Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon

Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are localized in the fallopian tubes. The occurrence of molar tubal ectopic pregnancy coexisting with intrauterine pregnancy is uncommon and consequently not often considered a diagnostic possibility. Case Report: We report the case of a 25-year-old woman, gravida 4 para 1, who complained of vaginal spotting and lower abdominal pain after 6 weeks of amenorrhea following clomiphene citrate ovarian stimulation. Transvaginal Ultrasonography revealed an intrauterine pregnancy and an unruptured left tubal ectopic pregnancy. She underwent successful laparoscopic salpingectomy while the intra-uterine pregnancy was allowed to continue. The ectopic pregnancy tissue histology reported an ectopic partial molar pregnancy. She subsequently had a normal vaginal delivery at 39 weeks and 3 days and her follow-up was uneventful. Conclusion: Heterotopic pregnancy is a rare but life-threatening condition. It should be suspected in a pregnant woman with a risk factor of multiple gestations who presents vaginal bleeding and lower abdominal pain in the context of early pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating the ectopic component. Routine histological examination of tubal specimens must be taken very seriously because some findings like molar pregnancies may require specific management.

Molar Ectopic Pregnancy: A Case Study from the Maternity Unit of the Bobo-Dioulasso Teaching Hospital

The authors reported a case of molar ectopic pregnancy seen and managed at the maternity unit of the Bobo-Dioulasso Teaching Hospital. The frequency of the molar ectopic pregnancy is difficult to assess. Besides, the histopathological examination of surgical specimen of the salpingectomy is not usual in our setting. For the management, we realized a total left salpingectomy with a histopathological examination of surgical specimens in association with serum b HCG follow up. During post operations period, the patient was put on estro-progestin contraception for a year, a regular checkup of the biological marker of the molar pregnancy till negativation, a clinical, ultrasound and radiological checkup. No anomaly was noticed at the end of the follow up.

Tubal pregnancy with molar degeneration in concurrent eutopic pregnancy. A case report

This research paper presents the infrequent case of a heterotopic pregnancy based on a tubal ectopic pregnancy with molar degeneration in concurrent eutopic pregnancy. Treatment with evacuation/suction curettage and perlaparoscopic salpingectomy was required. This case report confirms what is biologically valid in the statistically unlikely.

Bilateral Tubal Molar and Embryonic Pregnancy

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

Ectopic Tubal Molar Pregnancy: A Case Report

Background: Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies. Aim: We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy. Case report: A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination and the histological examination show an aspect of a partial molar ectopic tubal pregnancy. Conclusion: Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.

Link between caries,periodontitis,and pregnancy:The role of personalized oral hygiene

Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus.This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women,with particular emphasis on periodontal disease and dental caries.Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight,many pregnant women do not receive adequate dental care.This gap in care is often due to misconceptions about the safety of dental treat-ments during pregnancy and lack of awareness on the part of healthcare profes-sionals.Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support,have proven effective in improving oral health in this population.Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient,thereby enhancing maternal and fetal health outcomes.Integration of personalized oral hygiene management into maternal health pro-grams and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.Core Tip:In this article,we reviewed a recent study on the effects of personalized oral hygiene management on the oral health of pregnant women,as discussed in the article by Men et al.The study demonstrated that personalized oral hygiene interventions significantly improved oral health outcomes during pregnancy by reducing the prevalence of dental caries and periodontal disease.We emphasized the importance of individualized oral care programs that integrate education and tailored support,and we highlighted their significance in enhancing maternal and fetal health.This approach underscores the need for incorporating personalized oral hygiene management into routine prenatal care in order to optimize health outcomes.CONCLUSION This article emphasizes the critical role of personalized oral hygiene management in improving oral health during pregnancy.By tailoring oral care strategies to individual needs,significant improvements in dental health may be achieved,as evidenced by the reduced CAT scores observed in the experimental group in the study by Men et al[25].This personalized approach not only addresses common oral issues such as dental caries and periodontal disease but also underscores the broader implications for maternal and fetal health.Despite the positive results,there remains a gap in consistency in the application of oral health practices during pregnancy,partly due to misconceptions and lack of awareness among patients and healthcare providers.Future research should aim at validating these findings across diverse populations,investigating the impact of oral hygiene interventions at various stages of pregnancy,and evaluating their long-term effects on maternal and fetal health.Integrating personalized oral hygiene management into maternal health programs and promoting continuous education for pregnant women and healthcare professionals are essential steps toward enhancing overall health outcomes.By proactively managing oral health,the risks associated with pregnancy may be reduced while improving maternal and neonatal well-being.

