Small ovarian fibromas (< 10cm) associated with elevated serum CA125 levels are rarely encountered, particularly in women of reproductive age. We report a rare case diagnosed in a 35-year-old patient after adnexectomy for a solid ovarian mass of approximately 5cm in maximum diameter, accompanied by elevated serum CA125 levels. In preoperative evaluation, no signs of inflammation from the genital tract were found, and no medical history of endometriosis, uterine leiomyomas, or non-gynecological cancer was reported. Intraoperative frozen section biopsy of surgical specimen obtained from the ovarian tumor had negative evaluation for malignancy. Histological examination of the surgical specimen confirmed the diagnosis of ovarian fibroma. The postoperative course was uneventful. Two months after surgery, the blood serum CA125 levels were within normal ranges. The patient is assessed at regular intervals in the gynecology outpatient clinic. In this paper, based on the data of the modern literature, a brief review of this rare nosological entity is made.

Large cervical leiomyomas (≥10cm) are extremely rare. Our case report concerns the surgical treatment of a patient with a large cervical leiomyoma associated with chronic pelvic pain, bilateral hydroureteronephrosis and significant impairment of renal function. A 47-year-old patient of reproductive age with a normal menstrual cycle and a medical history of chronic pelvic pain presented to the gynecology clinic for examination. Clinically, the presence of a large pelvic mass was found, the upper margins of which were palpable at the level of the umbilicus. A preoperative assessment revealed bilateral hydroureteronephrosis due to obstructive uropathy and renal dysfunction. Hydroureteronephrosis, as a consequence of the large pelvic mass, probably originating from the cervix of the uterus, was evaluated as the main cause of renal dysfunction. Tumor markers were negative. The imaging studies confirmed the clinical diagnosis of uterine leiomyoma, and the surgical treatment of the patient with laparotomy was decided. Intraoperatively, the presence of a large uterine cervical fibroid was detected, and a total abdominal hysterectomy and bilateral adnexectomy were performed. Operating was difficult, with significant surgical difficulties. The postoperative course was uneventful, without immediate complications. The patient's symptom relief began gradually, immediately after surgery. Three months after surgery, the patient reported complete relief of her pelvic pain. A re-examination of the urinary tract revealed complete recovery of renal morphology and function. In the paper, after the presentation of the case, a brief review of cervical leiomyomas is attempted based on the literature, mainly regarding the diagnostic and therapeutic approach.

Amniotic fluid embolism is a rare, unpredictable and often catastrophic obstetric complication that usually occurs during labor or caesarean section. The pathogenetic mechanism has not been fully elucidated to date. Amniotic fluid embolism is believed to happen due to an anaphylactic reaction to embryonic antigens that enter the mother's circulation and trigger a variety of immune processes that produce an anaphylactic-like response. The diagnosis remains clinical. The disease manifests abruptly with cardiovascular shock, encephalopathy, fetal discomfort and disseminated intravascular coagulation. There is no special treatment. The treatment is supportive and focuses on rapid stabilization of the cardiopulmonary system, adequate oxygenation of the vital organs and correction of coagulation, ensuring the best possible perinatal outcome. In this article, based on current data, a literature review of this rare obstetric complication is attempted, particularly with regard to diagnosis and the basic treatment principles, the timely and correct application of which can provide the best possible outcome for the mother and the newborn.

Uterine atony is the leading cause of postpartum hemorrhage. The etiological mechanism has not been fully clarified. Various predisposing risk factors either pre-existing in pregnancy or appearing during pregnancy have been blamed to date for causing postpartum hemorrhage and uterine atony. The diagnosis of uterine atony is clinical. The diagnosis presupposes the confirmed emptying of the endometrial cavity and the exclusion of traumatic etiology bleeding from the genital system. The multidisciplinary treatment after the early recognition of bleeding it is useful to focus on achieving satisfactory uterine contraction with administration matrix contraceptives (oxytocin, erysipelas alkaloids, prostaglandin, carbetocin) and in maintaining its hemodynamic stability with the use of preservatives (massages, double compression of the uterus) and surgical techniques . The tamponade balloon Bakri, the package from gauzes, several types of hemostatic sutures, ligation of internal iliac arteries, uterine arteries embolism and obstetric hysterectomy are older and newer techniques included in the modern invasive treatment of uterine atony .In this article based on recent bibliography is attempted a review of this obstetric complication, regarding its basic principles of invasive treatment, the timely and correct application of which can yield the best possible result and ensure the best health of mother.

Endometriosis of the rectus abdominis muscle is an extremely rare form of extrapelvic localization of the disease. It is usually iatrogenic and develops after caesarean section or gynecological surgery. Preoperative diagnosis is very difficult and a challenge for gynecologists and surgeons; thus, the diagnosis is histological. The treatment of choice consists of wide local excision of the lesion on healthy margins. We cite a case of isolated endometriosis in the rectus abdominis muscles in a 46-year-old patient with a previous caesarean section, the diagnosis of which was made randomly when performing abdominal total hysterectomy for the treatment of chronic pelvic pain. Histological examination of the surgical specimen confirmed the diagnosis. Simultaneously, the surgical specimen of the uterus and ovaries was free of endometriosis. Postoperatively, the patient mentioned discharge of her symptoms. No further therapeutic intervention was deemed necessary, as it was considered that a complete resection of the endometrial tissue implantation from the muscles of abdominal wall was performed. The present case report lay emphasis on the significant difficulties involved in the preoperative diagnosis of endometriosis of the rectus abdominis muscle. Concurrently, it is pointed out that, despite its rarity, individual extrapelvic endometriosis located in the rectus abdominis muscle should be included among other pathological entities in the differential diagnosis of chronic pelvic pain in women of reproductive age, who gave birth by caesarean section or underwent gynecological surgery with abdominal or laparoscopic access.