Liangcheng Wang

Intrauterine balloon tamponade (IBT) is widely used for treating obstetric hemorrhage. However, only a few reports on IBT failure exist. We report a case of IBT failure caused by an over-expanded lower uterine segment (LUS). A 30-year-old woman with twin pregnancy presented with bleeding after cesarean section. During surgery, uterine atony was observed; however, intravenous administration of oxytocin and ergometrine resolved the condition. Continuous hemorrhage was observed postoperatively, despite the administration of uterotonics and uterine massage. Although IBT was performed, the bleeding persisted, as recognized from the drainage fluid. Enhanced computed tomography revealed that the bleeding spot could not be compressed by the inflated balloon due to the over-expanded LUS. The balloon was removed; uterine artery embolization was required to achieve hemostasis. Our experience indicated that over-expanded LUS could cause IBT failure. If bleeding continues post-IBT replacement and an over-expanded LUS is observed, alternative treatments should be promptly provided.

It has been well established that the appearance of pseudocysts and polyhydramnios are typical signs indicative of fetal bowel stenosis/obstruction. However, the characteristic ultrasonographic findings that distinguish it from fetal bowel strangulation are rarely reported.

The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. However, these techniques have difficulty correctly identifying cleavage planes and are prone to cyst rupture. We present a surgical cystectomy technique that correctly identifies the cleavage plane with a low risk of ovarian cyst rupture, even in patients with multicystic ovarian cysts. Cystectomy was performed using Maryland forceps with gentle open and close dissecting motions only. Both the surgeon and assistant handled the ovarian cortex and cyst wall, and soft traction between the cortex and cyst wall as far as the nearby dissection plane without grasping the cyst wall was essential. In patients with multicystic ovarian cysts, making a plane at the notch between cysts decreases the risk of cyst rupture. This technique allows the correct identification of the cleavage plane for dissection and avoids the risk of cyst rupture.

Most fetal ovarian cysts increase in size during the late stages of pregnancy. Early treatment of a huge neonatal cyst may reduce the risk of gastrointestinal obstruction.

A 26-year-old gravida 2 para 1 woman had a monochorionic-triamniotic (MT) triplet pregnancy that was eventually terminated by emergency caesarean section at week 31 of gestation owing to rapid changes in cervical length. She was referred to our hospital at week 9, and a diagnosis of MT triplet

Purpose The aim of the study was to investigate if ultrasound probes are reusable medical devices that risk becoming contaminated after a patient examination in Japan. Methods The level of bacterial contamination on transvaginal ultrasound (TVU) probes following current routine probe cleaning at a university hospital (site A) and a clinic (site B) in Japan was investigated. Results A total of 98.1% of probes were found to be contaminated at site A (median CFU 40, IQR 10, 132.5) and 94.1% were found to be contaminated at site B (median CFU 50, IQR 20, 85). Of the contaminated probes, 52.9% at site A and 64.6% at site B harbored potentially pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA). Conclusion These findings suggest that there is a high rate of ultrasound probe residual bacterial contamination in Japan.

Key Clinical Message: Pregnancy complicated by ankylosing spondylitis is rare. Labor assistance and instrumental delivery may be difficult due to hip stiffness. Restriction in lumbar flexion may cause difficulties in administering neuraxial analgesia. Difficult intubation for general anesthesia due to limited neck mobility is another potential risk that must be considered.