Broad ligament term pregnancy in an unscarred uterus: misdiagnosis and the challenges

A broad ligament pregnancy is a rare condition, but full term broad ligamnet pregnancy especially in an unscarred uterus is extremely rare. It is often misdiagnosed and usually finally diagnosed during surgery. Here is case of full term broad ligament pregnancy, which remained undiagnosed throughout her pregnancy, unfortunately had IUFD. Patient was referred to our hospital in view of failure of induction with increased BP records. No ultrasound was available on admission. On clinical assessment it appeared as transverse lie with IUFD. So cesarean was decided as a mode of delivery. Emergency ultrasound could just confirm IUFD with pelvic mass? Fibroid (actually deviated uterus). On laparotomy the broad ligament pseudosac had occupied entire abdomen. After delivery of baby, anatomy was found completely distorted. Highly vascular omental adhesions on fundus with difficulty in placental removal. Placenta could be traced reaching abdomen posteriorly. The first clinical impression was suspicion of placenta percreta. Uterus appeared non salvageable and hysterectomy was decided. Placenta was found lying in abdomen, adhered to bowel, omentum and fundus of uterus. The final diagnosis of broad ligament pregnancy could be made after the cut section of the uterus and anatomic evaluation. Patient required blood transfusions preoperatively .She remained stable and discharged on postoperative day nine. This case holds importance because may be outcome was different if it was a booked and investigated pregnancy. May be baby and uterus were salvageable with better outcome

Pelvic pain due to intrauterine retention of fetal bone after second trimester medical termination of pregnancy: a rare case report

Intrauterine retention of fetal bone is a rare complication of second trimester termination of pregnancy. These patients may present with abnormal uterine bleeding, dysmenorrhea and secondary infertility. In this case pelvic pain was the only symptom. A 32-year-old woman with history of second trimester medical termination of pregnancy was examined. Pelvic ultrasound revealed retained products of conception. After surgical evacuation, intrauterine retained fetal bone was identified to be the cause of pelvic pain. In patients with history of second trimester abortion, cause of pelvic pain should be properly evaluated

Glyoxalase I gene deletion mutants of Leishmania donovani exhibit reduced methylglyoxal detoxification

Background: Glyoxalase I is a metalloenzyme of the glyoxalase pathway that plays a central role in eliminating the toxic metabolite methyglyoxal. The protozoan parasite Leishmania donovani possesses a unique trypanothione dependent glyoxalase system. Principal Findings: Analysis of the L. donovani GLOI sequence predicted a mitochondrial targeting sequence, suggesting that the enzyme is likely to be targeted to the mitochondria. In order to determine definitively the intracellular localization of GLOI in L. donovani, a full-length GLOI gene was fused to green fluorescent protein (GFP) gene to generate a chimeric construct. Confocal microscopy of L. donovani promastigotes carrying this chimeric construct and immunofluorescence microscopy using anti-GLOI antibodies demonstrated that GLOI is localized in the kinetoplast of the parasite apart from the cytosol. To study the physiological role of GLOI in Leishmania, we first created promastigote mutants heterozygous for GLOI by targeted gene replacement using either hygromycin or neomycin phosphotransferases as selectable markers. Heterozygous mutants of L. donovani display a slower growth rate, have lower glyoxalase I activity and have reduced ability to detoxify methylglyoxal in comparison to the wild-type parasites. Complementation of the heterozygous mutant with an episomal GLOI construct showed the restoration of heterozygous mutant phenotype nearly fully to that of the wild-type. Null mutants were obtained only after GLOI was expressed from an episome in heterozygous mutants. Conclusions: We for the first time report localization of GLOI in L. donovani in the kinetoplast. To study the physiological role of GLOI in Leishmania, we have generated GLOI attenuated strains by targeted gene replacement and report that GLOI is likely to be an important gene since GLOI mutants in L. donovani showed altered phenotype. The present data supports that the GLOI plays an essential role in the survival of this pathogenic organism and that inhibition of the enzyme potentiates the toxicity of methylglyoxal

Prognosticating ovarian reserve by the new ovarian response prediction index

Background: Knowledge of patient's potential ovarian response can help individualise the medication dosage and thus prevent adverse effect of excessive ovarian response and, decrease the rates of cancelled cycles, overall it will help to improve the cost benefit ratio of ovarian stimulation regimes. In addition to age, several clinical, endocrine and USG markers and dynamic tests have been proposed for the prediction of ovarian response to stimulation. Among these use of AMH levels and AFC are of particular interest However, despite the predictive power that each marker for the ovarian response may individually have, all these markers have errors associated with their estimation. So, prediction of ovarian response using a single biomarker may not be sufficient for formulation of a precise treatment plan.Methods: This study includes 50 patients undergoing ivf cycle. All patients satisfied the following criteria; age <or equal to 39 yrs, BMI between 20-30, regular menstrual cycles, both ovaries present, no history of ovarian surgery, no severe endometriosis and no evidence of endocrine disorders. The only exclusion criteria was the presence of ovarian cysts as assessed by TVS.Results: The results showed significant correlation between the number of obtained follicles and the number and maturity of collected oocytes. In addition, the results using the ORPI were always better than those obtained using other predictive factors (AFC, AGE and AMH) separately.Conclusions: The present study reinforces the ORPI, which is a simple 3 variable index that exhibits an excellent ability to predict low and excessive ovarian response. ORPI might be used to improve the cost benefit ratio of ovarian stimulation regimens by guiding the selection of medication and by tailoring the doses and regimens to the actual needs of patients

