Chorioamnionitis

The placenta is made of multiple layers, the outermost is referred to the “chorion”, and the innermost is referred to as the “amnion”. Within the amnion contain the fetus and amniotic fluid. Chorioamnionitis refers to inflammation that is present either at the chorion, amnion, or both. However since infection can also involve the fetus, amniotic fluid, or umbilical cord, with medical complication can be referred to as IAI, intra-amniotic infection.

It is mainly caused by the rupture of the amniotic sac, where polymicrobial flora from the vagina or cervix ascending through the cervical canal to cause infection. However it can also occur if the mother has bacteremia, or if the mother had an invasive procedure that might expose the amniotic cavity to pathogens. Normally, the cervical mucous plug and placenta, mother’s vaginal flora, and immune responses from the fetal membrane, can prevent this infection.

In chorioamnionitis, labor should be induced to deliver the baby and other products of conception. If C-section is considered, be aware that it may cause increased risk of infection at the wound, venous thrombosis, and endomyometritis. In conjunction with delivery, broad spectrum antibiotics should be given. UpToDate suggests the combination of IV Ampicillin 2g Q6hr and IV Gentamycin 5mg/kg QD. Other alternative antibiotics include Unasyn (Ampicillin/Sulbactam), Timentin (Ticarcillin/Clavulanic potassium), Zosyn (Piperacillin/Tazobactam), Cefoxitin, Cefotetan, and Ertapenem. Additional anaerobic coverage, such as Metronidazole or Clindamycin, should be added to the patients regimen when C-section is performed to reduce infectious complications. In fever, the mothers can be given acetaminophen.

Source:
https://www.uptodate.com/contents/intra-amniotic-infection-clinical-chorioamnionitis-or-triple-i?search=chorioamnionitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Cystic teratoma / Dermoid cyst

Teratomas fall under the category of “ovarian germ cell tumors”, or tumors that arise from the reproductive cells. Teratomas are the MC type of germ cell tumor. Mature teratomas aka Mature cystic teratoma aka Dermoid cysts are the most common ovarian tumor in women in their 20-30s. They are benign, and made from mature/differentiated tissues that are derived from the 3 cell layers: ectoderm, mesoderm, and endoderm. The types of tissues may be found in the dermoid cyst include: skin, sebaceous glands, fluid, hair, teeth, bone, thyroid tissue, and muscle. Its formation is theorized to be because of abnormal differentiation of germ cells, or some failure in meiosis I or II.

Patients with dermoid cysts are typically asymptomatic. Symptoms may occur when the mass exceeds a certain size. Complications include torsion and rupture of the cyst, where the latter scenario may risk hemorrhage and shock.

The diagnosis of teratomas may be made initially with U/S. Some signs that may point to this diagnosis include: the visualization of a hyperechoic structure present within the mass, there being a fluid-fluid level, or there being some kind of calcification. Additional Doppler imaging should be done to help rule out other possibilities. If there is blood flow, other tumors, including malignant “immature” teratomas may be the issue. A definitive diagnosis can be made once the mass gets excised and histology studies are done.

The treatment of mature teratomas is to conduct ovarian cystectomy. The removal of the cyst itself would help to prevent torsion, rupture, and the potential of the tumor growing malignant parts. Those who do not plan to conceive anymore may consider salpingo-oophorectomy.

Source:
https://www.uptodate.com/contents/ovarian-germ-cell-tumors-pathology-epidemiology-clinical-manifestations-and-diagnosis?search=cystic%20teratoma&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H9
https://www.uptodate.com/contents/ultrasound-differentiation-of-benign-versus-malignant-adnexal-masses?search=cystic%20teratoma&topicRef=3236&source=see_link#H23239137