Case Reports in Obstetrics and Gynecology
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Acceptance rate38%
Submission to final decision101 days
Acceptance to publication23 days
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Case Reports in Obstetrics and Gynecology has recently been accepted in Scopus.

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Case Reports in Obstetrics and Gynecology publishes case reports and case series related to obstetrics, maternal-fetal medicine, gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, and reproductive endocrinology.

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Case Reports in Obstetrics and Gynecology maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

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Case Series

The Utility of Circulating Tumor DNA (ctDNA) Monitoring in Cancer Patients Who Are Pregnant or Planning to Become Pregnant

The number of pregnant women with cancer is on the rise. These patients and their providers encounter complex medical management decisions. Standard-of-care systemic therapy and radiological imaging can impair fetal development and affect viability. Conversely, insufficient monitoring and treatment can lead to cancer progression, compromising the health of the patient. Personalized and tumor-informed circulating tumor DNA (ctDNA) testing (Signatera™, bespoke mPCR NGS assay) is a validated, noninvasive blood test that can accurately assess cancer progression and tumor response to treatment ahead of radiological imaging, across solid tumors. In this case series of four patients, we explore the clinical utility of longitudinal ctDNA testing in the medical management of pregnant patients with solid tumors, to aid in informed decision-making for patients and providers.

Case Report

Fetal Intervention for Refractory Supraventricular Tachycardia Complicated by Hydrops Fetalis

Introduction. Few reports have shown promising treatments for refractory fetal tachycardia. Data are limited regarding optimal treatment, route of treatment, and medication dosages. Over 90% of cases of fetal tachycardia can be attributed to supraventricular tachycardia (SVT). The first-line treatment of fetal SVT is transplacental digoxin. Case Presentation. We present the management of a patient with fetal tachyarrhythmia diagnosed at 24 weeks and offer a unique approach for treatment. Fetal intramuscular injection of 72.3 mcg of digoxin allowed for resolution of SVT and sustained normal sinus rhythm. Further assessment in the third trimester showed persistent hydrops in the setting of mirror (Ballantyne’s) syndrome resulting in delivery. Discussion/Conclusion. Our observations suggest that a one-time injection of digoxin allows for complete resolution of SVT. Utilizing an invasive approach for management of SVT that is resistant to traditional treatment modalities appears to both be therapeutic and decrease maternal adverse effects associated with more toxic effects of other transplacental medications.

Case Report

Laparotomy for Advanced Abdominal Ectopic Pregnancy

Background. Abdominal pregnancy is the rarest and the most serious type of extrauterine pregnancy. The mainstay of treatment for advanced abdominal pregnancy is surgery. The fetus can be delivered easily, and there are two options for the management of the placenta: removal of the placenta and leave the placenta in situ. Case Presentation. This is a 26-year-old primigravida lady who does not recall her first day of last normal menstrual period (LNMP) but claimed to be amenorrhic for the past 9 months. She had antenatal care (ANC) follow-up at a private hospital and had obstetric ultrasound two times and told that the pregnancy was normal. Currently, she presented with absent fetal movement of one week and vaginal bleeding of 3 days duration. She had history of abdominal pain with fetal movement before one week. Upon examination, the abdomen was 34 weeks sized, with easily palpable fetal parts; fetal heartbeat was negative, with mild abdominal tenderness. The cervix was closed and uneffaced. She was investigated with ultrasound which reveals 3rd trimester abdominal ectopic pregnancy with negative fetal heartbeat. Laparotomy was done to deliver a 2000 gm female stillborn with GIII maceration from the peritoneal cavity. Placenta was removed after releasing adhesion from the bowel and omentum. She had smooth postoperative course and discharged on her 5th postoperative day. Conclusion. Abdominal ectopic pregnancy could be missed despite having repeated ultrasound scanning and may continue to third trimester. High index of suspicion and correlation of patient’s sign and symptom is very important to make early diagnosis.

