Topics: Systems-based Practice, Obstetric Complications E lective repeat cesarean delivery (CD) contributes sig-

This article reports a case of perinatal mesenchymal hepatic hamartoma and reviews the literature on the subject. A fetus presented with polyhydramnios and a large multiloculated cystic abdominal mass at 33 weeks of gestation. The ultrasound appearance was most consistent with a mesenteric cyst. Prenatal drainage was considered, due to the size of the lesion. However, a conservative management was opted for. A female infant was born at 35 weeks by classical cesarean section. The immediate postnatal period was characterized by hemodynamic instability. Laparotomy revealed a pedunculated mesenchymal hamartoma of the liver, which could not completely be resected. The infant had an uneventful postoperative recovery and is doing well at 6 months of age. Hepatic mesenchymal hamartoma are rare benign tumors. Most cases are detected in early childhood. They usually present as a cystic rapidly growing abdominal mass. Prenatal diagnosis remains challenging. In children diagnosed in the perinatal period, the outcome seems worse and determined by the compressive effect of the mass.

Different regimes of thromboprophylaxis in women with cesarean section influenced the occurrence of bleeding complications.

Cervical insufficiency is seen in 0.1% - 1% of all pregnancies and classical treatment involves vaginal cerclage. In some conditions, such as an extremely short, deformed or absent cervix, surgery needs to be done by transabdominal approach. We use a simplified technique for laparoscopic transabdominal cerclage compared to the technique described in previous studies. Furthermore, we give a review on the literature published on this subject. We have a case series of 12 patients operated in a non-pregnant state with previously failed vaginal cerclage (n = 4) or in which a vaginal approach appeared to be impossible due to a history of cervical surgery (n = 8). Minor complication of vaginal erosion of the cerclage tape was described in 2 cases. Comparable studies of transabdominal cerclage via laparotomy or laparoscopy could not show any difference in obstetric outcome. Several studies mentioned the advantages of the laparoscopic approach (short hospitalisation, fast recovery, high placement of the suture,) and no complications were described. Transabdominal cerclage performed by laparoscopy seems to be a feasible technique in cases transvaginal cerclage fails or is technically impossible.

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