Uterine sacrifice in obstetric emergencies case series: Complex cases of fetal distress, labor challenges, and life-saving interventions.

This study highlights the complexities and challenges in managing obstetric emergencies, detailing critical interventions and outcomes in various high-risk cases. A retrospective analysis was conducted on four high-risk obstetric cases, each characterized by distinct complications necessitating immediate medical interventions. The study specifically examined cases involving: Fetal Distress cases where fetal health was compromised, necessitating interventions such as emergency cesarean sections. Complex Labor Dynamics detailed examinations of labor complications such as obstructed labor, precipitate labor, or labor complicated by malpresentation. Early pregnancy complications analysis focused on emergencies arising in the first trimester or early second trimester, including ectopic pregnancies and complications in pregnancies with a history of multiple cesarean sections. Severe postpartum hemorrhage investigations into cases of significant blood loss post-delivery, which required interventions ranging from pharmacological management to surgical procedures like hysterectomy. The first case concerned a 28-year-old primigravida with fetal bradycardia and thick meconium, requiring an emergency cesarean section. Postoperative complications included gestational thrombocytopenia and anemia, necessitating a total abdominal hysterectomy for severe sepsis. The newborn showed good recovery, indicated by Apgar scores. In Case 2, the need for a hysterectomy following complications during the third stage of labor was likely due to the presence of Placenta Accreta Spectrum, specifically placenta accreta or increta. While a retained placenta typically can be managed with less invasive methods, the situation escalates when the placenta is abnormally adherent to, or deeply invasive into, the uterine muscle. This can lead to uncontrollable bleeding, making a hysterectomy necessary and justified as a life-saving measure to control the severe hemorrhage while the histology confirms the diagnosis for the placenta accreta. In the third case, the decision to perform a dilation and curettage over manual vacuum aspiration was influenced by several factors. Given the severity of the patient's hemorrhage and the presence of a suspicious echogenic structure, a dilation and curettage provided a more controlled environment for thorough evacuation and immediate bleeding control. This approach was also supported by the combination technique using both Karman aspiration and a curette, allowing for effective management of complicated cases, particularly in patients with a history of multiple cesareans and potential scar tissue. The fourth case involved a 37-year-old multipara with severe postpartum hemorrhage from uterine atony, treated with surgery and managed for diabetic ketoacidosis, leading to discharge on the fourth day. This underscores the urgency and complexity of managing obstetric emergencies effectively.

Post-partum hemorrhage: a multidisciplinary approach to 'the golden hour' quantum leadership and communication.

Background: Quantum leadership in postpartum hemorrhage (PPH) simulation training remains underexplored. Quantum leaders excel in PPH's chaotic settings, differing from traditional leaders. Aiming: To assess the impact of simulation training on quantum leadership skills in maternity teams. Research design: A quasi-experimental approach. Sample: 60 maternity professionals from Rafik Hariri University Hospital, Lebanon. Tools: Structured interviews, observational checklists and a leadership skills scale. Results: Most participants had limited PPH simulation experience and showed an initial low proficiency. Significant improvements were evident, post training. Conclusion: Simulation training enhances quantum leadership in PPH management among maternity professionals.

We looked at how a new style of leadership, called 'quantum leadership', can help medical teams better manage a serious childbirth complication called postpartum hemorrhage (PPH). This leadership style is especially good in unexpected and chaotic situations like PPH. Our study took place in a special training lab at Rafik Hariri university hospital in Lebanon, involving 60 medical professionals. We found that many had not been trained this way before and had less than 10 years of experience. Their starting skills and confidence were low. However, they showed significant improvement after our training. This shows the importance of this kind of training for childbirth care professionals.

Vasa previa Type 3: Advocating for universal screening and investigation of risk factors: A case report.

Vasa previa is a critical obstetric condition marked by unprotected fetal vessels near the cervical os, traditionally divided into Types 1 and 2, based on its association with velamentous cord insertion and accessory placental lobes, respectively. The recent introduction of Type 3 vasa previa addresses atypical cases. We report a unique intrapartum diagnosis of Type 3 vasa previa in a 39-year-old at 38 weeks of gestation, identified during labor induction without prior risk indicators. Despite lacking traditional risk factors, advanced imaging and clinical vigilance led to a primary cesarean delivery, confirming the diagnosis through intraoperative findings of three aberrant vessels with marginal cord insertion. This case emphasizes the critical importance of considering vasa previa in prenatal and intrapartum care to prevent adverse outcomes, advocating for universal screening practices to identify this rare but significant condition.

