Search

The prevalence of clinically symptomatic cervical leiomyomas in pregnancy is lower than 0.1%. Surgical intervention is necessary in extremely rare cases and only few are described in the literature. This study presents a case of successful vaginal myomectomy in the 13th week of pregnancy followed by a delivery of a healthy neonate in term by cesarean section.

Objectives: Uterine fibroids are one of the most common benign tumors of the female genital tract. The major complication of myomas in pregnancy is a recurrent pain, however the misscariage is the main threat. The negative impact of myomas on the course of pregnancy may also result in i.e. uterine bleeding, higher incidence of a maternal-fetal incommunicability, an incorrect position of the fetus and its deformities., Material and Methods: The patient aged 31 was admitted to Mother and Child Health Center in Zabrze due to the threatened miscarriage. The primigravid at 19 weeks' gestation was previously diagnosed with myoma. On admission the ultrasonography revealed one alive fetus in the uterus and a nodular change on the right side of the uterine fundus, 13 x 11 cm in size and non-homogenous echo., Results: The patient was qualified to the conservative myomectomy. 11 days after the enucleation of 25 cm in diameter myoma, patient in good condition, with the maintained, alive foetus was discharged from the hospital. Patient at 34 weeks' gestation was re-admitted due to the beginning of uterine contraction. After one week of observation within the ward, with tocolytic drugs and steroids administered, at 35th week of pregnancy the patient gave birth to a live daughter via the Ceasarian section., Conclusions: Prenatal myomectomy can be safely performed in the first and second trimester of pregnancy, however it is recommended to deliver the baby via Caesarean section, due to fear of intrauterine rupture of the uterus.

Hyperparathyroidism during pregnancy is diagnosed in 0.5-1.4% women and poses a serious challenge. Symptoms of primary hyperparathyroidism (PHP), namely fatigue, lethargy and proximal muscle weakness, are unspecific and could be mistaken as complaints naturally present during pregnancy. Thus, diagnosis is usually delayed. Moreover, the complications of PHP are very common. They occur in 67% of mothers and even in up to 80% of progeny. Appropriate management is a matter of debate. According to clinical symptoms, biochemical evaluation and trimester of pregnancy an operation or conservative management should be introduced. The recognition and understanding of the illness is therefore vital. Due to the lack of unequivocal guidelines concerning pregnancy and PHP, in this review we will analyze recent findings to facilitate proper proceedings.

Objectives: the aim of this retrospective study was to assess if a first trimester subchorionic hematoma (SCH) influences the pregnancy outcome and whether pv bleeding can be a prognostic factor for the pregnancy course., Material and Methods: the study included 185 pregnant women hospitalized due to symptoms of a threatening miscarriage. Patients were divided into 2 groups: 119 women with SCH (study group) and 66 patients with normal prenatal scan (control group), further subdivided into cases with and without pv bleeding, irrespectively of the outcome of the ultrasound scan. Obstetric and neonatal data were analyzed., Results: 1. A pregnancy complicated by SCH is more often associated with a poor outcome -- 23.78% of the study group patients had a miscarriage versus 7.62% of the controls. 2. Pregnancy with SCH is more likely to be lost before 9 weeks of gestation. 3. The "N" ratio, that expresses the maximal length of the hematoma to the maximal length of the fetus, equal to 2.5 or more, is associated with a risk of miscarriage. 4. The surface area of SCH equal to 280mm(2) or more is more likely to reveal with vaginal bleeding. 5. Vaginal bleeding can be a prognostic factor for the mode of delivery -- a higher rate of the Cesarean section is observed in patients with pv bleeding. 6. SCH is a complication that occurs in older women, with the limit of 30 years of age. 7. In this study there were no significant correlations between subchorionic hematoma or pv bleeding and PTL, IUGR, PIH, abnormal volume of the amniotic fluid, parity and order of gestation and delivery, Conclusions: subchorionic hematoma can be associated with poor pregnancy outcome and the "N" index may be a useful predictor of the further course of a pregnancy Pv bleeding may be a prognostic factor for the delivery mode.

Hemangioma is the most common primary tumor of the spine. Pregnancy is a risk factor increasing the possibility of disclosure or exacerbation of symptoms of spinal hemangioma. This paper presents a case of 32-year-old woman with hemangioma of Th6 vertebrae, which was revealed by paresis of the lower limbs and sphincters dysfunction at 34 weeks gestation. Pregnancy has ended with a cesarean section. Then posterolateral thoracotomy and removal of hemangioma were performed. Spinal cord was decompressed and stabilization of the spine with metal implants was carried out. Histological examination discovered cavernous hemangioma weaving. The patient is followed up in the outpatient clinic. Despite the improvement of neurological status--enhancement of the sensory function and development of bladder and rectal sphincter automatism--she did not regain the ability to walk alone.

