A 40-year-old, gravida 3 para 2 (1-1-0-2), previous primary cesarean section for nonreassuring fetal status, presented at a tertiary hospital for confirmation of cesarean scar pregnancy (CSP). Transvaginal ultrasound confirmed a CSP at 8 2/7 weeks age of gestation with good embryonic cardiac activity, raising concern for early placenta accreta spectrum. A multidisciplinary team composed of an obstetrician, advanced pelvic surgeon, urologist, and anesthesiologist managed the patient. The patient underwent total abdominal hysterectomy with bilateral salpingectomy, as the patient has a completed family size. Before the procedure, she was given cefuroxime as prophylactic antibiotic. Intraoperatively, there were dense adhesions between the posterior bladder wall and the previous cesarean section scar. Inadvertent injury to the bladder wall was incurred during adhesiolysis. Cystorrhaphy was done by a urologist, while the rest of the surgery was unremarkable, with a 450 ml estimated blood loss. The postoperative course was unremarkable. Bladder rest was achieved by maintaining an indwelling Foley catheter, which remained in place upon discharge on postoperative day 3 and was continued for 7 days thereafter. At follow-up, a successful voiding trial was conducted, confirming the return of normal bladder function.

Human ; Female ; Adult: 25-44 Yrs Old ; Cesarean Section ; Salpingectomy ; Hysterectomy ; Fetal Distress ; Placenta Accreta ; Cefuroxime ; Catheters ; Cicatrix

Background: Early stage ovarian cancer may be managed with fertility-sparing surgery, to preserve the uterus and contralateral ovary, thus preserving future reproductive function. The aim of this study was to determine the reproductive outcome of early stage ovarian cancer managed conservatively by unilateral salpingooophorectomy, and to compare the survival and recurrence rate among those who had and did not have pregnancy after treatment. Methodology:: A retrospective cohort study was conducted on 34 patients with early stage ovarian cancer who underwent fertility-sparing surgery from January 2005 to December 2018. Fertility outcome following treatment was determined. Survival and recurrence rate was analyzed between those who had and did not have pregnancy after surgery. Results: A total of 34 out of 661 (5.14%) new cases of ovarian cancer who underwent fertility-sparing surgery were analyzed, with a mean age of 23.71 ± 5.57 years (range: 12-36 years old), with the most common complaints of increasing abdominal girth (11/34, 32.35%) or palpable abdominal mass (11/34, 32.35%). Successful pregnancy was seen in 9 cases (26.47%), with 2 of them currently pregnant. Overall recurrence and survival rates were 14.71% and 91.18%, respectively. There was no statistically significant difference in the survival rate (88.89% vs 92%, p-value 0.7778) and rate of recurrence (22.22% and 12%, p-value 0.4578) between those who got pregnant after fertility-sparing surgery for early stage ovarian cancer, FIGO Stage IA and IC, compared to those who did not get pregnant. Conclusions Fertility-sparing surgery can be effectively offered to young patients with early stage ovarian cancer, to preserve reproductive function, with 26.47% successful pregnancy rate. Pregnancy had no significant effect on recurrence and survival among FIGO stage IA and IC ovarian cancer who underwent fertility-sparing surgery by unilateral salpingooophorectomy.
Fertility ; Health Services ; Ovarian Neoplasms