Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.
Pregnancy ; Humans ; Female ; Young Adult ; Adult ; Cesarean Section/adverse effects* ; Retrospective Studies ; Pregnancy, Ectopic/surgery* ; Pregnancy, Cornual/surgery* ; Uterus/surgery* ; Uterine Rupture/etiology* ; Abortion, Spontaneous

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.
Cesarean Section ; Female ; Fetal Weight ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Labor Pain ; Labor, Induced ; Maternal Age ; Parity ; Pregnancy ; Prostaglandins ; Trial of Labor ; Uterine Rupture ; Vaginal Birth after Cesarean

OBJECTIVE: Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome. METHODS: We conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses. RESULTS: The incidence of preterm delivery (< 32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at < 32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively. CONCLUSION: Comparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.
Cerclage, Cervical ; Female ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Membranes ; Observational Study ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Rupture ; Uterine Cervical Incompetence

A 32-year-old multiparous woman (gravida 2, para 2) with a history of previous cesarean section had acute abdominal pain and collapsed at 21 weeks of gestation. Exploratory laparotomy was performed because of the patient's worsening condition; ultrasound examination results were suggestive of massive hemoperitoneum, and fetus in vertex presentation with bradycardia. Uterine rupture between the left lower segment and borderline of the cervix in the anterior wall with active bleeding was confirmed. An uncomplicated classical cesarean section was performed, but the fetus was stillborn due to preterm birth. Hysterectomy was performed after the cesarean section. The patient was admitted to intensive care units for 3 days and was discharged in 12 days following delivery. Placenta percreta at the anterior lower segment of the uterus was confirmed in the pathology report.
Abdominal Pain ; Adult ; Bradycardia ; Cervix Uteri ; Cesarean Section ; Female ; Fetus ; Hemoperitoneum ; Hemorrhage ; Humans ; Hysterectomy ; Intensive Care Units ; Laparotomy ; Pathology ; Placenta Accreta* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Premature Birth ; Ultrasonography ; Uterine Rupture* ; Uterus

Middle East respiratory syndrome (MERS) is a lethal respiratory disease — caused by MERS-coronavirus (MERS-CoV) which was first identified in 2012. Especially, pregnant women can be expected as highly vulnerable candidates for this viral infection. In May 2015, this virus was spread in Korea and a pregnant woman was confirmed with positive result of MERS-CoV polymerase chain reaction (PCR). Her condition was improved only with conservative treatment. After a full recovery of MERS, the patient manifested abrupt vaginal bleeding with rupture of membrane. Under an impression of placenta abruption, an emergent cesarean section was performed. Our team performed many laboratory tests related to MERS-CoV and all results were negative. We report the first case of MERS-CoV infection during pregnancy occurred outside of the Middle East. Also, this case showed relatively benign maternal course which resulted in full recovery with subsequent healthy full-term delivery without MERS-CoV transmission.
Cesarean Section ; Coronavirus ; Coronavirus Infections ; Female ; Humans ; Korea* ; Membranes ; Middle East ; Middle East Respiratory Syndrome Coronavirus* ; Placenta ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women* ; Rupture ; Uterine Hemorrhage

A 30-year-old woman experienced severe abdominal pain 8 days after vaginal delivery. The patient was diagnosed with hemoperitoneum due to rupture of the left uterine artery pseudoaneurysm, which was confirmed via ultrasound with color Doppler and computed tomography scans. This patient was treated with bilateral uterine artery embolization to maintain fertility. A uterine artery pseudoaneurysm that causes delayed postpartum hemorrhage can occur after cesarean section or vaginal delivery. A uterine artery pseudoaneurysm can be fatal, so its detection and diagnosis are critical. Herein, we report a case of delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture.
Abdominal Pain ; Adult ; Aneurysm, False* ; Cesarean Section ; Diagnosis ; Female ; Fertility ; Hemoperitoneum* ; Humans ; Postpartum Hemorrhage ; Postpartum Period* ; Pregnancy ; Rupture* ; Ultrasonography ; Uterine Artery Embolization ; Uterine Artery*

