Gestational gigantomastia accompained by distal breast tissue necrosis. A case report

Rare condition characterized by an intensive and excessive breast enlargement is known as gigantomastia. Gestational gigantomastia manifests during pregnancy and could represent a life-threatening condition for both the mother and the fetus, therefore the risk of spontaneous abortion complicates the choice of treatment approach. We present a clinical case of a patient requesting medical assistance with a progressive breast growth. The onset occurred on the 5th week of gestation and, subsequently, was aggravated by distal tissue necrosis. The ambiguity of treatment approach in such situation is based on, on the one hand, the insecurity of watch-and-wait approach due to the high risk of septic complications and, on the other hand, the increasing danger of fetal loss in the case of surgical treatment during the first trimester of pregnancy. After an adequate assessment of mothers health state, a decision was made towards the wait-and-see tactic until the complete formation of the placental barrier. A total bilateral mastectomy was performed at the 19th week of pregnancy, with a favorable outcome for the patient and her child. This case emphasizes the significance of an individual, interdisciplinary approach to the choice of management for patients with this pathology.

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A Conceptual study of use of Prajastapak Mahakshaya in BOH w. s. r. to recurrent abortion.

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v8i05.688 ◽

2020 ◽

Vol 8 (05) ◽

Author(s):

SHAGUFTA Shaikh

Keyword(s):

Mode Of Action ◽

Fetal Loss ◽

First Trimester ◽

Pharmacological Action ◽

Recurrent Abortion ◽

Healthy Environment ◽

Modern Drug ◽

First Trimester Of Pregnancy ◽

Conceptual Study ◽

Micronized Progesterone

Acharya Charak in Sutrasthan has classified drug According to their mode of action as “MAHAKSHAYA” and has defined mode of action of Prajasthapan Mahakshaya as that removes the Doshas which cause hindrance in process of conception and for the viability and sustenance of pregnancy. In this study aim would be to analyze the mode of action of each drug with its Rasa,Guna,Virya,Vipak and Doshagnta in conception and maintenance of Preganacy especially in case of BOH due to Recurrent Abortion where there is fetal loss especially in First trimester .Prajasthapan Mahakshaya executes its mode of action by two means : 1st-Maintainence of Healthy Environment of Conception. 2nd-Preventing the loss of pregnancy This mode of action can be established by usage Prajasthapan Mahakshya in First trimester of Pregnancy instead of use of Human chorionicgonadotropin and micronized progesterone as support in first trimester of pregnancy .Hence effort has been made to provide an alternative to Modern drug and Theoretical establishing the efficacy and pharmacological action of Prajasthapan Mahakshaya.

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When diamniotic twins suddenly become monoamniotic twins: spontaneous septostomy of the dividing membrane

BMJ Case Reports ◽

10.1136/bcr-2021-243513 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243513

Author(s):

Angela Vidal ◽

Cristina Nastasia ◽

Markus Hodel ◽

Joachim Kohl

Keyword(s):

Twin Pregnancy ◽

Rare Condition ◽

First Trimester ◽

Sonographic Diagnosis ◽

Sudden Failure ◽

Reliable Diagnosis ◽

Accepted Standard ◽

Perinatal Management ◽

Twin Pregnancies ◽

First Trimester Ultrasound

In twin pregnancies, amnionicity and chorionicity are crucial as they strongly determine prenatal and perinatal management. First trimester ultrasound allows a highly reliable diagnosis of amnionicity and chorionicity, making it an internationally accepted standard in antenatal care. However, in rare cases, amnionicity can change from diamniotic to monoamniotic throughout pregnancy, substantially impacting perinatal management. We report the case of a confirmed monochorionic diamniotic twin pregnancy with a diagnosis of spontaneous septostomy of the dividing membrane (SSDM) at 28 weeks of gestation, resulting in a pseudomonoamniotic pregnancy. Even though SSDM is a rare condition and its sonographic diagnosis might be challenging, it should be considered if, in a known diamniotic pregnancy, there is a sudden failure to visualise the intertwin membrane truly separating both twins.

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Reimplantation of an Inverted Maxillary Premolar: Case Report of a Multidiscplinary Treatment Approach

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.33.4.f141658760372j12 ◽

2009 ◽

Vol 33 (4) ◽

pp. 279-282 ◽

Cited By ~ 3

Author(s):

Ayca Ulusoy ◽

Murat Akkocaoglu ◽

Seden Akan ◽

Ilken Kocadereli ◽

Zafer Cehreli

Keyword(s):

