Rare Complication Post-Conization for Cervical Dysplasia: Rectovaginal Fistula.

(1) Background: High-grade cervical dysplasia is primarily caused by human papillomavirus (HPV) infection. Conservative surgery is the preferred treatment approach for this condition. The most commonly employed technique is the loop electrosurgical excision procedure (LEEP), which involves removing the affected portion of the cervix. Excisional treatments are often curative, and complications are typically rare and minor. (2) Methods: The loop electrosurgical excision procedure (LEEP) is the standard method used for conservative surgery in high-grade cervical dysplasia. It entails the excision of the specific area of the cervix where the abnormal cells are present. The procedure employs a wire loop carrying an electrical current to remove the affected tissue. (3) Results: Excisional treatments, such as LEEP, have shown to be effective in treating high-grade cervical dysplasia. They have a high success rate in eliminating abnormal cells and reducing the risk of cervical cancer. Complications associated with LEEP are infrequent and usually minor. Short-term complications may include bleeding, which can be managed easily. Long-term complications may involve cervical canal stenosis, which can impact fertility. (4) Conclusions: Conservative surgery, particularly the loop electrosurgical excision procedure (LEEP), is the preferred and effective treatment for high-grade cervical dysplasia caused by HPV infection. It offers a high cure rate with rare and minor complications. While short-term bleeding is a common occurrence, it is manageable. Long-term complications such as cervical canal stenosis may impact fertility. However, an extremely rare and possibly unique complication described in this case is the development of a vaginorectal fistula. This complication is likely due to indirect thermal injury resulting from compromised tissue. Further research is needed to better understand and prevent such complications.

First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension.

OBJECTIVE: Previous studies have suggested an association between low levels of first trimester serum Pregnancy Associated Plasma Protein-A (PAPP-A) and the occurrence of hypertension in pregnancy (PIH). The purpose of this study was to determine the predictive value of maternal PAPP-A levels in the identification of women at risk of PIH. METHODS: Maternal serum PAPP-A was measured between 11-13 + 6 wks' gestation, as part of the first trimester screening of aneuploidies. Our study included only singleton pregnancies (973 cases) over a three years period. PAPP-A levels were expressed as gestational age-specific multiples of the median (MoM). Hypertension in pregnancy was documented by standard criteria. RESULTS: One hundred and eleven pregnant women developed hypertension (8.9%). In these patients, PAPP-A levels ranged from 0.53 to 1.08 MoM. After performing a backward stepwise regression equation and a ROC curve procedure, a PAPP-A MoM value <0.8 was able to significantly predict PIH (p < 0.001, area under the ROC curve 83%, sensitivity 68%, specificity 86%, 95 degrees CI 0.57-0.94). CONCLUSION: Low levels of serum PAPP-A (?0.8 MoM) may be a potential resource in order to early screen pregnant women at increased risk of hypertension in pregnancy.