The paper presents a case of placental tumor causing hemodynamic changes. Doppler studies and fetal echocardiography allowed the diagnosis of hyperkinetic circulation in the course of fetal anemia. Cordocentesis has been performed and confirmed fetal anemia. The treatment used, intrauterine blood transfusion, allowed the compensation of hemodynamic and hematological disorders. Paper presents a detailed diagnostic and therapeutic procedures in the event chorangioma in pregnancy.

This is a case report of a successful pregnancy outcome in a 36-year-old primigravida with an enormous leiomyoma. Potential pregnancy complications and pain treatment during pregnancy are discussed in the following work.

Background: Renal angiomyolipoma is a rare benign tumour composed of adipose tissue, blood vessels and smooth muscles. However it can locally grow to a great size and its numerous blood vessels may cause major bleeding requiring immediate intervention., Case: At 20th week of pregnancy a previously healthy 26-year old pregnant woman with an episode of sudden and severe pain in the left flank followed by fainting was diagnosed with a bleeding tumour of the left kidney. The diagnosis was based on ultrasonography and magnetic resonance imaging (MRI). Diagnostic angiography was followed by selective embolization of the tumour blood vessels. At 38th week of pregnancy elective caesarean section was performed and after the puerperium the tumour was resected., Conclusion: Embolization of renal angiomyolipoma bleeding vessels during pregnancy can be an effective therapeutic approach protecting against further bleeding and haemorrhagic shock thereby obviating the need to perform urgent surgery and allowing the woman to carry her pregnancy to term safely in outpatient setting.

The women with spleen's tumor and trombocytopenia was diagnosed and observed during pregnancy, labour and puerperium. The lowest level of thrombocytes (50 K/microl) was detected in 32nd week of pregnancy. Termination of the pregnancy by cesarean section was performed because of a big risk for the mother and child (tumor's crack, haemorrhage, infection). The same time the splenectomy was conducted. The results were successful.

A case of a 30 years old pregnant woman suffering from bilateral ovary tumour was presented. When she was sixteen weeks pregnant she had both tumours enucleated using the method of laparoscopy. Diagnostic and therapeutic process have been described. Authors are convinced that laparoscopy as a method of treatment can be safely applied to pregnant women provided, that specific rules are obeyed and elaborate precautions during the surgery are taken.

Design: The multipara with spleen's tumor was diagnosed and observed during pregnancy, labour and puerperium. The spleen's tumors are very rare and they should be examined individually. Termination of the pregnancy by cesarean section was performed because of the big risk for the mother and child (tumor's crack, haemorrhage, infection). After 3 months post partum the spleen with tumor was operated (splenectomy). It was cystic spuria., Results: The cystic spleen was diagnosed by accidental abdominal USG and this test prevented threatening complications., Conclusions: The abdominal USG should be used in pregnancy.

We present the case of 31-year-old woman in 13th week of pregnancy with the diagnosis of the ovarian cancer (cystadenocarcinoma papillare serosum G1) in the FIGO stage Ia. Taking into consideration this data and the patient's wish of preserving the pregnancy and the childhood bearing possibility in the future we performed only left salpingooophorectomy. Postoperative and further pregnancy course was uncomplicated. The pregnancy was terminated in the 40th week by cesarean section--a well doing male newborn in term was delivered. The cesarean section was at the same time the second look procedure. All organs of peritoneal cavity were inspected--no macroscopic changes were observed, oncologic smears and specific biopsies were taken showing no neoplasmatic lesions present in the histology. Nowadays it is the 5th year of systematic patient's control, who is in complete remission. This case report is the example of the limited treatment strategy success based on prognosing factors (tumor histology, grading, staging) as well as patient's wishes of preserving the fertility.

In a number of pregnant women benign ovarian cysts are found incidentally during routine ultrasound examination or after episode of pelvic pain in early pregnancy. In this paper we present perinatal outcome in pregnancies with ovarian cysts after fine needle aspiration or excision during laparotomy. These cases suggests the transabdominal needle aspiration is procedure of choice in ovarian hyperstimulation syndrome and excision during laparotomy is recommended in the case of spontaneous hyperreactio luteinalis or cystadenomas.

Objective: The clinical characteristics of pregnancy complicated by ovarian tumors were investigated., Material and Methods: A review was performed of patients who were seen with ovarian tumors in pregnancy from January 1985 to August 2000. We included patients with simple or complex tumors > 5 cm that were seen on ultrasonographic evaluation., Results: 23 patients of 21,506 deliveries were identified with ovarian tumors that met the criteria. 21 had operative intervention, whereas 2 were managed conservatively. Gestational ages at the time of surgery ranged from 16 to 24 weeks. No intraoperative et postoperative maternal or fetal complications occurred. In 2 cases adnexal masses seen on ultrasonography resolved spontaneously by 16 weeks. 19 ovarian tumors were benign. One patient had a stage III ovarian carcinoma and went to total hysterectomy, and other patient had a stage IA ovarian carcinoma and went to simple adnexectomy., Conclusions: Ovarian surgery in pregnancy for persistent masses is important to obtain a final histologic diagnosis. Optimal gestational age for the surgery is among 16 and 24 weeks.