Unexpected discovery of fetal bones instead of an intrauterine device: A unique gynecological case report.

This case report details an unusual and unexpected finding in a 37-year-old woman with a history of two cesarean sections, who had an intrauterine device implanted. The patient presented with symptoms of abnormal uterine bleeding and dysmenorrhea. An initial ultrasound confirmed the presence of the intrauterine device. However, a startling discovery was made during the intrauterine device removal procedure: fetal bones were found within the patient. This case underscores the importance of thorough diagnostic evaluations in gynecological practice, particularly when dealing with patients who have complex gynecological histories. Significantly, it brings to light the necessity of employing hysteroscopy for comprehensive diagnostic assessment in cases of abnormal uterine bleeding post-abortion. This approach could aid in identifying rare and unexpected findings, such as retained fetal bones, which might be missed by conventional ultrasound. The report emphasizes the need for vigilance and thoroughness in gynecological examinations and contributes to the understanding of potential complications and anomalies associated with intrauterine device usage and post-abortion care.

Diagnostic and treatment patterns in urinary and genital tract infections: insights from a referral clinic in Beirut, Lebanon.

BACKGROUND: Urinary Tract Infections (UTIs) and Genital Tract Infections (GTIs) are common yet serious health concerns. Precise diagnosis is crucial due to the potential severe consequences of misdiagnosis. This study aims to distinguish between UTIs and GTIs, highlighting the importance of accurate differentiation. MATERIALS AND METHODS: The study encompassed 294 patients, categorized into 4 groups: Group GNI (no infection, N = 57), Group GUI (urinary infection, N = 52), Group GGI (genital infection, N = 139), and Group GGUI (both infections, N = 46). Methods included patient interviews, clinical examinations, and laboratory tests such as urine and vaginal swab cultures. RESULTS: The investigation revealed no significant differences in age, BMI, residency, or nationality across groups. However, socioeconomic status varied, with Group GNI having the lowest proportion of low socioeconomic status. In obstetrical characteristics, non-pregnancy rates were higher in Groups GUI and GGUI, with GGUI showing a notably higher abortion rate. Symptom analysis indicated lower symptom prevalence in Group GNI, with pain, itching, pruritus, and vaginal discharge being less frequent, suggesting a link between infection presence and symptom severity. Treatment patterns showed higher usage of ciprofloxacin, antifungals, and vaginal tablets in Groups GUI and GGUI. Laboratory findings highlighted significant Leucocyte Esterase presence and variations in WBC and RBC counts, particularly in Group GGUI. CONCLUSION: The study emphasizes the need for advanced diagnostic techniques, especially those focusing on individual microbial patterns, to enhance UGTI diagnosis. Variations in symptom presentation and treatment across groups underline the necessity for personalized diagnostic and treatment strategies.

Twin pregnancy: Live fetus with complete hydatidiform molar-A case report.

Gestational trophoblastic disease encompasses a range of lesions, each culminating in varied clinical manifestations. Among these, the simultaneous occurrence of molar changes within the placenta and a viable fetus remains a particularly elusive and challenging presentation, posing intricate dilemmas for obstetricians. In this article, we delineate a distinct case involving a 21-year-old woman with a history of consanguineous marriage. She was referred from Médecins Sans Frontières to the Rafic Hariri University Hospital during her 19th week of gestation. With an unremarkable medical history and uncomplicated previous pregnancies, her presentation to the Rafic Hariri University Hospital was punctuated by symptoms of premature labor. Clinical evaluations revealed ruptured membranes, a fetus-positioned breech, and discernible complications tied to the placental morphology. Given these clinical findings, a decision was made in favor of a Cesarean delivery. Prior to this, the patient had been administered corticosteroids and tocolytics. Subsequent delivery produced a live male infant at 34 + 5 gestational days, and further assessment unveiled a complete molar pregnancy. The coexistence of a viable fetus alongside a complete molar pregnancy is an infrequently documented phenomenon, underlining the clinical significance of this case. A comprehensive literature survey reinforced the exceptional nature of our findings. Postpartum, both the mother and neonate were monitored for a month, ensuring their well-being. This case accentuates the paramountcy of prompt and precise diagnostic interventions when faced with atypical presentations. It further underscores the imperative for obstetricians to possess nuanced expertise in confronting the intricate challenges posed by gestational trophoblastic disease, ensuring optimal maternal and neonatal outcomes.