Poster Abstracts II
27a. Intrauterine Fetal Demise (IUFD) in Non-
Communicating Horn of Unicornuate Uterus: A
Case Report
Shashwati Pradhan MD*, Vanessa Hux MD, Bethany Stetson MD,
Jonathan Schaffir MD*
The Ohio State University, Department of Obstetrics and Gynecology,
Columbus, OH
Background: Pregnancy in unicornuate uteri or uteri with other Mulle-
rian anomalies are known to have greater risk of adverse pregnancy out-
comes, such as preterm delivery and IUFD. In cases of unrecognized
Mullerian anomalies, patients are at risk for medical complications, addi-
tional procedures and complicated hospital courses.
Case: The patient is a 32 year-old G1P0 at 29 weeks gestation by first
trimester ultrasound who presented for induction of labor for IUFD. After
transfer of care to our institution, she had presented for anatomy ultra-
sound at 29 weeks gestation when she was found to have an IUFD
measuring 19w4d. Induction of labor was attempted with multiple doses
of misoprostol, intracervical Foley catheter placement, and laminaria
without successful dilation. Given this course, pelvic ultrasound was per-
formed revealing an abnormal uterine cavity with empty uterine horn on
maternal left and fetus in right uterine horn. An exam under anesthesia
was performed to attempt intra-operative placement of intra-cervical
Foley. Under ultrasound guidance, entry into the non-pregnant left uterine
horn was performed without difficulty with the uterine sound; however,
despite multiple attempts, the pregnant uterine horn was unable to be
entered. Magnetic resonance imaging was performed and showed no
communication between the pregnant uterine horn and the cervix. With
high suspicion for a non-communicating horn containing the IUFD, we
performed an exploratory laparotomy where rudimentary non-commu-
nicating horn with normal-appearing fallopian tube and ovary containing
IUFD was identified and resected.
Patient recovered well post-operatively and was counseled on risks of
pregnancy with known unicornuate uterus.
Comments: In this case we report the uncommon finding of pregnancy in
a non-communicating horn of a unicornuate uterus. Although rare, it is
hypothesized that fertilization was possible through microscopic connec-
tions, as well as transmigration of the sperm from the left Mullerian
structures to the right. Evaluation of the patient’s anatomy on obstetric
ultrasound was limited due to late gestation at presentation to our insti-
tution and impacted the patient’s prolonged induction/hospital course.
This case serves as a reminder that prolonged unsuccessful inductions may
be a sign of a pregnancy in a location that lacks communication with the
cervix, and should prompt evaluation for Mullerian anomalies. In addition,
this case highlights the importance of early global evaluation of the uterine
cavity in obstetric ultrasound, optimally in the first trimester. This allows
for appropriate counseling to be conducted about adverse pregnancy
outcomes due to Mullerian anomalies.
27b. Fibroepithelial Polyp of the Vagina in an
Adolescent
Gisselle Perez-Milicua MD*, Francisco J. Orejuela MD, Ninad M. Patil MD,
Oluyemisi Adeyemi-Fowode MD*
Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
Background: Neoplasms of the vagina are uncommon. Presentation
varies and can include sensation of pressure, dyspareunia, urogenital
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obstruction, bloody discharge, tissue protruding from the vagina, and
abdominal pain in cases of large masses. Neoplasms that may develop in
other locations within the genital tract may also be found in the vagina
thus the differential must include both benign and malignant consider-
ations. We present an unusual case of a fibroepithelial polyp of the vagina
(FEPV) with an ano-cutaneous fistula in an adolescent.
Case: A sexually active 18 year old female was referred to the Pediatric
and Adolescent Gynecology clinic due to a vaginal bulge present for 1
year. She reported discomfort with walking and sitting, chronic con-
stipation and denied any abnormal vaginal discharge, pruritus, history of
sexually transmitted infections, stool or urinary incontinence. Exami-
nation revealed an anterior vaginal wall prolapse consistent with Stage
III pelvic organ prolapse. Redundant anterior vaginal mucosa was
irregular, thick with a width of 5 cm and approximately 3 cm from the
urethral meatus. A focused neurological exam at the perineum was
normal. External hemorrhoids were noted. Further investigation per-
formed with pelvic and transperineal ultrasounds revealed a 3.7 cm
heterogeneous soft tissue mass in the anterior vagina that was inde-
pendent of the urethra and bladder. A CT scan of the pelvis showed a
heterogeneous, well-circumscribed, lobulated, midline, 5.8 cm mass
distending the distal vaginal canal with no evidence of invasion to
adjacent structures. An office cystoscopy by Uro-Gynecology revealed no
urinary tract abnormalities. The patient underwent complete excision of
the vaginal mass without complications. Additional intraoperative
findings included a 5 mm ano-cutaneous fistula at 7 o’clock at the level
of the external anal sphincter and a 5 mm skin growth at 6 o’clock of
similar characteristics to the vaginal mass. Pathology of the vaginal mass
revealed a benign fibroepithelial polyp with hamartomatous features.
Postoperatively, a pelvic floor MRI showed a 2.5 x 1.1 cm nonspecific
polypoid lesion at 6 o’clock at the perineum which does not appear to
transect the external anal sphincter. It also showed a well-circumscribed
area at the superior aspect of the gluteal cleft most likely a sequela of an
infected sebaceous cyst. She is awaiting evaluation by Colorectal
Surgery.
Comments: Fibroepithelial polyps are benign lesions that can affect the
lower female genital tract. FEPV are mucosal polypoid lesions with a
connective tissue core covered by a benign squamous epithelium. They are
thought to be rare as few cases are reported in literature. The lesions can
vary in size and number and appear to be hormonally related and have
been reported more often in pregnant women. Although benign, it can be
confused with sarcoma botryoides, rhabdomyosarcoma and mixed
mesodermal tumor because of its bizarre histology. Treatment is by simple
excision and recurrence with complete resection is uncommon. Recur-
rence after incomplete excision has been reported as a benign lesion with
no malignant transformation. FEPV should be considered in the differential
for vaginal neoplasm.
28a. Post-Operative Infection After Vaginal
Septum Excision in Patients With Obstructive
Mu€ llerian Anomalies: A Case-Series
Robin Richards MD*, Maggie Dwiggins MD, Veronica Gomez-Lobo MD*
Medstar Washington Hospital Center-Georgetown University Medical Center,
Children’s National Medical Center, Washington DC
€ llerian
Backround: Prompt diagnosis and management of obstructed Mu
anomalies is critical in minimizing short and long term morbidity for
young women. Late presentations increase the risk for infectious compli-
cations, pelvic scarring, and infertility. More evidence is needed to inform
treatment of late, complicated presentations and improve long term