Vaginal Synechiae in a Pregnant Woman with Past Surgery of Low Septum Resection: A Case Report

Virginity is considered very highly in the Islamic and Arabic culture. It denotes chastity and a good upbringing. Because of this, a family with a girl afflicted with imperforate hymen is ...

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction.

To evaluate the value of a newly suggested ultrasonographic technique 'Sonocolpography' in diagnosing the complete transverse vaginal septum and other allied conditions and planning their treatment. Ten cases of complete vaginal septum, eight cases of atresia and four cases of vaginal aplasia seen at Kasr El Aini School of Medicine, Cairo University were selected for this study. Sonocolpography is done using a vaginal balloon and transabdominal ultrasonography. The efficacy of the latter is assessed in comparison to the conventional transabdominal technique. The different sonographic criteria in the conventional technique and in sonocolpography were determined for the studied cases. A cross-over test was also suggested for anticipating the needed surgery. This is done by pushing the balloon maximally inward and determining the ability of the echoes of the vaginal pouch to accommodate the balloon to stretch and to cross over the defect, in turn determining the needed surgery. Improved ultrasonographic images were successfully obtained for all cases studied. The diagnostic accuracy for these cases was 95.5% for septa, 86.4% for atresia and 90.9% for aplasia. The corresponding figures for the conventional techniques were 54.5, 68.2 and 77.2%, respectively. Sonocolpography was more sensitive and more specific for all cases studied compared to the conventional technique. Planning of the necessary surgery was successfully determined in 16 cases having positive cross-over tests, where excision and direct anastomosis were performed. Surgery planning was also successful in two cases having negative tests and four cases of invalid tests, where more extensive surgery was needed. Sonocolpography is a new achievement that is essential for imaging cases of the complete vaginal septum and other allied conditions, and also in planning the associated treatment.

Transverse vaginal septum is a rare condition that results from abnormalities in the vertical fusion between the vaginal components of the Mullerian ducts and the urogenital sinus. Associated menouria as a result of a fistulous connection of the vagina with the bladder is even rarer. A case is presented of a 22 year old unmarried woman who in addition to presenting with primary amenorrhea, complete transverse vaginal septum and cyclic hematuria, also had unilateral renal agenesis and a corrected congenital imperforate anus. A surgical correction is described as well as simple measures during follow-up that ensured non-contracture of the excision site. The fistulous connection between the bladder and upper vagina closed spontaneously. The patient has since been having normal menses for the past 15 months with no associated hematuria. The vagina has remained patent since. We conclude that for cases of transverse vaginal septum associated with menouria excision of the septum that ensures normal outflow of menstrual blood is sufficient to facilitate spontaneous closure of the fistulous connection between the bladder and vagina.

Cesarean delivery on maternal request is one of the important public health issues in China. Our study aimed to apply the theory of planned behaviour to comprehensively determine the factors regarding pregnant women's preference for cesarean section and to provide references for establishing measures to reduce cesarean delivery on maternal request. This cross-sectional analysis was conducted in four women's and children's hospitals in China from May to June 2018. Eligible women arriving for routine antenatal visits at these hospitals were recruited to answer a structured questionnaire. A total of 1853 pregnant women consented to participate in the investigation, with a response rate of 88.75%. Finally, 1677 pregnant women (984 nulliparae and 693 multiparae) were involved in the analysis. Descriptive statistics and logistic regression analyses were used. Of the study participants, 20.39% preferred cesarean section. For both nulliparae and multiparae, those who had lower scores of attitudes towards vaginal delivery, lower scores of childbirth self-efficacy and higher scores of subjective norms were more likely to prefer cesarean section. Pregnant women's birth preferences were significantly associated with their attitudes towards the delivery mode, childbirth self-efficacy and subjective norms, which is consistent with the theory of planned behaviour. Interventions to reduce cesarean delivery on maternal request can be developed based on the theory of planned behaviour.

Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation.

Index of suspicion.

