Gestational trophoblastic disease: a profile of 37 cases

Background: Objective of current study was to study the demographic details, pattern of presentation and response to the treatment in the patients presenting with Gestational Trophoblastic Disease (GTD).Methods: The present study was conducted in a tertiary teaching institute as a retrospective plus prospective study over a period of 5 years from August 2004 to August 2009. Total 37 cases were studied out of which 16 were studied retrospectively from the case record and 21 were studied prospectively. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy and the treatment received.Results: 37 cases of gestational trophoblastic disease were studied in a period of 5 years from August 2004 to August 2009. The incidence of gestational trophoblastic disease was 1in 600 deliveries with the mean age of patients being 26.9 years. Most common chief complaint at presentation was bleeding per vaginum after a period of amenorrhoea seen in 31 patients (84%) followed by hyperemesis seen in 8 (19%) patients. Out of 37 patients 29 (78%) had complete mole & 8 (22%) had partial mole, the ratio of being 3.6:1. Complete cure rate in present study was seen in 31 out of 37 (84%) patients and mortality was seen in 2.7%.Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. This is a highly curable tumor even in the presence of distant metastasis

Genital tuberculosis and infertility

Background: An analytical study to diagnose genital tuberculosis, using various modalities, it`s treatment options and fertility outcomes in infertile labour class women.Methods: A prospective study, where 120 women, presented to hospital due to infertility were subjected to hystero-laparoscopy over 36 months. Endometrium sent for TB-PCR and HPR. Those diagnosed with GTB were given Anti-Tubercular Drugs as per standard regimes and their fertility outcome was studied.Results: Out of 120 women, 32(27%) were diagnosed with GTB using accepted clinical criteria, TB-PCR and endometrial HPR. 30 of these 32 were diagnosed by HLscopic picture (94%) alone, 18 by positive endometrial TB-PCR (58%) and another 3 by HPR (10%). Among 32 women treated, 9(28%) conceived after treatment.Conclusions: High incidence of GTB amongst the labour class warrants strong suspicion and early diagnosis using hystero-laparoscopy and prompt treatment to minimize the short and long-term effects of GTB on fertility

Significance of obstetric Doppler studies in prediction of perinatal outcome in pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel color Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler studies in PIH and to analyse its role in predicting perinatal outcome.Methods: This was a prospective study of 106 singleton pregnancies in the third trimester with PIH. The results of last Doppler ultrasound within one week of delivery were used for analysis. Adverse perinatal outcome was studied in the form of emergency cesarean section for fetal distress, meconium stained amniotic fluid, Apgar at 5 min <7, NICU admission and perinatal mortality (stillbirths and neonatal death). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of various Doppler parameters were calculated after comparing with standard.Results: In the present study specificity and diagnostic accuracy of all Doppler ultrasound parameters was high in predicting adverse perinatal outcome. Cerebroplacental ratio showed highest specificity (98.55%), PPV (94.44%) and diagnostic accuracy (80.19%) in predicting adverse perinatal outcome and it is better than MCA PI and UA PI alone. Uterine artery Doppler evaluation also gives additional information in predicting adverse perinatal outcome.Conclusions: Amongst various Doppler parameters cerebroplacental index (MCA/UA PI) is best predictor of adverse perinatal outcome

A study comparing vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for cervical ripening and labour induction

Background: Induction of labor is a commonly practised intervention in modern obstetrics. The objective of this study was to compare the efficacy of vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for labour induction. It aims to assess the induction delivery interval, the outcome of labour, the incidence of instrumental delivery and Cesarean section. The neonatal outcomes and maternal complications would also be assessed.Methods: 105 women with singleton viable pregnancies of 28 weeks or more gestation with cephalic presentation, intact membranes and an unfavorable cervix (Bishops score less than 6) were randomly assigned to induction of labor using vaginal misoprostol or Foley catheter in combination with vaginal misoprostol. Women in the misoprostol only group received 25 micrograms of misoprostol per vagina every 4 hours for a maximum of six doses. Whereas women in the combination group received vaginal misoprostol and in addition Foley catheter was introduced through the cervix for 12 hours. Interruption of the trial was done in case of failure to enter the active phase of labour after 24 hours of induction, fetal distress, hyperstimulation, hypersensitivity to drugs.Results: The induction to delivery time was shorter in misoprostol group as compared to the Foley with misoprostol group by 3 hours. There was no significant change in Bishops score after induction with Foley in combination with misoprostol as compared to misoprostol alone. There was no increase in the maternal and fetal complications in the misoprostol group as compared to Foley with misoprostol.Conclusions: Misoprostol alone was more efficacious for ripening and inducing agent as compared to Foley in combination with misoprostol

