Complete non-puerperal uterine inversion caused by uterine hemangioma: a case report

Uterine inversion is a rare postpartum complication. It is a rare condition in which the internal surface of the uterus protrudes through the vagina. Non-puerperal uterine inversion (NPUI) is extremely rare. In most instances, it is linked to uterine tumors. Among these tumors, leiomyoma is the most frequent cause reported in data. This condition may not be noticed until time of surgery. Malignancy is suspected in most cases. Nevertheless, uterine inversion can be diagnosed preoperatively using radiology. Difficulties in diagnosing NPUI makes this clinical case a challenge in gynaecology and not commonly reported in literature. We report our experience in the diagnosis and treatment of a complete non-puerperal uterine inversion associated with uterine angioleiomyoma. The patient's age was 44, gravida 2 para 1 presented with intermittent vaginal bleeding for four months and an acute abdominal cramping pain. On examination, a large mass lesion was observed which occupies the vaginal cavity and the contour of the uterine cervix could not be reached. Biopsies and Immunohistochemistry matched with an angioleiomyoma. She underwent a transvaginal surgical reposition technique: Spinelli’s. It is important to diagnose accurate non-puerperal uterine inversion. Surgery provides good prognosis and it is necessary. We report a case of NPUI caused by angioleiomyoma. Nevertheless, malignancy must be eliminated in first place.

Modification of Total Magnesium level in pregnant Saudi Women developing gestational diabetes mellitus

BACKGROUND

The aim of our study is to measure total Magnesium in pregnant women screened for GDM and to compare total magnesium between whom were diagnosed having GDM and those having normal pregnancy.

METHODS

Our study is a prospective study involved 99 pregnant women referred to Maternity and Child Hospital Al Ahsa (Kingdom of Saudi Arabia) for 100g Oral Glucose Tolerance test. All included pregnant women were in their 24-28 weeks of gestation with free past medical history and were free for any medicine. A 100-g Oral Glucose Tolerance (OGTT) with total plasma magnesium measurement were done to all included women. All patient were followed tell delivery.

RESULTS

Among 99 patients enrolled in our study, GDM was diagnosed in 19 patients (19.2%). Fifteen patients have normal fasting glycaemia and were diagnosed having GDM on 100-g OGTT. Four patients have fasting glycaemia more than 126mg/dl (7mmol/l) confirming the diagnosis of GDM. Hypomagnesemia was confirmed in eight patients (8.08%). no one of them had GDM. The serum magnesium concentration in GDM women was lower that of normal pregnant women but the difference was not significant. (0.89±0.1 vs 0.92±0.2mmol/l, p=0.51). BMI, systolic and diastolic blood pressure were not significantly different between the pregnant women who developed or not gestational diabetes.

CONCLUSION

In our study, the development of GDM cannot be explained by low total serum magnesium. The low total serum magnesium in patient diagnosed having GDM compared to whom free of GDM and the importance of magnesium in the genesis of insulin resistance should encourage more large trial to explain the exact role of magnesium in the pathophysiology of GDM.

The effect of placental removal method at cesarean delivery on perioperative hemorrhage: a randomized clinical trial ISRCTN 49779257

OBJECTIVES

To evaluate whether the method of placental removal during cesarean section has an impact on perioperative hemorrhage and maternal infectious morbidity.

STUDY DESIGN

Three hundred and two patients admitted for abdominal delivery were recruited in a prospective randomized clinical intention-to-treat trial. Participants were assigned to have their placenta removed either manually or spontaneously. The drop in hematocrit was the primary outcome; postpartum maternal infectious morbidity was also assessed.

RESULTS

Two patients were excluded for incomplete data. One-hundred-fifty-one were randomized to the manual removal group and 149 to the spontaneous group. The demographic characteristics of the two populations were similar. The mean drop (%) in the manual removal group was greater than in the spontaneous group (5.57+/-3.86 and 2.65+/-2.67, respectively; P<0.01). the incidence of postpartum infectious morbidity was also significantly greater in the manual group (RR 15.8, 95% CI 2.19-117.5).

CONCLUSION

Routine manual removal of placenta at cesarean section significantly increases perioperative blood loss and postpartum maternal infectious morbidity.

[Adnexal torsion: a report of 135 cases]

OBJECTIVES

To evaluate the clinical findings and therapeutic options following adnexal torsion.

STUDY DESIGN

A retrospective series of 135 patients presenting with adnexal torsion between January 1992 and December 2001 in Sousse- Tunisia- a university teaching hospital.

RESULTS

Adnexal torsion accounted for 14.8% of surgically treated adnexal tumors. Pregnancy was associated in 17% of cases and diagnosis was accurate at first clinical examination in only 57.8% of cases. Ultrasound allowed visualisation of Adnexal Diseases in all cases. Operative laparoscopy was successfully achieved in 34% of patients. Conservative management was used in 57% of the premenopausal patients. No major postoperative complication was noted.

CONCLUSION

Clinicians must be aware of a possible adnexal torsion in women with acute pelvic pain. Ultrasound is a useful tool in these situations. Laparoscopy allows diagnosis and surgical management even during pregnancy.