Emergency peripartum hysterectomy: a retrospective study at a tertiary care hospital

Background: The main objective is to study the incidence, demographic profile, indications and feto-maternal outcome associated with emergency peripartum hysterectomy (EPH).Methods: We conducted a retrospective, observational study over a period of 5 years; from January 2011 to December 2015.We studied 81 patients who underwent EPH for various indications in Department of Obstetrics & Gynaecology, MGM Medical College, Indore.Results: The rate of EPH in present study was 1.46 per 1000 deliveries. Uterine rupture (64.2%) was the most common indication followed by morbidly adherent placenta (11.1%), uterine atony (11.1%).The most common morbidities were wound sepsis and pyrexia. Maternal mortality was 8.6% whereas perinatal mortality was 62 %.Conclusions: Proper antenatal intrapartum care, early referral and judicious decision making regarding caesarian section are the potential methods which can be implemented to prevent this catastrophic event

A study of maternal and perinatal outcome in induction of labour at 40 weeks and 41 weeks of gestation

Background: To study and compare the maternal and perinatal outcome of induction of labour in pregnancies at 40 week and 41 week of gestation.Methods: 150 pregnant women who completed 40 weeks of pregnancy and were screened through exclusion and exclusion criteria .They were induced with intracervical PGE2 gel. Maternal and perinatal outcomes were determined and compared in 40 week group (40+0 – 40+6days) and 41week group (41+0–41+6 days).Results: Prolongation of pregnancy is observed frequently in nulliparous  women in both the groups (74% vs 62%).Caesarian rates were more in 41 week group compared to 40 week group (30% vs 12%, p=0.007). Maternal outcome in terms of PPH, perineal tears and sepsis are observed more in 41 week group though it was not statistically significant (p=0.493). Birth asphyxia, MAS and MSL are factors responsible for worse perinatal outcome in 41 week group that was statistically significant (p=0.009). Age and duration of labour showed no difference in both groups.Conclusions: Labour induction should be done at 40 weeks - it is reasonable option because it prevents a lot of maternal and perinatal complications

Role of serum progesterone in threatened miscarriage

Background: Miscarriage is the inadvertent loss of a pregnancy before the fetus is viable. The World Health Organization defines this un-survivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, M. G. M. Medical College and M.Y. Hospital, Indore from October 2013 to October 2014 on 100 patients.Results: The incidence of first trimester threatened miscarriage, in the Gynaec O.P.D. of M.Y. Hospital, Indore, was 8.8%. The most common risk factor was a history of previous miscarriages in 38% of cases while 9% had advanced maternal age and 35% had advanced paternal age. History of preterm labour was positive in 25% cases and that of congenital anomaly in previous pregnancy in 7% cases. UTI and vaginitis were diagnosed in 10% and 11% cases respectively. Systemic illness was in 24% cases while 6% cases had endocrine disorders. On USG missed miscarriage was found in 8% inconclusive ultrasound was found in 34% cases, rest were normal. Of the 38 cases giving history of previous 1, 2, 3 and more than or equal to 4 miscarriages were 22%, 6%, 8% and 2 % respectively. 36% of the patients presented with bleeding per vaginum. only while 30% had bleeding with pain and 33% cases had only pain in abdomen. On USG 58% had normal scans. USG scan was inconclusive in 34% and only 35% continued with viable pregnancy, rest aborted. 7 of the 100 cases had preterm labour and 51 cases continued to term. Rest 42 aborted. H/o contact, travel, trauma, heavy work did not have any statistically proven effect on outcome of pregnancy.Conclusions: Progesterone assays are currently available in most immunoassay platforms and have shown excellent performance in terms of assay sensitivity, specificity, accuracy and precision with rapid turnaround times. Furthermore, the cost per test for progesterone assay is affordable. Several studies have shown that progesterone is the most specific biomarker for distinguishing viable from nonviable pregnancies. The downfall of progesterone as a biomarker is due to the different cut-off values used by researchers. The cut-off values were also determined on different study populations

Radiological appearance of Appendicular osteosarcoma: A case report

A 42yr old male patient with complaints of on and off pain of right shoulder and arm since 3months. No e/o weight loss and loss of appetite. No e/o fever. No e/o discharging sinus/ superficial swelling over the right arm

A VERY INFREQUENT ASSOCIATION OF WILLIAM-BEURAN SYNDROME AND TETRALOGY OF FALLOT

WB-S Autosomal Dominant Disorder is the most common genetic disorder. We report a case of 20 year old with infrequent association of WBS and TOF. Clinical examination and ECHO confirmed TOF, WB-S was suspected based on the clinical signs used in the scoring system of WB-S which were described by AAP(2001), FISH study was performed in this patient because of having more than 3 clinical signs of WB-S and FISH study showed 7q11.23 deletion and remains the gold standard laboratory investigation for WB-S. KEYWORDS: Tetralogy of Fallot; William Beuren Syndrome; Clinical Diagnosis; Fluroscence In Situ Hybridisation

