Virtual embryoscope for detection of structural abnormalities in first trimester pregnancy

Background: To determine whether there is an additional value of virtual embryoscopy with 3Dimensional (3D) ultrasound above (2D) ultrasound regarding detection rates of structural abnormalities in first trimester pregnancy.Methods: This was a prospective study consisting of 52 pregnant women with gestational age ranging from 6 to 12 weeks. 2D and 3D ultrasound scan was performed using GE voluson E8 transvaginal probe. All scans were evaluated by ten gynecologists trained in USG. The observations were noted and compared for anatomical details and detection of structural defects.Results: It was found that images were seen well with 3D (virtual embryoscope). i.e. maximum count 19 in the table and there is statistically significant difference between 3D and 2D images with a p-value <0.01 at 95% confidence interval (CI).Conclusions: Virtual embryoscope is an innovative tool for evaluation of developing embryo and early foetal morphology. The advantages are the ability to reconstruct 3D images with the stored scanned volume and examine without having to rescan the patient

Evaluation and correlation of placental vasculature by three-dimensional power Doppler ultrasonography with umbilical Doppler in normal and IUGR pregnancies

Background: In recent years there have been significant developments in the use of 3D Power Doppler (3DPD) imaging and quantitative 3DPD histogram analysis to estimate both placental volume and intraplacental vasculature. This study is to evaluate the distribution and variation of placental vascular indices according to gestational age and placental volume and position. Co relate the umbilical Doppler indices with placental vascular indices.Methods: From September 2016 to October 2017, three-dimensional (3D)-power Doppler ultrasound was performed in 200 singalton pregnancies from 20 to 40 weeks of gestation. Using the same pre-established settings for all patients, power Doppler was applied to the placenta and placental volume was obtained by the rotational technique (VOCAL). The 3D-power histogram was used to determine the placental vascular indices: vascularization index (VI), flow index (FI) and vascularization-flow index (VFI). Umbilical Doppler was measured on the free loop of umbilical cord. The placental vascular indices were then plotted against gestational age placental volume, position and umbilical Doppler SD ratio, PI and RI. These values were evaluated in IUGR fetus.Results: Analysis of the results showed that the placental vascular indices estimated by 3D-power Doppler ultrasonography presented constant distribution throughout gestation despite the significant increase in placental volume. Placental position at fundal region shows higher value of VI, FI, and VFI. Placental position with relation to VI, FI, and VFI shows statistically significant with p value <0.01. Placental vascular indices VI, FI and VFI when corelated with systolic/ diastolic ratio, pulsatility index and resistive resistance index of umbilical artery shows poor negative correlation, only VI and FI shows statistically significant with SD ratio as p value is <0.01and <0.04. VFI did not show statistically significant as p value is 0.10(NS). With pulsatility index p value is statistically significant is less than<0.01 with vascular indices. Resistive index p value is statistically significant is less than <0.01 for VI and VFI but not significant with FI as p value is 0.06.Conclusions: Doppler ultrasound assists in the evaluation of placental vascularization in normal and IUGR pregnancies, may play an important role in future research on fetoplacental insufficiency

Pregnancy with lupus nephritis: a case report

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that commonly affects women of childbearing age. Lupus nephritis in pregnancy increases risk of maternal and fetal morbidity and mortality. Active disease during pregnancy and disease flares can lead to poor outcome. Higher rates of fetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes, gestational diabetes, osteoporosis, avascular necrosis, hypertension, preeclampsia, ecclampsia, stroke, HELLP syndrome, and maternal death are major issues. There is difficulty in recognizing disease flare because of normal physiological changes during pregnancy. Preeclampsia mimics disease symptoms of lupus nephritis and presents confusion in diagnosis. Management option is limited to few safer drugs. Lupus nephritis with antiphospholipid antibodies presents with refractory fetal loss and complete heart block associated with anti-Ro antibodies. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. Our aim is to report a case of primigravida 37 years old with controlled lupus nephritis

London Loves the Thames - Flows and Assemblages - Movie

Visual represetation of flows and assemblages along London South ban

Study of intravenous ferric carboxy maltose in iron deficiency anemia in women attending gynecological clinic - safety and efficacy

Background: Several intravenous iron preparations are available for the treatment of iron deficiency anemia (IDA). Some of these require multiple small infusions to prevent labile iron reactions while iron dextran (DEX) is associated with a risk of potentially serious anaphylactic reactions. Ferric carboxymaltose (FCM), a nondextran intravenous iron, is an effective and a safe option which can be administered in high single doses without serious adverse effects.Methods: It was a prospective study including 150 women of age >18 years with a definitive diagnosis of IDA and Hemoglobin (Hb) between 7-10 gm% from December 2013 to October 2014.Out of these, eleven women were lost to follow up and were excluded from the study. Intravenous FCM (500-1000mg) was administered and the improvement in Hb levels and iron stores was assessed after 3 weeks of total dose infusion.Results: Out of 150, 139 women were included in the study. Most of the women were in the age group of 30-39 years (38.12%). Most of the patients (74.10%) had mild anemia. Mean Hb levels increased over a period of 3 weeks after FCM administration from 8.70±1.04 gm% to 11.07±1.02 gm% which was statistically significant. Other parameters like S.TIBC (Serum total iron binding capacity), S. Ferritin, S. Iron also suggested a significant improvement after FCM administration. No serious life threatening adverse events were observed with FCM.Conclusion: Intravenous FCM is an effective and a safe treatment option for IDA and has an advantage of single administration of high doses without serious adverse effects

Caesarean section under spinal and epidural anesthesia in complete atrioventricular block without a pacemaker: a rare case report

Complete heart block (CHB) during pregnancy is rarely encountered. Management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist, and neonatologist. Treatment varies from medical management to temporary or permanent pacemaker insertion. Complete atrioventricular block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. We successfully managed caesarean section in a pregnancy with complete atrioventricular block under spinal and epidural anesthesia without a pacemaker. Asymptomatic pregnant women with congenital complete atrioventricular block can tolerate caesarean section under spinal and epidural anesthesia without a pacemaker

Acute pyelonephritis in pregnancy: a case series at Institute of Kidney Diseases and Research Centre

Acute pyelonephritis is one of the most common indications for antepartum hospitalization, estimated at approximately 9.7% of all indications for predelivery hospitalization, and when diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration, and careful monitoring of fluid balance. Here, we present four cases of acute pyelonephritis in pregnancy treated and patient successfully delivered with healthy babies

Therapeutic plasma exchange for early aggressive management of post-partum hemolytic uremic syndrome: a tertiary care centre experience

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient

Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS.Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment.Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach

A novel treatment option in management of tubal ectopic pregnancy after in vitro fertilization with embryo transfer by trans-vaginal aspiration of gestational sac: a case report

Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). Ectopic pregnancy occurs mostly in the fallopian tubes (90%), and the most common region is the ampula. Its prompt diagnosis and appropriate management is important in preventing severe morbidity and mortality. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic injection Methotrexate. We report a case of tubal ectopic pregnancy in a patient who underwent IVF-ET and was successfully treated conservatively by ectopic aspiration and instillation of injection KCl locally in the ectopic site