Gestational trophoblastic neoplasia (GTN) represents a heterogeneous group of pregnancy-related tumors that usually develop from the malignant transformation of trophoblastic tissue after molar evacuation. The first presentation as an invasive mole is particularly rare. GTN is considered the most curable gynecological malignancy as most cases are treated successfully with chemotherapy agents. Although extremes of reproductive age are an established risk factor for complete moles, GTN is extremely rare in perimenopausal women. GTN should be considered in the differential diagnosis of patients with abnormal uterine bleeding. Delays in the diagnosis and treatment can worsen the prognosis of patients with GTN.Here, we describe the case of a 54-year-old woman who presented to the emergency department with abdominal pain and heavy vaginal bleeding. She reported pregnancy-related symptoms that had developed over two months but was apprehensive to search for medical care. The final diagnosis was an invasive mole that had a catastrophic clinical course. Arterial embolization should be considered in patients with uncontrollable vaginal bleeding and hemodynamic instability.

An ectopic pregnancy is located outside the uterus, mostly found in the fallopian tubes. The main predisposing factors are usually related to anatomical and/or functional disturbances of the fallopian tubes. Typically, an ectopic pregnancy presents with vaginal bleeding or abdominal pain in the first trimester of pregnancy, although it may be asymptomatic. The diagnosis of ectopic pregnancy, which is based on transvaginal ultrasound associated with the serum beta fraction of human chorionic gonadotropin values, is of the highest relevance due to the mortality risk involved. We report the case of a 26-year-old woman who presented with a four-week history of amenorrhea and abdominal pain. Initially, the diagnostic hypothesis was a pelvic inflammatory disease, as the patient complained of pain during deep palpation of the lower quadrants of the abdomen, and gynecological observation detected malodorous discharge and cervical tenderness. Antibiotic treatment was initiated. The patient was later diagnosed with ectopic pregnancy, which was discovered during a routine pregnancy ultrasound. She was submitted to urgent laparotomy with intraoperative confirmation of the interstitial location of the gestational sac.

Virtual poster abstractsrarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcomes of fetuses with ICH. Methods: Medline, Embase, Clinicaltrials.gov and Cochrane Library databases were searched. We included studies reporting the outcomes of fetuses with ICH. The primary outcome was perinatal death (PND), i.e. the sum of intra-uterine (IUD) and neonatal death (NND). The secondary outcomes were IUD, NND, TOP, need for surgery/shunting at birth, cerebral palsy, neurodevelopmental delay, and intact survival. Outcomes were explored in the whole population and for intra and extra-axial ICH. Meta-analyses of proportions were used to combine data, we reported pooled proportion and their 95% confidence intervals (CI). Results: 16 studies (193 fetuses) were included. PND occurred in 14.6% (95%CI 7.3-24.0), of fetuses with ICH. Of those liveborn, 27.6% (95%CI 12.5-45.9) required a shunt after birth and 32.0% (95%CI 22.2-42.6) had cerebral palsy. 16.7% of children had mild and 31.1% experienced severe neurodevelopmental delay. A normal outcome was reported in 53.6% fetuses. Looking at location, PND occurred in 13.3% (95%CI 5.7-23.4) of fetuses with intra-axial and in 26.7% ) with extra-axial bleeding. In cases with intra-axial hemorrhage, 24.7% required a shunt after birth and 27.1% had cerebral palsy. Mild and severe neurodevelopmental delay were observed in 15% (95%CI 6.9-25.6) and 32.3% 3) of cases, respectively, while 51.9% experienced a normal outcome. Robust evidence for fetuses with extra-axial hemorrhage could not be extrapolated due to the small number of cases. Conclusions: Fetuses with ICH are at high risk of perinatal morality and impaired neurodevelopmental outcome. Postnatal shunt placement was performed in 28% and cerebral palsy was diagnosed in approximately one third of these infants.