Case Reports in Women's Health最新文献

{"title":"Outcomes of subsequent pregnancies following modified one-step conservative uterine surgery (MOSCUS) in the management of placenta accreta spectrum: Two case reports and a narrative review of the literature","authors":"Anh Dinh Bao Vuong ,&nbsp;Xuan Trang Nguyen ,&nbsp;Xuan Trang Thi Pham ,&nbsp;Phuc Nhon Nguyen","doi":"10.1016/j.crwh.2026.e00781","DOIUrl":"10.1016/j.crwh.2026.e00781","url":null,"abstract":"<div><div>Cesarean hysterectomy is a common management approach for placenta accreta spectrum. While conservative uterine management can preserve fertility, outcome data remain limited. This article reports the long-term results of modified one-step conservative uterine surgery (MOSCUS) in two cases of placenta accreta spectrum and reviews the literature on the outcomes of subsequent pregnancies after conservative management of the condition. Two women with a history of placenta accreta spectrum managed with MOSCUS attended a tertiary referral hospital in southern Vietnam with term and near-term pregnancies. The pregnancy outcomes were favorable with elective cesarean delivery. Neither uterine rupture nor recurrent placenta accreta spectrum was observed. The low uterine segment of the myometrial layer was 1–1.5 cm in thickness. The mothers and neonates were discharged uneventfully. The data relating to the subsequent pregnancy outcomes after conservative management reported in the literature spanning 2020–2025 are limited and heterogeneous. Commonly, the materno-fetal outcomes are favorable. The recurrence of placenta accreta spectrum in late pregnancy ranges from 5.5 % to 22.7 %. The major concerns are the increased rate of cesarean section and postpartum hemorrhage. In conclusion, the MOSCUS is a promising method that preserves fertility. A well-resourced antenatal care system with a multidisciplinary team is needed to manage these high-risk pregnancies. Further data are required to strengthen these findings.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00781"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis beyond the pelvis: Insights from atypical presentations leading to diagnostic delays","authors":"Lance De Barry,&nbsp;Vishal Bahall","doi":"10.1016/j.crwh.2026.e00786","DOIUrl":"10.1016/j.crwh.2026.e00786","url":null,"abstract":"","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00786"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147395685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twin-twin transfusion syndrome in a dichorionic-diamniotic gestation with post-laser amniotic band sequence: A case report","authors":"Melissa Chambers,&nbsp;Madushka Y. De Zoysa ,&nbsp;Tamera Hatfield","doi":"10.1016/j.crwh.2026.e00783","DOIUrl":"10.1016/j.crwh.2026.e00783","url":null,"abstract":"<div><div>Twin-twin transfusion syndrome most commonly develops in monochorionic-diamniotic twin pregnancies but rarely has been documented in dichorionic pregnancies. Twin-twin transfusion syndrome can often be successfully treated with fetoscopic laser surgery; sequelae are infrequent but can include chorion-amnion membrane separation, preterm rupture of membranes, preterm delivery, neurodevelopmental delay, and, rarely, amniotic band syndrome.</div><div>This report concerns the case of a 30-year-old nulligravid woman who presented for routine anatomy evaluation in the setting of a dichorionic-diamniotic monozygotic twin pregnancy. On initial evaluation, selective growth restriction with discordant amniotic fluid was noted, concerning for the development of twin-twin transfusion syndrome. On subsequent evaluation, she was diagnosed with stage 2 twin-twin transfusion syndrome and underwent successful fetoscopic laser ablation at 20 weeks of gestation. Ultimately, the patient underwent cesarean section at 29 weeks for labor after rupture of membranes. The postnatal course was complicated by amniotic band syndrome in one of the neonates.</div><div>This case highlights twin-twin transfusion syndrome diagnosed in the rare setting of a dichorionic-diamniotic monozygotic twin pregnancy and a rare postoperative complication of amniotic band syndrome after fetoscopic laser surgery.