Hyperemesis Gravidarum: An Out of the Box Presentation, a Rare Case Report and Literature Review
Bibliographic record
Abstract
Infratentorial ependymoma presenting as hyperemesis gravidarum during pregnancy is not reported in the literature. The management of these rare infratentorial tumors during pregnancy poses a great challenge to the obstetrician, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of the tumor and pose varying risks to both the mother and the fetus. We report a case of an infratentorial ependymoma presenting as hyperemesis gravidarum at 24 weeks of gestation. A 36-year-old diabetic woman was admitted with persistent vomiting at 24 weeks of gestation with a provisional diagnosis of hyperemesis gravidarum. She had history of hyperemesis gravidarum throughout the antenatal period and was on regular follow-up by obstetrician and physician. She developed features of intracranial hypertension and bilateral abducent nerve palsy during hospital stay. An MRI scan of the brain revealed a tumor of the fourth ventricle causing obstructive hydrocephalus. An emergency ventriculoperitoneal shunt was done to relieve the intracranial pressure. Subsequently, she underwent a suboccipital craniotomy with complete removal of the tumor. Histopathology was consistent with ependymoma. During the postoperative period, she developed stridor and dyspnoea and was ventilated. Intrauterine death of the fetus was confirmed by ultrasonology as there was cessation of the fetal heart sound. A hysterotomy was done to remove the fetus as an induction of labor failed. She subsequently developed ventilator associated pneumonia and adult respiratory distress syndrome followed by septicemia and expired on the 12th postoperative day despite appropriate antibiotics and other supportive measures. To our knowledge, this is the first reported case of infratentorial ependymoma presenting during pregnancy. Intracranial tumors, especially infratentorial tumors during pregnancy, are associated with high maternal and fetal morbidity and mortality as they behave differently from supratentorial tumors. A definite protocol for the management of pregnant patients with infratentorial tumors is lacking as there are only few reported cases. Early detection and treatment plays an important role in the management of these tumors. J Clin Gynecol Obstet. 2014;3(4):143-146 doi: http://dx.doi.org/10.14740/jcgo287w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".