Introduction: Perianal and perirectal abscesses are rare in pregnant women and typically cause severe, constant pain, often accompanied by purulent rectal drainage. Diagnosis can be aided by digital rectal examination and magnetic resonance imaging (MRI). This report discusses the management of a pregnant patient with an anorectal abscess, which is a rare condition during pregnancy. Case Presentation: We present a case of a 25-year-old pregnant woman (G1P0A0) at 37-38 weeks of gestational age with a history of sepsis due to a perianal abscess before her last menstrual period. She presented to the emergency room of Dr. Soetomo General Hospital, Surabaya, with a three-day history of fever and painful anal discharge. Magnetic resonance fistulography revealed a perianal fistula measuring 33.6 mm in length and 3.7 mm in width at the six o'clock position on the right side. The obstetric evaluation showed no uterine contractions cephalic presentation, and the fetus was at a high position. Laboratory tests indicated anemia and leukocytosis. A cesarean section was performed, delivering a male infant weighing 3,305 g with Apgar scores of 8 and 9. Subsequently, the surgical team performed drainage and debridement of the abscess. Conclusion: Anorectal abscesses causing anal pain in pregnant women are uncommon. Timely clinical assessment and management are crucial to prevent adverse maternal and fetal health effects. Further prospective studies are warranted to evaluate the outcomes of different delivery methods in pregnant women with anorectal abscesses.

Complete transverse vaginal septum complicated by pyocolpos, primary vesicoureteral reflux and ectopic ureter with renal loss: a case report.

Concurrent imperforate hymen, transverse vaginal septum, and unicornuate uterus: a case report

Objective To elucidate the characteristics of symptomatic attack of rudimentary uteri in MRKH syndrome and highlight the rare and unexpected possibilities. Methods A cohort of 202 Chinese MRKH syndrome patients admitted to the Peking Union Medical College Hospital from Jan 2009 to Dec 2016 was analyzed retrospectively. Based on the symptoms of abdominal pain before vaginoplasty, the patients were categorized into the asymptomatic and symptomatic groups. Results Totally, 21 patients had their uteri removed due to obstructive bleeding, 19 of them had symptoms of abdominal pain before vaginoplasty, the mean duration of abdominal pain before artificial vaginoplasty was 5.0 years (range, 0.5–10 years), and the mean age at first onset of recurrent abdominal pain was 14.3 years old (range 11–18). Two special cases showed unusual long incubation periods up to 23 years. Ultrasound detected endometrioid echo in four asymptomatic patients. Among the symptomatic group, 7 patients had no imaging evidence for endometrial cavities despite clinical pain. Two of them developed severe symptoms over the next two or four years and eventually had their uteri removed. Two patients reported persistent abdominal pain with a visual analog scale (VAS) score of 4–5, still under observation. Three patients were lost to follow-up. Conclusion More than 10% of the patients with MRKH syndrome had surgical indication to remove the rudimentary uteri. The discrepancy between clinical symptoms and imaging calls for the vigilance for prophylactic surgery or prolonged follow-up.

Mid cavity complete transverse vaginal septum: Ultrasound diagnoses and management

Obstruction of the lower female genital tract leading to proximal dilatation and development of hematotrachelos is most commonly a result of congenital abnormalities such as an imperforate hymen, a complete transverse vaginal septum, or rarely, cervical atresia. Acquired hematotrachelos is rare, and the possible etiology includes iatrogenic trauma to the uterocervix such as cervical surgery, dilation and curettage, obstetric laceration, cervical or endometrial carcinoma, and radiation therapy. We report an unusual case of a patient in who spontaneously acquired hematotrachelos developed in the perimenopausal period. Combined speculum inspection of the cervix and recognition of transvaginal echographic features assisted the diagnosis. In addition, we tried a new treatment method, using the firm plastic end of an Ipas Karman cannula (6 mm diameter and 6 cm length) with nylon fixation retained for I month that resulted in a patent cervical canal.

American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome

Cesarean Section on Request at 39 Weeks: Impact on Shoulder Dystocia, Fetal Trauma, Neonatal Encephalopathy, and Intrauterine Fetal Demise