple infections (HPV 16+18+31) were detected in only one case. Evaluation of the relationship between HPV status and some environmental risk factors, including individual, socio-economic, and hygiene status, showed a significant association between HPV infection and oral contraceptive use. CONCLUSION: Based on these data, a combination of cytology and HPV DNA testing allows for identification of patients with a high risk of developing high-grade cervical lesions and improves cervical cancer prevention.