Maternal and fetal death associated with acute pancreatitis during pregnancy:A case report

BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.

Persistent challenges in the diagnosis of acute pancreatitis due to primary hyperparathyroidism during pregnancy

In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.

Independent risk factors for twin pregnancy adverse fetal outcomes before 28 gestational week by first trimester ultrasound screening

BACKGROUND The incidence of multiple pregnancies has increased worldwide recently and women with a twin pregnancy are at higher risk of adverse outcomes compared with women with a singleton pregnancy.It is important to understand the risk factors for adverse fetal outcomes in twin pregnancy in order to guide clinical management.AIM To identify the independent risk factors,including maternal personal and family medical histories and first trimester ultrasound screening findings,for adverse fetal outcomes of twin pregnancy before 28 weeks of gestation.METHODS The data of 126 twin pregnancies in our hospital,including pregnancy outcomes,first trimester ultrasound screening findings and maternal medical history,were retrospectively collected.Twenty-nine women with adverse outcomes were included in the abnormal group and the remaining 97 women were included in the control group.RESULTS Patients in the abnormal group were more likely to be monochorionic diamniotic(13/29 vs 20/97,P=0.009),with a higher mean pulsatility index(PI,1.57±0.55 vs 1.28±0.42,P=0.003;cutoff value:1.393)or a higher mean resistance index(0.71±0.11 vs 0.65±0.11,P=0.008;cutoff value:0.683)or early diastolic notch of bilateral uterine arteries(UtAs,10/29 vs 15/97,P=0.024)or with abnormal ultrasound findings(13/29 vs 2/97,P<0.001),compared with the control group.Monochorionic diamnioticity,higher mean PI of bilateral UtAs and abnormal ultrasound findings during first trimester screening were independent risk factors for adverse fetal outcomes(P<0.05).CONCLUSION First trimester ultrasound screening for twin pregnancy identifies independent risk factors and is useful for the prediction of fetal outcomes.

A Case Report of Kissing Molars Class II

Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.

Analysis of Perinatal Outcomes of Twin Pregnancy in a Referral Hospital for High Risk

Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.

Correlates of Mistimed Pregnancy and Unmet Need for Family Planning among Women of Reproductive Age in Sandema, Ghana

Background: Globally, an estimated 80 million unintended pregnancies comprising both mistimed and unwanted pregnancies are recorded yearly. Yet only half of the women at risk of mistimed pregnancy use contraceptives. In developing countries, over 100 million females have unmet need, and national surveys in Ghana indicate 23% unmet need rate. Methods: Using a cross-sectional community-based approach, a sample size of 300 women of reproductive age were selected using multi-step cluster sampling techniques. The study was quantitative, using structured interviewer-administered questionnaires. Results: Two-third (66%) of the women in reproductive age still had unmet need, 71% were currently pregnant, and more than a third (36%) confirmed ever having a mistimed pregnancy. Fifty-three percent (53%) of the women confirmed never communicating with their partners on family planning issues, a little below half (45%) took their own health care decisions. Seventy nine percent (79%) ever received family planning services from a health professional. Factors related to unmet needs included mistimed pregnancy, level of education, preferred birth/pregnancy interval, communication between partners and the autonomy to spend self-earnings. Conclusion: Considering that high rates of unmet need results in mistimed pregnancy, improved policies around the influence of unmet need on mistimed pregnancies are needed.

Term Abdominal Pregnancy with Live Baby;Case Report from St Padre Pio Hospital Akwa Nord Douala (August 2024)

In this report, we present a case of a term abdominal pregnancy managed in St Padre Pio Hospital Douala (Cameroon). The 28-year-old G2P1001 woman whom we received to our facility at 15 weeks gestation with an intrauterine pregnancy confirmed by ultrasonography. She returned at 21 weeks with a history of syncope and blood transfusion in another facility. An obstetrical ultrasonography done that day revealed a live fetus located at the upper right side within the peritoneal cavity. She continued with her routine Antenatal visits, and at each visit, an ultrasonography was done, revealing a slowly growing fetus. At 38 weeks, a laparotomy was carried out, and the live male baby weighing 2500 grammes was extracted. The placenta was implanted in the uterus;it was removed with minimal blood loss of approximately 400 mls. The mother was heamodynamically stable post-operatively. The newborn presented with mild cyanosis, an oxygen saturation of 80%, which resolved after 24 hours of oxygen administration. Both mother and baby were discharged from the hospital one week after laparotomy in a stable state. This case illustrates that intra-abdominal pregnancies, though rare and complex, can be managed to term and produce viable fetuses. Practitioners should, therefore, understand the challenges in its management.