This is a case report of a first trimester cesarean scar pregnancy (CSP) evolving into a placenta accreta at term based on the ultrasound imaging. The gestational sac, initially implanted at the site of previous scar, grew into the uterine cavity as the pregnancy progressed and resulted into a viable birth complicated by placenta accreta.
Cesarean scar pregnancy is a rare form of ectopic pregnancy and is associated with increased maternal morbidity and mortality. Thus, early recognition of the salient sonographic findings is crucial because a delay could lead to a life threatening condition. Early diagnosis also gives women the option to choose between expectant management and termination of pregnancy. The exact incidence of CSP has not been determined but its incidence is on the rise in parallel with the high rate of cesarean sections. There are two types of CSP. The first type is due to the implantation of the gestational sac on the scar with progression towards the uterine cavity. In this type expectant management is justifiable since pregnancy may progress into a viable pregnancy. The second type involves growth of gestational tissues towards the bladder and abdominal cavity and is associated with uterine rupture if immediate intervention is not undertaken. In this report, we present a case of a first trimester CSP that was managed expectantly and developed into placenta accreta at term.

Human ; Female ; Adult ; Placenta Accreta ; Pregnancy Trimester, First ; Gestational Sac ; Uterine Rupture ; Pregnancy, Ectopic ; Cesarean Section ; Embryo Implantation

This is a case report of a first trimester cesarean scar pregnancy (CSP) evolving into a placenta accreta at term based on the ultrasound imaging. The gestational sac, initially implanted at the site of previous scar, grew into the uterine cavity as the pregnancy progressed and resulted into a viable birth complicated by placenta accreta.
Cesarean scar pregnancy is a rare form of ectopic pregnancy and is associated with increased maternal morbidity and mortality. Thus, early recognition of the salient sonographic findings is crucial because a delay could lead to a life threatening condition. Early diagnosis also gives women the option to choose between expectant management and termination of pregnancy. The exact incidence of CSP has not been determined but its incidence is on the rise in parallel with the high rate of cesarean sections. There are two types of CSP. The first type is due to the implantation of the gestational sac on the scar with progression towards the uterine cavity. In this type expectant management is justifiable since pregnancy may progress into a viable pregnancy. The second type involves growth of gestational tissues towards the bladder and abdominal cavity and is associated with uterine rupture if immediate intervention is not undertaken. In this report, we present a case of a first trimester CSP that was managed expectantly and developed into placenta accreta at term.

Human ; Female ; Adult ; Placenta Accreta ; Pregnancy Trimester, First ; Gestational Sac ; Uterine Rupture ; Pregnancy, Ectopic ; Cesarean Section ; Embryo Implantation

Pyometra, an accumulation of pus within the uterine cavity, is a rare gynecologic disease with an incidence of 0.01-0.5% among all gynecologic patients and 13.6% among elderly gynecologic patients. Pyometra in itself is rare, much so is uterine rupture occurring secondary to it. No local data reporting incidence of ruptured pyometra in the Philippines has been published. This is a case of a 63-year-old Gravida 5 Para 5 (5-0-0-4), with Cervical Endometrioid Adenocarcinoma Stage IIIB, presented with abdominal pain. Whole abdominal Computed Tomography scan revealed pneumoperitoneum. Initial assessment was pneumoperitoneum probably secondary to ruptured viscus. The patient underwent exploratory laparotomy which revealed ruptured pyometra. Subsequent management included drainage, culture guided antibiotics, radiotherapy and brachytherapy. Spontaneous rupture of pyometra is a serious medical condition which requires an accurate diagnosis in order to arrive in appropriate surgical and medical management. However, pre-operative diagnosis is difficult despite the presence of advanced imaging techniques, hence high level of suspicion is warranted in identifying this condition.

Human ; Female ; Middle Aged ; Uterine Rupture ; Pyometra ; Pneumoperitoneum ; Brachytherapy ; Carcinoma, Endometrioid ; Injections, Intraperitoneal ; Abdominal Pain

Abortion, Induced ; adverse effects ; Adult ; Device Removal ; Embolization, Therapeutic ; Female ; Humans ; Intrauterine Devices ; Pregnancy ; Uterine Artery ; Uterine Rupture ; etiology