Case Report ◽

Root Resorption ◽

Treatment Approach ◽

Multidisciplinary Treatment ◽

Rare Condition ◽

Treatment Alternative ◽

Normal Position ◽

Sufficient Space ◽

Viable Treatment

Inversion of premolars is an extremely rare condition, which usually requires extraction. This case report describes the inversion of an impacted maxillary second premolar in an 11-year-old male, and the multidisciplinary treatment approach for bringing the tooth into a normal position within the arch. In order to provide sufficient space for surgical reimplantation of the tooth, the mesially-drifted neighbouring maxillary first molar was first endodontically treated, followed by orthodontic distalization of the tooth. The inverted tooth was removed surgically and reimplanted without the use of splints for stabilization. After a 12-month follow-up period, the tooth maintained its vitality without any root resorption. Reimplantation of impacted inverted premolars can be a viable treatment alternative to extraction

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Placental massive perivillous fibrinoid deposition is associated with adverse pregnancy outcomes: a clinicopathological study of 12 cases

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0087 ◽

2016 ◽

Vol 5 (1) ◽

pp. 35-39

Author(s):

Maili Qi ◽

Kenneth Tou En Chang ◽

Derrick Wen Quan Lian ◽

Chong Kiat Khoo ◽

Kok Hian Tan

Keyword(s):

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Local Population ◽

Fetal Loss ◽

Perinatal Outcomes ◽

First Trimester ◽

Adverse Outcomes ◽

Special Focus ◽

Adverse Perinatal Outcomes ◽

Adverse Pregnancy

Abstract Introduction: Massive perivillous fibrinoid deposition (MPFD) is a very rare placental condition characterized by abnormally extensive fibrinoid deposition in the placental villous parenchyma. The aim of this study is to document clinical and pathological features with special focus on pregnancy outcomes of this condition in consecutive cases of MPFD in our local population. Methods: This is a retrospective clinico-pathological study of cases affected by MPFD over the period January 2010–July 2014 in our hospital. We document clinical features (including perinatal outcome and subsequent pregnancies) and placental pathological characteristics. Results: Twelve cases of MPFD were identified among 3640 placentas (0.33%). There was no identified recurrence. The affected infants had adverse outcomes, including intrauterine growth restriction (IUGR) (75%), preterm birth (58.3%), and fetal loss (25%). A high frequency of reduced PAPP-A in the first trimester (25%), and concurrent gestational hypertension or pre-eclampsia (25%) was noted. Conclusion: MPFD is associated with adverse perinatal outcomes. Further research to better understand its pathogenesis and to improve clinical diagnosis and management is warranted.

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Matrix metalloproteinases MMP-2 and MMP-9 as markers for the prediction of preeclampsia in the first trimester

Česká gynekologie ◽

10.48095/cccg2021228 ◽

2021 ◽

Vol 86 (4) ◽

pp. 228-235

Author(s):

Elena Timokhina ◽

◽

Vadim Zinin ◽

Irina Ignatko ◽

Sapyat Ibragimova ◽

...

Keyword(s):

Matrix Metalloproteinases ◽

Matrix Metalloproteinase ◽

Pregnant Women ◽

Prognostic Significance ◽

Subsequent Development ◽

First Trimester ◽

Control Group ◽

Early Markers ◽

Threatening Condition ◽

Metalloproteinase 9

Summary: Introduction: Preeclampsia is a life-threatening condition for the mother and foetus. Globally, it is diagnosed in 10 mil. women every year, which accounts for 3% to 8% of all pregnancies. Currently there is no proven effective treatment for preeclampsia. The aforesaid text actualises the issue of predicting this complication. To determine the prognostic significance of matrix metalloproteinases-2 and -9 levels as early markers of preeclampsia, the present prospective study was conducted. Materials and methods: The levels of matrix metalloproteinases-2  and -9  were assessed in 72  patients. Thirty-four  of them subsequently developed preeclampsia during pregnancy (20 patients with moderate preeclampsia, 14 patients with severe preeclampsia), and constituted the basic group; 38 patients made up the control group. Results: In pregnant women with the subsequent development of preeclampsia, the level of matrix metalloproteinase-2 at 11–13 weeks of gestation was 155 ± 73.4 ng/mL and significantly exceeded its level in pregnant women without hypertensive disorders – 75.0 ± 32.8 ng/mL. The study conducted demonstrates a significantly lower concentration of matrix metalloproteinase-9 in pregnant women with preeclampsia compared to the control – 749 ± 296 ng/mL and 1,667 ± 552 ng/mL (P < 0.001). The performed research figures that in the first trimester, the cut-off value of matrix metalloproteinase-2 for predicting the development of preeclampsia is ≥ 102 ng/mL (sensitivity 88.24% and specificity 82.76%). For matrix metalloproteinase-9, a level of ≤ 980 ng/mL in the first trimester predicts the development of preeclampsia with a sensitivity of 85.29% and a specificity of 84.48%. Conclusion: The study established the cut-off values of matrix metalloproteinases-2 and -9 for predicting the development of preeclampsia in the first trimester.

