Successful full-term delivery after out-of-hospital cardiac arrest during the second trimester of pregnancy: a case report.

Out-of-hospital cardiac arrest in pregnancy is extremely rare. In this case report, a 43-year-old female patient at 24.0 weeks of gestation collapsed outside her home after cardiac arrest. The paramedics performed cardiopulmonary resuscitation with defibrillation for ventricular fibrillation. Spontaneous circulation was achieved after 19 minutes. The fetus was stable during postarrest care. The patient exhibited high blood pressure with seizure-like symptoms for 2 days afterwards, which resolved with magnesium sulfate. She gradually recovered and returned to her daily activities while on treatment with beta blockers for cardiomyopathy and premature ventricular contractions until delivery. At 37.2 weeks of gestation, she underwent elective Cesarean section under spinal anesthesia. The baby weighed 2.55 kg and did not present with any complications. Here, we report a case of successful full-term delivery in a patient who underwent cardiopulmonary resuscitation for sudden cardiac arrest during the second trimester of pregnancy.

Case of suspected torsion and amputation of myoma during pregnancy.

INTRODUCTION: Uterine myoma occurs in 1.6-2% of pregnancies. Most myomas during pregnancy are asymptomatic, but 10-20% may develop complications. The most common complication is abdominal pain, usually caused myoma degeneration or torsion of a pedunculated myoma. CASE PRESENTATION: A 40-year-old pregnant woman was transferred with severe left upper abdominal pain with suspicion of left ovarian torsion at 32 weeks of gestation. Magnetic resonance imaging (MRI) demonstrated a 9.8 cm-sized oval mass abutting the uterine fundus, suggesting subserosal myoma with degeneration. She was admitted for pain control, and the pain was relieved in a few days with conservative management. Two years later, she revisited our hospital for the treatment. Total laparoscopic hysterectomy with bilateral salpingectomy was performed. A 6-cm isolated solid mass adhering to the omentum in the pelvic cavity was observed intraoperatively. The trace on the anterior wall of the uterus was considered to be a broken pedicle that had initially connected the mass. CLINICAL DISCUSSION: In our case, the patient had severe abdominal pain, and ultrasound and MRI findings suggested subserosal myoma degeneration. A retrospective diagnosis of torsion was made following the surgery, which was assumed to cause the pain during pregnancy, and that an amputation occurred during or after the pregnancy. CONCLUSION: Diagnosis is based on clinical manifestations and radiologic examination, however, it is usually difficult to diagnose preoperatively, especially among pregnant women who have diagnostic test limitations. Therefore, if a pregnant woman with a myoma complains of abdominal pain, various possibilities should be considered.

Huge follicular carcinoma originated from struma ovarii in young woman; Extremely rare case.

INTRODUCTION: Struma ovarii (SO) is a rare ovarian mature teratoma which is composed of 50% or more thyroid tissues. Malignant transformation is reported to occur in less than 5% of all cases, and it leads to 5-6% metastatic disease. The most common type is a papillary carcinoma. However, follicular carcinoma of arising from SO is extremely rare. CASE PRESENTATION: A 23-year-old nullipara complained of right lower abdominal pain. CT scan revealed a large complex cystic and solid mass in pelvic cavity with moderate amount ascites with peritoneal thickening and omental infiltration. We performed a right salpingo-oophorectomy and surgical staging. CLINICAL DISCUSSION: It was diagnosed with follicular carcinoma, stage IA. After the multidisciplinary team meeting, we decided not to conduct additional treatment, including total thyroidectomy followed by radioiodine treatment and T4 therapy because thyroid tests were normal findings. CONCLUSION: There is still no established treatment consensus for follicular carcinoma of SO patients. The choice for a conservative or radical approach depends on the doctor. However, conservative surgery could be considered for low risk, early stage patients who have childbearing potential.

Predictors of Newborn's Weight for Height: A Machine Learning Study Using Nationwide Multicenter Ultrasound Data.

There has been no machine learning study with a rich collection of clinical, sonographic markers to compare the performance measures for a variety of newborns' weight-for-height indicators. This study compared the performance measures for a variety of newborns' weight-for-height indicators based on machine learning, ultrasonographic data and maternal/delivery information. The source of data for this study was a multi-center retrospective study with 2949 mother-newborn pairs. The mean-squared-error-over-variance measures of five machine learning approaches were compared for newborn's weight, newborn's weight/height, newborn's weight/height2 and newborn's weight/hieght3. Random forest variable importance, the influence of a variable over average node impurity, was used to identify major predictors of these newborns' weight-for-height indicators among ultrasonographic data and maternal/delivery information. Regarding ultrasonographic fetal biometry, newborn's weight, newborn's weight/height and newborn's weight/height2 were better indicators with smaller mean-squared-error-over-variance measures than newborn's weight/height3. Based on random forest variable importance, the top six predictors of newborn's weight were the same as those of newborn's weight/height and those of newborn's weight/height2: gestational age at delivery time, the first estimated fetal weight and abdominal circumference in week 36 or later, maternal weight and body mass index at delivery time, and the first biparietal diameter in week 36 or later. These six predictors also ranked within the top seven for large-for-gestational-age and the top eight for small-for-gestational-age. In conclusion, newborn's weight, newborn's weight/height and newborn's weight/height2 are more suitable for ultrasonographic fetal biometry with smaller mean-squared-error-over-variance measures than newborn's weight/height3. Machine learning with ultrasonographic data would be an effective noninvasive approach for predicting newborn's weight, weight/height and weight/height2.

