Obstetric outcomes in women with mullerian duct malformations

Background: Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aims to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.Methods: This retrospective study evaluates the obstetric outcome of 24 in patients with uterine malformations with pregnancy in Sapthagiri Hospital from August 2010 to August 2013. A total of 60 randomly selected pregnant women with a previously confirmed normally shaped uterus were taken as a control group.Results: A total of 2595 women were admitted for various obstetric reasons during August 2010-2013 (period of 3 years). Of them 24 cases had uterine anomaly, the rate of anomaly being 9.2 per 1000 pregnant women. A bicornuate uterus was present in 7 (29%) septate uterus in 6 (25%) arcuate in 5 (20.8%), and unicornuate with rudimentary horn in 2 (8.4%). Unicornuate uterus without rudimentary horn in 1 (4.2%) and uterus didelphys in 1 (4.2%). Transverse vaginal septum was seen in 2 (8.4%) patients. The rate of malpresentation was high in uterus didelphys, arcuate and bicornuate uterus. Abortion rates were equal in both septate and bicornuate uterus. A comparison of mode of presentation and termination of pregnancy is illustrated. Preterm deliveries (33.4%) and miscarriage rates (20.8%) were more common compared to controls. Less than half the women (45.8%) had term deliveries compared to controls where pregnancies which reached term were 86.7%. An assessment of mode of delivery, termination, period of gestation at delivery and birth weight between study group and control group is given.Conclusions: Women with congenital uterine malformation usually have higher incidence of complications during pregnancy and delivery. Early diagnosis and treatment can improve obstetric outcomes

Alpha methyldopa induced hepatotoxicity in pregnancy

We report a case of gestational hepatitis due to alpha-methyldopa and briefly review the literature on alpha-methyldopa-induced hepatotoxicity in pregnancy. A 32 year old woman, primigravida with 34 weeks of gestation with pre eclampsia, presented with symptoms of nausea, dark coloured urine and jaundice. She was on alpha methyldopa (Aldomet) 250 mg thrice a day since the last five weeks. Laboratory investigations revealed raised bilirubin, serum aspartate transaminases and serum alanine transaminases. Platelets were normal. Peripheral smear did not show haemolysis. With the exclusion of viral, haemolytic and obstructive causes, drug induced jaundice was considered as a differential diagnosis. Alpha methyldopa was withdrawn and replaced with nifedipine for her pre eclampsia treatment. Her repeat bilirubin level done two weeks later showed a drop. She went into labour at 38 weeks and delivered vaginally. In postpartum follow up her liver tests returned to normal in two weeks, about six weeks after stopping methyldopa. Hepatotoxicity should be considered as one of the adverse drug reaction of alpha methyldopa. It is not possible at present to predict which patients will develop liver disease following the administration of this drug. An awareness of the possibility of methyldopa induced hepatotoxicity should be present in the clinician’s mind and liver function tests should be done at regular intervals. The occasional occurrence of this harmful side effect is not a contraindication to the use of this antihypertensive agent