A comparative review of maternal and neonatal outcome among pregnant women with COVID-19 in first and second wave in a tertiary care centre of South Rajasthan

Background: Corona virus disease 2019 has taken a huge toll over health infrastructure and care all across the world. This article depicts our experience of COVID-19 in pregnant women and analyses maternal and neonatal outcome of same in first and second wave of this pandemic. Aim and objectives of the study were to compare the demographic characteristics, presenting features and fetomaternal outcome in COVID positive pregnant women in first v/s second wave in a tertiary care hospital.Methods: The RTPCR COVID-19 positive pregnant women admitted during the period April-2020 to March-2021 were considered in 1st wave of COVD-19 and that from April-2021 till June-2021 as 2nd wave of COVID-19. Data like baseline characteristics, past medical, obstetric history, clinical presentation, laboratory results, imaging findings, management modalities, maternal and neonatal outcome were analysed and compared.Results:  Peak of 1st wave of COVID-19 was found during the months of July-September 2020, while of 2nd in April-June 2021. Most women presented with COVID-19 RTPCR positive were asymptomatic both in 1st and 2nd wave. Though most patients were managed on room air in both waves, 6.52% and 9.38% were on oxygen, 1.09% and 10.94% were managed with mechanical ventilation and BIPAP in 1st and 2nd wave respectively. There was significant (p<0.05) increase in maternal deaths in the 2nd wave (7.03%) as compared to 1st wave (1.09%).Conclusions: A significantly large number of patients were affected in 2nd wave of COVID-19 pandemic with more morbidity and mortality. Neonatal population remained relatively unaffected in both waves

A study on cardiotocography for predicting fetal prognosis in high-risk pregnancy

Background: The admission cardiotocography (CTG) in high-risk obstetrics patients for continuous monitoring of fetal heart rate (FHR) has become crucial in the modern obstetric practice. It is not only a good screening and inexpensive test but also non-invasive, easily performed and interpreted. Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology, Pannadhay Rajkiya Mahila Chikitsalaya at RNT medical college, Udaipur from April 2022 to September 2022. A total of 100 high risk obstetrics patients were subjected to cardiotocography (CTG). The Women eligible for the study were those who had gestational age ≥32 weeks with cephalic presentation in first stage of labour with singleton fetus in vertex presentation and categorised as high-risk during the time of admission. Results: A total of 100 high risk obstetric patients were subjected to CTG. Out of these common high-risk factors in our study consisted of postdated pregnancy (21%) followed by pre-eclampsia (19%), oligohydramnios (16%) cord around neck (13%). Majority of them (47%) fall under 20-25 years and constituted by primigravida (59%).  CTG was reactive in (65%), non-reactive in 25% of cases and 10% patients had suspicious tracings. The incidence of neonatal intensive care unit (NICU) admission, fetal distress and APGAR score less than 7 was significantly higher with suspicious and nonreactive CTG than reactive CTG. Conclusions: CTG test is a simple, non-invasive screening test should be used in high risk pregnancy as admission test. The heavy load of constant monitoring and adverse perinatal outcome can be reduced by CTG monitoring in high-risk obstetrics patients

Comparative study of post-partum intrauterine contraceptive device in vaginal and intra caesarean insertion

Background: Institutional deliveries have increased all over the country, thereby providing opportunities for quality postpartum family planning services. In this period, women are highly receptive to accept family planning methods. Objective of this study was to evaluate CuT Multiload 375, in terms of acceptance, safety, efficacy, continuation rate, removal rate and to find out PPIUCD complications e.g. bleeding irregularities, perforation, expulsion and discontinuation due to various reasons.Methods: Prospective analytical study was conducted from February 2016 to June 2016 in the department of Obstetrics and Gynecology, at RNT Medical College, Udaipur, Rajasthan, India.100 patients in each vaginal and cesarean group were selected randomly. Multiload 375 was inserted after obtaining written consent.Results: Missing threads were detected more in cesarean group (22.8%) than vaginal group (12.9%). Cumulative expulsion rate was 15.2% in vaginal group and 10.8% in cesarean group. Heavy Bleeding PV with or without the pain was the main reason for removal of CuT in both the groups. Removal rate for vaginal and cesarean group was 15.2% and 10.8% respectively.Conclusions: PPIUCD is very effective, safe and reversible contraceptive method which provides contraceptive effect soon after birth. Although there is relatively high incidence of expulsions and removal in the both group still the continuation rate was 69.4% in vaginal group and 78% in cesarean group