Hemoperitoneum: a complication of loop electrosurgical excision procedure.

Loop electrosurgical excision procedure (LEEP) is commonly performed for the management of cervical intraepithelial neoplasia. Although LEEP is considered to be a relatively simple procedure, several unexpected complications have been reported in the literature. Herein, we report a case of hemoperitoneum caused by uterine perforation following LEEP. Blood collection in pelvic cavity and two small defects of the uterus were confirmed by diagnostic laparoscopy. The defects were sutured and the patient recovered well after the operation.

Successful extracorporeal cardiopulmonary resuscitation in a postpartum patient with amniotic fluid embolism.

Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, which is characterized by a sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation (DIC). We report a case of sudden cardiac arrest due to an amniotic-fluid embolism which was successfully treated with veno-arterial extracorporeal membrane oxygenation (ECMO). A 32-year-old female at 39.1 weeks of gestation was scheduled for induction labor. During labor, a sudden generalized tonic-clonic seizure was developed followed by dyspnea and hypotension. An immediate vaginal delivery was performed, and the baby was healthy. Despite the appropriate cardiopulmonary resuscitation, she became hypoxemic and experienced recurrent cardiovascular collapse. ECMO was applied promptly, and the patient became stable rapidly and was discharged without any complications. ECMO seems to be a proper treatment option for catastrophic amniotic-fluid embolism.

Spontaneous Version of Fetal Presentation in Twin Pregnancies During Third Trimester: Longitudinal Assessment.

Little is known about longitudinal changes of the first twin presentation in twin gestations. This is a retrospective cohort study including 411 women who were admitted consecutively and delivered live-born twins at 36 weeks of gestation or more. Longitudinal assessment of the first twin presentation was conducted during gestation and at birth in all cases. Gestational age at antenatal assessment was divided into two intervals: early-third trimester (28-31 weeks) and mid-third trimester (32-35 weeks). Fetal presentation was categorized as vertex or non-vertex. We analyzed change of fetal presentation between antepartum intervals and birth. First twin presentation at early-third trimester had the same presentation at birth in 87.6% (360/411) of the study population. In this 'no change' group, vertex presentation was seen in 95.6% (283/296) and non-vertex was seen in 67.0% (77/115) of cases. In total, 96.1% (395/411) of the study population maintained their presentation between mid-third trimester and birth. Vertex presentation was seen in 98.4% (310/315) and non-vertex was seen in 88.5% (85/96) of cases. When comparing vertex with non-vertex, vertex presentation during third trimester was a more reliable predictor of presentation at birth (p < .001). The only factor that contributed significantly to spontaneous version of the first twin during mid-third trimester and birth was a lower birth weight of the first twin compared with the second twin. In conclusion, first twin presentation with vertex during third trimester is not likely to change into non-vertex at birth. We concluded that vertex presentation in twin gestations at early- and mid-third trimester is very predictable. In contrast, a non-vertex first twin presentation is relatively unstable.

Gastric type mucinous endocervical adenocarcinoma of the uterine cervix: very rare and interesting case.

Gastric type mucinous endocervical adenocarcinomas of the uterine cervix (GAC) are a newly classified mucinous subtype with morphologically in 2014, WHO. They have a much more aggressiveness and show unusual metastatic patterns compared to usual type endocervical adenocarcinoma. They tend to present at higher stage and even in stage I, they have worse survival. Therefore, differential diagnosis of GAC from the usual type of endocervical adenocarcinoma is very important because they are related to a significant risk of recurrence and decreased 5-year disease-specific survival. Besides, GACs are mostly not associated with human papillomavirus (HPV) infection and p16 immunohistochemistry is also typically negative in GAC that is HPV-unassociated tumor. We report a very rare and interesting case of stage IB1 GAC with negative HPV DNA and p16.

Acceleration time-to-ejection time ratio in fetal pulmonary artery predicts the development of neonatal respiratory distress syndrome: a prospective cohort study.

OBJECTIVE: This study investigates whether fetal pulmonary artery Doppler waveforms can predict the subsequent development of respiratory distress syndrome (RDS). STUDY DESIGN: A prospective cohort study was performed in women with impending preterm birth. Pulsatility index, resistance index, systolic-to-diastolic ratio, peak systolic velocity, and acceleration time-to-ejection time (At/Et) ratio were measured in the main pulmonary artery of fetus just before delivery. RESULTS: Neonates who developed RDS (n = 11) had significantly lower gestational age at birth than those without RDS (n = 31; median: 28.7 [range: 24.7 to 34.9] versus 32.9 [range: 25.7 to 36.0] weeks; p = 0.003); there was no difference in antenatal corticosteroid administration. Pulmonary artery At/Et ratio was significantly higher in fetuses that developed RDS compared with those that did not (median: 0.37 [range: 0.26 to 0.41] versus median: 0.30 [range: 0.21 to 0.44]; p = 0.008). RDS prediction score (=a hundredfold At/Et ratio) is significantly associated with the subsequent development of RDS after controlling for gestational age by logistic regression analysis (odds ratio = 1.31, 95% confidence interval 1.05 to 1.63, p = 0.017). CONCLUSION: An elevated At/Et ratio in the fetal pulmonary artery is independently associated with the development of RDS in preterm infants. These data suggest that fetal pulmonary artery Doppler velocimetry may provide a reliable noninvasive technique to evaluate fetal lung maturity, similar to the way in which middle cerebral artery Doppler has replaced amniocentesis for the assessment of fetal anemia.