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Umbilical nodes and cords play a crucial role in fetal development and are essential for the transfer of nutrients and oxygen between the mother and the fetus. Sonographic diagnosis of umbilical nodes and cords has become an integral part of prenatal care, allowing for the early detection of abnormalities and potential complications. The umbilical cord is a vital structure connecting the fetus to the placenta, providing essential nutrients and oxygen for fetal growth and development. Sonographic examination of the umbilical cord and its associated nodes has become an indispensable tool in prenatal care, enabling the early detection of abnormalities and potential complications. This review aims to analyze the current literature on sonographic diagnosis of umbilical nodes and cords, highlighting the key points and advancements in this field. A 37-year-old booked G4P2+1A2 Nigerian woman was registered for prenatal tertiary health care at 12 weeks of gestation. The booking investigations were normal and the booking packed cell volume was 37%. She was compliant with scheduled clinic visits and routine drugs. Pregnancy was carried to term uneventfully. Elective cesarean section was successfully performed at 38 weeks of gestation owing to the patient's prior history of third-degree perineal tear. The intraoperative findings included a loose cord around the neck of the baby and double true knots along the length of the 65 cm umbilical cord. The baby was delivered with appearance, pulse, grimace, activity and respiration (APGAR) scores of 7 in the first minute, 9 in the fifth minute, and the birth weight was 3.0 kg. Mother and baby were discharged 48 h postpartum in stable clinical condition. Although the presence of true double umbilical knots is rare, its coexistence with the nuchal cord is even rarer. There are risk factors associated with true umbilical knots. The possible risk factor implicated in this index case is the gender of the fetus and maternal multiparity. True umbilical knots are usually associated with certain fetal negative outcomes of pregnancy. There are currently no evidence-based treatment options available.
RESUMO
Background: Uterine dehiscence is a separation of uterine musculature with intact uterine serosa. It can be encountered at the time of cesarean delivery, suspected on obstetric ultrasound or diagnosed in-between pregnancies. The antenatal diagnosis may occasionally elude the Obstetricians. This particular case demonstrates an intra-operative diagnosis of uterine dehiscence with missed antenatal ultrasound diagnosis in an asymptomatic woman. Case presentation: She was a 32-year-old Nigerian second gravida who booked for antenatal care at 32 weeks of gestation following a referral from her attending Obstetrician from a neighboring state due to relocation. She had 3 antenatal visits and 2 antenatal ultrasound investigations without uterine scar thickness report. She subsequently had elective Cesarean section (CS) at a gestational age of 38 weeks plus 2 days due to persistent breech presentation on a background of a previous lower segment CS scar. There was no previous uterine curettage prior to or after the previous lower segment CS scar and there was no labor pains prior to the elective CS. The surgery was successful with intra-operative findings of moderate intra parietal peritoneal adhesions with rectus sheath and obvious uterine dehiscence along the line of the previous CS scar. The fetal outcomes were normal. Immediate post-operative condition was satisfactory and the woman was discharged on a third-day post operation. Conclusion: Obstetricians are charged to maintain a high index of suspicion when managing pregnant women with history of emergency CS in order to avert the adverse consequences of uterine rupture from asymptomatic uterine dehiscence. Based on this report, it may be useful to routinely assess the lower uterine segment scar of women with previous emergency CS using the available ultrasound facilities. However, more studies are needed before advocating for routine antenatal uterine scar thickness testing following emergency lower segment CS in low and middle-income settings.
RESUMO
Background: Ovarian ectopic pregnancy is a rare form of non-tubal ectopic pregnancy. It can rupture before the end of the first trimester, causing hemoperitoneum, and present with signs and symptoms similar to other commoner abdominal emergencies or the pregnancy can continue intraperitoneally. Therefore, they are not often diagnosed preoperatively. Ultrasound can assist in diagnosis of ovarian ectopic pregnancy but the findings could be ambiguous or inconclusive. We present a case of ruptured ovarian ectopic pregnancy at the second trimester causing massive hemoperitoneum that was suspected as an intrabdominal malignancy co-existing with intrabdominal pregnancy. Case presentation: She was a 34 year-old Nigerian unbooked G4P3+0, (3 alive), who presented to the labor ward on 21st January, 2021 with a complaint of a 6-week history of abdominal pain and swelling. Pain was insidious in onset, generalized, non-colicky, non-radiating, constant, no known aggravating or relieving factor, but it was of moderate intensity. She had amenorrhea with a positive serum pregnancy test without prior early ultrasound. At presentation, initial abdominopelvic ultrasound revealed intra-uterine viable pregnancy but repeat ultrasound done showed a left adnexal ectopic gestation and an echo-rich intraperitoneal fluid collection. Laparotomy was done and ovarian pregnancy was accurately diagnosed intra-operatively. Tissue samples from the ovary confirmed normal products of conception, namely chorionic villi, trophoblastic cells and ovarian stroma at histology. Conclusion: Despite advances in imaging techniques, the diagnosis of ovarian ectopic gestation is still very difficult. When premenopausal women present with amenorrhea, generalized non-colicky abdominal pain and swelling in combination with ambiguous findings of pregnancy on ultrasound in the absence of trauma, differential diagnoses should include ruptured ovarian pregnancy. Obstetricians should maintain a high index of suspicion to forestall delayed diagnosis and the potential maternal morbidity and mortality. However, the need for high-index of suspicion should be for any ectopic, not just ovarian pregnancy.