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00783"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy care and intrapartum management of a woman with high-level cervical spinal cord injury and neurogenic bladder: a case report","authors":"Monchai Suntipap ,&nbsp;Thanathip Samitinthu ,&nbsp;Potsanop Kassayanan ,&nbsp;Tanapat Pansaksiri ,&nbsp;Kasidis Nontaprom","doi":"10.1016/j.crwh.2025.e00777","DOIUrl":"10.1016/j.crwh.2025.e00777","url":null,"abstract":"<div><div>Pregnancy in women with high-level cervical spinal cord injury presents complex challenges, particularly related to autonomic instability, neurogenic bladder dysfunction, and risks of autonomic dysreflexia. Optimal management requires coordinated multidisciplinary care and individualized delivery planning. The case is presented of a 32-year-old woman (gravida 4, para 1) with a chronic spinal cord injury involving the sixth and seventh cervical levels, with neurogenic bladder and bilateral vesicoureteral reflux. Her urodynamic profile evolved from detrusor areflexia to reduced compliance with terminal detrusor overactivity, managed with clean intermittent catheterization. Pregnancy was closely monitored with multidisciplinary collaboration. At 38 weeks and 3 days of gestation, she presented in spontaneous active labor with stable hemodynamics and no features of autonomic dysreflexia. Continuous bladder drainage was instituted, and rapid cervical progression precluded neuraxial anesthesia. A supervised vaginal delivery was achieved in a semi-recumbent position without autonomic instability. A healthy male neonate was delivered with Apgar scores of 9 and 9. Postpartum recovery was uncomplicated, including postpartum tubal ligation and structured bladder management with temporary Foley drainage followed by resumption of clean intermittent catheterization. Renal surveillance and early outpatient follow-up confirmed stable maternal and neonatal outcomes. This case demonstrates that vaginal delivery can be safely accomplished in select women with high-level cervical spinal cord injury when multidisciplinary care, optimized bladder management, and vigilant intrapartum monitoring are available. Individualized, condition-based decision-making should guide the mode of delivery rather than neurological level alone.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00777"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undiagnosed placenta accreta spectrum complicated by massive haemorrhage during mid-trimester medical termination of pregnancy: a case report","authors":"Natalie Drever ,&nbsp;Sunthra Shanmuga Lingam ,&nbsp;Joanna Arnold","doi":"10.1016/j.crwh.2026.e00790","DOIUrl":"10.1016/j.crwh.2026.e00790","url":null,"abstract":"<div><div>Placenta accreta spectrum (PAS) is a well-recognised cause of severe obstetric haemorrhage in late pregnancy but is rarely encountered during abortion, particularly in the mid-trimester. Diagnosis in this setting is challenging, and unrecognised abnormal placentation may result in catastrophic maternal morbidity. We report the case of a 28-year-old multiparous woman with three prior caesareans who presented at 17 weeks of gestation with preterm prelabour rupture of membranes and placenta previa. Targeted mid-trimester ultrasound reviewed by a maternal–fetal medicine subspecialist demonstrated no sonographic features suggestive of PAS. Following counselling, medical termination of pregnancy was initiated using mifepristone and misoprostol. Uncontrolled bleeding led to timely transfer to the operating theatre for hysterotomy and management of haemorrhage. The procedure was complicated by sudden massive haemorrhage, haemodynamic collapse, and intraoperative cardiac arrest. Despite uterine evacuation and resuscitative measures, uncontrolled bleeding necessitated an emergency subtotal hysterectomy, complicated by dense vesicouterine adhesions and bladder injury. The patient survived following massive transfusion, intensive care admission, and multidisciplinary management. This case highlights the limitations of mid-trimester imaging in reliably excluding clinically significant PAS. It also underscores the potential for abrupt, life-threatening haemorrhage during medical termination of pregnancy in women with multiple previous caesarean deliveries. As caesarean rates rise, clearer guidance is needed regarding risk stratification, imaging pathways, and procedural planning for mid-trimester abortion to minimise maternal morbidity.