Fetal Ovarian Cysts: Prenatal Diagnosis Using Ultrasound and MRI, Management and Postnatal Outcome—Our Centers Experience

The present study provides our clinical experience regarding the imaging diagnosis, management and postnatal outcome of neonates prenatally suspected of having developed ovarian cysts. This multicenter observational study included patients diagnosed prenatally with fetal ovarian cysts and follow-up in the postnatal period. Descriptive statistics were used to render the information regarding the prenatal imaging aspect of the fetal pelvic masses using ultrasound and/or MRI, prenatal surveillance and postnatal neonate’s immediate outcome, indications leading to surgery and pathologic aspect. The inclusion criteria were fulfilled by 21 patients. The mean gestational age at the time of initial diagnosis was 31.28 weeks of gestation (WG). Only five out of 21 cysts regressed completely during pregnancy without postnatal complications. In addition, 11 out of 21 infant’s required surgical treatment in the first two weeks after birth, mainly for ovarian torsion. Five out of 21 neonates were referred to postnatal follow-up clinically and by ultrasound, but three out of five cases required emergency surgical treatment for acute complications. Ultrasound plays a major role in the diagnostic of fetal ovarian cyst. From our experience, MRI does not bring supplementary data or change the management. Spontaneous resolution of fetal ovarian cysts is to be expected but the ovarian mass could lead to serious complications, if resolution does not occur in due time.

Asuhan Kebidanan Komprehensif Covid- 19 Pada Ny. R Di Desa Gegjlik Wilayah Kerja Puskesmas Kajen I Kabupaten Pekalongan Tahun 2021

Comprehensive midwifery care is care which is a function and activity that provides services for clients who have problems or needs in health including the period of pregnancy in Ny. R with High Risk Maternal Age 37 years and Pregnancy Distance 11 Years, ovarian cysts, and Reactive Covid-19, delivery of sectio caesarea covid-19, postpartum, and normal newborns. The purpose of writing is to be able to provide comprehensive midwifery care for Ny. R In Gegjlik Village, the Work Area of the Kajen I Health Center, Pekalongan Regency in 2021 in accordance with standards, competencies, authorities, and properly documented The data collection method used by the author during the pandemic is in accordance with the Covid-19 Prevention and Control Guidelines of the Ministry of Health of the Republic of Indonesia : washing hands, wearing masks, maintaining distance, avoiding crowds, and reducing mobility.Keywords: Comprehensive midwifery care; Pregnancy; Ovarian cysts; Reactive Covid-19; Sectio Caesarea covid-19; Postpartum; Normal newborns. AbstrakAsuhan kebidanan Komperhensif adalah asuhan yang merupakan fungsi dan kegiatan yang memberikan pelayanan klien yang mempunyai masalah atau kebutuhan dalam kesehatan meliputi masa kehamilan pada Ny. R dengan Risiko Tinggi yaitu Usia Ibu 37 tahun dan Jarak Kehamilan 11 Tahun ,kista ovarium, dan Reaktif Covid-19, persalinan sectio caesarea covid-19, nifas , dan bayi baru lahir nonatus normal. Tujuan penulisan yaitu Dapat memberikan Asuhan Kebidanan Komprehensif Pada Ny. R Di Desa Gegjlik Wilayah Kerja Puskesmas Kajen I Kabupaten Pekalongan Tahun 2021 sesuai dengan standar, kompetensi, kewenangan, dan di dokumentasikan dengan benar Metode pengumpulan data yang digunakan penulis pada masa pandemi sudah sesuai dengan Pedoman Pencegahan dan Pengendalian Covid-19 Kementerian Kesehatan Republik Indonesia : mencuci tangan, memakai masker, menjaga jarak, menghindari kerumunan, dan mengurangi mobilitas.Kata kunci: Asuhan kebidanan Komperhensif; Kehamilan; Kista ovarium; Reaktif Covid-19; Sectio caesarea covid-19; Nifas; Bayi baru lahir nonatus normal

Acute Diffuse Peritonitis Due to Spontaneous Rupture of an Infected Endometrioma: A Case Report

Background. Endometriosis is defined as a chronic, inflammatory, estrogen-dependent gynaecologic disease. It affects approximately 5–10% of reproductive-age women worldwide. Ovarian endometriosis is the most frequent form of this condition. Endometriotic cysts are found in about 17–44% of women diagnosed with endometriosis. It is well known, that ovarian endometriomas can cause infertility and chronic pelvic pain. Enlarging cysts can also cause ovarian torsion. In addition, ovarian endometriosis slightly increases the risk for ovarian cancer. The rupture of endometriotic ovarian cysts is an exceptional complication. According to the literature, the prevalence is less than 3% among women with endometriosis. The rupture of an ovarian endometrioma can cause acute peritonitis, which can lead to sepsis, septic shock and can be lethal. The occurrence of abscesses within an ovarian endometrioma is an extremely rare complication. Generally, the origin of infected endometriotic ovarian cysts is related to the previous invasive procedures involving pelvic organs or the use of intrauterine devices. Also, ovarian abscesses can be caused by the hematogenous or lymphatic spread of bacteria. Although, the literature points out that infection of endometriotic ovarian cysts can develop spontaneously. In these rare cases, reservoir and route of infection remains an enigma.Case report. A 49-year-old female was brought to the emergency room with severe generalized lower abdominal pain (6/10) and three days lasting fever. Abdominal examination revealed diffuse abdominal pain with anterior abdominal wall muscle tension. Painful solid masses were felt on both sides of the uterus during the pelvic examination. Cystic masses were detected in both ovaries during transvaginal sonography. Computer tomography (CT) of the abdomen and pelvis revealed abnormal changes in both ovaries. A small amount of free fluid was found in the pelvic cavity along with thickened pelvic peritoneum. Suspecting acute peritonitis and bilateral tubo-ovarian abscesses, surgical treatment was performed. Lower midline laparotomy with bilateral adnexectomy and abdominal lavage with 4000 ml normal saline were done. The outcome of peritonitis was evaluated using the Mannheim peritonitis index (MPI=17 – low risk of morbidity and mortality). The histopathological examination revealed the diagnosis of bilateral endometriotic cysts complicated with acute inflammation, with associated acute inflammation of both fallopian tubes. Microbiological cultures from the purulent fluid were negative.Conclusions. Although the occurrence of abscesses within an ovarian endometrioma is an extremely rare finding in clinical practice, it has to be considered by gynaecologists because it might result in a surgical emergency that can be life-threatening. Being aware of the risk factors of abscesses within an endometrioma can lead to an early diagnosis of this rare condition and help to avoid serious complications.