Hydatid cyst of ovary: an unusual site

Discovering a hydatid cyst in pelvic region, especially as primary localization, is a rare event; as a matter of fact according to data provided by literature the incidence is between 0.2 and 2.25%. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. When possible the optimal treatment is represented by radical laparotomic cystectomy. We report a case of an old postmenopausal woman presented with intermittent dull aching pain with 16 weeks cystic pelvic mass which mimicked the ovarian malignancy even after imaging techniques. We treated the case with laprotomic cystectom

PRES in pregnancy: MRI and it's role in decision making

Posterior reversible encephalopathy syndrome (PRES) is an alarming clinic-neuro-radiological syndrome accompanying various clinical conditions, presenting with headache, encephalopathy, seizures, cortical visual disturbances or blindness. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the water-shed regions of the posterior cerebral hemisphere, fortunately, completely reversible with management of the primary condition. We report a case of primigravida with 26 weeks pregnancy, who presented with acute, severe, in-tractable, throbbing headache, tingling sensation in the posterior neck and upper shoulder region, photophobia, nausea and mild pre-eclampsia. Standard therapy did not relieve the headache, BP remained fluctuant, so migraine/some intra-cranial pathology was suspected. MRI is the gold-standard diagnostic modality. It revealed the classical acute PRES picture. PRES implies breaching of the blood brain barrier, resultant cerebral edema and potential for further intra-cranial events of serious proportions. Notably, PRES may be seen with normotension. Pregnancy was terminated un-eventfully, recovery was prompt and complete. Two weeks later, the patients showed marked improvement clinically and neuro-imaging features of PRES had dis-appeared

Rare case of deep pelvic retroperitoneal mature cystic teratoma

Mature cystic retroperitoneal teratomas are typically rare childhood tumours. Less than 20% of these occur in adults more than 30 yrs of age. Our adult patient presented with such a tumour, which had grown to a disproportionately large extent. It was deeply embedded in the true pelvis extending laterally to the pelvic wall and inferiorly till the ischiorectal fossa and was adherent to the surrounding structures displacing all. A provisional diagnosis was made after MRI scan and patient was posted for exploratory laparotomy. After extensive blunt and sharp dissection, the cyst wall could be separated from the surrounding structures and successfully excised. Histopathology confirmed the diagnosis. Being such a rare tumour, it is essential to have a high degree of suspicion in such cases that can be supported by advanced imaging modality. Early diagnosis and complete surgical removal are the mainstay of management that provide an excellent prognosis for such patients.

Perinatal outcome in oligohydramnios and borderline amniotic fluid index: a comparative study

Background: Oligohydramnios is associated with adverse perinatal outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission.Methods: This was a prospective study of 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI ≤ 5 cm and borderline AFI of 5.1 to 8 cm. Perinatal outcome was studied in the form of onset of labor, mode of delivery, fetal heart rate variations, meconium staining  and lower segment caesarean section (LSCS) for fetal distress, Apgar score, birth weight, NICU admission and neonatal mortality.Results: Patients with oligohydramnios with AFI ≤5 cm were significantly associated with IUGR and presence of abnormal umbilical artery Doppler velocimetry (p <0.05). Adverse perinatal outcome was seen in higher percentage of patients having AFI ≤5 cm than with borderline AFI. The difference was statistically significant for overall caesarean delivery rate and LSCS for fetal distress (p <0.05).Conclusions: Oligohydramnios with AFI of ≤5 cm is associated with high caesarean delivery rate and LSCS for fetal distress

A study of the prevalence of gestational diabetes mellitus and its maternal and fetal outcomes in a tertiary care hospital

Background: The aim of this study was to study the prevalence of gestational diabetes mellitus (GDM) using Diabetes in Pregnancy Study group India (DIPSI) criteria to diagnose patients with GDM and to study the maternal and neonatal outcomes.Methods: 500 patients attending the antenatal clinic between January 2013 to September 2014 with singleton pregnancies between 24 and 28 weeks of gestation were evaluated by administering 75g glucose in a nonfasting state and diagnosing GDM if the 2-hour plasma glucose was more than 140 mg/ dl. Women with multiple pregnancies, pre-existing diabetes mellitus, cardiac or renal disease were excluded from the study.Results: 31 women were diagnosed with GDM (prevalence 6.2%). The prevalence of risk factors such as age more than 25, obesity, family history of Diabetes Mellitus, history of GDM or birth weight more than 4.5kg in previous pregnancy and history of perinatal loss were associated with a statistically significant risk of developing GDM. Though the incidence of Gestational hypertension, polyhydramnios and postpartum haemorrhage was higher in the GDM group, it did not reach statistical significance. More women in the GDM group were delivered by LSCS. There was no significant difference in the incidence of SGA or preterm delivery in the groups. The mean birth weight in GDM group was higher than in the non GDM group.Conclusions: Early detection helps in preventing both maternal and fetal complications. This method of screening is convenient to women as it does not require them to be fasting