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00790"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral haemorrhagic cysts on ultrasound with an intraoperative diagnosis of spontaneous bilateral unruptured ectopic pregnancies: A case report with management challenges in a rural setting","authors":"Eleanor Horsburgh,&nbsp;Penelope Black","doi":"10.1016/j.crwh.2026.e00788","DOIUrl":"10.1016/j.crwh.2026.e00788","url":null,"abstract":"<div><div>Spontaneous bilateral ectopic pregnancy is extremely rare, with an estimated incidence of 1 in 200,000 spontaneous pregnancies. Diagnosis is challenging, particularly in rural and remote settings where clinicians may have limited experience with rare presentations and reduced access to advanced imaging and specialist support. This report presents the case of a 36-year-old woman (gravida4, para 3) who presented to a rural hospital with vaginal bleeding and pelvic pain at 4 + 5 weeks of gestation. Serial quantitative beta-human chorionic gonadotropin levels increased from 962 IU/L to 6545 IU/L over 15 days. Transvaginal ultrasound demonstrated no intrauterine pregnancy, a right adnexal mass, and bilateral haemorrhagic ovarian cysts. She was admitted with suspected right tubal ectopic pregnancy. After discussion regarding the ultrasound findings and management options, the patient was consented for a right salpingectomy. However, at laparoscopy, bilateral unruptured tubal ectopic pregnancies were identified. Following an intraoperative discussion with next of kin, a right salpingectomy and additional left salpingostomy were performed to preserve natural fertility. Her postoperative recovery was uncomplicated and she was discharged home with serial quantitative testing of beta-human chorionic gonadotropin levels until negative. Histopathology confirmed bilateral tubal ectopic pregnancies. Bilateral ectopic pregnancy is difficult to diagnose preoperatively. This case highlights the potential diagnostic significance of bilateral corpus lutea and the importance of maintaining a high index of suspicion. In rural settings, limited access to sonographic expertise and fertility services may complicate both diagnosis and management. Bilateral ectopic pregnancy should be considered in suspected ectopic pregnancies with bilateral adnexal findings. Careful imaging review and fertility-conscious surgical planning are essential, particularly in rural and remote healthcare settings.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00788"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small bowel volvulus secondary to torsion of a mature cystic teratoma in the first trimester of pregnancy: A case report","authors":"Wondwosen Mengist Dereje ,&nbsp;Biniam Gezahagn zewude ,&nbsp;Gashaw Tesfa Aragaw ,&nbsp;Meredin Nuru Seyide ,&nbsp;Asmare Getaneh Aynishet ,&nbsp;Misganaw Abere Worku ,&nbsp;Samuel Addisu Abera ,&nbsp;Gebremariam Maru Yemru ,&nbsp;Alem Demissie Bogale ,&nbsp;Asratu Getnet Amare ,&nbsp;Fasil Tadesse Ashagrie","doi":"10.1016/j.crwh.2025.e00776","DOIUrl":"10.1016/j.crwh.2025.e00776","url":null,"abstract":"<div><div>Small bowel volvulus is a rare but potentially life-threatening surgical emergency. Its occurrence in association with ovarian cyst torsion during pregnancy is exceedingly rare, with few cases reported. To the authors' best knowledge, this case represents the first documented instance occurring in the first trimester.</div><div>A 37-year-old woman (gravida 3, para 2) at 12 weeks +2 days of gestation was referred with a 16-h history of crampy abdominal pain, initially infraumbilical and later diffuse, accompanied by multiple episodes of vomiting, which progressed from ingested matter to bilious, and 12 h of progressive abdominal distension.</div><div>On presentation, she appeared acutely ill and in severe pain, with abdominal examination revealing generalized peritonitis. She was promptly started on intravenous antibiotics and fluid resuscitation, and an emergency laparotomy was performed. Intraoperatively, a torsioned adnexal mass, gangrenous right ovary, fallopian tube, and a segment of small bowel were identified and resected. The patient left the operating room with stable vital signs and was subsequently transferred to the ward, where she recovered well. Six months later, she delivered a healthy 3.5 kg female infant via repeat cesarean section, with no complications.</div><div>Although small bowel volvulus is rare, it must be considered in patients with intestinal obstruction. Delayed recognition can cause ischemia, necrosis, and perforation, so maintaining suspicion, performing timely investigations, and initiating early surgical intervention are essential to improve outcomes and reduce morbidity and mortality.