A VERY INFREQUENT ASSOCIATION OF WILLIAM-BEURAN SYNDROME AND TETRALOGY OF FALLOT

WB-S Autosomal Dominant Disorder is the most common genetic disorder. We report a case of 20 year old with infrequent association of WBS and TOF. Clinical examination and ECHO confirmed TOF, WB-S was suspected based on the clinical signs used in the scoring system of WB-S which were described by AAP(2001), FISH study was performed in this patient because of having more than 3 clinical signs of WB-S and FISH study showed 7q11.23 deletion and remains the gold standard laboratory investigation for WB-S. KEYWORDS: Tetralogy of Fallot; William Beuren Syndrome; Clinical Diagnosis; Fluroscence In Situ Hybridisation

Quantification of joint mobility limitation in adult type 1 diabetes

AimsDiabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a method to measure it complicate studying associations with organ involvement and treatment outcomes. We measured metacarpophalangeal (MCP) joint extension as a metric and describe magnetic resonance (MR) imaging determinants of MCP restriction.MethodsAdults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, and function [Duruoz hand index (DHI) and grip strength]. Patients were segregated by mean MCP extension (<20°, 20°–40°, 40°–60°, and >60°) for MR imaging (MRI) scanning. Patients in the four groups were compared using ANOVA for clinical features and MRI tissue measurements (tenosynovial, skin, and fascia thickness). We performed multiple linear regression for determinants of MCP extension.ResultsOf the 237 patients (90 men), 79 (33.8%) with cheiroarthropathy had MCP extension limitation (39° versus 61°, p < 0.01). Groups with limited MCP extension had higher DHI (1.9 vs. 0.2) but few (7%) had pain. Height, systolic blood pressure, and nephropathy were associated with mean MCP extension. Hand MRI (n = 61) showed flexor tenosynovitis in four patients and median neuritis in one patient. Groups with MCP mobility restriction had the thickest palmar skin; tendon thickness or median nerve area did not differ. Only mean palmar skin thickness was associated with MCP extension angle on multiple linear regression.ConclusionJoint mobility limitation was quantified by restricted mean MCP extension and had structural correlates on MRI. These can serve as quantitative measures for future associative and interventional studies

Kilonova Luminosity Function Constraints Based on Zwicky Transient Facility Searches for 13 Neutron Star Merger Triggers during O3

We present a systematic search for optical counterparts to 13 gravitational wave (GW) triggers involving at least one neutron star during LIGO/Virgo's third observing run (O3). We searched binary neutron star (BNS) and neutron star black hole (NSBH) merger localizations with the Zwicky Transient Facility (ZTF) and undertook follow-up with the Global Relay of Observatories Watching Transients Happen (GROWTH) collaboration. The GW triggers had a median localization area of 4480 deg², a median distance of 267 Mpc, and false-alarm rates ranging from 1.5 to 10⁻²⁵ yr⁻¹. The ZTF coverage in the g and r bands had a median enclosed probability of 39%, median depth of 20.8 mag, and median time lag between merger and the start of observations of 1.5 hr. The O3 follow-up by the GROWTH team comprised 340 UltraViolet/Optical/InfraRed (UVOIR) photometric points, 64 OIR spectra, and three radio images using 17 different telescopes. We find no promising kilonovae (radioactivity-powered counterparts), and we show how to convert the upper limits to constrain the underlying kilonova luminosity function. Initially, we assume that all GW triggers are bona fide astrophysical events regardless of false-alarm rate and that kilonovae accompanying BNS and NSBH mergers are drawn from a common population; later, we relax these assumptions. Assuming that all kilonovae are at least as luminous as the discovery magnitude of GW170817 (−16.1 mag), we calculate that our joint probability of detecting zero kilonovae is only 4.2%. If we assume that all kilonovae are brighter than −16.6 mag (the extrapolated peak magnitude of GW170817) and fade at a rate of 1 mag day⁻¹ (similar to GW170817), the joint probability of zero detections is 7%. If we separate the NSBH and BNS populations based on the online classifications, the joint probability of zero detections, assuming all kilonovae are brighter than −16.6 mag, is 9.7% for NSBH and 7.9% for BNS mergers. Moreover, no more than 10⁻⁴, or φ > 30° to be consistent with our limits. We look forward to searches in the fourth GW observing run; even 17 neutron star mergers with only 50% coverage to a depth of −16 mag would constrain the maximum fraction of bright kilonovae to <25%

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta