Browsing by Author "Tian, Wendy"

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    A BRCA1+ Patient with Twin Pregnancy of a Complete Mole with Complete Fetus
    (American Medical Women's Association, 2023-03-23) Yaqub, Amna; Taminack, Hope; Ungureanu, Ilinca; Ganapaneni, Sruthi; Tian, Wendy; Scifres, Christina; Robertson, Sharon
    Title: A BRCA1+ Patient with Twin Pregnancy of a Complete Mole with Complete Fetus Authors: Yaqub, A., Tominack, H., Ungureanu, I., Ganapaneni, S., Tian, W. MD, Scifres, C. MD, & Robertson, S. MD Background: A complete molar pregnancy is a non-viable pregnancy that results from the implantation of a diploid fertilized egg containing no maternal DNA. Twin pregnancy of a complete mole with complete fetus (CMCF) is a very rare occurrence with an incidence of 1/22,000 to 1/100,000 pregnancies. Continuing a CMCF pregnancy can result in many risks to the health of the mother and fetus. Case: A 35-year-old G3P2 female presented to an obstetric scan at 20 weeks gestation, which was suspicious for both a viable fetus and a molar pregnancy. She had no significant medical history other than being BRCA1+, with two previous uncomplicated pregnancies. Her initial ultrasound at 10 weeks gestation was indeterminate on whether this was a partial mole vs CMCF. The patient was offered the option to terminate the pregnancy due to risk of complications but chose to proceed with the pregnancy. Because she was BRCA1+ with a strong family history of breast and ovarian cancer, she had a planned Cesarean-hysterectomy with bilateral oophorectomy at 34 weeks. Mother and infant were discharged on postoperative day 2, and the pathology report of the placenta confirmed the removal of a complete mole. Serial β-hcg levels were followed after delivery. Clinical Significance: Due to the high risk of complications, pregnancy termination is typically offered to patients in this situation. Patients who choose to continue the pregnancy should be thoroughly informed of potential complications. Risks associated with continuing a CMCF pregnancy include preeclampsia, vaginal bleeding, intrauterine death of the fetus, and the development of gestational trophoblastic disease. This patient was also complicated by being BRCA1+, which impacted surgical planning. Conclusion: CMCF pregnancy is a rare occurrence with many associated risks. In BRCA1+ patients who choose to continue a CMCF pregnancy, extensive counseling is necessary with consideration for risk-reducing surgical management at time of delivery.
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    Emergent Intervention of a Non-Communicating Rudimentary Uterine Horn Pregnancy
    (2023-03-24) Friel, Rylee; Evelyn, Crowley; Ali, Yasmin; Bell, Libby; Tian, Wendy; Scott, Nicole
    Background: Non-communicating rudimentary uterine horns (NRCH) arise from Mullerian duct malformations during embryonic development. Pregnancies of the rudimentary horn account for 0.0013% to 0.00067% of all pregnancies. Such pregnancies are non-viable and pose major risks to the mother. Without early detection and management, maternal mortality rates can be as high as 88% due to rupture. Case Description: A 22-year-old G1P0 female at 7 weeks gestation presented to the emergency department with abdominal pain for 3 weeks. A transvaginal ultrasound (TVUS) was performed and a fetal pole with cardiac activity was seen in the right adnexa, suspicious for ectopic pregnancy. She had an unremarkable TVUS 1 year ago. A diagnostic laparoscopy was performed for presumed treatment of ectopic pregnancy. During the procedure, patient was found to have a right non-communicating rudimentary uterine horn with pregnancy noted inside. The left horn was connected to the cervix and otherwise normal. Intraoperatively, the right ureter was not identified. Due to high risk of rupture, the rudimentary right horn with pregnancy and the right fallopian tube were resected. A postoperative CT urogram revealed a solitary renal kidney and single left ureter. Clinical Significance: The high mortality rate of ruptured NCRH pregnancies highlights the importance of early detection and proper management of such pregnancies. Mullerian duct anomalies are usually detected with ultrasound or magnetic resonance imaging prior to conception. In this case, the NRCH was formerly unknown and treated as an ectopic pregnancy with fetal cardiac activity. The complete resection of the rudimentary horn with pregnancy and fallopian tube proved to be an appropriate management for this emergent situation. Conclusion: In emergent situations of an undetected NRCH until pregnancy, resection of rudimentary horn with ipsilateral fallopian tube is not only therapeutic, but also preventative for potential future ectopic pregnancies.