Uterine compression suture (UCS) has become widely acknowledged as an effective measure to achievehemostasis mainly for atonic bleeding. We described a case in whom UCS was effective in performing cesarean hysterectomy. A 28-year-old woman after term planned CS due to placenta previa had severe postpartum hemorrhage. Unresponsive to uterotonics, UCS was performed, which did not achieve hemostasis, with bleeding amount of 7000 mL. Peripartum (cesarean) hysterectomy was performed without any difficulty. UCS compressed the uterus or at least prevented the uterine cavity from filling with a large amount of blood. This reduced the amount of bleeding during the surgery. UCS may also be useful for other conditions such as prophylaxis of uterine re-inversion or prophylaxis of bleeding after perimortem cesarean section. Thus, UCS may be more widely applicable than previously considered.

Introduction: Vaginal infections are the most commonly reported condition among women with HIV/AIDS and such infections often represent the most common initial manifestation of the illness. As a consequence, post-infective early and late complications are frequently reported in these patients. Vaginal stenosis has been reported as a rare late complication of severe vaginal infections. The vaginoscopic treatment with miniaturized instruments of a severe vaginal stenosis with huge hematocolpos in a HIV-infected woman is here reported.
Case presentation: A 38 year-old HIV-infected woman was referred to our Emergency Unit because of severe pelvic pain, increasing over time, beginning a week before, after a sexual intercourse. At physical and ultrasonographic examination, complete vaginal stenosis up to the vaginal vestibule (miming a transversal vaginal septum) with a giant haematocolpos was diagnosed. She was scheduled for traditional surgical treatment in the operating room with Hegar dilatators but the procedure was unsuccessful. The patient was then scheduled for an operative vaginoscopy in office setting by means of a 5mm oval-profile hysteroscope. The use of 5Fr bipolar electrode and mechanical instruments allowed to make a break in the “wall”, thus allowing the complete drainage of the haematocolpos without any significant complication.
Conclusion: Vaginoscopy with miniaturized instruments represent a safe, convenient, and efficient therapeutic modality that can be used in patients with a restrictive vaginal opening or narrow vaginal canal.

Sirenomelia is a sporadic congenital anomaly caused by a disruptive vascular defect. This syndrome is characterized by fusion of the lower extremities, almost invariably associated with bilateral renal agenesis and generally absence of sacrum, rectum and bladder. In this case, the bilateral renal agenesis was present with severe oligohydramnios, in association with other anomalies as single umbilical artery and ambiguous external genitalia, which are often found in other cases publicated, and truncus arteriosus type IV. This latter association has been never described before in the revision of the literature.

Ectopic pregnancy accounts for 2% of all first-trimester pregnancies and within the United States it remains as the leading cause for maternal death in the first trimester. Early detection of an ectopic pregnancy is imperative to ensure prompt treatment, which includes possible medical or surgical management to prevent life-threatening complications. Most ectopic pregnancies implant within the fallopian tube, but ectopic pregnancies can occur in the cervix, abdomen, ovary, or uterine cornua. These types of ectopic pregnancies are often harder to detect and have an increased risk for hemorrhage. We present a case of a peritoneal pregnancy which was missed at initial laparoscopy in which operative findings were notable for a bleeding right fallopian tube with no evidence of the gestational tissue. An exploratory laparotomy was performed twenty-four hours later for concerns of an acute abdomen revealed an ectopic implant with active bleeding and peritoneal erosion over the rectum. This case illustrates the ramifications of a ruptured ectopic pregnancy and also highlights the limitations of laparoscopy as a diagnostic modality in evaluating for an ectopic pregnancy

Mullerian developmental anomalies are rare causes of primary amenorrhea in 46, XX adolescent girls. The aim to report this case is that Mullerian anomalies should be considered between the differential diagnosis of primary amenorrhea to prevent the delaying of the diagnosis. A 15 year-old female patient presented with a complaint of not menstruating. Medical history revealed an appendectomy at the age of 9 years, and surgical intervention due to a right para-ovarian hemorrhagic cyst at the age of 12 years. Apelvic Magnetic Resonance Imaging (MRI) evaluation revealed two uteri, one of which was rudimentary. Normal-sized uterus was not continued byvaginal lumen; however, the rudimentary uterus was connected with vaginal lumen. A hemorrhage to peritoneal cavity was suspected by pediatric endocrinologist and referred to gynecologist and radiologist for detailed investigation. It was concluded that the previously excised cyst might be bleeding into the peritoneal cavity as a result of menstruation. Then, the patient was scheduled for surgery.

In medical school, future physicians are taught the phrase "primum non nocere", first do no harm. That adage motivates every physician, every healthcare provider, to go to great lengths to avoid an incorrect diagnosis for a patient. As a gynecological surgeon, that adage is put to the test with every operative patient dealing with a pelvic mass. Encountering an undiagnosed malignancy during and anticipatedbenign surgical intervention is stressful for the surgeon, but devastating to the unprepared patient. Recently, attention has focused on uterine morcellation at time of laparoscopic hysterectomy. Stemming from the inadvertent morcellation of a leiomyosarcoma in a patient presumed to have been benign fibroids, the question has arisen of informed consent disclosures versus the appropriateness of a selected surgery when the possibility of a malignancy exists (WSJ Dec 2013).

A 20 year old woman presented in gynaecology department feeling generally unwell with vomiting and a large abdominal mass. The mass was of 28 weeks gravid uterus size. She reported a normal period 5 weeks earlier. A urine pregnancy test was weakly positive. She had a regular cycle with no other significant medical or surgical history. On examination she was pale and tachycardia, Pulse 104/min, BP 134/70 mmHg, Temp 36.4.