A rare case of Meigs syndrome in pregnancy with bilateral ovarian masses

Meig’s syndrome is defined as the triad of ascitis, pleural effusion, along with benign ovarian tumour. Ovarian fibroma represents approximately 2-5% of the surgically removed ovarian tumours and Meig’s syndrome occurs in only 1-2% of these cases, thus contributing to its rare occurrence. Here we report an unusual case of pregnancy with Meig’s syndrome with ovarian fibroma on one side and large serous cystadenoma on other side. We present this case to emphasize the importance of this rare entity while dealing with any case of ascites.

Evaluation of safety and tolerability of antiretroviral therapy in pregnant and non-pregnant women

Background: The study was conducted to evaluate safety and tolerability of different components of combined antiretroviral therapy (CART) in pregnant and non-pregnant women and to find out substitute of the drug causing intolerance.Methods: An observational study on 75 pregnant and 125 non pregnant, HIV infected women receiving CART, over a period of 1 year (Jan 2013-Jan 20140 in SRN Hospital affiliated to MLN Medical college, Allahabad. All women were examined clinically and investigated for baseline hematology, LFT, RFT, S. Cholesterol levels and blood sugar levels. Safety and tolerability of CART was assessed by clinical assessment, investigations done at 6 months interval or earlier if required.  Results: 64% (48) pregnant women and 60.4% (63) non pregnant women had Adverse Effects (AE). Most common AE was Liver Function Abnormality (LFA). Among NRTIs, zidovudine was substituted in 42% (21) pregnant and 17.4% (11) non pregnant women and among NNRTIs, efavirenz was substituted in 92.3% (12) pregnant women and 52.6% (30) non pregnant women.Conclusions: The safety and tolerability of CART in pregnant and non-pregnant women did not differ by class of ARV, but there were differences among individual drugs. Zidovudine, efavirenz and nevirapine were substituted more commonly in pregnant women. 

Psychosocial status and quality of life of adolescent girls in Karnataka, India

Background: This study was conducted with the objective to assess the psychosocial status and quality of life (QOL) of adolescent girls in Karnataka, India.Methods: This was a cross sectional community based study which was conducted on 400 adolescent girls each in rural (Bellary district) and urban (Bangalore district) areas of Karnataka, India. WHO’s ‘HEEADSSS’ questionnaire and ‘WHOQOL-BREF’ tool have been used to assess psychosocial status and quality of life of adolescent girls, respectively.Results: It was observed that nearly 5% girls were at severe and very severe risk of developing psychosocial abnormalities in both rural and urban study area. The mean QOL score was highest for social relations (7102±21.6) and was minimum for physical domain (49.59±12.63).Conclusions: This calls for urgent community based interventions directed to adolescents and their families having higher vulnerability for psychosocial abnormalities and poor quality of life

Clinicohaematological study of anaemia in antenatal patients

Background: According to WHO, approximately 75% of pregnant women in developing countries and 18% in developed countries are anaemic. In India prevalence of anaemia is reported to be 33%-89% and is one of the important causes of maternal morbidity and mortality. The present study was done with the objective to study the socio-demographic factors related to anemia and the distribution of different types of anaemia in antenatal patients.Methods: A prospective analytical study was done on 205 pregnant females who presented with anemia (Hb <11 gm/dl) in 1st, 2nd and early 3rd trimester (up to 30 weeks of gestation) in the department of obstetrics and gynecology of Swaroop Rani Nehru Hospital, Prayagraj from September 2017 to September 2018.Results: The rural background with lower socio-economic status comprised majority of the anemic patients (65.9%) with the major cause being iron deficiency anemia (68.8%). The patients mainly presented with anemia at late second or early third trimester (82.4%). Clinical signs like pallor, oedema and symptoms like palpitations and dyspnoea were more associated with severe anemia than mild and moderate anemia.Conclusions: Anemia prevention and prompt detection is the need of the hour with effective management. In India, major cause of anaemia are nutritional deficiencies which can be treated by proper diet and medications. The advises of routine iron supplementation during pregnancy, regardless of whether the mother is anemic or not, is strongly recommended by this study.

Vaginal foreign body in a 6 year old girl: a game for the child but a challenge for the gynaecologist

A 6 year old girl visited our gynaecology out-patient department of S.R.N hospital, Allahabad, India with the complaint of relapsing blood stained vaginal discharge for 3 months. Different gynaecologists, including us, tried treating the condition with different courses of antibiotics. To each, the girl responded only for few days and relapsed again. We investigated completely into the background of the child's home and school environment, her playing habits and her behaviour with her kins. Then, we got her various investigations done but with no derangement. With the backup of her history, examination and investigations, we performed another detailed examination of her genitals. The findings were intriguing as to their cause, and it definitely was a lesson to all of us.

Knowledge, attitude and practices regarding reproductive health among rural and urban adolescent girls

Background: Menstruation is a biological event imbued with social, cultural and personal significance. Due to impact of social media and internet the incidence of indulging in unprotected sexual intercourse and unplanned pregnancies are rapidly increasing among teenagers. Objectives were to assess the knowledge regarding safe sex and contraceptive methods and compare the menstrual and sexual awareness among adolescent girls in rural and urban settings.Methods: The health questionnaire was prepared from WHO adolescent health manual as reference base. The adolescent survey was done.Results: In present study maximum number of girls had attained menarche between 12-15 years in both groups. The study showed lack of menstrual hygiene among rural girls in compare to urban girls where 79% girls use either sanitary pads or cotton and in comparison to urban girls, rural girls had more restrictions in going out.Conclusions: Education regarding proper physiology of menses and there should be open discussion regarding restrictions and taboos related to menses at the school level to minimise the false beliefs

Recurrent ectopic pregnancy after ipsilateral salpingectomy: a rare case report

Ectopic pregnancy occurs in 1.3% to 2% of all pregnancies, and there is a potential threat for maternal morbidity and mortality. Ipsilateral ectopic pregnancy after partial or total salpingectomy is a rare occurrence. Current surgical management of tubal pregnancy includes conservative (usually salpingostomy) and radical (total or partial salpingectomy) methods. However, in some cases, these methods may not solve the problem. We are presenting the case of a 26 year old female G3P1+1 who presented with bleeding per vaginum, pain in abdomen, severe pallor, hypotension, and tachycardia following 3 months amenorrhoea. She had a previous right sided ruptured ectopic pregnancy and right salpingectomy done 5 years back. On laparotomy, there was right adnexal mass of 5x7 cm size. Given the possibility of transperitonal migration of human embryos and sperm, which has a greatly increased risk associated with previous ectopic pregnancies, total salpingectomy should be the treatment of choice if conservative methods of treatment are not suitable. This case emphasizes that salpingectomy does not exclude ectopic pregnancy on the ipsilateral side. Total salpingectomy too carries the potential for the recurrence of ectopic pregnancy on the same side hence the need for clinician awareness and vigilance

A rare case of spontaneous heterotopic pregnancy presented as ruptured ectopic pregnancy

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of 30 year old patient who was treated for a heterotopic pregnancy. She had taken treatment for genital tuberculosis in the past. The patient presented acutely with a ruptured tubal pregnancy in shock and this was managed by emergency laparotomy. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation