Spontaneous severe ovarian hyperstimulation syndrome in successive pregnancies with successful outcomes.

BACKGROUND: Ovarian hyperstimulation syndrome is a known complication of ovarian stimulation, particularly with injectable gonadotropins. Spontaneous ovarian hyperstimulation is rare and often involves a conformational change in the follicle-stimulating hormone receptor, increasing its binding with human chorionic gonadotropin or thyroid-stimulating hormone. Few data are available regarding the management or outcomes of spontaneous ovarian hyperstimulation syndrome. CASE: A 23-year-old white female without history of infertility treatment presented with ovarian hyperstimulation syndrome in two pregnancies. The patient was treated by paracentesis catheter placement and albumin replacement. She had regression of symptoms between 11 weeks and 12 weeks of gestation in both pregnancies and delivered healthy term infants. CONCLUSION: The case presented involves a patient with spontaneous severe ovarian hyperstimulation syndrome in two successive pregnancies. The patient was managed aggressively with paracentesis and albumin replacement resulting in two successful pregnancies.

Effect of skin coverage method following subcuticular suturing on wound infection rates at cesarean delivery.

OBJECTIVE: The objective of this study was to determine whether the use of cyanoacrylate skin glue following subcuticular skin closure was associated with a decrease in wound outcomes in comparison with subcuticular closure plus Steri-strips at cesarean delivery. METHODS: This was a retrospective cohort study of patients undergoing cesarean delivery at a single center over a two-year period. The primary outcome of wound infection and secondary outcomes of wound separation and composite wound complication rate were assessed throughout the six-week postpartum period. RESULTS: Of 660 women who met inclusion criteria, 35 (5.3%) experienced a wound infection and 90 (13.6%) experienced a wound separation. The composite wound complication rate was 16.4% (n = 108). Of the 515 cases with a skin coverage method noted, use of skin glue was associated with a marginal decrease in wound infections (p = 0.057), as well as a significantly reduced incidence of wound separation (p = 0.03) and composite wound complications (p = 0.006). CONCLUSION: Cyanoacrylate skin glue may be superior to Steri-strips for wound separation and composite wound complication rates when utilized with subcuticular suture at the time of cesarean delivery and may yield some benefit for prevention of wound infection.

Treatment of a late second-trimester incarcerated uterus using ultrasound-guided manual reduction.

BACKGROUND: Incarcerated gravid uterus diagnosed after 20 weeks of gestation is extremely rare and carries significant morbidity to the fetus and mother. CASE: A 33-year-old woman presented at 21 weeks of gestation with urinary retention. Ultrasonography was performed and a diagnosis of an incarcerated gravid uterus was confirmed using magnetic resonance imaging. Under general anesthesia with ultrasonographic guidance, the incarcerated uterus was successfully released. The patient delivered at 33 weeks by spontaneous vaginal delivery. CONCLUSION: Use of ultrasonography for guidance along with general anesthesia during manual reduction may aid the release of a late second-trimester incarcerated uterus.

Spontaneous methicillin-resistant Staphylococcus aureus epidural abscess in pregnancy.

BACKGROUND: Epidural abscess is a rare complication of regional anesthesia, and spontaneous formation is even more uncommon. Diabetes mellitus, concomitant infection, intravenous drug use, and immune suppression are risk factors for spontaneous epidural abscess. CASE: A 29-year-old white woman presented at 28 weeks of estimated gestational age reporting an intermittent headache. She had Horner syndrome and was hospitalized. A cervicothoracic epidural abscess was diagnosed. Surgical decompression and parenteral antibiotics resulted in complete resolution of neurologic symptoms. Cultures were positive for methicillin-resistant Staphylococcus aureous. CONCLUSION: Spontaneous epidural abscess is a rare condition and diagnosis is often delayed. The finding of Horner syndrome led to imaging of the cervical spine and diagnosis of epidural abscess. Early intervention resulted in resolution of neurologic symptoms and a successful pregnancy outcome.