Objective: Ovarian tumors during pregnancy are a rare event. More ovarian tumors are detected accidently during ultrasonography examination or caesarean section at term., Study Design: Ovarian tumor was recognized at the 36 years old patient during 21 weeks of pregnancy and was observed and treated during caesarean section., Results: During caesarean section the mesonephroid ovarian carcinoma at IA stage has been diagnosed and unilateral cystectomy after meticulous surgical exploration was done.

Objective: Visualisation of myomas in pregnancy and evaluation of their dimension, localisation and echogenic structure are essential to establish the proper diagnosis and further therapeutic management., Design: Our goal was to define a diagnostic value of ultrasound examinations for uterine myomas assessment during pregnancy., Materials and Methods: The study group included 53 women with uterine myomas which were visualised in ultrasound examination before pregnancy or during first and second trimester., Results: During third trimester the presence of uterine myomas were observed in 40 cases what is 75.5% of all examined women. The difference of 6.1 mm in the mean values of measured diameters was obtained in comparison of ultrasound examination and intraoperative evaluation (7.6% of mean value diameter). It was found a statistically significant correlation between ultrasonic and intraoperative myomas diameters evaluation (p < 0.01)., Conclusions: 1. The accuracy of ultrasonic measurements completes the knowledge about presence and size of uterine myomas what is of great importance to establish proper diagnosis and mode of delivery. 2. Difficulties in ultrasound visualisation of myomas situated on the posterior uterine wall were noticed during third trimester. Limited role of ultrasound examination was observed in assessment of uterine myomas during third trimester.

Objective: Ovarian neoplasms represent one of the diagnostics problems in obstetrics. The enlarged uterus changing the topography of the minor pelvis makes correct diagnosis of ovarian neoplasms difficult., Design: The aim of our study was to evaluate the accuracy of ultrasound examination in diagnostics of ovarian neoplasms during pregnancy., Materials and Methods: Ultrasound examination was performed in the group of 9,356 pregnant women, admitted to the Institute of Obstetrics and Gynaecology Medical University of Łódź during the second and the third semester., Results: We diagnosed 14 neoplasmatical ovarian tumors (0.17% examined population). Each of them was of the diameter larger than 50 mm. The other 2 tumors were not visualised in ultrasound examination, but during the laparotomy performed because of acute abdominal symptoms. 15 benign and 1 border line tumor were found among ovarian neoplasms., Conclusions: During ultrasound examination in pregnancy should contain routine assessment of both adnexa. There are difficulties in visualisation of adnexal lesions located behind uterus. Therefore the role of ultrasound tumor diagnostic in pregnant women is limited.

We have attempted to determine the accuracy of greyscale and color Doppler ultrasound in the differentiation of adnexal masses in pregnancy. The studied group included 2245 pregnant women from low risk population. Following criteria were evaluated: maximal diameter and volume of the tumor, echogenicity, presence of septa and papillary projections in grey scale sonography. Color Doppler analysis included blood vessel presence and arrangement and blood flow characteristics with the use of pulsatility (PI), resistive (RI) and systolic/diastolic (S/D) indices. Preoperative CA-125 serum levels were available in 11 patients. In 66 (2.94%) patients adnexal tumors were detected during routine ultrasound scan at the end of the first trimester. Twenty-seven masses (1.2%) persisted beyond 16 weeks of gestation and were subsequently surgically removed. Pathological diagnosis confirmed 19 serous cystadenomas, 4 endometriomas and 2 dermoids, one pedunculated myoma and one fibrothecoma. Mean size of the tumors was 79 Jmm (range: 43-245 mm), mean volume 166. lml (range: 30-1320 ml). Doppler indices values presented as mean, SD and range were as follows: PI = 1.26 +/- 0.71 (range: 0.57-3.84); RI = 0.61 +/- 0.15 (range: 0.33-0.89) and S/D = 2.62 +/- 0.98 (range: 1.17-4.91). Median serum concentration of CA-125 was 17 IU/ml (range: 8.4-1247 IU/ml). Only 3 of these women had elevated (> 35 IU/ml) levels: 2 endometriomas (344 IU/ml and 1247 IU/ml) and one myoma (37 IU/ml), respectively. Based on the sonographic findings two solid tumors were incorrectly classified as probably malignant (fibrothecoma and subserous myoma). Negative predictive value of ultrasound diagnosis in the studied population was therefore 92.6% (25 of 27). We conclude that although prenatal sonography has the potential to correctly classify most of adnexal masses, caution in risk assessment is needed especially when persistent solid tumor is found.