Placental changes in hypertensive pregnancy: a comparison with normotensive pregnancy

Background: Hypertensive pregnancy may be responsible for vascular damage, enhanced systemic inflammation and insulin resistance in the placenta as oxygen and nutrient transfer is impaired and oxidative stress is generated affecting the placental growth and development. Placental growth pattern in hypertensive pregnancies shows a variable pattern owing to placental insufficiency. Present study was done to investigate the morphological and histological changes in placenta in hypertensive pregnancy.Methods: A total of 42 pregnant women with hypertensive disorder with gestational age 28-42 weeks and singleton pregnancy were enrolled as cases in the study. A total of 42 matched normotensive pregnant women were enrolled as controls. All the women were followed up till delivery. At delivery, placental specimen were collected and assessed for morphological, morphometric and histological changes. Findings were compared with normotensives. Data was compared using Independent sample’s ‘t’-test and Chi-square test.Results: Mean age of cases was 27.60±4.37 years, majority were gravida 1/2 (66.7%), 45.2% had moderate to severe edema, 50% had urinary albumin levels >100 mg/dl. A total of 8 (19.0%) had gestational hypertension, 16 (38.1%) had preeclampsia, 10 (23.8%) had severe preeclampsia and 8 (19.0%) had eclampsia. Mean placental weight and diameter of cases was significantly higher than that of control group. Mean placental thickness was also higher but difference was not significant statistically. Calcification, infarction and hematoma were seen in 45.2%, 16.7% and 11.9% of cases as compared to 28.6%, 4.97% and 0% of controls. Histologically, syncytial knots, cytotrophoblastic cellular proliferation, hyalinized area, proliferation of medium sized blood vessels, stromal fibrosis and fibrinoid necrosis in significantly higher proportion of cass as compared to controls (p<0.05). Mean fetoplacental ratio was 5.01±0.99 and 5.24±0.61 in controls (p=0.195).Conclusions: Hypertension during pregnancy affects the placental growth and development

Social egg freezing: a gateway to fertility insurance

Background: There is a decline in fertility due to delayed childbearing and hence, elective egg freezing (oocyte cryopreservation) offers a solution. Two primary techniques are used for human oocyte cryopreservation: slow freezing and vitrification. Vitrification is highlighted as a promising method. The present study was conducted to evaluate the pregnancy outcomes from oocytes that were frozen for social reasons and oocytes were frozen by method of vitrification. Methods: This retrospective study was conducted at RISAA IVF International Fertility Centre, New Delhi, collecting the data available over 6 years (2017-2023). It focused on freezing of oocytes and collected data on frozen, thawed, and fertilized oocytes, analysing thawing, survival, and fertilization rates by patient age group. Data was processed using Microsoft Excel and SPSS, with quantitative data presented as mean and standard deviation, and qualitative data as frequencies and proportions. Results: In this study of 25 patients who froze their oocytes, the average age at cryopreservation was 33.38 years. The mean age at implantation was 36.48 years. On average, patients had 10 retrieved oocytes. Most patients with thawed oocytes were in the 35-37 age group, although the highest survival and fertilization rates (86.9%) occurred in the above-40 age group. Established pregnancies were more common in the 35-37 age group, with 5 out of 10 pregnancies regardless of the day of embryo transfer. Conclusions: Elective egg freezing (oocyte cryopreservation) has emerged as a valuable solution to preserve fertility

Scar endometriosis: not a rarity now a day

Endometriosis at the site of previous surgery scar is much on the rise now-a-days mainly due to increased rate of caesarean sections. Generally, it presents as a triad of underlying mass at the incision site, cyclical menstrual scar pain with or without discharge from scar site, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical, and diagnosis is mad after surgical excision. Here we discuss a case of scar endometriosis that presented to us with complaint of greenish coloured discharge from a lesion below the primary scar site 5 years after the primary surgery. Through this article, authors wish to discuss the etiology, management and preventive measures for scar endometriosis

Cervical ectopic pregnancy: ultrasound diagnosis and conservative management

An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal endometrial cavity. Cervical ectopic pregnancy is a rare form of ectopic pregnancy and can be defined as implantation of blastocyst in the endocervix, below the internal os; representing less than 1 % of all ectopic pregnancies. Ultrasound diagnosis of this abnormal pregnancy was first described by Raskin (1978); thus early diagnosis in either weakly or non-symptomatic women in the first trimester is done; allowing conservative management. A 35 year old female, gravida 4 with living 1 issue and 2 abortions presented with a history of continuous bleeding per vaginum for last 1.5 months. Outside ultrasound depicted single live fetus of 7 weeks in cervical canal. She had a history of undergoing medical termination of pregnancy by surgical procedure of dilatation and evacuation at private hospital for completion of abortion. There was a history of excessive bleeding post procedure and 2 units of blood transfusion; referred in anaemic state to our institute with pack in situ. Pack was removed after 24 hours and managed conservatively. On general examination tachycardia present, BP was normal and patient was haemodynamically stable. On palpation abdomen was soft, non-tender and no organomegaly noticed. Urine pregnancy test was positive, serum βHCG levels were raised, USG depicted heterogeneous collection in cervix. Injection methotrenate (1mg/Kg body wt.) given. βhCG repeated after 7 days; levels decreased significantly. Patient was improved symptomatically and bleeding stopped. Cervical pregnancy is a rare condition, if not diagnosed and treated early during the course of pregnancy can have hazardous complications. Thus early diagnosis and management is necessary for preserving patient’s fertility without significant complications

Scar endometriosis: not a rarity now a day

Endometriosis at the site of previous surgery scar is much on the rise now-a-days mainly due to increased rate of caesarean sections. Generally, it presents as a triad of underlying mass at the incision site, cyclical menstrual scar pain with or without discharge from scar site, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical, and diagnosis is mad after surgical excision. Here we discuss a case of scar endometriosis that presented to us with complaint of greenish coloured discharge from a lesion below the primary scar site 5 years after the primary surgery. Through this article, authors wish to discuss the etiology, management and preventive measures for scar endometriosis

Cervical ectopic pregnancy: ultrasound diagnosis and conservative management

An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal endometrial cavity. Cervical ectopic pregnancy is a rare form of ectopic pregnancy and can be defined as implantation of blastocyst in the endocervix, below the internal os; representing less than 1 % of all ectopic pregnancies. Ultrasound diagnosis of this abnormal pregnancy was first described by Raskin (1978); thus early diagnosis in either weakly or non-symptomatic women in the first trimester is done; allowing conservative management. A 35 year old female, gravida 4 with living 1 issue and 2 abortions presented with a history of continuous bleeding per vaginum for last 1.5 months. Outside ultrasound depicted single live fetus of 7 weeks in cervical canal. She had a history of undergoing medical termination of pregnancy by surgical procedure of dilatation and evacuation at private hospital for completion of abortion. There was a history of excessive bleeding post procedure and 2 units of blood transfusion; referred in anaemic state to our institute with pack in situ. Pack was removed after 24 hours and managed conservatively. On general examination tachycardia present, BP was normal and patient was haemodynamically stable. On palpation abdomen was soft, non-tender and no organomegaly noticed. Urine pregnancy test was positive, serum βHCG levels were raised, USG depicted heterogeneous collection in cervix. Injection methotrenate (1mg/Kg body wt.) given. βhCG repeated after 7 days; levels decreased significantly. Patient was improved symptomatically and bleeding stopped. Cervical pregnancy is a rare condition, if not diagnosed and treated early during the course of pregnancy can have hazardous complications. Thus early diagnosis and management is necessary for preserving patient’s fertility without significant complications