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Rationale: Primary myelofibrosis is encountered with the myeloproliferative diseases and is the least prevalent among women of childbearing age. The prognosis is guided by pancytopenia, leukemic transformation and thrombosis which are the dominant complications., Patient Concerns: Data regarding protocol management during pregnancy in the context of myelofibrosis are insufficient. Fewer than ten cases have been described until now and half of this cases have resulted in fetal death due to placental infarction during the second and third trimesters., Diagnoses: We present the case of a 34-year-old pregnant woman diagnosed with Jak 2- negative primary myelofibrosis. Personal history did not include miscarriage or stillbirth., Interventions: The patient was previously treated with anagrelide hydrochloride, which was interrupted at 6 weeks of gestation when the pregnancy was confirmed. It was replaced with Interferon-a 3 MU/day. Because of severe thrombocytosis, administration of aspirin 150 mg/day was recommended., Outcomes: The pregnancy was uneventful. The patient was hospitalized at 33 weeks of gestation because of moderate vaginal bleeding and high risk of preterm birth. After a specialized hematological investigation, the treatment with aspirin was replaced with low-molecular-weight heparin 0.6 ml per day. This combined treatment assisted in the natural tendency to lower platelet counts during pregnancy and resulted in stabilization of the hematological status. At 38 weeks of gestation the patient delivered a healthy baby boy via cesarean. He weight 2850 grams and his Apgar score was 9. Anticoagulant and interferon treatments were continued post-partum under hematologist surveillance., Lessons: This case was rare and complex. Because it was related to pregnancy it required continuos collaboration and supervision between obstetrician and hematologist.

The incidence of adherent placenta has known a continuous ascendant incidence in the last decades. A correct management implies prenatal care and a careful planning of birth. We present the case of a 31-year-old G4P3, 37 weeks and 3 days' gravida which presented herself at the emergency room, accusing unsteady painful low-intensity uterine contractions and asking for a cardiologic consult. The anamnesis revealed that this pregnancy was not properly monitored by a specialist and her medical history included two deliveries by caesarean section, a known untreated familial hypertrophic cardiomyopathy and a 36 weeks ultrasound scan describing a single fetus with a suspected cardiac hypertrophy and a praevia, anterior inserted placenta. In this context, the suspicion of an adherent placenta was confirmed by emergency ultrasound where a mild bladder invasion was observed. Due to the possibilities offered by an emergency medical hospital complete preparation for delivery was possible during one hour. A successful cesarean hysterectomy was performed, with the extraction of the fetus from transverse presentation trough vertical hysterotomy and rapid closing of the uterine incision after cutting the cord. The vezicotomy for uterine catheterization and excision of invaded submucosal area and subsequent hysterectomy were uncomplicated. Both mother and fetus presented a favorable prognosis. We present this case in the context of its complexity and the successful applied approach. [ABSTRACT FROM AUTHOR]

A velamentous insertion of the umbilical cord is characterized by the atypical aspect of the placental end of the cord, consisting in divergent umbilical vessels surrounded by fetal membranes and with no Wharton's jelly present, resulting a cord that is inserted rather into membranes than the placental disk. By the divergence of the umbilical vessels as they travers the amnion and the chorion before reaching the placenta this condition associates important obstetrical complications and the diagnosis by ultrasonography as early is possible is important for the guidance of the subsequent management. In this retrospective study we aimed to evaluate the incidence of velamentous cord insertion in University Emergency Hospital of Bucharest for a period of five years and analyze the pregnancies outcome and the obstetrical impact of this condition. Using the statistics department of University Emergency Hospital Bucharest we determined an incidence of 0.23% of pregnancies complicated by velamentous cord insertion. The examined parameters included intrauterine fetal death, small for gestational age, preterm delivery (<37 weeks), single artery umbilical cord and low Apgar score at 1 minute. We chose to exemplify with a case of early diagnosis of this condition, respectively at 15 weeks of gestation. The attempt to visualize cord insertion in the mid-trimester as a routine part of obstetric sonography is recommended. The identification of velamentous cord insertion dictates the mode and timing of delivery and can improve fetal outcome. [ABSTRACT FROM AUTHOR]