Emiliasari Malawat, Agung B Setiyanto, Adhi Pribadi, Budi Handono, Anita Deborah Anwar Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Regional Hospital, Bandung, IndonesiaCorrespondence: Emiliasari Malawat, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Regional Hospital, Bandung, 40161, Indonesia, Email emiliasari24001@mail.unpad.ac.idIntroduction: Situs inversus is a rare congenital condition characterized by a mirror-image reversal of thoracic and/or abdominal organs, with an estimated incidence of 1 in 10,000 live births. Although many individuals are asymptomatic, the condition is associated with congenital heart disease (CHD), and because a mirror-image heart may appear structurally normal, it can be overlooked at routine prenatal ultrasonography unless fetal laterality is determined first.Case Description: A 25-year-old primigravida was referred at 34– 35 weeks of gestation for evaluation of fetal growth restriction; fetal situs inversus had not been identified at previous antenatal examinations. Ultrasonography showed the stomach on the right, the liver on the left, the descending aorta to the right of the spine and the inferior vena cava to the left, with the cardiac apex directed to the right. Fetal echocardiography confirmed atrial situs inversus with mirror-image dextrocardia and normal systemic and pulmonary venous return, without structural cardiac defects or features of heterotaxy. Doppler indices were normal, and the fetus was categorized as small for gestational age. The patient delivered a neonate weighing 2365 grams vaginally at 39 weeks and 4 days, and postnatal echocardiography confirmed mirror-image dextrocardia with normal intracardiac anatomy.Conclusion: Isolated situs inversus totalis can remain undetected until the third trimester because each standard view of a mirror-image heart appears normal. Determining fetal laterality at the start of every obstetric scan, followed by detailed fetal echocardiography to exclude CHD and heterotaxy, consideration of genetic evaluation, and postnatal follow-up for primary ciliary dyskinesia, allows accurate counseling and appropriate perinatal planning.Keywords: situs inversus, dextrocardia, ultrasonography, prenatal, fetal heart, fetal growth retardation, case reports
Zhi-Jun Jiang,1,2,* Jia Wu,1,* Yang Zhang,3 Li-Ming Shen,3,* Wen-Qiu Chen,3 Xi Zhang,3 Quan-Ming Luo,4 Fa-Jin Lv,1 Ying Tang3 1State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Radiology, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan, People’s Republic of China; 3Department of Obstetrics and Gynecology, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan, People’s Republic of China; 4Department of Radiology, Nanbu County People’s Hospital of Sichuan Province, Nanbu, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fa-Jin Lv, State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China, Email fajinlv@163.com Ying Tang, Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China, Email 925393235@qq.comBackground: This study explored the correlation of the junctional zone, depth of myometrial invasion (DMI), and their combination (COJD) with symptom recurrence after ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS) in patients diagnosed with intrinsic adenomyosis.Methods: A total of 326 patients undergoing FUAS between June 2017 and March 2024 were enrolled in this retrospective analysis. Symptom recurrence was defined as the return of menorrhagia or dysmenorrhea after ≥ 3 months of relief. Risk factors for recurrence were identified by logistic regression and Cox proportional hazards models. The receiver operating characteristic (ROC) analysis was conducted to determine the optimal cutoffs for maximal junctional zone thickness (JZmax) and DMI, which were utilized for constructing the COJD score.Results: Symptom recurrence was observed in 58 patients (17.8%). Multivariate logistic regression identified JZmax as an independent predictor of recurrence (OR = 1.060, 95% CI: 1.026– 1.095, P < 0.001). The optimal cutoffs were 23.1 mm for JZmax and 51.4 mm for DMI. Besides, COJD was significantly related to recurrence in Cox regression (HR = 6.004, 95% CI: 1.125– 32.054, P = 0.036). Median recurrence-free survival reduced progressively with the increasing COJD score: 53.0 months for COJD = 0, 45.8 months for COJD = 1, and 38.7 months for COJD = 2 (P = 0.046).Conclusion: The COJD score, combining JZmax with DMI, was an independent predictor of symptom recurrence after FUAS, with a score of two identifying patients at the highest risk of early recurrence.Plain Language Summary: The combination of JZmax with DMI may predict adenomyotic symptom recurrence following FUAS. The COJD score was an independent predictor, with a score of 2 identifying patients at the highest risk for early recurrence.Keywords: JZmax, DMI, COJD, intrinsic adenomyosis, symptom recurrence, focused ultrasound ablation surgery
