This article is a literature review on Sampson’s Artery. Despite its popularity among gynecologists, not much is known about this artery. It is considered a physiologically insignificant artery located below the round ligament but can serve as a source of severe bleeding. Namesake Dr. John A. Sampson was a predominant gynecologist who studied pelvic anatomy and coined the term “endometriosis”. A study at the University of Hawaii John A. Burns School of Medicine revealed that only 41% of medical students were able to identify Sampson’s artery. Many anatomy text books fail to acknowledge Sampson’s artery, which could explain its obscurity and popularity among gynecologists as a secret artery.

Ovarian Hyperstimulation Syndrome (OHSS) is a complication associated with In Vitro Fertilization (IVF) treatment. The clinical manifestations are due to an increase of vascular permeability and extravasations of fluid in a third space. Herein we report an unusual case of OHSS revealed by an isolated bilateral pleural effusion. A 37-year-old patient presented with dyspnea and orthopnea in addition to dry cough and chest pain 2 weeks after an IVF cycle with 13 oocytes retrieved, E2: 2435 pg/ml and 2 cleavage stage embryo transferred. Patient was afebrile, tachycardic, tachypneic with normal oxygen saturation. Decreased breath sounds of both lung bases were detected. Laboratory tests showed Albumin 2.8 g/dl, Human Chorionic Gonadotropin (hCG) 1494 mU/ml, fibrinogen > 500 mg/dl, D-Dimer 666 ng/ml. Hematocrit, renal and liver function tests were in normal range. Electrocardiogram was normal. Transvaginal sonography did not show free fluid. Chest X-ray revealed bilateral pleural effusion and angio-CT discarded Pulmonary Embolism (PE). Patient was admitted to the intensive care unit for seven days. She was symptomatically treated with intravenous diuretics and albumin, oxygen and low molecular weight heparin with a good recovery. Then she was discharged on the thirteenth day. Three days after she was re-admitted for chest pain without any other symptoms. PE was discarded again with a lung scintigraphy and pleural effusion persisted in Chest X-ray. The patient improved after 2 days of symptomatic management. A single intrauterine gestational sac was seen but it ended in miscarriage at 8 weeks. Severe OHSS is a life-threatening complication that requires an early diagnosis and treatment.

Human reproduction is characterized by its inefficiency. The loss of pregnancy at any stage can be a devastating experience and particular sensitivity is required in assessing and counseling couples with Recurrent Miscarriage (RM). Recurrent Miscarriage (RM) represents a clinical challenge for physicians not only because there are multiple possible etiologies, but also because the diagnostic testing is costly and time consuming. Despite several well-known etiologic factors, the cause of RM cannot be determined in almost 50% of cases. Multiple potential etiologies for RM have been described and, as a consequence, several recommendations with very different levels of evidence have been published regarding the evaluation and management of this condition.

Background: Celiac disease is an immune-mediated mucosal disorder primarily affecting the small intestine in genetically-susceptible individuals. It may be triggered by dietary exposure to gluten. In some patients, extra-intestinal or autoimmune changes may occur, as hepatobiliary, neurological, or endocrine disorders. The aim to study the reproductive health indicators among Sudanese female with celiac disease (15-45 years) and to determine menstrual pattern, infertility status as well as obstetrical outcome among those women at Ibn sina specialized hospital from December 2014 to June 2015. Material and Methods: This is a descriptive analytic hospital based study, carried out at Ibn sina specialized hospital, conducted from December 2014 to June 2015, included 81 women, diagnosed as celiac disease, attended celiac clinic during the study period. The data was collected using a questionnaire by me after agreed informative consent and analyzed by computer using SPSS program (20). Results: 32 (39.5%) of women were between 25-34 years and 58 (71.6%) of women were on strict gluten diet. 52 (64.1%) of women had menarche after age of 16, 30 (37%) experienced oligomenorrhoea and 2 (2.5%) had secondary amenorrhoea and their menstrual pattern was improved with gluten free diet(P value 0.002), 36 (44.4%)of women were married, 21 (58.3%) of these women experienced difficulty in conceiving which affected by the duration of their disease(P value 0.000), 23 (63.9%), 21 (58.3%) had past history of miscarriage and pregnancy induced hypertension respectively. Conclusion: celiac disease has a significant role in women reproductive health, in the form of delay menarche, a change of menstrual pattern, difficulty in conceiving, and poor obstetric outcome such as miscarriage and pregnancy induced hypertension.

Background: Aberrant progesterone signaling has been demonstrated in mechanistic studies to be a shared common pathway in fibroids and endometriosis. Progesterone receptor modulation with the Selective Progesterone Receptor Modulator (SPRM) ulipristal may decrease pain associated with endometriosis. Case: A 25-year-old nulligravidae with endometriosis-related pelvic pain refractory to medical and surgical intervention was administered 15mg ulipristal every other day for 3 months. Daily pain scores and bleeding diary were recorded and serum chemistries and hormone levels were checked prior to, during and after treatment. Pre-treatment and surveillance endometrial biopsy specimens were examined for histology and stained for estrogen and progesterone receptor status. During therapy, pain scores decreased to a median of 0 (P<0.05) and the patient became amenorrheic. Surveillance endometrial biopsy demonstrated SPRM-associated endometrial changes that appeared strikingly similar to simple hyperplasia and resolved with ulipristal discontinuation. Immunohistochemical evaluation demonstrated the presence of estrogen and progesterone receptors before and during ulipristal treatment. Conclusion: Progesterone receptor modulation with ulipristal substantially improved pain symptoms in a patient with treatment-refractory endometriosis. SPRM-associated changes in the endometrium closely mimicked hyperplasia, developed after less than three months of treatment and resolved after discontinuation of ulipristal and induction of withdrawal bleed.