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Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2–3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care. Synopsis: A young woman develops a very rare cardiomyopathy in the peripartum, requiring intensive care support. With rapid efforts to diagnose, she makes a good recovery. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Inter‐observer agreement for the American Association of Gynecologic Laparoscopists (AAGL) 2021 Endometriosis Classification staging system has not been described. Its predecessor staging system, the revised American Society for Reproductive Medicine (rASRM), has historically demonstrated poor inter‐observer agreement.We aimed to determine the inter‐observer agreement performance of the AAGL 2021 Endometriosis Classification staging system, and compare this with the rASRM staging system.A database of 317 patients with coded surgical data was retrospectively analysed. Three independent observers allocated AAGL surgical stages (1–4), twice. Observers made their own interpretation of how to apply the tool in the first staging allocation. Consensus rules were then developed for a second staging allocation.First staging allocation: odds ratio (OR) (and 95% CI) for observer 1 to score higher than observer 2 was 8.08 (5.12–12.76). Observer 1 to score higher than observer 3 was 12.98 (7.99–21.11) and observer 2 to score higher than observer 3 was 1.61 (1.03–2.51). This represents poor agreement. Second staging allocation (after consensus): OR for observer 1 to score higher than observer 2 was 1.14 (0.64–2.03), observer 1 to score higher than observer 3 was 1.81 (0.99–3.28) and observer 2 to score higher than observer 3 was 1.59 (0.87–2.89). This represents good agreement.These findings suggest that in its current format the AAGL 2021 Endometriosis Classification staging system has poor inter‐observer agreement, not superior to the rASRM staging system. However, performance improved when additional measures were taken to simplify and clarify areas of ambiguity in interpreting the staging system. [ABSTRACT FROM AUTHOR]