Hyperreactio luteinalis is a rare entity of pregnancy characterized by bilateral and functional enlargement of the ovaries that present thin-walled cysts. Several hypotheses suggest it is caused by increased concentrations or ovarian sensitivity to chorionic gonadotropin. Many cases do not present symptoms or complications during pregnancy, and diagnosis is done accidentally by routine ultrasound. This rare benign condition is usually self-limited and resolves spontaneously following delivery. However, some have to be differentiated from malignant ovarian tumors by histological examination. Surgery is indicated when there are complications such as ovarian torsion or peritonitis due to hemorrhage or rupture. We present a case of hyperreactio luteinalis during the third trimester of pregnancy.

Paraganglioma is an extra-adrenal neuroendocrine neoplasia derived from neural crest precursors that arise in association with autonomic ganglia. Also called extraadrenal pheochromocytomas, these tumors are defined by their anatomical site and whether they are hormonally functional. Paragangliomas are rare neoplasms of the female genital tract and may be located in the ovaries, uterus or cervix. Those that appear in the vulvovaginal region are extremely rare. Clinical manifestations depend on unregulated catecholamine secretion and location. Diagnosis is based on morphological and immunohistochemical findings. Surgical resection is the primary treatment for this tumor as it does not respond to chemotherapy and radiotherapy. Due to its low frequency and nonspecific symptomatology, diagnosis may be difficult. We present a case of primary vulvovaginal paraganglioma.

Müllerianosis is an embryonal disease of the müllerian or paramesonephric ducts, consists in the mixture of two or more types of tissues and results in the formation of adenomyosis, endometriosis, endosalpingiosis, and endocervicosis. It most often affects the urinary bladder in women of childbearing age. Müllerianosis of the cervix is a very rare benign condition, with few reported cases. The exact pathogenesis remains a matter of debate. There are several theories on its etiology; the main two are the implantation and metaplastic theories. Symptoms range from absent to pelvic pain and dysmenorrhea. It generally appears as a cystic tumor with glands of different sizes lined by endometrial, endocervical, or tubal epithelium. This lesion could be confused with other benign, premalignant, or even malignant lesions, and histopathological confirmation is necessary. Because it is a benign ...

Ovarian steroid cell tumors are classified into stromal luteoma, Leydig cell tumor and steroid cell tumor not otherwise specified, according to their embryonal origin. Ovarian steroid cell tumor not otherwise specified is a rare benign tumor, but with malignant potential; it accounts for less than 0.1% of all ovarian tumors. They should be considered as a cause of virilization in adult women due to testosterone production. Only a female fetus is at risk of virilization. Like other ovarian stromal tumors, the tumors must be treated surgically. Surgery is indicated in cases of solid unilateral ovarian enlargement, due to a 50% chance of malignancy. In pregnancy, ovarian steroid cell tumors not otherwise specified are exceptionally rare and should be differentiated from luteoma of pregnancy and other malignant ovarian neoplasms. More frequently they may be complicated by rupture and/or tors...

Postpartum hemorrhage can be a life-threatening condition. Successful approaches have been described using uterine compression sutures to control postpartum hemorrhage, in some cases by a combination of techniques. Procedures to reduce blood loss consist of uterine massage, medical treatment, uterine tamponade and hysterectomy. The uterine compression suture, or B-Lynch technique, has been proposed to control postpartum hemorrhage in such cases of uterine atony, preserving fertility. Although report of complications of this procedure is scarce, the appearance of necrosis, pyometra, uterine rupture and, more recently, exaggerated and abnormal invasion of the placenta (placenta accreta) in a subsequent pregnancy has been described. It is necessary to inform patients on potential complications of the procedure and the need of postoperative follow-up to confirm their absence. We present a ca...

