Background: Herlyn-Werner-Wunderlich (HWW) syndrome also known as obstructed hemivagina ipsilateral renal agenesis (OHVIRA) is characterized by the presence of a didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. OHVIRA most commonly presents with symptoms of menarche pelvic pain, dysmenorrhea and an abdominal mass. Surgical intervention is often required to correct malformations and reduce the incidence of pelvic endometriosis, infection, and adhesions, and infertility for these patients. We present three cases MDA with various presentations and clinical courses.

Background: Pregnancy oversight and the childbirth process have been modernized with advances in medicine, which have diverged from the natural birthing process. Today many more women are opting for elective caesarean delivery (CD) to reduce the mental, physical, and painful burden of giving birth. In response to patient requests, cesarean delivery birthing procedures are now being performed around the world. In March 2017, the Centers for Disease Control (CDC) reported 32.0% of pregnancies were delivered via cesarean delivery in the U.S. Recently; there has been a focus on evaluating the use of infiltrative anesthesia during cesarean delivery. Previously infiltrative anesthesia was only considered for use in rare sittings and high-risk patients, in which general anesthesia was not readily available or contraindicated. This article focuses on the rare use of infiltrative anesthesia for cesarean delivery. Discussion:In cases of life threatening high-risk emergency, cesarean delivery is the standard treatment. In some emergency situations or when vaginal delivery is contraindicated, barriers exist towards administration of general or regional anesthesia. A review of the literature identifies historic reports of an alternative pain management, in such scenarios. Infiltrative anesthesia for cesarean delivery has been previously used in areas where health care funds, hospital resources, and staff are limited, typically in small hospitals and rural communities. Conclusion:Cesarean delivery under infiltrative anesthesia may be seen as an antiquated method, but it is an important clinical option as it may still have some useful applications. Cesarean delivery under infiltrative anesthesia should be viewed as an alternative in specific situations and not simply a procedure of historic interest.

Background The number of deliveries via cesarean section has increased in the United States, to a rate of 32.3%, which is almost double the global rate of 18.6%. 1 With a greater rate of deliveries via cesarean section comes increased rate of associated complications in subsequent pregnancies and longer hospital stays. 2 One complication of cesarean section is the formation of a cesarean scar defect (CSD), niche or isthmocele, which has no standard definition but can be grossly described as a disruption or defect in the myometrium associated with uterine scar. 3-6 Approximately 1.9% of women are diagnosed with CSD, however the prevalence of CSD is difficult to quantify, given that smaller CSDs may be asymptomatic. 4 As more women are encouraged towards a trial of labor after cesarean (TOLAC) the performance of the uterus during labor is of growing concern due to the risk of uterine rupture. 2,7 Risk factors for CSD include cesarean section during advanced stage of labor, multiple cesarean deliveries, retroflexed uterus, and uterine incision nears the cervix. 4,8-11,12 Single-layer uterine closure has also been proposed as a risk factor for CSD, but there is still no consensus on the optimal approach to uterine closure. 13,14 Small asymptomatic defects may not require treatment; however larger defects may cause pelvic pain, dysmenorrhea, intermenstrual bleeding or infertility, requiring surgical intervention. 8,15 Surgical repair has shown to be an effective treatment, providing symptom relief for most patients and resolving infertility in 92% of patients. 8,11,16

Background: The incidence of adnexal masses in pregnancy is estimated to be 2%. Surgical intervention is required, particularly in the setting of potential malignancy, ovarian torsion, or direct mass affect on the pregnancy. Single incision laparoscopic surgery (SILS) averts the potential morbidity of multiple trocar insertions as it is associated with less bleeding, pain and better cosmetics and tissue retrieval. We describe the use of SILS technique in a 16 5/7-week pregnancy complicated by a 20cm left adnexal cystic mass that was managed with a single-incision laparoscopic left salpingectomy with cystectomy. Case:The patient was a 24 year old, pregnant, Gravida 2 Para 0010 with gestational diabetes and morbid obesity (Body-Mass Index of 42.18). Her only pregnancy ended as a spontaneous abortion. She initially presented to our clinic at 15 3/7 weeks for further evaluation of a large, 19.0 x 15.8 x 9.0cm maternal abdominal cystic mass, which had been detected on prenatal ultrasound. She was managed by Single-Incision diagnostic laparoscopy and Single-incision laparoscopic left salpingectomy and left paratubal cystectomy at 16 5/7 weeks. Pathologic examination of the paratubal cyst revealed the mass to be a benign mullerian serous cystadenofibroma. Her recovery was uncomplicated, with discharge on the first postoperative day. Conclusion:In summary, removal of this patient's adnexal mass in pregnancy was warranted to avert potential complications. The patient's paratubal cyst was drained without leakage and then removed intact through the umbilical incision. Single incision laparoscopic cystectomy for large ovarian and paratubal cysts in pregnancy is not only feasible, but has also been shown to result in better outcomes. There were no complications in this patient intraoperatively, postoperatively, or in a subsequent pregnancy.

No abstract