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The rupture of an unscarred uterus in pregnancy may result in catastrophic consequences for both mother and baby. This is usually related to a delayed diagnosis and treatment, because of a low index of suspicion. There have been described a series of risk factors incriminated in unscarred uterine rupture, such as abdominal trauma, labor induction, obstructed or neglected labor, and operative vaginal deliveries. Although it is a rare event that happens more often in old multiparous patients, there have been reported cases of uterine rupture in primiparous women. A uterine rupture is an unpredictable event that happens suddenly, can have dramatic, but non-specific symptoms, and requires a high index of suspicion and prompt management to reduce maternal and neonatal morbidity and mortality. The purpose of this study is to synthesize available information about the rupture of the unscarred uterus, its risk factors, diagnosis, and management. [ABSTRACT FROM AUTHOR]

This review has the purpose to evaluate and report clinical characteristics, treatment, and obstetric outcomes of adnexal torsion in pregnant women in order to raise awareness of the need for prompt diagnosis and surgical intervention. Adnexal torsion (AT) in pregnancy is a rare event but is a surgical emergency that needs prompt intervention. Misdiagnosis or delay in treatment can lead to loss of ovarian function with an effect on future fertility and loss of the pregnancy. The use of assisted reproductive technology is associated with an increased risk of AT. Diagnosis of AT is very challenging due to its nonspecific signs and symptoms such as abdominal pain, nausea, vomiting, and abdominal tenderness. Furthermore, pregnant women with AT present with specific characteristics, and these common signs and symptoms may be caused by other obstetric and non-obstetric conditions. Ultrasound examination may not be as valuable as in non-pregnant women. MRI can assist in making the diagnosis in pregnant women. Clinical suspicion of AT should not delay treatment if the imaging evaluation is not clarifying. In standard practice, the surgical treatment of AT is performed by laparoscopy which is safe for pregnant patients regardless of the trimester. The treatment is based on a conservative approach by preserving the adnexa although initially, the ovary may seem necrotic. During the intervention the adnexa is de-twisted, and cystectomy or cyst aspiration is performed, if any adnexal mass is present, to reduce the recurrence risk. Surgery during pregnancy for suspected AT does not lead to adverse obstetrical outcomes. Given the difficulties of the diagnosis of AT in pregnancy, it is of great importance that clinicians are familiar with this complication in pregnancy and are aware of the need for prompt intervention. [ABSTRACT FROM AUTHOR]

Skin cancer during pregnancy is common, with malignant melanoma being the most frequent and the most aggressive. Any pigmented skin lesion that suffers changes should be examined by a specialist and if considered high-risk, biopsy should be performed right away and not postponed as it is thought to be safe during pregnancy. Recent studies showed that it has the same outcome compared with the non-pregnant state, if diagnosed and treated as soon as possible. Diagnosis of skin cancer, including melanoma, does not necessarily require an early delivery or termination of pregnancy, if in the first trimester, except for pregnant patients with poor prognosis (advanced disease) that need more aggressive, systemic treatment. Management needs to be established in specialized centers with a multidisciplinary team. Monitoring should be performed by a team consisting of an obstetrician, a maternal-fetal medicine specialist, a neonatologist, and an oncologist. [ABSTRACT FROM AUTHOR]

Urolithiasis during pregnancy is a rare condition despite the prolithogenic state determined by the physiological changes in the urinary system. The incidence is similar among pregnant women and the general female population, pregnancy not being a risk factor for the appearance of kidney stones. Urolithiasis is a challenge for the obstetrician because diagnosis and treatment require a particular approach in order not to harm the fetus. Ultrasonography is the first choice for diagnosing kidney stones even though it has a reduced sensibility. The first line of treatment in renal colic is expectant management. If this is ineffective, then urological interventions are being taken into consideration. Left untreated, urolithiasis exposes the pregnancy and the baby to higher risks of complications. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD), with its two main forms, Crohn’s disease, and ulcerative colitis, are characterized by chronic inflammation of the gastrointestinal tract. It is frequently diagnosed during childbearing years and its overlapping with pregnancy adds more complexity to the management of the disease. This review article aims to summarize what is acknowledged so far regarding IBD in pregnancy, providing up-to-date information. A systematic literature electronic search for journal articles and guidelines regarding IBD during pregnancy was undertaken. The most favorable pregnancy outcomes for pregnant women with IBD occur when the disease is in remission both at the time of conception and during the pregnancy. Most of IBD medication is considered safe during pregnancy and continuing therapy in pregnancy is fundamental for achieving optimal outcomes. Proper management of active IBD in pregnancy requires multidisciplinary care to lower adverse outcomes. There is insufficient knowledge among patients regarding how their pregnancy outcomes could be optimized. [ABSTRACT FROM AUTHOR]

