Pubic symphysis diastasis is rare in normal vaginal delivery. Etiology is not clear but it is associated with multiparity, macrosomia, physiological joint loosening and excessive force on the pubic area. Symptoms include pain around the pubic symphysis, hips, groin, lower abdomen and inner thighs, as well as tenderness over the area. Imaging shows distance between pubic bones. Management varies from case to case and outcomes are scarcely known. Delayed diagnosis has health implications for the woman in the short and long term. We report a case of postpartum pubic symphysis diastasis. An 18-year-old woman presented lacerating pain in the pubic area in the second day of the postpartum period, after a pregnancy of normal evolution and a spontaneous vaginal delivery, with a term live newborn and no apparent complications. On physical examination, we found moderate pain in the pubic region, w...

Twin reversed arterial perfusion sequence is a complication of monochorionic twin pregnancies in which one twin that exhibits lethal anomalies, including acardia, is perfused by the other ‘pump’ twin via anastomoses between placental arteries. This results in growth and characteristic anomalies of the acardiac twin, and possible heart failure of the pump twin. The exact pathophysiological mechanisms that lead to this devastating phenomenon are not well known. It occurs in about 1% of monochorionic pregnancies and in one out of 35 000 pregnancies. Mortality is usually due to anemia and cardiac complications which can lead to cardiac failure, appear early during pregnancy and cause the death of the pump twin. We report a case of twin reversed arterial perfusion in a 28-year-old patient with 12 weeks monochorionic-diamniotic pregnancy that was referred for absent cardiac activity in one...

Objective: To compare pre and post-partum sexual hormones concentrations in preeclamptic patients and in healthy normotensive pregnant women. Design: Casecontrol study. Setting: Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Participants: Normotensive and preeclamptic pregnant women. Methods: A total of 142 patients were selected. Ninety preeclamptic patients were selected as the study group (group A) and 71 healthy normotensive pregnant women with similar age and weight were selected as controls (group B). Blood samples were extracted from all patients before labor and immediately after diagnosis in group A to determine sexual hormones concentrations. Post-partum follow-up samples were collected at 7 days and 6 weeks later in both groups. Main outcome measures: General characteristics, concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate,...

The increased use of laparoscopy has resulted in additional complications specific to this type of approach, such as incisional hernias that are usually associated with trocar size larger than 10 millimeters. These are a rare complication of laparoscopic surgery, with a reported incidence below 1%. They are a cause of postoperative morbidity and require immediate surgery. All entry sites should be closed to avoid such complications. A case of bilateral post-laparoscopic incisional hernia is described. A 35-year-old female patient with a history of laparoscopic surgery with a 3-port approach presented with vomiting, moderate-intensity abdominal pain and abdominal distension. Computed axial tomography showed intestinal loops at the site of trocar placement in both iliac fossae. During emergency laparoscopy, distended bowel loops were found, with two portions included in the bilateral defec...

Placental chorioangiomas are benign vascular tumors and are the most common placental tumors, with a prevalence of 1%. It rarely surpasses 4 - 5 centimeters in length and, when it happens, is referred to as giant chorioangioma. Pregnancies with giant chorioangiomas are associated with maternal and fetal complications, such as severe microangiopathic haemolytic anemia, preterm labor, polyhidramnios, intrauterine growth restriction, thrombocytopenia and hydrops. A case of giant chorioangioma diagnosed at 22 weeks is presented. Despite close follow-up, delivery occurred at 30 weeks of pregnancy due to polyhidramnios and premature rupture of membranes. Both mother and newborn recovered without complications.

Persistent left superior vena cava is the most frequent congenital venous anomaly, observed in 0.3-0.5% of the general population and in 4-8% of patients with congenital heart disease. The perinatal outcome is significantly worse if it is associated with cardiac defects and the prognosis is excellent in isolated cases. We report a case of persistent left superior vena cava diagnosed in a 30-week fetus in a 21-year-old female patient referred for prenatal fetal echocardiographic evaluation. During the visualization of the three vessels, a supernumerary circular vascular structure was observed to the left of the pulmonary artery, extending into the lateral wall of the left atrium, consistent with persistent left superior vena cava. No other heart abnormalities were found. The pregnancy was uncomplicated and a healthy baby was born full-term without any complications. Postnatal echocardiogr...

Paratubal cysts are simple cystic structures filled with serous fluid that are located along the Fallopian tube, usually arising from the broad ligament or mesosalpinx. It is important to always consider tube torsion as a differential diagnosis for female patients presenting with an acute abdomen, and to be aware of the need for quick diagnosis and surgical treatment in order to preserve the patient’s fertility, especially in younger patients of child-bearing age. We present the case of a 16 year-old female patient who complained of intense hypogastric pain together with vomits. During laparoscopy, a torted paratubal cyst was found in the right adnexa. Laparotomy was performed to remove the cyst and salpingectomy was carried out, since the right Fallopian tube was unsalvageable. Histological analysis showed that the mass was a paratubal cyst.