Postpartum hemorrhage is an important cause of maternal mortality. The rupture of a uterine artery pseudoaneurysm, a rare vascular lesion of unknown prevalence, produces secondary postpartum hemorrhage without an evident cause. If not properly diagnosed and treated, it can be life threatening. Etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. Its clinical presentation is varied and often associated with other more frequent gynecological and obstetric pathologies. Patients may present no symptoms, vaginal bleeding or even postpartum hemorrhage and hypovolemic shock. To prevent fatal bleeding, a rapid and accurate diagnosis must be made, based on non-invasive imaging studies. Angiographic embolization is a safe and effective method to control hemorrhage in hemodynamically stable patients and should be an option before resortin...

Catamenial pneumothorax is a rare and complex clinical condition that should be considered as a cause of spontaneous and recurrent pneumothorax that is often misdiagnosed. It is a pulmonary pathology commonly associated with menstruation since it occurs within 72 hours before or after the onset of menstrual bleeding. The etiology and the exact underlying mechanism have not been identified, but it could be a rare form of extra-pelvic endometriosis characterized by the presence of functional endometrial tissue in the pleura, pulmonary parenchyma, and respiratorytract. Diagnosis is a challenge, so it can result in recurrences. It should be suspected in young women of childbearing age. The first line of treatment is medical, while surgical treatment is necessary to avoid recurrence. A case of recurrent catamenial pneumothorax is presented.

Placental mesenchymal dysplasia is a rare and benign placental abnormality. It is characterized by placentomegaly with multiple cystic lesions of the villous tree and vascular abnormalities along with increased maternal serum alpha-fetoprotein concentrations. It is an unknown clinical entity and can be confused with gestational trophoblastic disease due to the similar ultrasound findings in both entities; but the management and the perinatal outcome are different. It should be included in the differential diagnosis of ultrasound findings showing a normal-appearing fetus and a placenta with cystic lesions. However, placental mesenchymal dysplasia is associated with complications such as intrauterine growth restriction and intrauterine fetal death. Due to the high number of complications and associated pathologies, it is necessary to increase ultrasound evaluations to reduce fetal morbidit...

Ovarian teratomas are tumors derived from the three germinal layers. Gliomatosis peritonei is a rare condition characterized by glial tissue implants in peritoneum, commonly associated with immature ovarian teratoma, but not with mature teratomas. Definitive diagnosis is based on histopathological examination. Currently, there are no guidelines for its follow-up. Prognosis is favorable; however, implants may present fibrotic regression or exceptionally degenerate into glioblastoma. Treatment should be similar to that of metastatic ovarian carcinoma if immature glial tissue or other teratomatous components are found in peritoneum or omentum. Long-term follow-up is necessary in patients with residual peritoneal disease due to risk of recurrence and malignant transformation. We present a case of gliomatosis peritonei associated to mature ovarian teratoma.

Objective: To compare the uterocervical angle with the cervical length in the prediction of impending preterm delivery in symptomatic patients. Design: Case-control study. Institution: Central Hospital “Dr. Urquinaona”, Maracaibo, Venezuela. Participants: Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery beyond 7 days (group B). Methods: At the time of diagnosis, the patients were evaluated using transvaginal ultrasound and were followed until delivery. Main outcome measures: General characteristics, uterocervical angle, cervical length, impending preterm delivery, and prognostic efficacy. Results: 326 patients were included, 75 women presented impending preterm delivery (group A) and 251 patients were considered as controls (group B). The patients in group A had significantly higher values of the uterocervical angle and lower cervical le...

Objective: To establish the prognostic usefulness of cervical length and uterine artery pulsatility index for imminent preterm delivery in symptomatic patients. Design: Case-control study. Setting: Central Hospital "Dr. Urquinaona ", Maracaibo, Venezuela. Participants: Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery within more than 7 days (group B). Methods: Cervical length and uterine artery pulsatility index were determined at hospital admission and all were followed until delivery. Main outcome measures: General characteristics, cervical length, uterine artery pulsatility index, imminent preterm delivery, and prognostic efficacy. Results: 119 participants were assigned to group A and 362 patients to group B. Cervical length was lower in group A, and the uterine artery pulsatility index was higher compared with group B (p <0.0001). Cervi...