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Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia

Thrombosis and Haemostasis ◽

10.1160/th10-05-0334 ◽

2011 ◽

Vol 105 (02) ◽

pp. 295-301 ◽

Cited By ~ 98

Author(s):

Jantien Visser ◽

Veli-Matti Ulander ◽

Frans Helmerhorst ◽

Katja Lampinen ◽

Laure Morin-Papunen ◽

...

Keyword(s):

Adverse Effects ◽

Live Birth ◽

Pregnancy Complications ◽

Birth Rate ◽

Neonatal Outcome ◽

Recurrent Miscarriage ◽

Fetal Loss ◽

Live Birth Rate ◽

First Trimester ◽

Significant Difference

SummaryRecurrent miscarriage affects 1–2% of women. In more than half of all recurrent miscarriage the cause still remains uncertain. Thrombophilia has been identified in about 50% of women with recurrent miscarriage and thromboprophylaxis has been suggested as an option of treatment. A randomised double-blind (for aspirin) multicentre trial was performed among 207 women with three or more consecutive first trimester (<13 weeks) miscarriages, two or more second trimester (13–24 weeks) miscarriages or one third trimester fetal loss combined with one first trimester miscarriage. Women were analysed for thrombophilia. After complete work-up, women were randomly allocated before seven weeks’ gestation to either enoxaparin 40 mg and placebo (n=68), enoxaparin 40 mg and aspirin 100 mg (n=63) or aspirin 100 mg (n=76). The primary outcome was live-birth rate. Secondary outcomes were pregnancy complications, neonatal outcome and adverse effects. The 0.92–1.48] was found for enoxaparin and placebo and 65% [RR 1.08, 95% CI 0.83–1.39] for enoxaparin and aspirin when compared to aspirin alone (61%, reference group). In the whole study group the live birth rate was 65% (95% CI 58.66–71.74) for women with three or more miscarriages (n=204). No difference in pregnancy complications, neonatal outcome or adverse effects was observed. No significant difference in live birth rate was found with enoxaparin treatment versus aspirin or a combination of both versus aspirin in women with recurrent miscarriage.

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Midgut volvulus secondary to congenital malrotation in pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-234664 ◽

2020 ◽

Vol 13 (5) ◽

pp. e234664 ◽

Cited By ~ 1

Author(s):

Eelyn Chong ◽

David S Liu ◽

Vishnupriya Rajagopal ◽

Neil Strugnell

Keyword(s):

Perinatal Outcomes ◽

First Trimester ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Midgut Volvulus ◽

Threatening Condition ◽

Life Threatening ◽

Uncommon Condition ◽

Adverse Perinatal Outcomes ◽

In Pregnancy

Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Prompt investigation and definitive surgical treatment are required when pregnant women present with bilious vomiting and new-onset abdominal or back pain especially beyond the first trimester.

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Detection of antitrophoblast antibodies in the sera of patients with anticardiolipin antibodies and fetal loss

Blood ◽

10.1182/blood.v82.9.2730.2730 ◽

1993 ◽

Vol 82 (9) ◽

pp. 2730-2741 ◽

Cited By ~ 35

Author(s):

KR McCrae ◽

AM DeMichele ◽

P Pandhi ◽

MJ Balsai ◽

P Samuels ◽

...

Keyword(s):

Fetal Loss ◽

Thromboxane A2 ◽

First Trimester ◽

Anticardiolipin Antibodies ◽

Trophoblast Cells ◽

Fetal Demise ◽

Blood Fluidity ◽

Increased Risk ◽

History Of ◽

Placental Blood

Abstract Women with anticardiolipin antibodies (ACLA) are at increased risk for fetal loss. One potential explanation for this outcome is that sera from these individuals contain antibodies reactive with trophoblast cells, which are involved in the establishment of the uteroplacental vasculature and maintenance of placental blood fluidity. To examine this hypothesis, we compared the incidence of trophoblast-reactive antibodies in 27 patients with ACLA and a history of fetal loss with that in 29 normal pregnant women. Sera from 20 patients, but only one control, contained trophoblast-reactive antibodies (P < .001). These antibodies were not directed against major histocompatibility class I antigens, and reacted with both term and first-trimester trophoblast cells. In most cases, sera from which ACLA were adsorbed by cardiolipin- containing liposomes maintained reactivity against cells. In addition, patient Ig fractions immunoprecipitated an approximately 62-kD protein from the trophoblast cell surface, stimulated the release of arachidonic acid and thromboxane A2 by trophoblasts, and inhibited the binding of prourokinase to trophoblast urokinase receptors. These observations show that sera from women with ACLA and a history of fetal loss contain antitrophoblast antibodies. These antibodies may be serologically distinct from ACLA, and may contribute to the pathogenesis of fetal demise.

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