A Case Study on Ayurvedic Management in PCOS

Female reproductive system consists of hypothalamo-pituitary-ovarian axis and intact uterine-adnexa which maintains a complex mechanism. In human body all the systems are interrelated to function properly; any imbalance in one system may cause multisystem pathogenesis. Polycystic ovarian syndrome (PCOS) is a common endocrinopathy, which is multifactorial and polygenic condition, manifested as oligoovulation or anovulation, signs of hyperandrogenism and multiple small ovarian cysts. Signs and symptoms vary within individual’s overtime. This adversely affect the reproductive system by menstrual disorders, infertility, obesity, depression, sleep apnea, insulin resistance and in due course may result in diabetes mellitus, endometrial cancer, cardiovascular disease etc. According to Ayurveda PCOS is a disorder which involves the three Doshas, Dhathus like Rasa, Raktha and Medas. The Srothas involved in this condition are Rasa, Rakta and Arthava vaha which eventually manifests features such as Anarthava (amenorrhea), Vandhyathwa, Pushpagni, Abeeja rtuchakra (anovular bleeding). Here is a case report of 19 year old girl who presented with irregular menstruation, rapid weight gain and hair loss. On USG she was detected to have bilateral PCO pattern. Based on the clinical features, treatment principles adopted were Aamapachana, Vata anulomana, Kaphapittahara and Arthava janana. After 2 months of internal medications, symptoms reduced markedly and menstruation was normal. Adherence to Ayurvedic principles is found to be helpful in PCOS for a healthy and fruitful life.

A Unique Presentation of Metastatic Gallbladder Carcinoma

Gallbladder carcinoma can be challenging to diagnose and treat and usually leads to poor outcome, due to its aggressive nature and the nonspecific clinical presentation at early stage. We describe an interesting case of a 60-year-old female who presented with stage 3 appendiceal carcinoma after appendectomy was performed outside hospital. Further imaging workup demonstrated enlarged ovarian cysts and porcelain gallbladder. Upon exploration, she was found to have carcinomatosis and we proceeded with cytoreductive surgery (CRS) and hyperthermic intraperitoneal therapy (HIPEC). Final pathology demonstrated carcinoma from gallbladder primary.

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

BackgroundOvarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.MethodsWe report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded.ResultsThe patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time.ConclusionGiant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review

Background: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. Methods: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥ 40 mm was performed. Results: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter < 40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to < 35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥ 40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. Conclusions: IUA is a promising therapy for preserving ovaries with simple cysts ≥ 40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.

Estimation of the polymorphism of matrix metal proteinase genes in patients with endometrioid ovarian cysts

Aim. To determine the association of the MMP-9 genetic polymorphism with the risk of developing endometrioid ovarian cysts (ECC). Materials and methods. 55 women aged 19 to 47 were examined. 27 women underwent surgery for ECC (group 1). The control (group 2) consisted of 28 patients without endometriosis and operated because of tubal infertility. Single nucleotide polymorphism was investigated. Genotyping was performed by restriction fragment length polymorphism analysis. Results. We did not find statistically significant differences between the group of patients with ECF and the control group in terms of age 29.0 (25.95; 33.1), 34.5 (29.3; 37.0); p0.05, body mass index 21.2 (19.8; 22.6), 21.95 (20.4; 23.9), p0.05, age of menarche onset 13.0 (12.95; 14.0), 13.0 (12.0; 14.0), p0.05, duration of menstrual bleeding 5.0 (5.0; 5.0), 5.0 (5.0; 6.0), p0.05 for the 1st and 2nd groups, respectively, also dysmenorrhea (2 0.019; p=0.8918), the number of births (2 3.441; p=0.3285) and abortions (2 2.822; p=0.0930) in anamnesis. The frequencies of all studied genotypes of metalloproteinase MMP-9 C (1562) T of the MMP9 gene in the group of patients with ECF and the control group are in HardyWeinberg equilibrium (p=0.99, p=0.43 for 1 and 2 group) which excludes differences in the distribution of genotype frequencies of polymorphic loci of MMP9 genes in the group of patients with ECF and the control group. However, the result could be influenced by the severity of the disease and the size of the study groups. Conclusion. Given the undoubted role of matrix metalloproteinases in the pathogenesis of genital endometriosis, further studies with large samples in various populations are needed.

Multiple paraovarian cysts requiring emergency surgery: a rare clinical finding

This report presents an unusual case of multiple paraovarian cysts that required emergency surgery due to a paraovarian cyst being entrapped by another paraovarian cyst. Laparoscopic surgery is considered useful for diagnostic and therapeutic purposes and is therefore recommended owing to difficulty in differentiating paraovarian cysts from ovarian cysts.