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Introduction: Unicornuate uterus is a rare Müllerian anomaly. Its potential association with a rudimentary uterine horn can cause a diagnostic delay. The most common consequences are pelvic pain, hematometra, and endometriosis. Diagnosis of a unicornuate uterus is usually done by imaging combining ultrasound and magnetic resonance imaging. The aim of this systematic review is to assess the role of laparoscopic approach in the management of this rare condition. Methods: A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases prior to 1 May 2022 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The inclusion criteria were: cases of rudimentary horn managed through laparoscopy only; laparoscopic treatment of communicating or noncommunicating uterine horn. Results: The search strategy identified 45 articles. After this first screening, 37 studies were evaluated. The full text of remaining articles was examined. 35 studies were finally included in this article. All included studies were case reports, due to the rarity of this condition. Rudimentary horns were noncommunicating in all cases. Conclusion: The laparoscopic removal of a rudimentary uterine horn could be considered a feasible therapeutic option. An accurate preoperative evaluation is mandatory to assess anatomic variants and to select the optimal and tailored surgical approach, based also on the symptoms complained by the patient.

Aim To evaluate the risk of SARS-CoV-2 transmission in surgical smoke and aerosols during laparoscopy and open surgery. Material and methods A systematic review (PROSPERO ID: CRD42021268366) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were selected based on the title and abstract as well as the type of publication. Primary objectives of the study were to assess potential risk of contamination as well as comparing laparoscopic and open procedures in terms of danger of SARS-COV-2 transmission. Results Fifty-three articles were identified and included in the review. No case of SARS-CoV-2 transmission to operating room personnel during open or minimally invasive surgery was identified at the time the review was conducted. Furthermore, no significant difference was observed between smoke and aerosols generated from open surgery and those generated from minimally invasive surgery. Conclusion COVID-19 transmission in surgical smoke and aerosols has yet to be observed. However, given the potential risk of viral transmission, caution should be exercised when performing surgery to ensure the safety of the operating room personnel. When clinically indicated and when protective measures can be implemented, minimally invasive surgery should be performed instead of open surgery to ensure optimal patient outcomes.

Benign gynaecological diseases are usually treated with minimally invasive approaches. Robotic surgery seems an alternative to laparoscopic surgery. No definitive conclusions have yet been made regarding comparison of robotic versus laparoscopic surgery for benign diseases. In this scenario, we performed a systematic review in order to assess the advantages and disadvantages of laparoscopy versus robotic surgery and conclude whether laparoscopy should be replaced by robotic surgery for the treatment of benign gynaecological conditions, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement. We included 64 studies: no significant difference was observed regarding overall complication rate; no significant benefit of robotic approach was demonstrated regarding length of hospital stay and conversion to laparotomy; furthermore, robotic surgery is more easily used by non-experienced surgeons, while it is more expensive and characterised by longer operative time. In conclusion, current evidence indicates neither statistically significant nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic surgeries for benign gynaecological diseases. Impact statement

A female infant is born at 40 weeks and 6 days of gestation to a 36-year-old gravida 3 para 3 mother via cesarean section because of failure to progress. Membranes rupture at delivery, with thick meconium but no cardiotocographic abnormalities. Maternal medical history was significant for methamphetamine (MTA) abuse during pregnancy, but she denies other illicit drug use. There is no history of oligohydramnios, chorioamnionitis, antepartum hemorrhage, gestational diabetes, preeclampsia, or maternal hypertension. The infant’s Apgar scores are 5, 7, and 9 at 1, 5, and 10 minutes, respectively. At birth, the infant is flaccid and has persistent apnea that requires positive pressure ventilation followed by endotracheal intubation. She is, therefore, transferred to the NICU on mechanical ventilation. On admission, her cord blood gas measurement shows a pH of 7.22, Pao2 48 mm Hg (6.4 kPa), Paco2 31.5 mm Hg (4.2 kPa), bicarbonate 20.2 mEq/L (20.2 mmol/L), and base excess −7. Her physical examination findings are unremarkable; she is at the 50th percentile for weight (3,100 g), 80th percentile for length (55 cm), and 50th percentile for head circumference (34 cm). Serial neurologic examinations did not reveal any abnormalities. Her subsequent arterial blood gas measurement on admission to the NICU shows a pH of 7.27, Pao2 51.7 mm Hg (6.9 kPa), Paco2 38 mm Hg (4.8 kPa), bicarbonate 24.2 mEq/L (24.2 mmol/L), base excess −2, and lactate 1.85 mmol/L (0.21 mmol/L). She is hemodynamically stable and undergoes extubation at 6 hours of age. Her laboratory tests, including complete blood cell …

