B7-H3 and B7x are members of the B7 family of immune regulatory ligands that are thought to attenuate peripheral immune responses through co-inhibition. Previous studies have correlated their overexpression with poor prognosis and decreased tumor-infiltrating lymphocytes in various carcinomas including uterine endometrioid carcinomas, and mounting evidence supports an immuno-inhibitory role in ovarian cancer prognosis. We sought to examine the expression of B7-H3 and B7x in 103 ovarian borderline tumors and carcinomas and study associations with clinical outcome. Using immunohistochemical tissue microarray analysis on tumor specimens, we found that 93 and 100% of these ovarian tumors express B7-H3 and B7x, respectively, with expression found predominantly on cell membranes and in cytoplasm. In contrast, only scattered B7-H3-and B7x-positive cells were detected in non-neoplastic ovarian tissues. B7-H3 was also expressed in the endothelium of tumor-associated vasculature in 44% of patients, including 78% of patients with high-stage tumors (FIGO stages III and IV), nearly all of which were high-grade serous carcinomas, and 26% of patients with low-stage tumors (FIGO stages I and II; Po0.001), including borderline tumors. Analysis of cumulative survival time and recurrence incidence revealed that carcinomas with B7-H3-positive tumor vasculature were associated with a significantly shorter survival time (P ¼ 0.02) and a higher incidence of recurrence (P ¼ 0.03). The association between B7-H3-positive tumor vasculature and poor clinical outcome remained significant even when the analysis was limited to the high-stage subgroup. These results show that ovarian borderline tumors and carcinomas aberrantly express B7-H3 and B7x, and that B7-H3-positive tumor vasculature is associated with high-grade serous histological subtype, increased recurrence and reduced survival. B7-H3 expression in tumor vasculature may be a reflection of tumor aggressiveness and has diagnostic and immunotherapeutic implications in ovarian carcinomas.

The NICHD fetal heart rate category during labor may be associated with survival for infants born at 23 and 24 weeks of gestation. Cesarean delivery was not associated with improved survival.

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Introduction:Tubal abortion is characterized by the extrusion of an ectopic pregnancy initially implanted in the fallopian tube through the fimbriated ostium into the peritoneal cavity. It may present as either complete or incomplete expulsion, may lead to severe bleeding, or present with less acute findings which nevertheless requires surgical evaluation. Recognition of a complete tubal abortion through surgical evaluation may be challenging but is essential because it allows conservative management which allow preservation of tubal function and fertility without disrupting tubal anatomy or function.Case Series: We present a case series of surgical evaluation and management of tubal abortion, with the first case which demonstrated complete tubal abortion and subsequent implantation into the omentum which required surgical dissection. The second case demonstrates acute complete tubal abortion in an asymptomatic patient, who underwent diagnostic laparoscopy revealing the subsequent pathology. Conclusion:This case series highlights other findings in literature, that conservative surgical management entailing evacuation of products of conception and blood clots to prevent chronic pain and further adhesion formation is sufficient management of complete tubal abortion. This approach ensures preservation of tubal anatomy and allows patients an opportunity for future fertility.

Placenta accreta spectrum (PAS) are life-threatening obstetrical conditions, which may have catastrophic outcomes when encountered in the emergency setting. We present a case of a 36 yo G4P3003 at 14 weeks 4 days who received prenatal care at outside facility who had passage of incomplete abortion at home and brought in hypotensive shock with active vaginal bleeding. Massive transfusion protocol was started and patient was brought to operating room and proceeded with suction dilation and curettage. Despite removal of products of conception confirmed with US guidance; brisk heavy bleeding continued with use of multiple uterotonics. The decision was made to proceed with abdominal hysterectomy with removal of an atonic uterus that was bivalved in OR showing abnormal placentation later confirmed with pathology. Patient postoperative course was uneventful; extubated from surgical ICU and discharged 3 days later. We wish to highlight the importance of astute clinical practice and timely decision making by the Ob/Gyn team in the presentation of a critical patient with placenta accreta encountered in the early second trimester.