Binyan Chen,1,* Huanqing Chen,1,* Jinyi Tong,2 Lei Xu,3 Yahui Wang2 1The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Respiratory, Suzhou Research Center of Medical School, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yahui Wang, Department of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, People’s Republic of China, Email 362303714@qq.comBackground: The incidence of lower extremity deep vein thrombosis following gynecologic laparoscopy is 4.0%, whereas postoperative well-leg compartment syndrome (WLCS) is much rarer, with a reported incidence of only 0.03%– 0.20%. Both conditions can present with postoperative lower limb swelling and pain. We report a case of postoperative lower limb swelling and pain that suspected to be caused by venous congestion injury secondary to decreased compliance of the external iliac vein, a condition that has not been previously reported in the literature.Case Presentation: A 44-year-old woman underwent an 8-hour gynecologic laparoscopic procedure in the Lloyd-Davies position. Thirty minutes after surgery, she developed acute swelling, pain, and numbness of the right lower limb. Deep vein thrombosis was initially suspected, but treatment was ineffective. Unilateral well-leg compartment syndrome (WLCS) was subsequently considered, and her symptoms were relieved following supportive treatment, including dehydration therapy and elevation of the affected limb. Repeated review of the surgical video suggested lower limb congestive injury potentially associated with decreased compliance of the external iliac vein. The patient also experienced persistent postoperative symptoms resembling venous intermittent claudication, consistent with the clinical manifestations of impaired external iliac venous outflow.Conclusion: This case highlights the need for increased attention to the condition of the external iliac vascular sheath during gynecologic laparoscopic surgery. Swelling and thickening of the vascular sheath, resulting in decreased compliance of the venous wall, may lead to severe venous congestion injury of the lower limb and may require timely intraoperative intervention when necessary. This case may provide a reference for the clinical diagnosis and management of postoperative lower limb swelling and pain following gynecologic laparoscopic surgery.Keywords: Laparoscopic surgery, surgical complication, the external iliac vein, venous compliance
Sri Wulandari Novianti,1 Henny Suzana Mediani,2 Siti Yuyun Rahayu Fitri,2 Ikeu Nurhidayah21Doctoral Program Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia; 2Pediatric Nursing Department, Faculty of Nursing, Padjadjaran University, Bandung, West Java, IndonesiaCorrespondence: Henny Suzana Mediani, Pediatric Nursing Department, Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia, Email henny.mediani@unpad.ac.idAbstract: Breastfeeding is essential for maternal and child health, yet global exclusive breastfeeding rates remain below WHO targets. Although community-based breastfeeding education and counseling interventions have expanded substantially, existing evidence has been synthesized primarily around outcome effectiveness, while critical implementation details, including how interventions are delivered, by whom, at what intensity, and how families are involved, remain scattered across the literature and have not been systematically mapped. This scoping review aimed to map existing evidence on community-based breastfeeding education and counseling interventions, focusing on delivery models, providers, family involvement, intervention intensity, and outcomes. A scoping review was conducted following the methodological framework of Arksey and O’Malley, and reported in accordance with PRISMA-ScR guidelines. Literature searches were performed across Scopus, PubMed, and EBSCO, and eligible studies were selected using the Population–Concept–Context (PCC) framework. Data were extracted using structured table and analysed using narrative and descriptive synthesis. Twenty studies met the eligibility criteria. Five key domains were identified: (1) delivery models, including individual counselling, motivational interviewing, teach-back, peer counselling, community health worker support, digital/telehealth strategies, and multimodal integrated approaches; (2) intervention providers, involving midwives, nurses, lactation consultants, peer counsellors, and community health workers; (3) family involvement, which was conceptually recognised but inconsistently operationalised, with limited structured engagement of fathers and extended family members; (4) intervention intensity and follow-up, ranging from brief single sessions to continuous support for up to six months, with considerable variation in dosage across studies; and (5) outcomes, where breastfeeding self-efficacy showed consistent improvement, whilst exclusive breastfeeding and early initiation outcomes were heterogeneous, particularly in standalone digital interventions. Community-based breastfeeding interventions are increasingly multimodal and relational, with the use of digital platforms expanding; however, substantial variation remains in how these interventions are implemented, particularly in intervention dosage and the structured involvement of family, with no shared framework for describing or comparing these components across studies. Future research should strengthen family-integrated, context-adapted intervention designs, guided by a common reporting framework that remains flexible enough to accommodate differing community needs while enabling more meaningful comparison of implementation approaches across settings.Keywords: breastfeeding, scoping review, counseling, community health, father involvement, digital health
