Co-Existence of a Rudimentary Non-Communicating Horn with a Unicornuate Uterus in Association with 2 Components of the VACTERL Association: A Case Report

The prevalence of congenital uterine anomalies has been reported as 6.7% in the general population. The unicornuate uterus accounts for 2.4-13% of all Mullerian anomalies and has a prevalence of 1:1000. A unicornuate uterus may be present alone or with a rudimentary horn and 75-90% of rudimentary horns are non-communicating. A pregnancy in the rudimentary horn may lead to uterine rupture, haemoperitoneum with a high risk of maternal mortality. The association of a unicornuate uterus with a non-communicating uterine horn to the VACTERL association of defects (vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies and limb defects) has been described only twice in the literature. We report a patient who was born with an extra thumb and had a trachea-bronchial remnant with oesophageal stenosis that were both operated on earlier, and they were associated with a non-communicating rudimentary uterine horn. To the best of our knowledge, this is the third case reported in the literature of a VACTERL association to a unicornuate uterus with a non-communicating functional rudimentary horn. Given the high risk for the patient if pregnant an early diagnosis is paramount. This case highlights the importance of considering Mullerian defects in the young patient born with components of the VACTERL association.

Tubal Stump Ectopic: A Case Report on Repeat Ipsilateral Tubal Ectopic Pregnancy

Background: Tubal Stump Ectopic is an infrequent event with critical obstetrical consequences. A case is illustrated from Northern Ireland in which an ectopic pregnancy was discovered in the tubal stump previously undergone salpingectomy. Case Facts: A 34-year-old woman (G2 E1) with a tubal stump ectopic of a previous cornual excision two years prior, presented to EPAU complaining of mild abdominal pain and 6 weeks amenorrhoea. She was clinically stable (β-hCG 1407 mIU/mL), while TVUS revealed no evidence of IUP or adnexal mass but fluid in the Pouch of Douglas. Laparoscopic salpingectomy was performed after a diagnosis of tubal stump ectopic. Inference: Women who has had a previously ectopic pregnancy are at a significantly greater probability of relapse. To correctly and quickly identify the implanted location, a TVUS should be conducted. Laparoscopic diagnostic salpingectomy should be performed through excision by diathermy to prevent the risk of EP in the tubal stump.

Puerperal Infections Complicated by COVID-19 Co-Infection: Two Independent Case Reports with Need for Intensive Care

Introduction: The current SARS-CoV-2 pandemic affects all medical fields. In obstetrics, the focus is on the effects on pregnancy and fetuses. Here we present two cases of parturient women that demonstrate the high risk of postpartum SARS-CoV-2 co-infections. Materials and Methods: Patients` data were obtained from their medical records after confirmation of written informed consent. Literature review was conducted across PubMed. Case Report: i) A 33-year-old Caucasian Gravida II, Para I was transferred to our tertiary hospital at 23+1 weeks of pregnancy with previous preterm premature rupture of membranes (PPROM) at 17+5 weeks of gestation. During antenatal corticosteroid therapy for fetal lung maturation with 24+0 weeks, intrauterine fetal death was diagnosed in the course of amniotic infection. Due to progressive hemodynamic instability and confirmed SARS-CoV-2 co-infection, our patient had to be treated with catecholamines for 24 hours and stayed at the intensive care unit (ICU) for 72 hours. An acute myocardial injury occurred during septic shock. Immediate intensive care prevented permanent damage. ii) A 27-year-old Caucasian Gravida III, Para III was admitted to our tertiary hospital, 11 days after her third caesarean section. After circulatory collapse at home, the patient arrived with signs of hemorrhagic shock. Emergency curettage was performed, and because of cardiopulmonary worsening pulmonary embolism was suspected. Computed tomography revealed typical signs of COVID-19 pneumonia. Our patient was treated by nasal oxygen in the ICU for 24 hours. Similar to the first patient, acute myocardial injury occurred without any lasting harm. Conclusion: Our two cases show rapid and worse clinical courses in parturient women with SARS-CoV-2 co-infection. Rapid diagnosis and availability of intensive care were crucial for the prevention of long-term harm. In peri- and postpartum situations of acute clinical worsening, exclusion of SARS-CoV-2 co-infection is an important diagnostic step.

Palbociclib and Exemestane are Active in Pretreated Low-Grade Serous Ovarian Cancer

We describe a case of a 55-year-old woman with a rare metastatic micropapillary low-grade serous ovarian cancer who had been heavily pretreated. A KRAS-mutation and c-MYC-amplification were detected, and we initiated a therapy with the CDK4/6- inhibitor Palbociclib in combination with the steroidal aromatase inhibitor exemestane. We postulated that the combination therapy leads to a blocking of the c-MYCamplification-activated cell cycle, proliferation, and inhibition of apoptosis, further enhanced by other oncogenes like mutated RAS. This therapy showed a good and lasting response representing a new opportunity for therapy in heavily pretreated metastatic micropapillary low-grade serous ovarian cancer.