Prevalence and Individual-Level Determinants of Uptake of Three or More Doses of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Busia County, Kenya

Background: Malaria in pregnancy causes maternal anemia, low birth weight, intrauterine growth retardation, and preterm deliveries. In malaria-endemic regions in Kenya, percentage of pregnant women hospitalized with malaria reach up to 60%. WHO recommends at least three doses of sulphadoxine pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) antenatally. This study sought to ascertain the prevalence and individual-level factors influencing the uptake of IPTp-SP3+. Methods: A facility-based cross-sectional study at Busia County Referral Hospital. 384 mothers were consecutively sampled at the maternity unit during delivery. Semi-structured questionnaires were used to collect data. Odds ratio (OR) and adjusted OR were used to determine statistical significance of individual factors influencing uptake of three or more IPTp-SP. Results: 43.0% of participants took IPTp-SP3+. Individual factors that affected the uptake of IPTp-SP3+ included starting ANC visits in the first trimester (adjusted odds ratio (aOR) = 2.1, 95% CI: 1.23 – 3.67, p = 0.046), having more than four ANC visits (aOR = 3.1, 95% CI: 1.49 – 6.50, p = 0.002), having a higher monthly income (aOR = 2.6, 95% CI: 1.24 – 5.36, p = 0.012), being aware of the advantages of IPTp-SP medications (aOR = 3.7, 95% CI: 1.40 – 9.74, p = 0.008), and having a positive attitude toward ANC services (aOR = 3.2, 95% CI: 1.61 – 6.31, p = 0.001). Conclusion: Less than half of the pregnant mothers are complyingIPTp-SP3+. There should be aggressive efforts by the County and National Ministries of Health promoting initiation of ANC attendance early and attendance of all the recommended eight visits together with ensuring availability of the drugs.

Thyroid disease in pregnancy: A review of diagnosis, complications and management

Malfunction of the thyroid gland is the second most common endocrine disorder encountered during pregnancy. It is well known that overt disease of the thyroid gland, either hyper or hypo can adversely affect pregnancy outcome. There is also an ongoing debate surrounding the issue of subclinical hypothyroidism and its effect on the cognitive development of the unborn child. The goal of this paper is to present a systematic review of the literature and the current recommendations for diagnosis and treatment of thyroid disease in pregnancy and postpartum.

Rare uterine serosal pregnancy after in vitro fertilization in a woman with bilateral salpingectomy

Objective:To improve the understanding of ectopic pregnancy after bilateral salpingectomy through case analysis and literature review.Method:A case of uterine serosal pregnancy after in vitro fertilization and embryo transfer(IVF-ET)in a woman with bilateral salpingectomy was reported in detail and summarized,and relevant literatures searched in Pubmed were analyzed.Results:The patient had a sudden abdominal pain 18 days after transplantation.Ultrasound showed no pregnancy sac in the intrauterine cavity and bilateral adnexal areas,but there was a large amount of fluid in the Pouch of Douglas,which was an indication for surgical exploration.During the operation,the pregnancy tissue was found on the uterine serosal and cleared in time.And the patient recovered well after surgery.Review of the literatures showed that most of ectopic pregnancies after bilateral salpingectomy were treated surgically and had a good prognosis.Conclusion:Ectopic pregnancy after bilateral salpingectomy is extremely rare and should be early judged by the patients’signs.Surgical treatment timely can achieve good outcome.

A Study on the Correlation of Body Mass Management During Pregnancy with Adverse Pregnancy Outcomes and Labor Progression

Objective:To investigate the effects of body mass management during pregnancy on adverse pregnancy outcomes,duration of labor,and neonatal birth weight.Methods:472 pregnant women who visited Beijing Anzhen Hospital from January to December 2023 were selected,and the pregnant women were divided into 236 each in the observation group and the control group.Body mass of pregnant women was measured and BMI was calculated in early and late pregnancy respectively,and the pregnant women in the control group were guided by routine management,while the observation group was guided by body mass management during pregnancy.The growth of maternal body mass,mode of delivery,postpartum hemorrhage,neonatal score,neonatal blood glucose at birth,and umbilical artery blood,as well as the comparison of the duration of labor,were observed.Results:The observation group was significantly better than the control group in terms of mode of delivery,postpartum hemorrhage,and body mass growth,with statistically significant differences(P<0.05),and there was no statistical significance in terms of neonatal scores,neonatal blood glucose at birth,and umbilical artery blood(P>0.05);the time of the first stage of labor and the time of the second stage of labor of the mothers in the observation group was significantly better than that of the control group,with statistical differences(P<0.05),and the time of the third stage of labor of the mothers in the observation group was statistically better than that of the control group.There was no statistically significant difference between the time of the third stage of labor in the observation group and the control group(P>0.05),and the time of the total stage of labor in the observation group was statistically better than that in the control group(P<0.05).Conclusion:Body mass management during pregnancy can effectively improve maternal control of weight gain,reduce labor time,and decrease the occurrence of adverse pregnancy outcomes.