A comparative study between total laparoscopic hysterectomy and total abdominal hysterectomy for benign uterine pathologies at tertiary care institute, Udaipur

Background: Hysterectomy is one of the most commonly performed procedures in gynaecological surgery. The most common indication is benign uterine disease. As the time is passing trend is towards those approaches which are minimally invasive, less painful, have less complications, less blood loss and are more cosmetic. Thus, total laparoscopic hysterectomy has gained popularity. The purpose of this study was to compare the 2 different routes of hysterectomy.Methods: In this prospective randomized observational study patients undergoing both the types of hysterectomy, that is, TAH (total abdominal hysterectomy) and TLH (total laparoscopic hysterectomy) during 2 year period at Rajkiya Pannadhay Mahila Chikitsalaya RNT medical college Udaipur were included in the study. 50 women (25 in each group) aged between 31-72 years were included into the study.Results: We observed that duration of surgery was found to be longer in TLH than TAH (112.56±19.45 min versus 57.9±19.26 min, P<0.001 (HS)). The length of hospital stay was less in TLH than TLH (p=0.0001) and the amount of intra-operative blood loss were also less in TLH than TAH (163.60±44.15 versus 313.20±123.48 ml, p<0.001). TLH group had early ambulation compared to TAH group (2.24±0.44 day versus 3.12 ±0.33 day, p<0.001), difference on the basis of length of hospital stay was highly significant which was shorter in TLH than TAH (4.40±1.15 versus 10.32±8.19 days, respectively; p<0.001). In current study patient satisfaction level was found highly significant between TLH and TAH (100% versus 56%, p<0.001).Conclusions: TLH is a safe and effective method of doing hysterectomy. The present study concluded that TLH is associated with less hospital stay, less blood loss, less use of analgesics, early ambulation, early start of oral feed, and better patient satisfaction.

Prognosticating ovarian reserve by the new ovarian response prediction index

Background: Knowledge of patient's potential ovarian response can help individualise the medication dosage and thus prevent adverse effect of excessive ovarian response and, decrease the rates of cancelled cycles, overall it will help to improve the cost benefit ratio of ovarian stimulation regimes. In addition to age, several clinical, endocrine and USG markers and dynamic tests have been proposed for the prediction of ovarian response to stimulation. Among these use of AMH levels and AFC are of particular interest However, despite the predictive power that each marker for the ovarian response may individually have, all these markers have errors associated with their estimation. So, prediction of ovarian response using a single biomarker may not be sufficient for formulation of a precise treatment plan.Methods: This study includes 50 patients undergoing ivf cycle. All patients satisfied the following criteria; age &lt;or equal to 39 yrs, BMI between 20-30, regular menstrual cycles, both ovaries present, no history of ovarian surgery, no severe endometriosis and no evidence of endocrine disorders. The only exclusion criteria was the presence of ovarian cysts as assessed by TVS.Results: The results showed significant correlation between the number of obtained follicles and the number and maturity of collected oocytes. In addition, the results using the ORPI were always better than those obtained using other predictive factors (AFC, AGE and AMH) separately.Conclusions: The present study reinforces the ORPI, which is a simple 3 variable index that exhibits an excellent ability to predict low and excessive ovarian response. ORPI might be used to improve the cost benefit ratio of ovarian stimulation regimens by guiding the selection of medication and by tailoring the doses and regimens to the actual needs of patients

Glyoxalase pathway of trypanosomatid parasites: a promising chemotherapeutic target

Trypanosomatids are pathogenic protozoa of the order Kinetoplastida. A unique feature of these parasitic protozoa is the presence of a unique dithiol trypanothione (N1, N8 -bis(glutathionyl)spermidine) and the flavoenzyme trypanothione reductase. This is in contrast to human and other eukaryotes, which contain ubiquitous glutathione/glutathione reductase system. An important function of thiols is to protect cells from toxic metabolic by-products such as methylglyoxal, a reactive 2-oxoaldehyde. Methylglyoxal is a mutagenic and a cytotoxic compound. The glyoxalase system is involved in the detoxification of methylglyoxal. The exceptionality of the glyoxalase enzyme in the parasitic protozoa is the dependence on the dithiol – trypanothione for detoxifying the toxic methylglyoxal. The detoxification process by the glyoxalase enzyme in eukaryotes and most other organisms is dependent on the tripeptide glutathione. The glyoxalase enzyme of trypanosomatids are also exceptional in a way that they use the divalent cation nickel as a cofactor like the glyoxalase enzyme of E. coli, whereas in eukaryotes the cofactor is zinc. This reflects that both the substrate as well as the cofactor of the kinetoplastids glyoxalase enzyme is distinct from that of the glyoxalase enzyme of eukaryotes. These differences reveal that the active site of the glyoxalase enzyme of the parasite and its mammalian counterpart are significantly different thereby proposing that the glyoxalase enzyme of the protozoan parasite can be a potential chemotherapeutic target