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Reprod. Med., Volume 6, Issue 1 (March 2025) – 5 articles

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6 pages, 947 KiB  
Case Report
New-Onset Anti-LGI1 Encephalitis in a Pregnant Woman
by Britteny Randall, Eric Schmitt, Blaine McGraw, Donald Gloeb and Matthew Blattner
Reprod. Med. 2025, 6(1), 5; https://doi.org/10.3390/reprodmed6010005 - 5 Feb 2025
Viewed by 355
Abstract
Background and Clinical Significance: Anti-Leucine-rich glioma inactivated-1 (anti-LGI1) encephalitis is a rare, autoimmune disorder often presenting with limbic encephalitis. The reported incidence of anti-LGI1 is 0.83/million/year, with elderly males accounting for the overwhelming majority of cases. While anti-LGI1 encephalitis is a well-known cause [...] Read more.
Background and Clinical Significance: Anti-Leucine-rich glioma inactivated-1 (anti-LGI1) encephalitis is a rare, autoimmune disorder often presenting with limbic encephalitis. The reported incidence of anti-LGI1 is 0.83/million/year, with elderly males accounting for the overwhelming majority of cases. While anti-LGI1 encephalitis is a well-known cause of autoimmune encephalitis in men over 50, our literature review found no published cases in pregnant women. The purpose of this study is to describe a rare presentation of this pathology in an unexpected population. Case Presentation: A 21-year-old gravida 2, para 1001 woman at 20 weeks’ gestation presented with worsening seizure-like activity for the past four months, frequent falls, loss of consciousness, and concern for trauma to the abdomen. Her neurologic workup one month prior revealed a 72 h electroencephalography (EEG) with epileptic seizures of the left frontotemporal region, but a normal magnetic resonance image (MRI) of her head. A repeat MRI during this hospitalization showed bilateral limbic and basal ganglia T2 hyperintensities. She was treated with increasing doses of antiepileptic drugs without improvement and was transferred to a neurology intensive care unit, where she was diagnosed with anti-LGI1 encephalitis. She was initially treated with oral corticosteroids with inadequate response, then with intravenous immunoglobulin therapy (IVIG). Her seizure activity persisted throughout her pregnancy, requiring multiple admissions for IVIG, but she eventually delivered a healthy baby and continues to receive long-term care for her new diagnosis. Conclusions: This case illustrates classic findings of anti-LGI1 encephalitis in a non-classic patient population. Knowledge that such a case exists may serve to broaden the differential diagnoses when physicians are presented with a similar pregnant patient and expand the reported patient population in this rare disease. Full article
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7 pages, 5354 KiB  
Case Report
Recurrent Borderline Ovarian Tumors in the Adolescent Population: Case Report
by Maya Fisher, Christine McGough and Janelle P. Darby
Reprod. Med. 2025, 6(1), 4; https://doi.org/10.3390/reprodmed6010004 - 5 Feb 2025
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Abstract
Background and Clinical Significance: Borderline ovarian tumors (BOTs) are a rare diagnosis, especially in the adolescent population. This can make initial management and surveillance strategies difficult, given the limited guidelines and experience in this young age group. Case Presentation: We present [...] Read more.
Background and Clinical Significance: Borderline ovarian tumors (BOTs) are a rare diagnosis, especially in the adolescent population. This can make initial management and surveillance strategies difficult, given the limited guidelines and experience in this young age group. Case Presentation: We present two cases of recurrent serous BOTs diagnosed in adolescent patients. Both patients were initially treated with fertility-sparing surgery and followed with transabdominal pelvic ultrasounds. Secondary surgical debulking of recurrent disease with uterine preservation was successful in both patients with a long-term disease-free status. Conclusions: Although rare, BOTs can occur in adolescent patients and should be on the differential for ovarian masses in this age group. Fertility-sparing surgical techniques, reproductive endocrinology consultation, surveillance strategies, and hormone replacement therapy should all be taken into consideration when treating adolescent patients with BOTs. Full article
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6 pages, 1496 KiB  
Case Report
Case Report of Concomitant Presentation of Ovarian Torsion and Acute Appendicitis in a Patient Post-Hysterectomy
by Eric Schmitt, Krystal Glasford, Samantha Carson and Christopher Rosemeyer
Reprod. Med. 2025, 6(1), 3; https://doi.org/10.3390/reprodmed6010003 - 20 Jan 2025
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Abstract
Background: Diagnoses for right lower quadrant pain in women must include both gynecologic and non-gynecologic causes. In this differential, ovarian torsion and appendicitis are both serious etiologies that can require swift surgical intervention. Ovarian torsion is the least common of the two, [...] Read more.
