Belgin Selam

Laparoscopic management of heterotopic cesarean scar pregnancy with preservation of intrauterine gestation and delivery at term: case report

OBJECTIVEnTo present a case of laparoscopic removal of a heterotopic cesarean scar pregnancy under ultrasound guidance.nnnDESIGNnCase report.nnnSETTINGnPrivate hospital.nnnPATIENT(S)nA 34-year-old woman with heterotopic cesarean scar pregnancy.nnnINTERVENTION(S)nLaparoscopic removal of heterotopic cesarean scar pregnancy.nnnMAIN OUTCOME MEASURE(S)nDelivery at term after laparoscopic management of heterotopic cesarean scar pregnancy.nnnRESULT(S)nAn ongoing intrauterine pregnancy ended with a live birth after successful removal of the heterotopic gestational mass by a laparoscopic approach.nnnCONCLUSION(S)nSurgical removal of the ectopic mass by laparoscopy may be a radical approach in cases of heterotopic cesarean scar pregnancy. Laparoscopic excision of the cesarean scar pregnancy gives the opportunity to preserve the viable intrauterine gestation while maintaining a strong lower uterine segment. Ultrasound is an adjunctive tool that enables precise location of the ectopic mass during the operation.

Genetic amniocentesis after multifetal pregnancy reduction

OBJECTIVEnOur purpose was to evaluate the pregnancy loss rate resulting from genetic amniocentesis after multifetal pregnancy reduction.nnnSTUDY DESIGNnA cohort study was performed in pregnancies with maternal age >30 years. Pregnancy loss in a study population of 127 patients who underwent genetic amniocentesis after multifetal pregnancy reduction were compared with a control group of 167 patients who did not have genetic amniocentesis after multifetal pregnancy reduction.nnnRESULTSnThe pregnancy loss rate in patients who underwent genetic amniocentesis after multifetal pregnancy reduction was 3.1% (4/127 cases) compared with 7.2% (12/167 cases) in the controls (P >.05). In the study group evidence of infection was found in only 1 case, in which the pregnancy loss occurred 1 day after the amniocentesis. In the other cases the pregnancy losses occurred 5 weeks after genetic amniocentesis, and these losses could not be directly attributed to either genetic amniocentesis or the multifetal reduction procedure.nnnCONCLUSIONnOur data suggest that the performance of genetic amniocentesis after multifetal pregnancy reduction does not increase the risk of pregnancy loss over that observed in association with the reduction itself.

Transient osteoporosis of pregnancy: case report.

Transient osteoporosis of pregnancy is a rarely observed skeletal pathology developing in the last months of pregnancy. Meticulous evaluation is important for the differential diagnosis of severe and progressive hip and/or groin pain in pregnant patients. MRI is a valuable and safe technique for demonstrating bone marrow edema and skeletal abnormalities during pregnancy. Avoidance of vaginal delivery and non-weight bearing measures are essential in order to prevent complications such as hip fractures related to transient osteoporosis of pregnancy. We present the diagnostic evaluation and treatment of an uncommon case of transient osteoporosis of pregnancy with resolution of symptoms and postpartum.

OP10.05: Can multifetal pregnancy reduction alter uterine artery Doppler velocimetry?

Objectives: To determine whether the risk of fetal loss following trans-abdominal multifetal pregnancy reduction (TA-MFPR) of a monochorionic twin pair is similar to the one in dichorionic pairs. Study Design: A retrospective review of all TA-MFPR performed in our institution (1999–2007) was conducted. The procedurerelated fetal loss, defined as pregnancy loss prior to completion of 24 weeks, in pregnancies involving reduction of a monochorionic pair i.e. ‘‘Mono group’’ was compared to the loss rate in all other TA-MFPR i.e. ‘‘Non-mono group’’. This comparison was further stratified according to the specific pre and post reduction number of fetuses. Additionally, association between the number of needle insertions performed and the procedure related fetal loss was sought. Results: 394 TA-MFPR were eligible for analysis and an overall loss rate of 2.5% (10 of 394) was detected. The procedure related loss in the ‘‘Mono’’ and ‘‘Non-mono’’ groups as well as the impact of the pre and post reduction number of fetuses on the fetal outcome is displayed in table 1. Information regarding number of needle insertions was available on 182 TA-MFPR of which in 22 ‘‘Nonmono’’ and 16 ‘‘mono’’ cases the same needle insertion was used to reduce more than a single fetus. The loss rate for single, two and three needle insertions was 3/165, 0/11 and 1/6 respectively (pnon significant). Conclusions: Fetal loss following TA-MFPR is independent of the chorionicity of the pair reduced. Additionally, we noted a trend suggesting an increased risk for fetal loss with increased number of needle insertions. Since monochorionic twins carry an increased pregnancy-related complication rate, it is our practice to attempt reduction of such pairs, preferably by using a single needle insertion. This can be achieved by a careful selection of the needle pathway to reach both fetuses.