Proceedings in Obstetrics and Gynecology

Malignant phyllodes tumor in a patient with hereditary retinoblastoma: a case report and literature review

Damon D. Shearer et al. — Wed, 08 May 2013 08:20:19 PDT

Patients with hereditary retinoblastoma are at increased risk for second malignancies, most notably sarcomas, particularly after treatment with radiation. Malignant phyllodes tumor is a rare secondary malignancy in these patients. We present a review of the literature and report of a patient with hereditary retinoblastoma who developed two secondary malignancies, including malignant phyllodes tumor. The patient’s phyllodes tumor presented as a palpable breast mass with suspicious findings on mammogram and ultrasound. The mass was shown to be at least a borderline phyllodes tumor via sonographic percutaneous biopsy and confirmed malignant phyllodes tumor on final surgical excision.

Maternal thrombocytopenia in pregnancy

Usha Perepu et al. — Mon, 29 Apr 2013 08:14:18 PDT

Thrombocytopenia is a common occurrence in pregnancy. Although pregnancy is associated with physiological changes in platelet count, several pathological conditions cause thrombocytopenia, which can have a significant impact on the mother and the baby. There are diverse etiologies for thrombocytopenia, some of which are unique to pregnancy. This review provides a detailed discussion of the diagnosis and management of the various causes of thrombocytopenia in pregnancy.

Von Willebrand’s disease diagnosed after hemorrhage following hysteroscopic myoma resection and endometrial band excision

Murat Bozkurt et al. — Mon, 15 Apr 2013 08:20:26 PDT

Von Willebrand factor, the largest human plasma protein, is an adhesive multimeric glycoprotein that mediates platelet adhesion to both the subendothelial matrix and endothelial surfaces and acts as a carrier for coagulation factor VIII in the circulation. Von Willebrand disease (vWD) is the most common inherited bleeding condition that involves extended or excessive bleeding and is caused by the deficiency or defect of vWF. In this case report, we present vWD diagnosed after hemorrhage following hysteroscopic myoma resection and endometrial band excision. The importance of a detailed medical history is emphasized as even health care workers cannot spontaneously give this information. Further tests are recommended in patients who have a history of prolonged bleeding as bleeding time and other routine coagulation tests done preoperatively cannot always make a definite diagnosis.

Giant endometrial polyp protruding from the external cervical os in a postmenopausal woman: magnetic resonance imaging and hysteroscopic findings

Ahmet Said Çil et al. — Mon, 15 Apr 2013 08:11:56 PDT

Endometrial polyps are most commonly seen in the postmenopausal women with uterine bleeding, although the giant polyps which originate from the uterine cavity and protruding from the cervical os are rare. Several cases which have been described in the literature are usually developed secondary to tamoxifen use, and the polyps do not extend or protrude from the external cervical os. Most of the polyps protruded from the cervical os can mimic a cervical neoplasia or endocervical polyp. We report the case of a giant endometrial polyp (8x4x3 cm in size) which was protruding from the external cervical os and that developed spontaneously without tamoxifen use in a multiparous 73 -year-old woman presenting with vaginal bleeding. Hysteroscopic polypectomy was performed and no recurrence was seen at 6 months after surgery. Diagnosis, management and outcome of this rare entity have been discussed according to the literature.

Mark K. Santillan, MD

Kristina W. Thiel — Wed, 10 Apr 2013 11:23:36 PDT

Dr. Mark Santillan, MD, brings a great deal of energy to his position as Assistant Professor in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa. As an active physician in the high-risk obstetrics clinic, researcher into the causes of preeclampsia, and Clinical Research Director for the Maternal Fetal Tissue Bank, that level of energy is a must.

University of Iowa Dept. of Obstetrics and Gynecology partners with Preeclampsia Foundation

Mark K. Santillan — Wed, 10 Apr 2013 11:23:34 PDT

The Preeclampsia Foundation is the only national 501(c)(3) not-for-profit patient advocacy organization serving the 5-8% of pregnant women - 300,000 women each year in the U.S. - who are affected by hypertensive disorders of pregnancy such as preeclampsia (formerly known as toxemia), eclampsia and HELLP syndrome. Their mission is to reduce maternal and infant illness and death due to preeclampsia, HELLP syndrome, and other hypertensive disorders of pregnancy by providing patient support and education, raising public awareness, catalyzing research and improving healthcare practices.

The Preeclampsia Foundation and the Department of Obstetrics and Gynecology of the University of Iowa will be co-hosting a continuing medical education course on October 18, 2013, “Controversies in the Care of Women with Preeclampsia: A National Debate.” For additional information, contact CME Division, University of Iowa Carver College of Medicine at 319-335-8599.

