Predrag Vukomanović

Vaginal birth in breech presentation in morbidly obese woman

The unexpected breech presentation in labour dealing with morbidly obese women places health professionals in a clinical dilemma. Obesity is defined as a body mass index (BMI) 30 kg/m and further categorised as Class I: BMI 30–34.9 kg/m, Class II: 35–39.9 kg/m and Class III: 40 (super-morbid) (Sturm 2003). There is a linear relationship between BMI and caesarean rate: 7.3% for normal, 11.3% for overweight, 15.5% for obese Class I, 20.4% for obese Class II and 27.3% for obese Class III categories, respectively. Morbid obesity seriously impacts on pregnancy and reported risks include an overall increase in caesarean delivery (OR 2.9), five-minute Apgar scores less than 7 (OR 3.0), birth weight more than 4500 g (OR. 8.1) and intrauterine growth restriction (OR 9.3) (Weiss et al. 2004). Extremely obese women are at an increased risk of caesarean delivery, which further increases the risks of maternal morbidity (Alanis et al. 2010). There is little evidence whether an elective caesarean section or normal vaginal birth is the optimal mode of delivery in morbidly obese women. Unlike North America, birth in extremely obese women with a BMI over 50 kg/m is not common in Europe (Alanis et al. 2010). We present a case of vaginal birth in a morbidly obese pregnant woman, with a foetus in breech presentation.

Unruptured tubal pregnancy in early second trimester

Introduction Most ectopic pregnancies are tubal pregnancies. They are potentially life-threatening conditions with a high mortality rate if unrecognized. The diagnosis is established when the first warning symptoms occur, or during the first prenatal visits to a gynecologist. The diagnosis in the second trimester is extremely rare, since clinical presentation resulting either from the expulsion of the fetus into the peritoneal cavity or from the tubal rupture is manifested by that time. If there is no rupture or the expulsion of the fetus, the pregnancy is allowed to continue and ectopic pregnancy diagnosis may be established in the second trimester. Case outline We present a case of a 31-year-old second gravida with a vital intrauterine pregnancy confirmed at the first examination. In the early second trimester, the patient visited her doctor due to vaginal bleeding. After a gynecological examination and ultrasonography, ectopic pregnancy was suspected, so the patient underwent laparotomy. Ectopic pregnancy was confirmed and adnexectomy was performed. Conclusion Early ultrasound examinations have to confirm whether eutopic pregnancy is present. A misdiagnosis and monitoring of ectopic pregnancy as eutopic one is potentially life-threatening for a pregnant woman.