Correlation of severity of hyperandrogenism with ovarian stroma to area ratio and stromal echogenicity in polycystic ovary syndrome patients

Background: Polycystic ovary syndrome is one of the most common endocrine disorders of reproductive age group. Rotterdam consensus although includes ovarian volume in diagnosis of PCOS but its ovarian stroma area that corresponds histological and thus its clinical features.Methods: A prospective study conducted on 55 PCOS cases and 55 age and weight matched healthy volunteers. Detailed medical, menstrual history and examination for clinical hyperandrogenism and anthropometry was done. Fasting venous blood samples were obtained on day 2 for androgen profiles. All the patients were subjected to pelvic ultrasound and also a 3D ultrasound was done. The S/A (ovarian stroma to area ratio) were obtained by outlining the peripheral profile of the stroma with a caliper and similarly total ovarian area by outlining in the maximum plane section. Stromal echogenicity was assessed semi quantatively.Results: S/A exhibits positive and significant correlation with DHEAS (r = 0.565, p0.05) in cases, whereas stoma echogenicity was increased in 78.2% cases and 20% controls and correlated significantly with DHEAS levels and not H score, probably due to small sample size.Conclusions: S/A bears a positive significant correlation with androgenic parameters studied and can be considered as one of the best predictor of hyperandrogenism. The stroma echogenicity measured semiquantatively can act as a clue for PCOS diagnosis. Their measurement and follow up during course of treatment may show significant role in defining the severity, progression or regression of the disease

Thanatophoric dysplasia, an enigmatic dilemma: a case report

Thanatophoric dysplasia is a rare, fatal form of skeletal dysplasia that affects fetus in utero. It is characterized by marked underdevelopment of fetal skeleton and short limbs. This disorder can be diagnosed antenatally and the couple should be counselled for termination of pregnancy. 20 years old female came in her second trimester carrying an ultrasound report which showed features of thanatophoric dwarfism. She was advised to terminate her pregnancy but she decided to continue with her pregnancy. She was induced after 40 weeks and she delivered a stillborn baby with dwarf like features, a condition identified as thanatophoric dwarfism. Early diagnosis can be done by ultrasound as early as 13 weeks of gestation and since babies born with thanatophoric dysplasia have a very poor prognosis, couples should be counselled regarding early termination of pregnancy. 3D ultrasound scan and molecular analysis can also help identify this disorder

Rare incidence of yolk sac tumor in pregnancy posing management challenge: a case report

Yolk sac tumor of the ovary, although rare but highly malignant, when diagnosed in a pregnant woman is difficult to manage because of risks involved to the fetus but with the advent of surgery and chemotherapy prognosis has greatly improved.A G3P2L2, 35 years old, woman got admitted at 8 months amenorrhea with absent fetal movements since two days with labor pains. She carried an ultrasound report, done at a private clinic which showed intrauterine death of fetus along with a pelvic tumor. Her CT done at our hospital confirmed a pelvic tumor mass posterior to the uterus and in close proximity with the rectum. A laparotomy was planned for her as the pelvic mass was preventing the descent of fetal head thus hindering vaginal delivery. Biopsy from the tumor mass revealed yolk sac tumor of the ovary. Her general condition was poor with low Hb levels and deranged LFT and KFT and was shifted to ICU for intensive care but she could not survive despite the best efforts.Early diagnosis of ovarian yolk sac tumor in pregnancy leads to timely intervention in the forms of surgery and chemotherapy which greatly improves the survival rates

A comparative study of transcervical foley’s catheter with intracervical PGE2 gel for pre-induction cervical ripening

Background: To compare the efficacy of transcervical foley’s catheter with intracervical PGE2 gel for pre -induction cervical ripening.Methods: It was a prospective interventional study conducted between April 2012 to April 2013 in the department of obstetrics and gynecology at L. L. R. M. medical college and S. V. B. P. hospital Meerut. A total of 80 pregnant women of ≥28 weeks of gestation with bishop score less than or equal to 4 and with various indications for induction of labour were randomly allocated to receive intracervical PGE2 gel (Group A) or transcervical foley’s catheter (Group B). Bishop score was repeated after 6 hours by the same person and the results were compared.Results: The groups were comparable with respect to maternal age, gestational age, indications of induction of labour and initial bishop’s score. The intragroup results were calculated by Wilcoxon signed rank test and intergroup results were calculated by Mann Whitney U-test. The change in bishop score in PGE2 group was 3 and in foley’s group was 3.25 after 6 hours of induction (interquartile range of median) which is significant. The mean change in bishops score was 2.65 in PGE2 group and 3.1 in foley’s group after 6 hours of induction and was significant, however the bishop’s score was comparable in both the groups and statistically insignificant.Conclusions: Both foley’s catheter and PGE2 gel are equally effective in pre-induction cervical ripening of cervix

Giant chorioangioma of placenta: an infrequent placental cause for adverse feto-maternal outcome