Analysis of Cardiac Functional Status and Factors Influencing Adverse Pregnancy Outcomes in Pregnant Women with Combined Heart Disease

Objective:To investigate the cardiac function of pregnant women with complicated heart disease during pregnancy and the factors influencing the adverse pregnancy outcome.Methods:A total of 162 cases of pregnant women with complicated heart disease admitted to the Beijing Anzhen Hospital from October 2021 to December 2023 were selected to compare the occurrence of adverse pregnancy outcomes in pregnant women with complicated heart disease at different levels of cardiac function and to analyze the single and multi factors leading to adverse pregnancy outcomes in pregnant women with complicated heart disease.Results:Among 162 pregnant women with combined heart disease in pregnancy,the highest percentage of heart disease type was congenital heart disease(80/49.38%),and the lowest percentage was other(9/5.56%);the overall incidence of adverse pregnancy outcomes in pregnant women with combined heart disease in pregnancy with cardiac function grades of 3–4 cardiac function(30/68.18%)was higher than that in pregnant women with combined heart disease in cardiac function grades of 1–2(40/33.90%)(P=0.000);age,marital status,hypertension,and past history of all pregnant women were not statistically significant(P>0.05);gestational age,type of heart disease,and cardiac function grading were statistically significant(P<0.05),and these factors were all independent risk factors for adverse pregnancy resolution in pregnant women with combined heart disease(P<0.05).Conclusion:The overall incidence of adverse pregnancy outcomes was higher in pregnant women with heart disease than in those with heart disease grades 1–2,and the number of pregnancies,the type of heart disease,and heart function grades were all independent risk factors for adverse pregnancy outcomes in pregnant women with heart disease.

Integrins and their potential roles in mammalian pregnancy

Integrins are a highly complex family of receptors that, when expressed on the surface of cells, can mediate reciprocal cell-to-cell and cell-to-extracellular matrix(ECM) interactions leading to assembly of integrin adhesion complexes(IACs) that initiate many signaling functions both at the membrane and deeper within the cytoplasm to coordinate processes including cell adhesion, migration, proliferation, survival, differentiation, and metabolism. All metazoan organisms possess integrins, and it is generally agreed that integrins were associated with the evolution of multicellularity, being essential for the association of cells with their neighbors and surroundings, during embryonic development and many aspects of cellular and molecular biology. Integrins have important roles in many aspects of embryonic development, normal physiology, and disease processes with a multitude of functions discovered and elucidated for integrins that directly influence many areas of biology and medicine, including mammalian pregnancy, in particular implantation of the blastocyst to the uterine wall, subsequent placentation and conceptus(embryo/fetus and associated placental membranes) development. This review provides a succinct overview of integrin structure, ligand binding, and signaling followed with a concise overview of embryonic development, implantation, and early placentation in pigs, sheep, humans, and mice as an example for rodents. A brief timeline of the initial localization of integrin subunits to the uterine luminal epithelium(LE) and conceptus trophoblast is then presented, followed by sequential summaries of integrin expression and function during gestation in pigs, sheep, humans, and rodents. As appropriate for this journal, summaries of integrin expression and function during gestation in pigs and sheep are in depth, whereas summaries for humans and rodents are brief. Because similar models to those illustrated in Fig. 1, 2, 3, 4, 5 and 6 are present throughout the scientific literature, the illustrations in this manuscript are drafted as Viking imagery for entertainment purposes.

Successful treatment of group A streptococcal toxic shock syndrome occurring in late pregnancy:a case report

Streptococcal toxic shock syndrome(STSS)is an acute,life-threatening illness caused by invasive group A Streptococcus(iGAS).The initial manifestations of STSS are atypical,and may progress to shock,multiple organ dysfunction syndrome(MODS),and disseminated intravascular coagulation(DIC)quickly.