The effects of preeclampsia on signaling to hematopoietic progenitor cells

Donna A. Santillan et al. — Wed, 10 Apr 2013 11:23:31 PDT

Background: The role of the microenvironment is important in cell differentiation. The effect of placental disease on the growth and differentiation and hematopoietic stem cells has not been well-studied.

Methods: Enzyme linked immunoassay was used to measure erythropoietin and osteopontin in plasma from umbilical cord blood of children born to normotensive and preeclamptic women. Additionally, CD34+ cells were isolated from umbilical cord blood and grown in complete methylcellulose media. Colony types were identified and enumerated.

Results: Differences in the concentration of erythropoietin in the cord blood between the controls and the preeclamptics approached significance (P = 0.067) using a Mann-Whitney U test. In the plasma of cord blood from children born to normotensive women, the median erythropoietin was 0.186 mIU/mL compared to 1.986 mIU/mL in children of preeclamptic women. We did not find any significant differences in the number and types of colonies; however, there was a trend toward increased BFU-E in the preeclamptic samples. Furthermore, this trend for increased BFU-E colonies was also seen from CD34+ cells isolated from umbilical cord blood of severe preeclamptics compared to mild.

Conclusion: Our preliminary studies suggest that abnormalities in the placenta, such as those found when the mother experiences preeclampsia, may affect the ability of hematopoietic stem cells to grow and differentiate.

Preeclampsia and MicroRNAs

Eric J. Devor et al. — Wed, 10 Apr 2013 11:23:28 PDT

Preeclampsia is a critical gestational condition that threatens the life of both mother and child. One of the most serious aspects of preeclampsia hampering both clinical management and scientific understanding is that there are, as yet, no early warning signs or risk markers. The discovery of microRNAs (miRNAs), tiny post-transcriptional regulators of gene expression, offers potentially fertile ground for developing such markers. The current state of knowledge about miRNAs in preeclampsia is presented along with information regarding miRNA detection in peripheral fluids that could lead to minimally invasive risk assessment.

Pre-eclampsia and eclampsia: global challenges in low resource settings complete with proposed interventions in rural Haiti

Rachel M. Bender et al. — Wed, 10 Apr 2013 11:23:23 PDT

Preeclampsia is a complex multi-pathway disease process diagnosed by hypertension with two readings of systolic blood pressure ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, separated by a 4-6 hour period, and proteinuria with a urine dipstick of ≥ 1+ or ≥ 300 mg per 24 hours, after 20 weeks’ gestation in a previously normotensive patient. Ninety-nine percent of pregnancy related deaths occur in middle and low-income countries (LMIC). Of these deaths, the World Health Organization (WHO) ranks pre-eclampsia and eclampsia as the second leading direct cause of maternal morbidity and mortality, behind only postpartum hemorrhage. A woman born in a developing country has a seven times greater risk of developing pre-eclampsia and a three times greater risk of progressing to eclampsia. This paper seeks to review what we know about the basics of detection and management to encourage thoughtful applications in improving the global burden of pre-eclampsia and eclampsia in low resources settings.

Coexistence of postpartum cardiomyopathy and single coronary artery anomaly

Murat Bozkurt et al. — Thu, 28 Mar 2013 10:36:34 PDT

Postpartum cardiomyopathy (PPCM) is dilated cardiomyopathy seen in the postpartum period in women who no prior history of cardiac diseases. In this case study, coronary angiography was used to determine the etiology of the cardiomyopathy after the decompensated heart failure had regressed. A congenital single coronary artery anomaly was detected by coronary angiography. In this case, PPCM can mimic pneumonia, thus making diagnosis difficult. When there is no response to antibiotic therapy, the obstetrician must consider cardiac disease and appropriate consultation should be obtained as soon as possible. To the best of our knowledge, single coronary artery anomalies coexisting with PPCM has only been documented in one other case in the literature. An association of single coronary artery anomalies with PPCM may be random, or, alternative, might contribute to the composition of the PPCM.

Isolated torsion of the fallopian tube in a postmenopausal woman; a rare entity

Murat Bozkurt et al. — Mon, 11 Mar 2013 08:55:13 PDT

Isolated torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain. The lack of pathognomonic symptoms, clinical ﬁndings on physical examination, and speciﬁc imaging or laboratory characteristics makes this entity difﬁcult to diagnose preoperatively, which can cause surgical intervention to be postponed. We report a case of isolated torsion of the right fallopian tube in a 58-year-old woman with a history of sexually transmitted infection. In most reported cases, there is no vascular flow on Doppler imaging modalities. We also detected high impedance of vascular flow around the cyst wall. Imaging modalities could not provide a definitive diagnosis. Tubal torsion was diagnosed upon laparotomy.

