ABSTRACT
Background: Accurate diagnosis of a müllerian anomaly is essential for appropriate management and prevention of complications. However, diagnosis is often missed or delayed. Case: This is a case of a nulliparous woman with a müllerian anomaly diagnosed at the age of 36 despite prior evaluation with ultrasound and laparoscopy. Magnetic resonance imaging (MRI) suggested a unicornuate uterus with a right non-communicating rudimentary horn. Hysteroscopy and chromopertubation confirmed the diagnosis. The rudimentary horn was resected laparoscopically using bipolar energy. Conclusion: An undiagnosed müllerian anomaly should be considered in the setting of persistent dysmenorrhea. Three-dimensional ultrasound or MRI should be used judiciously in patients with refractory dysmenorrhea or when ultrasound raises concern for a müllerian anomaly.
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Objective: To study whether application of the new 2018 guidelines for the diagnosis of polycystic ovary syndrome (PCOS) would decrease the diagnosis of PCOS. Second, to compare the metabolic profiles of women included and excluded in this new definition. Design: Retrospective cross-sectional chart review. Setting: University-affiliated hospital system. Patients: Women, ages 12-50, with the International Classification of Diseases code "Polycystic Ovary Syndrome" in 2017. Interventions: Application of the new 2018 guidelines for the diagnosis of PCOS. Main Outcome Measures: The primary outcome was the retention of PCOS diagnosis after applying the new 2018 guidelines. Secondary outcomes included the comparison of metabolic risk factors. Analysis was performed using chi-square tests for categorical variables and unpaired t tests for continuous variables, with a P value of <.05 determined to be significant. Results: Of 258 women with PCOS based on Rotterdam criteria, only 195 (76%) met the criteria based on the new 2018 guidelines. Those women who only met Rotterdam criteria (n = 63) had significantly lower body mass index (32.7 vs. 35.8), lower total cholesterol levels (151 vs. 176 mg/dL), lower triglyceride levels (96 vs. 124 mg/dL), lower total (33.2 vs. 52.3 ng/dL) and free testosterone levels (4.7 vs. 8.3), lower antimüllerian hormone levels (3.1 vs. 7.7 ng/mL), and were more likely to be multiparous (50% vs. 29%) than women who met 2018 criteria. Conclusions: Increasing the minimum antral follicle count to ≥20 antral follicles significantly decreases the number of women with the diagnosis of PCOS. Furthermore, the women that meet the new criteria have more health risks for metabolic syndrome than those who only meet the Rotterdam criteria.
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PURPOSE OF REVIEW: Nontubal ectopic pregnancies appear to be increasing in prevalence. Increasingly, minimally invasive methods for management are being utilized. A current literature review and recommendations for management of nontubal ectopic pregnancy is presented in this review. RECENT FINDINGS: Nontubal ectopic pregnancies are less common than tubal ectopic pregnancies but present a unique and significant threat to patient's health and are optimally managed by specialists familiar with the condition. Early diagnosis, prompt treatment and close follow-up to resolution are critical. Recent publications focus on fertility-sparing and conservative management through the use of medications both systemic and local; as well as minimally invasive surgical techniques. The Society of Maternal Fetal Medicine recommends against expectant management of cesarean scar pregnancies; however, optimal treatment is unknown and this holds true for management of other nontubal ectopic pregnancies. SUMMARY: Minimally invasive and fertility sparing management should be the mainstay in treatment of stable patients with nontubal ectopic pregnancy.