Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali.
The Pan African medical journal
Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1, 2019, to May 31, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.
10.11604/pamj.2024.47.66.36210
Vulvar oedema among pregnant Mozambican women.
Bergström S
Gynecologic and obstetric investigation
During a 3-year period, a total of 22 pregnant women with vulvar oedema were observed in a high-risk antenatal clinic (ANC) in Maputo. They were compared with 22 unselected normal ANC attenders, matched for age, parity, gestational length and area of living. Reported and observed genital ulcers were more prevalent in the oedema group than in the referent group. Reported and observed vaginal discharge was also significantly more common in the oedema group. Syphilis screening by VDRL was positive in 61.9% of oedema cases while positivity reached 5.0% in referents (p < 0.005). Cases found seropositive on screening were confirmed using Wassermann reaction (WR) in a reference laboratory, in which WR-positive cases underwent FTA-ABS analysis and IgM assay with solid-phase haemadsorption. IgM-positive individuals were significantly more prevalent among WR-positive oedema cases than among WR-positive referents (p < 0.05). It is concluded that among antenatal attenders in Maputo presenting with vulvar oedema, a significant proportion is associated with recent syphilis. Vulvar oedema should be considered as an important marker for seropositive syphilis during pregnancy.
10.1159/000292729
Giant fibroepithelial vulvar polyp in a pregnant woman.
BMJ case reports
Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.
10.1136/bcr-2020-236106
Aggressive angiomyxoma in pregnancy.
Rare tumors
Aggressive angiomyxoma (AA) is a rare, slow-growing mesenchymal neoplasm of vulvo-perineal region. Although AA is common in females of reproductive age, only a few cases during pregnancy have been documented in the English literature. It carries a high risk of local recurrence but rarely metastasizes. The high recurrence rate can partially be due to inadequate excision, which may be due to an incorrect preoperative diagnosis. We present a case of 25-year-old pregnant female presenting with a painless and soft mass attached to left labia majora by a stalk. This mass was clinically thought to be a lipoma. It was completely excised and was diagnosed as AA on histopathology. Gynecologists should consider the diagnosis of AA when a young female especially during her pregnancy presents with a vulvo-perineal mass. Incorrect diagnosis may lead to incomplete excision and recurrence.
10.4081/rt.2014.5362
Bartholin gland carcinoma: A case report.
Helmi Zeena,Nori Wassan,Ghani Zghair Muna Abdul,Abdulrahman Hadi Bahaa ALdeen
JPMA. The Journal of the Pakistan Medical Association
Bartholin gland carcinomas are rare types of tumours, accounting for less than 1% among females. This case report is of a 20-years patient in her 16th week of pregnancy who presented with pain and swelling in the left groin for two weeks. Examination showed a well-defined fixed swelling with induration in the left vulva, with an irregular margin and a diameter of about 5 cm, just at the Bartholin's gland site with two palpable ipsilateral lymph nodes. Bartholin's gland abscess was suspected. The decision was to drain the pus under general anaesthesia. During the procedure, a hard mass was felt at the left Bartholin glands region. The incision was extended, which unraveled a 5*5 cm abnormal-looking mass; it was hard and fixed to the adjacent tissues. Histopathology confirmed adenocarcinoma of Bartholin gland in stage III. The oncologist advised pregnancy termination and chemoradiation. Although surgical excision is essential for treating tumours, still, a multimodal approach can prove to be more effective.
Condyloma acuminatum: atypical presentation during pregnancy.
Nigam A,Mishra A
International journal of STD & AIDS
Genital warts (condylomata acuminata) are caused by human papillomavirus (HPV) and are usually transmitted sexually. We present an atypical case of a vaginal wart presenting as a single pedunculated mass protruding outside the vagina in a pregnant woman in labour. On examination of the vulva, a soft, pink papilliferous growth of 6 × 4 cm size was seen hanging outside the vaginal introitus. Speculum examination revealed that the growth was attached to the posterior and lateral vaginal wall near the fornix. Genital warts can proliferate during pregnancy due to altered immunity and increased blood supply, as seen in this case. Vaginal warts can also cause problems during delivery, since they prevent the vagina from stretching appropriately.
10.1258/ijsa.2009.009114
Feto-maternal outcome of pregnancy complicated by vulvar cancer: a systematic review of literature.