Fetal renal vein thrombosis is an uncommon diagnosis associated to inherited thrombophilia as well as prothrombotic clinical conditions. The typical ultrasound findings include enlargement of the affected kidney with parenchymal hyperechogenicity. We present a case of fetal renal venous thrombosis. A 27-year-old pregnant woman with 31 weeks pregnancy was referred for evaluation of a fetal abdominal mass. Ultrasound showed an enlarged and echogenic right fetal kidney. The renal pelvis was not visible, and there was absence of corticomedullary differentiation. The left kidney was normal in appearance. Doppler examination showed no blood flow in the vein of the right kidney. The investigation for thrombophilia was negative. Postnatal imaging proofed right renal vein thrombosis extending to the inferior vena cava.

Multiple pregnancies, most of which are twins, have a substantially increased risk of fetal morbidity and mortality compared to single pregnancies. The fetal death of one of the twins in monochorionic twin pregnancies is more frequent than in twin dichorionic pregnancies. Intrauterine fetal death occurs in 1-7% of all twin pregnancies and greatly increases the rate of complications of the surviving twin including fetal loss, preterm birth, and end organ damage. The gestational age at which intrauterine fetal death occurs and the chorionicity of the multiple pregnancy are the two most important factors when considering the risks of the surviving twin. The morbidity and mortality of these pregnancies may decrease with risk identification and intensive prenatal surveillance. Monochorionic pregnancies are more difficult to manage, and often pregnancies are interrupted at 34-36 weeks. Dichori...

Combination of postpartum spontaneous pneumomediastinum and subcutaneous emphysema is a very rare event that mainly occurs during the second stage of labor. Symptoms usually appear during the immediate postpartum period and include acute chest pain, shortness of breath, neck swelling and subcutaneous emphysema. These symptoms may mimic fatal conditions. It is a benign clinical situation and the symptoms generally resolve spontaneously without long-term consequences. Chest X-ray is the most important diagnostic test although normal results do not rule out the diagnosis. We present the case of a 20-year-old primiparous pregnant woman with pleuritic chest pain and swelling in neck and face during the immediate puerperium. She had subcutaneous emphysema and pneumomediastinum without significant cardiorespiratory compromise. Chest X-ray and computed tomography scan confirmed the findings. The...

Uterine rupture is an obstetric emergency that can have catastrophic results. Intraperitoneal prolapse of the amniotic sac, also known as amniocele, is a unique initial manifestation of silent or complete uterine rupture during pregnancy. It can occur as a result of preexisting injury, uterine abnormalities or alterations in uterine scarring. Ultrasound plays an important role in the diagnosis of this condition: it is essential for the management of these patients and optimizes maternal and perinatal outcome. We present the case of a 22-year-old patient with acute abdominal pain at 34 weeks’ gestation. Ultrasound showed a viable fetus inside the amniotic cavity along with oligohydramnios and an echogenic cystic lesion of 8 x 6 centimeters. Doppler and tridimensional ultrasound confirmed the diagnosis as intraperitoneal prolapse of the amniotic sac through a uterine rupture. During cesa...

Idiopathic granulomatous mastitis is a rare, benign chronic disease. Its etiology is not clear; however, the disease has been associated with breastfeeding, use of oral contraceptives, and an autoimmune component. The characteristic presentation is an inflammatory reaction with non-caseating granulomas. Histological features include signs of chronic granulomatous inflammation with giant cells, leukocytes, epithelioid cells, and macrophages, as well as microabscesses. In the differential diagnosis, all causes of granulomatous changes should be excluded. Due to its low frequency, the treatment is difficult to standardize and optimize. We present the case of a 36-year-old woman with a painful nodule in the right breast. Clinical presentation and imaging raised suspicion of carcinoma. Histopathology revealed acute and chronic inflammation, infiltration of macrophages and giant perivascular h...

Sebaceous carcinoma is a rare malignant tumor of the skin that usually appears in the head and neck region. Its clinical course is aggressive and local recurrences - distant metastases are common. Some cases of sebaceous carcinoma of the female genital tract have been reported. Although sebaceous glands are prominent in the vulva, sebaceous carcinomas rarely occur in this location. Little is known about the behavior and prognosis of this type of cancer. We present a case of a 69-year-old patient with a history of a 3 x 2-centimeter tumor for 9 months in the left labium majus. She had no medical or family history of malignant neoplasms. Increases in size was observed during this period, but otherwise, she was asymptomatic. Lesion was completely excised. The tumor was composed of lobes of tumor cells with sebaceous differentiation. Histopathological report revealed vulvar sebaceous carcino...

Objective: To compare serum brain natriuretic peptide concentrations in preeclamptic patients and healthy normotensive pregnant women. Design: Case-control study. Setting: Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Participants: A total of 180 patients were selected. Ninety preeclamptic patients were selected as the study group (group A) and 90 healthy normotensive pregnant women with the same age and body mass index as the study group were selected as controls (group B). Methods: Blood samples were extracted from all patients before labor and immediately after diagnosis in group A to determine serum cerebral natriuretic peptide concentrations. Main outcome results: General characteristics, serum brain natriuretic peptide concentrations and diagnostic efficacy. Results: There was a statistically significant difference in serum brain natriuretic peptide concentrations be...