Chorioangioma is a relatively rare benign tumor of placenta arising from chorionic tissue, with incidence being 1 in 100 cases. Giant vascular chorioangiomas render a challenge to obstetricians with their potential critical complications adversely altering feto-maternal outcome. Diagnosis is suspected antenatally by ultrasound and Doppler studies, and is corroborated by histopathology post-delivery. Here we report a pregnancy complicated by a giant placental chorioangioma with polyhydraminos in a young mother, diagnosed prenatally, and associated with deranged liver function tests, culminating into a preterm delivery of a plethoric stillborn fetus, followed by life-threatening postpartum hemorrhage in mother. Also clinical considerations and relevant literature review on prognostic factors affecting obstetric outcome are addressed. A case of giant chorioangioma placenta warrants close antenatal surveillance and institutional delivery as it may have untoward maternal complications as was seen. Vascularization of tumor is a pivotal determining factor of pregnancy outcome

Cardiac disease in pregnancy: still an arduous conundrum for the obstetrician

Cardiac diseases, complicating about 1 percent of all pregnancies, account for significant maternal morbidity and mortality by being the leading cause of obstetrical intensive care unit admissions and of indirect maternal deaths. Of late, there has been observed a changing pattern in heart disease, the etiology having shifted from primarily rheumatic to predominantly congenital (75–82%), with shunt lesions preponderating (20–65%). Counseling and management of women of childbearing age with suspected cardiac disease ought to commence prior to conception; they should be managed by interdisciplinary teams; high risk patients must be treated in specialized facilities, and diagnostic procedures and interventions should be executed by mavens with profound expertise in the cardiovascular diseases and proficiency in treating pregnant women. This article provides a comprehensive review on management of cardiac disease in pregnancy to assist obstetricians in tackling this mystifying medical situation effortlessly, attaining a favorable feto-maternal outcome

Evaluation of Hematological Parameters in Partial Exchange and Packed Cell Transfusion in Treatment of Severe Anemia in Pregnancy

Objectives. Anemia is a major public health problem throughout the world which assumes prominence in pregnant mothers. Patients with severe anemia continue to present themselves at term or in labor. This study was conducted to compare the improvements in hematological parameters of patients receiving partial exchange blood transfusion and transfusion of packed cells without exchange. Methods. One hundred and twenty-five severely anemic antenatal mothers were admitted from outpatient service. Partial exchange transfusion was given to sixty-six patients while fifty-nine received transfusion of packed cells with frusemide cover. Results. The two groups were comparable in terms of age, height, weight, religion, diet, education, occupation of self and husband, and income. Hemoglobin level in Group 1 was comparatively less than Group 2 at prelevel (5.2 ± 1.5 versus 6.6 ± 2.3, P = 0.001) and postlevel (7.2 ± 1.5 versus 8.6 ± 1.8, P = 0.001), respectively, but there was no significant difference between the two modes of transfusion (2.09 ± 1.6 versus 2.01 ± 1.5, P = 0.78). Conclusion. The study produced an equally significant improvement in hematological parameters in partial exchange and packed cell transfusion. Platelet counts were significantly less in partial exchange as compared with packed cell transfusion

Comparative evaluation of NESTROFT and RDW as screening tests for beta thalassemia trait in pregnancy

Background: Thalassemia is the commonest inherited hemoglobinopathy. It is estimated that there are about 45 million carriers of the beta thalassemia gene and about 15000 affected infants are born every year in India, thereby contributing to about 10% of the total thalassemia babies born all over the world. Beta Thalassemia Trait (BTT) is asymptomatic while Beta Thalassemia Major (BTM) presents with severe anemia and requires lifelong blood transfusion, so emphasis must shift from treatment to screening and offering prenatal counseling to affected parents.Methods: It was a hospital based cross sectional study on 500 antenatal women with microcytic hypochromic anemia with hemoglobin <9 gm% and MCV <80 fl and all these women underwent Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT), High Performance Liquid Chromatography (HPLC) and serum ferritin estimation.Results: In our study the sensitivity and specificity of NESTROFT was 93.3% and 95.7% respectively compared to Red cell Distribution Width (RDW) with a sensitivity and specificity of 66.6% and 78.9% respectively.Conclusions: For low resource settings like India, screening for beta thalassemia by NESTROFT is a cheaper and more reliable method with a high sensitivity and specificity and can be performed easily by paramedical staff

Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia

Background: The objective of the study was to compare computed tomography (CT) and magnetic resonance imaging (MRI) findings of eclampsia patients with respect to neurological signs and symptoms.Methods: This is a prospective observational study, 25 patients of eclampsia were studied, statistical analysis was done by Fishers’ exact and chi square test.Results: All patients in our study presented with antepartum or intrapartum eclampsia with neurological features ranging from headache, altered consciousness to coma. On neuroimaging by MR transiently high T2 signal intensity in the cerebral cortex and sub cortical white matter was seen, including edema. With MR angiography generalized vasospasm was also seen in 40% cases. MRI was found to be co-relating more than CT with the neurological presentation and had 90% sensitivity and 100% sensitivity.Conclusions: Symptoms like visual blurring, loss of vision and ophthalmological signs in eclampsia suggest occipital lobe involvement. Magnetic resonance imaging abnormalities in eclampsia correlate well with clinical findings as compared to CT and can be better imaging modality in eclampsia patients

Is scar tenderness a reliable sign of scar complications in labor?

Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG), severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor.Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor of scar complications in labour (p value=0.2). Past history of D&E has relative risk of 2.85 for scar complications.Conclusions: Scar tenderness is a sensitive sign of scar complications and should continue to be elicited for all women undergoing trial of labor after previous caesarean