Case Report

Management of a Novel Autoimmune Disease, COPA Syndrome, in Pregnancy

Background. COPA syndrome is a rare autoimmune disease, demonstrating an autosomal dominant inheritance pattern with variable penetration that occurs more frequently in females than males. This disease manifests in childhood as pulmonary hemorrhage, arthritis, and renal disease. Case. We present a case of obstetric management of a 20-year-old nulligravida patient with a diagnosis of COPA syndrome. Her case was further complicated by multiple antepartum admissions for hypoxemia and a complex psychosocial history of substance use. On her first antepartum admission, rheumatology recommended management with hydroxychloroquine, inhaled corticosteroids (budesonide), and bronchodilators (albuterol inhaler) as needed. On admission for induction of labor, she was again noted to have oxygen desaturations. A chronic thrombus was noted on computed tomography (CT), and a multidisciplinary team was recommended against Valsalva. Thus, she had a primary cesarean delivery. Her postpartum course was only remarkable for improved oxygenation status. Conclusion. Management of COPA syndrome should be performed by a multidisciplinary team including maternal-fetal medicine, rheumatology, and pulmonology specialists. Traditionally, COPA syndrome is treated with immunomodulator therapy often used to treat autoimmune syndromes. However, many of these medications are not well studied or contraindicated in pregnancy. Preconception counseling is recommended both to ensure pregnancy safe medications being prescribed and to provide information on the genetic inheritance of this disease. At time of entry to care, patients should have a baseline work-up including a radiographic imaging, complete blood count, complete metabolic panel, lactate dehydrogenase, and a 24-hour urine protein collection for baseline. Although thought to be rare, COPA syndrome has an autosomal dominance pattern of inheritance with variable penetrance that is more common in females. Thus, incidence of COPA syndrome in pregnancy will likely increase in the future. Further case studies are warranted to optimize management of patients with COPA syndrome in pregnancy.

Case Report

Renal Tumors in Pregnancy: A Case Report Focusing on the Timing of the Surgery and Patient Positioning

Management of renal mass during pregnancy is challenging. There is no consensus regarding the fundamental timing issues (which trimester) of the interventions and patient positioning during the procedures. We present three pregnant women with renal mass and their management, focusing on patient positioning and timing of surgical intervention. All patients were positioned supine with a 30-degree rotation to the left lateral without signs of compromising fetal circulation. This report’s three major takeaway points are the following: (1) Renal mass biopsy might be more beneficial in pregnant women than the normal population (unless CT findings suggest vascular angiomyolipomas) to achieve a definite diagnosis and avoid unnecessary interventions during pregnancy. (2) Surgical interventions, if indicated, should be performed as soon as possible and are applicable in all trimesters of pregnancy. (3) A minimum of 15-degree left lateral tilt (for both right- and left-sided renal masses) can provide enough venous return during the nephrectomy.

Case Report

Aplastic Anemia Treated with Eltrombopag during Pregnancy

Aplastic anemia is a rare blood disorder characterized by pancytopenia and hypocellular bone marrow. In patients with aplastic anemia, pancytopenia sometimes worsens during pregnancy, and relapse of aplastic anemia in pregnancy is common. Nevertheless, only supportive care with blood products is the mainstay of treatment of aplastic anemia in pregnancy. Thus, the obstetric management and treatment of aplastic anemia in pregnancy is extremely challenging. We herein report the first case of a pregnant woman complicated with aplastic anemia who was successfully treated with eltrombopag, a thrombopoietin receptor agonist. A 27-year-old primigravida woman who had a history of aplastic anemia refractory to immunosuppressive therapy and was treated with eltrombopag became pregnant. Eltrombopag treatment was continued after weighing the benefits and potential risks. Throughout pregnancy, the woman’s pancytopenia did not progress, and she delivered a 2336 g baby vaginally at 38 weeks of gestation. Her postpartum outcome was uneventful, and the neonate did not develop thrombocytosis. Since the efficacy and safety of eltrombopag in pregnancy has not yet been established, its routine use should be avoided. However, if limited to refractory cases and with adequate maternal and fetal monitoring, including neonatal blood examinations, the use of eltrombopag for patients with aplastic anemia during pregnancy may be acceptable and result in favorable maternal and fetal outcomes.

Case Reports in Obstetrics and Gynecology
 Journal metrics
Acceptance rate38%
Submission to final decision101 days
Acceptance to publication23 days
CiteScore-
Journal Citation Indicator-
Impact Factor-
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Article of the Year Award: Outstanding research contributions of 2020, as selected by our Chief Editors. Read the winning articles.