Aim: The objective of this study is to report the effect of COVID-19 convalescent plasma (CCP) therapy in pregnant women with moderate or severe COVID-19 infection. Methods: This study is a case series of 9 pregnant women with moderate or severe COVID-19 infection. All the patients (N=9) received two doses (400 mL) of ABO compatible CCP. The median gestational age at the time of confirmed COVID-19 diagnosis was 31 weeks (range: 16-39 weeks). Results: No adverse events with CCP were reported. On day 3 post-CCP administration, there was a significant improvement in oxygen saturation (p=0.032), decrease in the respiratory rate from baseline (p=0.041), and improvement in the lymphocyte counts (p=0.043). None of the patients required invasive ventilatory support or extracorporeal membrane oxygenation and all were discharged home (median time from CCP administration to discharge was 6 days). All the patients gave birth to healthy newborns. The newborns had negative SARS-CoV-2 PCR on days 2 and 5 of ages. Conclusion: Our case series demonstrated CCP therapy to be safe with improved clinical outcomes during moderate and severe COVID-19 infection in pregnancy. However, extensive studies are still needed to recommend the routine use of CCP in the pregnant population with COVID-19 disease.

Background The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection. Methods In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020). Results A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5–34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18–34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36–39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing. Conclusions In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.

BackgroundDeath of a child is a devastating experience for parents, owing to which parents may show dissatisfaction towards medical care or suffer from intense and prolonged grief. The objective of the present study was to explore the needs of bereaved mothers after the death of their infant.MethodsThe present study was a descriptive qualitative design that consisted of 10 mothers who have been bereaved in the past year. All mothers were recruited from the registry. Data were obtained through an unstructured single interview and analyzed using conventional content analysis.ResultsThe current study demonstrated that parents had the same needs despite their different backgrounds, socioeconomic standards, and religious beliefs. Their needs were based on several main points; 1) Lack of sensitivity/method in delivering the news, 2) Bonding with the child; 3) Safety and family support; 4) Providing understanding and meaning; 5) Ability to express emotions.ConclusionsThe key components that should be considered to support the bereaved parents include honesty, information, choices, and timing. The present study provided a comprehensive view of the overall experiences of the parents with neonatal death and the ability to give guidance to the healthcare providers.

BackgroundIn late December of 2019, a novel coronavirus (SARS-CoV-2) was identified in the Chinese city Wuhan among a cluster of pneumonia patients. While it is known that pregnant women have reduced immunity and they are at risk for COVID-19 infection during the current pandemic, it is not clear if the disease manifestation would be different in pregnant women from non-pregnant women.ObjectivesTo describe the maternal and neonatal clinical features as well as outcome of pregnancies complicated with SARS-CoV-2 infection.MethodsIn this retrospective national-based study, we analyzed the medical records of all SARS-CoV-2 positive pregnant patients and their neonates who were admitted to New-Jahra Hospital, Kuwait, between March 15th 2020 and May 31st 2020. The outcomes of pregnancies were assessed until the end date of follow-up (June 15th 2020).ResultsA total of 185 pregnant women were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis was 29 weeks (IQR: 18-34). The majority (88%) of the patients had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). During the study period, 141 (76.2%) patients continued their pregnancy, 3 (1.6%) had a miscarriage, 1 (0.5%) had intrauterine fetal death and only 2 (1.1%) patients developed severe pneumonia and required intensive care. Most of the neonates were asymptomatic, and only 2 (5%) of them tested positive on day 5 by nasopharyngeal swab testing.ConclusionPregnant women do not appear to be at higher risk to the COVID-19 than the general population. The clinical features of pregnant women with SARS-CoV-2 infection were similar to those of the general population having SARS-CoV-2 infection. Favorable maternal and neonatal outcomes reinforce the existing evidence and may guide healthcare professionals in the management of pregnancies complicated with SARS-CoV-2 infection.

Objectives To describe the epidemiology and outcomes of sacrococcygeal teratoma (SCT) and identify the factors affecting prognosis in a population-based cohort. Methods Analyses of fetal SCTs from a population-based congenital anomaly register between 1995 and 2012, linked to regional datasets. A systematic literature review was performed for published studies on perinatal SCT (1995 to 2012). Results Thirty-six confirmed SCT cases were identified, giving a total prevalence of 0.30 per 10 000 births (95%CI 0.20–0.39). Twenty-three cases (63.9%) were diagnosed prenatally. There were six false positive prenatal diagnoses, and the positive predictive value of ultrasound for SCT was 79.3%. Secondary complications in prenatally diagnosed cases were polyhydramnios (27.2%), fetal hydrops (9.1%) and rapidly growing tumour (54.0%). The perinatal (PNMR) and infant mortality rates were 333.3 per 1000 births and 285.7 per 1000 live births, respectively. All stillbirths and infant deaths occurred in cases diagnosed prenatally. Factors associated with higher PNMR in registerable births were solid, vascular tumour composition (1000), polyhydramnios (667), premature delivery (667) and rapidly growing tumour (454). In the systematic review, prenatal hydrops fetalis and prematurity were the most morbid association in SCT. Conclusion Prenatal ultrasound was relatively sensitive and specific in diagnosing SCT with good survival rates in live-born cases. © 2015 John Wiley & Sons, Ltd.