Ob-gyn clinical cases

This edition of our journal begins at the obstetrics section with a very interesting case report about the therapeutic challenges in a patient with Turner syndrome and in vitro fertilization (IVF) pregnancy, pointing out that pregnancy management in patients with Turner syndrome should be individualized, in order to reduce the risk of maternal and fetal complications.

The next paper presents the clinical experience of the Emergency University Hospital Bucharest regarding emergency and elective peripartum hysterectomy, a rare but critical surgical procedure, typically performed in the context of severe obstetric hemorrhage unresponsive to conservative management, the findings emphasizing the need for early diagnosis, coordinated multidisciplinary care, and institutional preparedness in managing patients at high risk for peripartum hysterectomy.

Moving on to gynecology section, the growing global demand for meat and dairy has led many livestock producers to use artificial hormones to speed up animal growth and increase production, raising serious concerns for human health. This study reviews the health effects of consuming hormone-treated animal products, through a meta-analysis of peer-reviewed articles published after 2012, encouraging stronger regulation, better consumer education, and safer, hormone-free farming practices in order to protect public health and ensure a more sustainable food system.

Empty follicle syndrome (EFS) is an uncommon but frustrating phenomenon observed during assisted reproductive technology (ART), wherein no oocytes are retrieved, despite optimal ovarian response and adequate follicular maturation. The case presented in our paper highlights the diagnostic and therapeutic challenges of genuine EFS and supports the use of dual trigger protocols in high-risk patients, particularly in those with polycystic ovary syndrome (PCOS), to improve oocyte maturation and IVF outcomes.

Furthermore, fertility is a very sensitive condition. The aim of the study presented was to compare the effects of major surgical methods on fertility in women diagnosed with ovarian endometrioma, concluding that complete laparoscopic excision of ovarian endometrioma provided superior disease control and higher spontaneous pregnancy rates compared to conservative methods. Also, the fertility benefit was balanced against the risk of reduced ovarian reserve.

Menopause, a physiological mile­stone in a woman’s life, is associated with vasomotor, urogenital, skeletal, cardiovascular and neurocognitive changes resulting from a decline in estrogen production. Timely and indi­vi­dualized initiation of hormone re­placement therapy can deliver significant improvements in symptoms, bone integrity and selected cardiovascular outcomes. The optimal management should follow evidence-based recommendations, include periodic reasses­sment, and involve shared decision-making with the patient.

At the end, it is presented a rare case of mechanical entrapment of an in­trauterine device (IUD) removing hook during attempted retrieval of a Mirena device in a 45-year-old multiparous woman. This case highlights the importance of a calm, stepwise approach when managing difficult IUD removals.