Fetus papyraceous ın a twın pregnancy: a case report without any maternal and fetal complications

Murat Bozkurt et al. — Thu, 07 Feb 2013 12:50:13 PST

Fetus papyraceous is defined as a compressed fetus, the mummified, parchment-like remains of a dead twin that is retained in-utero after intrauterine death in the second trimester. We report a case of fetus papyraceous (FP) in a diamniotic and dichorionic pregnancy with no maternal and fetal complications during pregnancy or the post-partum period.

Uterus didelphys with multiple fibroids: A case report

Mohammed Khairy Ali et al. — Mon, 28 Jan 2013 15:00:17 PST

Uterine anomalies are congenital malformations caused by fusion or resorption defects during embryogenesis. Uterus didelphys, or a double uterus, is a rare condition that occurs in female fetuses as they develop in the womb. Here we report a case of a 46 year old virginal female with uterus didelphys along with multiple fibroids of both uteri and a right ovarian cyst. The patient underwent a total abdominal hysterectomy with adnexa removal. The specimen showed leiomyoma of uterus with ovarian endometriosis.

Efforts to eradicate obstetrical fistulas in the developing world: a personal journey

Rene Genadry — Mon, 01 Oct 2012 09:25:52 PDT

My work with international health has been primarily focused on obstetrical fistulas. It all started in 2004 with a call to Bob Wheeless, a colleague whom I have known since my early days at Hopkins, to ask him to participate in the Houston Everett course that year. While accepting gracefully and enthusiastically, he promptly related to me his travel activities since recently retiring. He had been approached by a group involved in humanitarian work in Niger to help care for poor and unfortunate women with obstetrical fistulas at the Niamey National Hospital.

Sonographic prenatal diagnosis of congenital Marfan syndrome

Rachel M. Bender et al. — Mon, 01 Oct 2012 09:25:51 PDT

Congenital Marfan syndrome is a rare and severe disease of the newborn, causing devastating and often fatal effects on the cardiovascular, pulmonary, and musculoskeletal systems. Familial mutations of FBN1 have been studied and identified in Marfan syndrome, but the congenital variant is often due to de novo mutations, limiting the diagnostic capabilities of genetic screening. Ultrasound is essential for early diagnosis and management, yet few cases of sonographic diagnosis have been cited in the literature. This report outlines one such case of congenital Marfan syndrome diagnosed at 24-week ultrasound. Further detailed reports should aim to improve screening, diagnosis, and treatment of congenital Marfan syndrome to advance options in family planning and disease management.

A mysterious growth from vulva mimicking scrotum leading to abandonment by her husband.

Sanjoy Kumar Bhattacharyya et al. — Mon, 01 Oct 2012 09:25:49 PDT

Benign vulvar growths are rare. Initially these growths remain small and asymtomatic. Due to social stigma, young women in this stage often prefer to conceal the pathology. With considerable growth, apart from physical complaints, they might cause psychological problems of the subjects and even social withdrawal. Urgent detection and subsequent removal of the growth along with counselling is warranted to improve the patient’s self-esteem.

Division of Reproductive Science Research

Baoli Yang — Mon, 01 Oct 2012 09:25:48 PDT

The Reproductive Science Research Division in the Department of Obstetrics and Gynecology was established in 2009 and consists of four full time research faculty members and eight faculty members with joint appointment with other divisions in the department. Members in the Research Division conducted research in diverse areas of basic reproductive research.

Division of Maternal-Fetal Medicine

Stephen K. Hunter — Mon, 01 Oct 2012 09:25:47 PDT

The Division of Maternal-Fetal Medicine presently includes maternal-fetal specialists. They are: Kimberly K. Leslie, MD (Department Head), Stephen K. Hunter, MD, PhD, (Division Director), Jennifer R. Niebyl, MD, Asha Rijhsinghani, MD, and Mark Santillan, MD, and Jennifer Krupp, MD. Dr. Roger A. Williamson, double boarded in Genetics and Obstetrics, is an Emeritus member of the Division.

Division of Gynecologic Oncology

Koen DeGeest — Mon, 01 Oct 2012 09:25:46 PDT

The Gynecologic Oncology Division at the University of Iowa consists of four attending physicians, three fellows-in-training, two physician assistants, three nurses and supporting research and clerical staff. The concentration of our division remains the care of women with gynecologic malignancies. Our service area includes all counties of Iowa as well as western Illinois. Our patients are seen and treated in the National Cancer Institute designated Holden Comprehensive Cancer Center on the University of Iowa Hospitals campus.

Baoli Yang, MD, PhD

Mon, 01 Oct 2012 09:25:45 PDT

Baoli Yang, MD, PhD