Acute appendicitis is the most frequent non-obstetrical surgical emergency encountered in pregnancy with negative maternal and fetal outcomes, mostly attributed to appendicular perforation. The purpose of this article is to discuss the characteristics in diagnosing appendicitis in pregnancy, recommendations of management, as well as maternal and fetal outcomes. It is significantly challenging to diagnose appendicitis in pregnancy due to the anatomic displacement of the appendix caused by the enlargement of the uterus (which may cause uncommon symptomatology), the physiologic leukocytosis of pregnancy, the raised prevalence of abdominal discomfort along with the inability to perform computed tomography because of the radiation exposure of the fetus. These particularities may delay an accurate and timely diagnosis which is of utmost importance in order to avoid the significant complications associated with peritonitis. Rapid surgical intervention (especially laparoscopy) is recommended, nevertheless, the key in managing appendicitis in pregnant patients is finding a balance between the risk of delaying the diagnosis and consequent perforation against the risk associated with a negative appendectomy. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign tumors affecting female genital tract, responsible for a high morbidity across fertile age women, with a prevalence of 0,1-11% among pregnant women. Although generally asymptomatic, they can lead to a series of symptoms and complications such as pain, infertility, miscarriages, antenatal bleeding, postpartum hemorrhage, preterm labor, fetal malpresentation, placental abruptio and high cesarean section rates. The purpose of review is to update information regarding fibroids specifications and their correlation with pregnancy outcomes as well as fibroids management during pregnancy. Because of uterine fibroids heterogeneity and lack of large, randomized trials there are encountered discrepancies among studies, but it was observed that uterine fibroids increase the risks of negative obstetrical outcomes, especially when it goes to large, multiple, submucous and retroplacental myomas. Conservative management during pregnancy is advised, but in special situations myomectomy could be recommended and possible. Trial of labor should be offered to pregnant women even if they have large uterine fibroids, or previous myomectomy excepting fibroids obstructing the birth canal or patients who underwent extensive surgery for fibroids removal. [ABSTRACT FROM AUTHOR]

One of the most common surgical entities, globally, is hernia. Even though it affects female population less often than men and its occurrence is rather exceptional during pregnancy, it must not be neglected, especially due to the difficulties in diagnosing this entity correctly in the gestation period. We conducted a review article based on data from 13 papers published between 2015 and 2021 which assessed the challenge of hernia diagnosis during pregnancy, available and recommended investigations for a proper diagnosis, potential complications that hernia might cause in pregnant patients, the appropriate treatment during pregnancy and the ideal moment for surgery, if necessary. It appears to be widely acknowledged that it is best to uphold surgical repair of hernia until after delivery. Nevertheless, there is no clinical guideline available on this matter and the existing studies are either case-reports or have used rather small group of patients, therefore future studies are of utmost necessity. [ABSTRACT FROM AUTHOR]

Spontaneous hemoperitoneum in pregnancy (SHP) is an uncommon, but very critical complication when present in pregnancy, leading to important morbidity and mortality for both mother and fetus. The etiology includes a large spectrum of causes, not taking into consideration trauma or other pathologies not pregnancy related. One of the most frequent triggers is the rupture of the varicose veins around the uterus that can occur either spontaneously or during labor, that can be associated with the unfortunate event of delivery of a stillborn baby. Endometriosis has been suspected to be also implicated in the apparition of spontaneous hemoperitoneum in pregnant women due to the fragility of the tissues associated with endometriosis chronic inflammation (ruptured endometrioma, intraabdominal adhesions, decidualization at the site of endometriotic implants). Even the operative vaginal delivery can conduct to this complication, but the cases described in the literature were also associated with lesion of endometriosis at the bleeding site. Moreover, assisted reproductive procedures (IVF-ET) is incriminated as one of the possible etiologies. The improvements in the resuscitation, operative and anesthetic management of these cases have lowered the maternal mortality, but perinatal mortality still has a high value (31%). Symptoms as acute or subacute abdominal pain, that can be associated or not with hypovolemic shock and signs of fetal affliction, identified as heart decelerations, should raise a question mark regarding the possibility of a hemoperitoneum. Electronic research for subject related reviews and articles has been made, using PubMed, Medline, Cochrane Data Base and also the current international guidelines regarding the management of hemoperitoneum in pregnancy, recommended by Obstetrics and Gynecology Societies in United States and United Kingdom. Adequate case management as hematologic analysis, abdominal ultrasound, CT scan or MRI should reveal free intrabdominal fluid and estimate the blood loss, which can then be confirmed by paracentesis or by direct urgent laparotomy or laparoscopy. The aim of the current review is to raise awareness of this rare, but potentially fatal, complication in pregnancy and its most appropriate management, according to the current information presented in the medical literature. [ABSTRACT FROM AUTHOR]

Copyright of Ginecologia.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)