Background: Diagnoses for right lower quadrant pain in women must include both gynecologic and non-gynecologic causes. In this differential, ovarian torsion and appendicitis are both serious etiologies that can require swift surgical intervention. Ovarian torsion is the least common of the two, accounting for 2.7% of emergency surgery cases according to a 10-year review, while the lifetime risk of appendectomy for females is 23.1%. As many as 2–3% of patients undergoing surgery for acute appendicitis are instead found to have ovarian torsion. However, there are currently only rare case reports of these two conditions co-presenting in the same patient simultaneously, with little discussion on how to be better prepared before entering the operating room. Objective: The purpose of this study is to describe this rare co-presentation to better inform providers of this potential complication and to improve future patient care outcomes. Method: A case report of a patient seen at Tripler Army Medical Center, Honolulu, Hawaii, was assessed. Conclusions: This case shows the rare possibility of dual acute etiologies of abdominal pain warranting urgent surgical management. This case also highlights the need for a multidisciplinary approach in the pre-procedural evaluation of possible competing etiologies of acute abdominal pain that warrant surgical management. Additionally, this case brings up interesting ethical questions regarding informed consent, autonomy, and the obligation of intraoperatively consulted surgeons to provide definitive and indicated surgical care in the absence of prior discussion of possible pathology. Full article
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13 pages, 880 KiB  
Article
Time to Diagnosis and Treatment of Postpartum Hypertensive Disorders in the Emergency Department—A Single Retrospective Cohort Study
by Gabrielle J. Ezell, Nicolina Smith, Mary Condon, Katherine Joyce, John Joseph, Kylie Springer and D’Angela S. Pitts
Reprod. Med. 2025, 6(1), 2; https://doi.org/10.3390/reprodmed6010002 - 3 Jan 2025
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Abstract
Background/Objectives: In the postpartum period, approximately 12% of patients seek care in the emergency department (ED), with a higher representation of Black patients. Hypertension is a common reason for ED visits during this period, often leading to dangerously delayed diagnosis and treatment. Objective: [...] Read more.
Background/Objectives: In the postpartum period, approximately 12% of patients seek care in the emergency department (ED), with a higher representation of Black patients. Hypertension is a common reason for ED visits during this period, often leading to dangerously delayed diagnosis and treatment. Objective: This study aims to assess the time to diagnosis and treatment of hypertensive disorders in the postpartum period in the ED, focusing on potential disparities in care, to identify areas for quality improvement. Design: Retrospective cohort study. Setting: A multi-centered large medical institution in the metro Detroit area. Methods: Postpartum patients (day 2 through day 28) presenting to the ED from November 2015 to December 2022. Exposures: none. Main Outcome Measures: Primary analysis assessed the time elapsed between severe-range blood pressure readings (greater than/equal to 160 systolic and/or 110 diastolic) and the administration of antihypertensives. Secondary analyses assessed the presence of essential laboratory workups such as complete blood counts, complete metabolic panels, and urine protein and creatinine. Results: Among the 430 women who presented to the ED during the postpartum period with hypertension, 372 (86.5%) exhibited severe-range blood pressure (greater than/equal to 160 systolic and/or 110 diastolic). Patients presented on average on postpartum day 6. Of the patients with severe hypertension, only 72% received a complete blood count, 66% underwent evaluation of creatinine and liver profile, and 4% had a urine protein and creatinine test ordered. The average time from severe-range blood pressure reading to antihypertensive administration was 189 min for Black patients and 370 min for White patients. There were no statistically significant differences in the time of the first blood pressure reading, laboratory evaluation, or treatment of severe-range blood pressure between racial groups. Conclusions: This study identifies the most significant area for improvement in the timely administration of antihypertensive medication following severe-range blood pressure readings. Additional areas for improvement were observed in ordering essential laboratory tests to assess the severity of preeclampsia. The institution demonstrated delayed yet equitable care for White and Black patients, contrary to the existing literature indicating potential racial disparities. A targeted quality improvement plan has been implemented to improve the identified areas of concern to adhere to the ACOG’s treatment recommendations for hypertensive disorders of pregnancy. The impact on patient care will be reassessed at the 1-year mark. Full article
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10 pages, 203 KiB  
Article
Maternal Race and Clinical Vigilance in Obstetric Hemorrhage Management
by Michelle Joy Wang, Megan V. Alexander, Akanksha Srivastava, Diana Abbas, Sara Young, Swetha Tummala, Lindsey Claus, Ronald Iverson, Ashley Comfort and Christina D. Yarrington
Reprod. Med. 2025, 6(1), 1; https://doi.org/10.3390/reprodmed6010001 - 2 Jan 2025
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Abstract
Background/Objectives: Previous literature has described that non-white pregnant patients are at increased risk of severe morbidity from obstetric hemorrhage (OBH). Here, we investigate whether such disparities are secondary to delay in the administration of postpartum oxytocin for non-white patients compared to white patients. [...] Read more.
Background/Objectives: Previous literature has described that non-white pregnant patients are at increased risk of severe morbidity from obstetric hemorrhage (OBH). Here, we investigate whether such disparities are secondary to delay in the administration of postpartum oxytocin for non-white patients compared to white patients. Methods: This is a retrospective cohort study of all deliveries from 2018 to 2019, comparing (1) Hispanic white or non-white race (HW/NWR) pregnant people and (2) non-Hispanic white (NHW) pregnant people. Our primary outcome was the time from delivery to the first dose of postpartum oxytocin, and our secondary outcome was the frequency of other hemorrhage interventions. Results: Out of 3832 patients with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW, and 3188 patients identified as HW/NWR. We found no difference in time to first dose of postpartum oxytocin (p = 0.51), and there was also no difference in the frequency of other hemorrhage-related interventions. Conclusions: Our study found no delay in the administration of postpartum oxytocin for non-white patients. Full article
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