Matsuo Koji,Whitman Stephanie A,Blake Erin A,Conturie Charlotte L,Ciccone Marcia A,Jung Carrie E,Takiuchi Tsuyoshi,Nishimura Masato
European journal of obstetrics, gynecology, and reproductive biology
Vulvar cancer is an extremely rare complication during pregnancy, and its effect on pregnancy and survival is not well understood. A systematic literature review was conducted in order to examine the fetal and maternal outcomes and optimal management of pregnancy complicated by vulvar cancer. PubMed/MEDLINE were used to identify case reports with searching keywords "pregnancy" and "vulvar cancer" between January 1955 and February 2014 that identified 36 cases for analysis. Mean age was 30.7. The most common presenting symptom and gestational age were vulvar mass/swelling (75.0%) and the second trimester of pregnancy (54.8%), respectively. Vulvar biopsy at the time of initial presentation to care during pregnancy was performed in only 46.7% of cases. Among delayed cases for biopsy, mean duration of delay was 12.8 weeks and the majority had a delay for more than 8 weeks (62.5%). The majority of vulvar cancer was squamous histology (47.2%) and stage I disease (60.0%). Vulvectomy and inguinal-femoral lymphadenectomy were performed in 97.1% and 63.9%, respectively. Abdominal delivery was recorded in 46.2% of cases. Live birth and full term delivery rates were 96.3% and 74.0%, respectively. For survival analysis, delay in diagnosis and advanced stage disease were commonly associated with decreased disease-free survival (5-year rate, delay in diagnosis >8 versus ≤8 weeks, 0% versus 69.1%, hazard ratio (HR) 7.86, 95% confidence interval (CI) 2.03-30.6, p=0.001; and stage III-IV versus stage I-II, 0% versus 59.8%, HR 3.35, 95% CI 1.16-9.68, p=0.011) and overall survival (5-year rate, delay in diagnosis >8 versus ≤8 weeks, 0% versus 67.1%, hazard ratio (HR) 14.8, 95% CI 1.77-124, p=0.001; and stage III-IV versus stage I-II, 0% versus 86.4%, HR 8.22, 95% CI 2.06-33.2, p<0.001). In conclusion, while the majority of cases resulted in good pregnancy outcomes, diagnosis of vulvar cancer during pregnancy is frequently delayed. Since delayed diagnosis is a significant prognosticator of decreased survival outcomes, early recognition is integral in the management of pregnancy complicated by vulvar cancer.
10.1016/j.ejogrb.2014.04.017
Vulvar Leiomyosarcoma in Pregnancy.
Aljehani Ala M,Quatei Amani,Qattea Lina,Aljohani Renad M,Alkushi Abdulmohsen
Cureus
Vulvar leiomyosarcoma is a rare smooth muscle malignant neoplasm but it is the commonest type of vulvar sarcomas. It may mimic benign tumors and misdiagnosis could delay proper management. We report a case of a 38-year-old pregnant woman with leiomyosarcoma of the vulva. The patient presented to her primary general practitioner with a small vulvar mass that she had first noticed one year prior. The tumor was suspected to be benign Bartholin's cyst and treated with antibiotics. The patient declined improvement and had many consultations to different clinics where she had been diagnosed and treated the same. The tumor size started to grow rapidly after she got pregnant, and the patient was referred to our hospital where she underwent tumor resection. Histopathology revealed leiomyosarcoma. The patient had further assessment and close follow-up and has had no recurrence for 12 months. There is little literature available on vulvar leiomyosarcoma, most of which are case reports, and most gynecologic oncologists will go through their whole careers without seeing a single case.
10.7759/cureus.18772
Anal fissure and thrombosed external hemorrhoids before and after delivery.
Abramowitz Laurent,Sobhani Iradj,Benifla Jean Louis,Vuagnat Albert,Daraï Emile,Mignon Michel,Madelenat Patrick
Diseases of the colon and rectum
PURPOSE:Thrombosed external hemorrhoids and anal fissures are common and are responsible for severe discomfort during childbirth. However, the real incidence of these lesions is unknown. The aim of our study was to evaluate their incidence and the risk factors for these lesions during childbirth. METHODS:A prospective study with proctologic examination during the last 3 months of pregnancy and after delivery (within 2 months) was performed in 165 consecutive pregnant females. RESULTS:Fifteen females (9.1 percent) with anal lesions (13 thrombosed external hemorrhoids and 2 anal fissures) were observed during pregnancy. Fifty-eight females (35.2 percent) with anal lesions (33 thrombosed external hemorrhoids and 25 anal fissures) were observed during the postpartum period. Ninety-one percent of thrombosed external hemorrhoids were observed during the first day after delivery, whereas anal fissures were distributed, with no peak, over the two months after delivery. The 2 independent risk factors for anal lesions (among obstetric, baby's, and mother's information) were dyschezia, with a 5.7 odds ratio (95 percent confidence interval, 2.7-12), and late delivery, with a 1.4 odds ratio (95 percent confidence interval, 1.05-1.9). Furthermore, many thrombosed external hemorrhoids were observed after superficial perineal tears and heavier babies (P < 0.05). Only 1 of the 33 patients with thrombosed external hemorrhoids who were observed underwent a cesarean section. CONCLUSION:One third of females have thrombosed external hemorrhoids or anal fissures in the postpartum period. The most important risk factor is dyschezia. Traumatic delivery appears to be associated with thrombosed external hemorrhoids.
10.1007/s10350-004-6262-5