Successful management of ruptured ovarian ectopic pregnancy: a case report

Ovarian pregnancy is one of the rarest sites of non-tubal ectopic pregnancy. It has a prevalence of 0.5-3.5% in all ectopic pregnancies. It usually presents with rupture in the first trimester, a potential life-threatening condition. A preoperative diagnosis is difficult to make. Majority of the cases are diagnosed intraoperatively followed by confirmation on histopathology. We presented a case of 32-year-old woman with previous two normal deliveries at 7 weeks gestation who presented with abdominal pain and spotting. She was diagnosed with ruptured ovarian ectopic pregnancy on laparotomy and salpingo-oophorectomy was done. Later, ovarian pregnancy was confirmed on histopathology. The incidence of ovarian ectopic pregnancy is increasing and it should be considered as a differential diagnosis in women of childbearing age coming to emergency department with abdominal pain. It is important to keep a high index of suspicion for its diagnosis. High resolution transvaginal ultrasonography can help in earlier detection and preventing some of its complications like rupture, shock and maternal mortality

Spontaneous heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan

Vitamin D deficiency and maternal complications

Background: Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, Himachal Pradesh, India over a period of 12 months. Six hundred women were included in the study.Results: Forty-eight (8%) subjects developed preeclampsia-eclampsia syndrome, of which none had sufficient vitamin D levels, whereas 48 (100%) subjects had vitamin D deficiency.Conclusions: Maternal antenatal complications are more common in vitamin D deficient group

Vitamin D deficiency and adverse fetal outcome

Background: Vitamin D deficiency is recognized as the most untreated nutritional deficiency in the world. It is plausible that vitamin D deficiency could make the fetal heart more vulnerable to distress/birth asphyxia. Vitamin D deficiency has been hypothesized to be associated with low birth weight, low Apgar score at birth, higher rates of still births and admission to NICU. The aim of present study was to study prevalence of vitamin D deficiency in pregnancy and evaluate perinatal outcome.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: All the mothers who had still births suffered from vitamin D deficiency and the severe vitamin D deficiency was there in 90.91% (30) of these subjects. Severe vitamin D deficiency was seen in 78.95% (75) of the subjects having babies with birth weights <2.5 kg compared to 61.16% (288) subjects of the other group.Conclusions: Adverse fetal outcome are more common in vitamin D deficient group

Prevalence of vitamin D deficiency in antenatal women

Background: Vitamin D has an increasingly recognised repertoire of non-classical actions, such as promoting insulin action and secretion, immune modulation and lung development. It therefore has the potential to influence many factors in the developing fetus. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section. The present study was undertaken to study the prevalence of vitamin D deficiency in antenatal women of Shimla, India.Methods: The study was conducted in the department of Obstetrics and Gynaecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: Out of 600 subjects, 568 (94.67%) subjects had vitamin D deficiency and only 32 (5.33%) subjects had sufficient vitamin D levels. Vitamin D deficiency was more common in the vegetarians, dark skinned subjects and in those who were taking vitamin D supplements.Conclusions: It is concluded from this study that there is high prevalence of vitamin D deficiency in antenatal women of Shimla, India

Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome

Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects