Christine Joy Chang graduated Bachelor of Science, Medical Technology from University of Santo Tomas. She took up Medicine at Far Eastern University-Nicanor Reyes Medical Foundation and graduated 2010. She had her internship at Department of Health – Philippine Centers for Specialized Health Care and has rotated in various hospitals such as Philippine Heart Center, East Avenue Medical Center, Lung Center of the Philippines, National Kidney and Transplant Institue and Philippine Children’s Medical Center. She is currently a third year Obstetrics and Gynecology Resident at Quezon City General Hospital
Bilateral tubal pregnancy is the rarest form of ectopic pregnancy, and in most cases results from assisted reproductive techniques. Th e incidence of simultaneous bilateral tubal pregnancies has been reported to range from 1 per 725 to 1 per 1580 ectopic pregnancies or approximately corresponds to 1 per 200,000 pregnancies. till date, this is the only case reported in our institution. Bilateral tubal pregnancies are usually diagnosed intraoperatively, but with the advent of diagnostic tools and more readily available diagnostic modalities, an earlier diagnosis can be made to decrease maternal morbidity and mortality. Although the incidence of a bilateral tubal pregnancy is rare, both adnexae and ovaries as well as the entire pelvis should be thoroughly examined at the time of exploratory laparotomy when diagnosis of an ectopic pregnancy is made. Even if patients are at a high risk of having another ectopic pregnancy, conservative management is also an important consideration in such cases with attempts to save the tubes. Keeping in mind hopes of having future natural pregnancies, especially in our setting, where not everybody can aff ord assisted reproductive technologies Th is is a case of a 24-year old female, who came in at the emergency room complaining of severe hypogastric pain. She was admitted as a case of ectopic pregnancy, probably ruptured. Subsequently, emergency exploratory laparotomy was done. Upon exploration, there was 1.3 liters of hemoperitoneum. Th e left fallopian tube was converted to a 4x4 centimeter cystic, hemorrhagic mass with a 1.5 centimeter point of rupture at the ampullary area. Th e right fallopian tube on the other hand was converted into a 6x6 centimeter cystic, hemorrhagic mass with no point of rupture. Both ovaries and uterus were grossly normal. No adhesions were noted. Th e surgical team then proceeded with bilateral salpingectomy. Estimated blood loss was 2 liters. Histopathological examination confi rmed bilateral tubal pregnancy.
Tehila Avitan Department of Obstetrics and Gynecology, Shaare Zedek MedicalCenter, Israel.
Objective: Th e most common ocular fi nding in preeclampsia is severe arteriolar spasm. Optical Coherence Tomography (OCT) provides a non-invasive technique for visualization of the various retinal layers. Th e purpose of the study is to describe vascular retinal changes seen in preeclampsia. Study Design: Swept source OCT was used during the study. We extracted depth-integrated images using the IMAGEnet soft ware by selecting the outer retina in accordance with the automated layer segmentation system. Results: We report a case of a primigravida 40-year-old pregnant with monochorionic twins. She was admitted at 29 weeks of gestation due to elevated blood pressure (BP) without proteinuria. Blood tests were normal. Visual acuity was 20/20 bilaterally and funduscopy unremarkable. During hospitalization, the patient developed preeclampsia manifested by increasing BP and proteinuria. At 33 weeks the patient complained of bilateral visual blur. Th e visual acuity was right 3/20, left 2/20, as bilateral extensive, punctate, pale-yellow Elschnig's spots were present in the posterior fundus. We also noticed bilaterally swollen discs, discrete left peripapillary fl ame-shaped hemorrhages as well as some degree of macular edema. At that time, the BP increased and a cesarean section was performed. Two healthy babies were delivered. Over the next three weeks, as the patient recovered hemodynamically and visually the optic disc regained its usual appearance and the spots gradually faded. At the paroxysmal phase(second row) there is diff use structural changes well beyond the area of thickened retina. Two days later (third row), as the blood pressure is regularized and proteinuria resolving, the general changes in vascular texture persist but the central avascular area looks closer to baseline. Peripapillary macular edema is decreasing. Ten days later(last row), aft er substantial decrease of the retinal thickness, the overall texture of the deep vascular plexus has not returned to its initial state but the central avascular area looks normalized. Conclusion: OCT analysis revealed extensive outer retinal changes. No similar changes were detected at the level of the superfi cial capillary plexus or at other selected planes.Th e described ocular fi ndings should be regarded as the fi rst documentation of the selective eff ect of preeclampsia on the deep vascular plexus and outer retina.With its angiographic modalities, OCT should improve our understanding on the impact of preeclampsia on the retina. Th is novel modalities, considered to be safe in pregancy, are crucial in characterizing vascular and structural changes in normal and complicated pregnancy.