Potential Novel Ovarian Cancer Treatment Targeting Myeloid-Derived Suppressor Cells

Diagnosis by biopsy is difficult in the ovary, since it is located deep in the abdomen. As a result, ovarian cancer is mostly found insidiously during exploratory laparotomy. Consequently, early diagnosis of ovarian cancer is often difficult. The likelihood of peritoneal dissemination increases with the progress of ovarian cancer. With further progression, ovarian cancer metastasizes to the omentum, retroperitoneal lymph nodes, large intestine, small intestine, diaphragm, spleen, and other organs. Ovarian cancer has been considered a tumor that has a favourable response to chemotherapy, but more effective treatments are still being explored. Tumors use their own immune escape mechanism to evade host immunity. The immune checkpoint (IC) mechanism, one of the immune escape mechanisms, is established by programmed cell death-1 (PD-1)/PDligand-1 (PD-L1) communication. It has been shown that inhibiting PD-1/PD-L1 communication in various malignancies produces antitumor effects. However, the antitumor effect of ICI monotherapy on ovarian cancer is limited in actual clinical practice. In this review, we describe a novel cancer immunotherapeutic agent that targets myeloid-derived suppressor cells (MDSCs).

Association Between Cervical Length at 18-23 Weeks of Gestation and Spontaneous Preterm Delivery: A Cross Sectional Study

Introduction: Preterm birth is childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. Identifying ways to address preventable causes of preterm birth should be a top priority in developing regions of the world. the present study was planned to find the association between cervical length at 18 to 23 weeks of gestation done as a routine during all second level scans and spontaneous preterm delivery. Patients and Methods: This is a hospital based cross sectional study conducted during the period from January 2019 to December 2019. A total of 205 women presenting with singleton pregnancies between 18- 23 weeks of gestations were assessed by transvaginal ultrasound for the measurement of cervical length. Patients were interviewed and their demographic data such as age, obstetric index(GPALD), obstetric history such last menstrual period (LMP), estimated delivery date (EDD) and current pregnancy details such as BP, pulse rate, pallor, period of gestation, were recorded in a predesigned pro forma. Results: In a total of 205 subjects, the average age was found to be 23.26 ± 3.49 years with 52.2% of the women being primigravida. The mean gestation age at the time of enrollment was 20.72 ± 1.00 weeks with 33% of women showing a cervical length of 26-30 mm. The delivery outcome was found as 11% preterm, majority (89.27%) was term delivery. Conclusion: The present study showed that a significantly higher number of women with cervical length ≤ 30 mm (assessed at 18 to 23 weeks of gestation) had preterm labour compared to a woman with cervical length > 30 mm.

Acute Pancreatitis in Pregnancy: Three Case Reports

Acute pancreatitis is a rare condition during pregnancy, with peculiar specificities and particular findings. We report a series of 03 cases of pregnant women, treated for acute pancreatitis from 2016 to 2020. Their average age was 34.33 years and the diagnosis was based on clinical-biological clues: epigastric pain with strong elevation of lipasemia. Biliary etiology was confirmed in all patients initially by ultrasounds. Two patients had benign pancreatitis of favorable evolution. The third patient presented with a clinically severe pancreatitis and systemic inflammatory response syndrome, multiple organ failure syndrome with maternal and fetal deaths. Treatment was mainly symptomatic (medical), followed by cholecystectomy after delivery. Acute pancreatitis during pregnancy is a real threat for both the maternal and fetal prognosis and is a differential diagnosis that must be kept in mind for prompt management.

Prolonged SARS-CoV-2 Viral Shedding in Pregnancy and Risk of Extended inPatient Isolation: A Case Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), continues to challenge healthcare systems worldwide, and further investigation is required to determine its effects on the pregnant population. Prolonged viral shedding (>15-33 days), especially without appropriate testing guidelines, can subject admitted patients to unnecessarily long isolation, which influences emotional, physical, and clinical aspects of their antepartum course. We report a young, primigravida Haitian female admitted to the antepartum service at 22 weeks of gestation with preterm premature rupture of membranes (PPROM), who remained admitted in isolation for over 6 weeks due to persistent positive SARS-CoV-2 testing. This case highlights the importance of establishing testing guidelines to prevent unnecessary isolation, which has negative consequences for patient care. There is an urgent need for updated guidelines for the duration of isolation based on the presence of the viable virus.

Peripheral Administration of RF9 Does Not Affect Hypothalamic-PituitaryGonadal Axis in Normal Fed Adult Male Macaque

Stress represses hypothalamic-pituitary-gonadal axis (HPG-axis) but RF9, a synthetic peptide, rescues such repression. To assess the role of RF9 in regulating HPG-axis under normal physiological conditions in higher primates, RF9 was administered to intact adult male rhesus monkeys and response of the HPG-axis was examined by measuring plasma testosterone as an end parameter of the axis. Control group (n=4) received normal saline whereas the treated group (n=4) received RF9. On the first day of experiment, four bolus injections of normal saline (1ml/animal) were administered intravenously at 2-hr interval to the control monkeys. Similarly, on the second day of experiment, treated group received four iv bolus injections of RF9 (0.1mg/kg BW) at 2-hr interval. Serial blood samples were collected at 20 min interval during a 6-hr period which started just after first saline/RF9 injection. Plasma testosterone levels were measured by using a specific EIA. Overall means of plasma testosterone levels and plasma testosterone area under curve (AUC) and overall mean testosterone and mean testosterone AUC in short time windows following each injection of RF9 and saline were comparable between the groups. Our results demonstrate that RF9 has no role in regulating HPG-axis under normal physiological conditions in adult male monkeys.