Current Women's Health Reviews - Volume 18, Issue 3, 2022

Background: The incidence of Placenta Accreta Spectrum Disorders (PASD) has increased by 10-fold in 50 years along with the number of cesarean sections. Ultrasound examination using Placenta Accreta Index (PAI) score and Placenta Accreta Spectrum (PAS) stage as a predictor of PASD has been used worldwide at the antenatal screening. The high diagnostic value of these tools will help the physician to diagnose PASD early and minimize the rate of maternal neonatal mortality and morbidity. Objectives: To evaluate the value of PAI score and PAS stage in diagnosing PASD. Methods: This study is a diagnostic test study using the medical records of mothers who gave birth at Haji Adam Malik General Hospital Medan Indonesia between September 2017 to September 2020, who were diagnosed preoperatively as placenta previa suspected PASD through ultrasound examination using PAI score or PAS stage. The results of these two diagnostic tests were compared to clinical diagnostic criteria of PASD from The International Federation of Obstetrics and Gynecology (FIGO) with or without histopathological confirmation. Results: Of the 177 placenta previa cases, there were 142 women with PASD (80.2%). The diagnostic values of PAI score with 4.6 as an optimal cut-off point were 75% sensitivity, 83% specificity, 94% positive predictive values (PPV), and 47% negative predictive values (NPV). The diagnostic values of the PAS stage were 90% sensitivity, 83%, specificity, 96% PPV, and 68% NPV. Conclusion: PAI score and PAS stage have a diagnostic value that looks equally good when used as a diagnostic tool for PASD.

Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to the unopposed growth-promoting action of estrogen. WHO classified endometrial hyperplastic lesions into Benign Hyperplasia (BH) and atypical hyperplasia/ endometrial intraepithelial neoplasia AH/EIN. Phosphatase and tensin homolog (PTEN) is one of the earliest and most common genetic abnormalities detected in endometrioid adenocarcinoma (type I) and even in its precursors. This study aims at histological evaluation of hyperplastic endometrial lesions according to WHO 2014 and investigates the role of PTEN expression in highlighting the precancerous group (AH/EIN). Patient and Methods: This study included a series of 70 Egyptian patients who suffered from hyperplastic endometrial lesions. They were previously diagnosed according to WHO 1994 schema simple endometrial hyperplasia without atypia (n=18), simple endometrial hyperplasia with atypia (n=2), complex hyperplasia without atypia (n=25), complex hyperplasia with atypia (n=5) and hyperplastic endometrial polyps (n=20). Results: Cases were histologically re-evaluated according to WHO 2014 classification; BH (62 cases) and eight cases of AH/EIN. A significant difference in PTEN expression (regarding percentage and intensity of staining) in relation to histopathological diagnosis was detected (P-value 0.02 and <0.05, respectively). The sensitivity and specificity of the absence of diffuse PTEN protein expression (>50%) to detect AH/EIN were 100% and 77.4%, respectively. Conclusion: Diffuse, dim or loss of immunohistochemical expression of PTEN protein is significantly correlated with the new WHO classification segregation of AH/EIN as precancerous lesions. However, further studies are recommended to confirm this association.

Background: Acute abdominal due to primary mesenteric venous thrombosis is uncommon during pregnancy. Case presentation: This is a case presentation of a 23-year-old pregnant woman with a personal history of immune thrombocytopenia and splenectomy performed 4 years ago, who presented at the emergency department with abdominal pain, nausea, vomiting, and diarrhea. The patient underwent resection and anastomosis of gangrene in the small intestine due to mesenteric venous ischemia. Conclusions: The diagnosis of mesenteric venous thrombosis should be considered in the setting of acute abdomen in early pregnancy in women with prior history of coagulation disorder.