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00776"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid enlargement of a tubo-ovarian abscess in a patient with cervical cancer and multiple uterine fibroids: A case report","authors":"Yuki Yamazawa ,&nbsp;Takayoshi Iijima ,&nbsp;Daisuke Shigenaga ,&nbsp;Tamaki Cho ,&nbsp;Yuichi Imai ,&nbsp;Taichi Mizushima ,&nbsp;Etsuko Miyagi","doi":"10.1016/j.crwh.2026.e00784","DOIUrl":"10.1016/j.crwh.2026.e00784","url":null,"abstract":"<div><div>Locally advanced cervical cancer can be complicated by infections such as pyometra and tubo-ovarian abscess (TOA), although the pathogenesis of TOA is not fully understood. This report presents a case of TOA that rapidly enlarged in a patient with cervical cancer and multiple intramural uterine fibroids. A 61-year-old primigravida was diagnosed with stage IIB cervical cancer, classified as cT2bN0M0, squamous cell carcinoma, complicated by multiple fibroids. Concurrent chemoradiotherapy (CCRT) was planned, and the patient was admitted three weeks after her initial visit with lower abdominal pain. Computed tomography revealed an 8 cm TOA, pyometra, and an enlarged appendix. Conservative treatment with trans-cervical drainage and intravenous antibiotics was unsuccessful. Surgical drainage with bilateral adnexectomy and appendectomy was therefore performed. <em>Bacteroides fragilis</em> was identified in intra-abdominal pus cultures, consistent with findings from cervical drainage, suggesting that the TOA developed secondary to pyometra. One month after surgery, CCRT was resumed and completed without complications. TOA associated with cervical cancer can enlarge rapidly and may require surgical drainage. In patients with locally advanced cervical cancer and multiple uterine fibroids, the potentially increased risk of TOA should be considered.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00784"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulminant disseminated intravascular coagulation following marsupialization of a Bartholin gland abscess: a case report","authors":"Wojciech Flis ,&nbsp;Rafał Cudnik ,&nbsp;Maciej Władysław Socha","doi":"10.1016/j.crwh.2026.e00791","DOIUrl":"10.1016/j.crwh.2026.e00791","url":null,"abstract":"<div><div>Bartholin gland abscess is a common gynecological condition usually managed with minimally invasive procedures and associated with a favorable prognosis. Severe systemic complications are rare. Disseminated intravascular coagulation is a life-threatening coagulopathy most commonly associated with sepsis and severe systemic inflammatory response.</div><div>This report describes the case of a 20-year-old woman with no significant medical history who underwent marsupialization of a left-sided Bartholin gland abscess. The procedure was uncomplicated, and the initial postoperative course was unremarkable. Within 24 h, however, the patient developed sudden clinical deterioration with oliguria and petechial skin lesions, despite remaining afebrile and hemodynamically stable. Laboratory evaluation revealed thrombocytopenia, prolonged coagulation times, hypofibrinogenemia, markedly elevated D-dimer levels, and evidence of multiorgan dysfunction. Disseminated intravascular coagulation was diagnosed according to the International Society on Thrombosis and Haemostasis criteria. Blood cultures remained negative. The patient was managed with multidisciplinary care, broad-spectrum antibiotics, intensive supportive therapy, and blood product transfusions, resulting in gradual clinical and laboratory improvement. She was discharged without complications after 15 days of hospitalization.</div><div>This case highlights that fulminant disseminated intravascular coagulation may develop after minor gynecological procedures performed in the setting of localized infection, even in the absence of documented sepsis or septic shock. Early recognition and prompt multidisciplinary management are essential to ensure favorable outcomes.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00791"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choriocarcinoma: Navigating risk, resistance, and remarkable curability","authors":"Dominik Dannehl,&nbsp;Florin-Andrei Taran","doi":"10.1016/j.crwh.2025.e00772","DOIUrl":"10.1016/j.crwh.2025.e00772","url":null,"abstract":"","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"49 ","pages":"Article e00772"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147395684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}