Central placenta praevia accreta with focal bladder percretism. Conservative management.

Placenta praevia is a condition when placenta is inserted in an abnormal position near or over the internal cervical orifice (ICO). Abnormal placental attachment (placenta accreta, increta, percreta) is a wide spectrum disorder ranging from abnormal adherence to deeply invasive placental tissue. We report a very rare case of central placenta praevia accreta and focal bladder percretism in a 29 years old pregnant woman with an obstetrical history of one previous vaginal delivery and four curettages following miscarriage. She was taken in charge by Catania S. Marco' university-hospital at 20 weeks with diagnosis of Central Placenta Praevia and Accreta (CPPA) detected by means of ultrasounds (US). At 31 weeks Magnetic Resonance Imaging (MRI) confirmed CPPA with focal bladder percretism. After alerting multidisciplinary team and obtaining blood units available, a Caesarean Section (CS) at 34 weeks was planned, when by means of US a detachment area with bleeding was observed. An adequate informed consent was completed, where the pregnant woman and her husband accepted the risk of possible hysterectomy and blood transfusions. A Pfannestiel's laparotomy with transversal corporal uterine incision, bilateral uterine ligation, packed tamponage, removal of placental tissue separated during fetal extraction and leaving a portion of placenta only in the place of percretism, allowed conservative intervention (uterus preservation) ending in good results for both mother and fetus. KEY WORDS: Caesarean section, Curettage, Placenta praevia, Placenta accreta, Preterm birth.

Retroperitoneal sarcoma involving unilateral double ureter: management, treatment and psychological implications.

The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

Physical and psychological implications in a multiple and preterm caesarean section. A case report.

Cesarean section (CS) in Italy has continuously increasing rates. Due to the primary CS, the repeated CS have shown a superimposable trend. Consequently, a number of pathologies are related to such surgery among which placenta previa, dehiscence of previous scar, placenta accreta and preterm delivery. The purpose of this case report is to discuss the physical and psychological implications correlated with a very unusual case of a consecutive seventh CS in the same pregnant woman associated with several diseases: preterm delivery, fetal distress, intrauterine growth retardation (IUGR) (-4 weeks), central placenta previa with metrorrhagia, dehiscence of hysterectomic scar. In spite of the therapy (antifibrinolytic, tocolytic drugs, iron, folates, betamethasone) a preterm CS could not be avoided. Surgery was challenging; hysterectomy was avoided and the mother followed a normal post-operative course, whereas fetal distress and IUGR did not allow the survival of the newborn. A review of the literature regarding the clinical management and psychological aspects of a pregnant woman undergoing multiple complicated CS with the aforementioned disorders will be undertaken.

Huge fibroid (g. 3.000) removed during cesarean section with uterus preservation. A case report.

Removal of a giant fibroid during a caesarean section is very rare. We report a case of multiple myomectomy among which a huge myomas (cm 22, weight 3.000 g) in a 44 years old nullipara at 38 weeks. A 10 cm long suprapubic transversal incision according to Pfannenstiel on spinal anaesthesia was done; a female baby weighing 2.285 g, with Apgar score 9/10 was born. Owing to the uterine hypotonia following foetal extraction, myomectomy with womb preservation was carried out. Postoperative course was regular for mother and newborn too.