Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study

Background To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element “hand on the fetal head” in itself was protective, although the risk of a type 2 error was calculated to be 50%. Methods A prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI. Results The total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use. Conclusions Both hand on the fetal head and perineal support were associated with a reduced risk of OASI.

An unusual case of breast abscess caused by Proteus mirabilis and Prevotella buccalis

A 56-year-old nulliparous woman presented to the emergency department with acute onset of redness, sensitivity, and local fever in the left breast. Mastitis with abscess was diagnosed. Unusual pathogens were identified in the culture obtained from the abscess - Proteus mirabilis and Prevotella buccalis. Keywords: breast abscess; Proteus mirabilis; Prevotella buccalis.

Dr. N. Peters. - Incarceration of the elongated vaginal part. - (Centr. F. Gynaec., No. 3, 1895)

R. reports a rare case of incarceration of the vaginal part in Brown's pessary. A nulliparous woman, 41 years of age, had a sharp lengthening of the vaginal part so that the external mouth was in rima pudendorum, the anterior vaginal fornix, occupied its normal position, and the posterior one stood very high.

Non-Puerperal Uterine Inversion in a Nulliparous Woman with no Uterine Mass: A Case Report and a Literature Review

Background: Non-puerperal uterine inversion (NPUI) is an extremely rare condition. Most reported cases of uterine inversion ware in multiparous women. Moreover, non-puerperal uterine inversion usually occurs when there is a benign or malignant uterine mass present. In literature, there have been only 9 reported cases of non-puerperal uterine inversion in a nulliparous woman in the 10 year window from 2006 to 2017 [1]. Case: Here, a case of non-puerperal uterine inversion is discussed. Initially the patient was diagnosed as a sub-mucosal fibroid of the uterus. The diagnosis of Non-puerperal uterine inversion was made only during operation. But the case reported in this paper, is the first reported case in a patient who did not have any uterine mass and also was nulliparous. At first, an attempt to reposition the uterus was made by Huntington method but was failed. Then, it was decided to perform the total abdominal hysterectomy. Her postoperative period was uneventful and she was discharged without complication after only seven days. Conclusion: Non-puerperal uterine inversion is rarely encountered by Gynecologist. However, the rare occurrence of this case is often difficult to diagnose, especially when the exact cause of the condition is not known preoperatively. Our patient was lean, thin and malnourished, suffered from general weakness for long time. Could the weakness of the uterine muscle and ligaments be the cause for inversion? The reported case provides an indication for future research on the causes of nonpuerperal uterine inversion, specifically the scenario which has no association to uterine mass in a nulliparous woman.

Rapidly recurring ovarian fibrosarcoma after optimal debulking surgery in a 46-year-old woman

Ovarian fibrosarcoma is an extremely rare tumour with no universally accepted guidelines for treatment. We present a 46-year-old nulliparous woman with ovarian fibrosarcoma who mainly presented with a painful abdominal enlargement. Optimal debulking surgery was performed, and a specimen of the tumour was examined. A frozen section examined during surgery revealed spindle cell morphology, raising the suspicion of ovarian fibrosarcoma, which was later confirmed by immunohistochemistry staining. Our patient refused to undergo chemotherapy and died 3 months after surgery due to tumour recurrence. Although no clear consensus exists for administering chemotherapy for fibrosarcoma, some published case reports have shown a lower chance of recurrence and better prognosis in patients who undergo chemotherapy compared with our patient.

“I Want a Baby, But Not With Him”

This chapter addresses the ethical issues surrounding provision of emergency contraception in the emergency department. The highlighted case illustrates a case in which a nulliparous woman presents to the emergency department after consensual intercourse and requests emergency contraception. We review recommendations by national organizations regarding emergency contraception, including for which patients and in what situations emergency contraception should be offered. We discuss the disparity between providers in offering emergency contraception and drivers of this disparity, including patient characteristics and provider personal beliefs and education about emergency contraception. Finally, we discuss the validity of conscientious objection in providing emergency contraception in the framework of the principles of medical ethics: autonomy, beneficence, and nonmaleficence.