Retrospective study of cases of rupture uterus

Background: This study aimed to evaluate the risk factors, clinical presentation, management, maternal and perinatal outcome of patients with rupture uterus.Methods: In this study, clinical records of 14 cases of rupture uterus occurring between January 2001 to August 2004 were reviewed.Results: During this period 17312 deliveries were conducted and 14 cases of rupture uterus were managed. Incidence of rupture uterus was 0,8/1000 deliveries. In 10/14 (71.4%) of cases, rupture occurred in scarred uterus (either of cesarean delivery or of any surgery).9/14 (64.2%) women had rupture of previous cesarean section scar and 4/14 (28.5%) women had rupture of unscarred uterus .7/14 (50%) women had more than one risk factor responsible for rupture uterus. 10/14 (71.4%) women were unbooked.10/14 (71.4%) women had subtotal hysterectomy; 4/14 (28.5%) had repair of scar site. Invariably blood had to be transfused in every case per and post-operatively.6/14 (42.8%) of fetuses could be salvaged; in 7/14 (50%) women; there was intrauterine death, while another (7.14%) woman had preterm neonatal death.Conclusions: Uterine rupture is a preventable complication. In our study, most of women had no antenatal check-up and/or managed initially by untrained personnel. Antenatal and intranatal care, identification of high-risk cases and education of the people about supervised pregnancy and delivery will reduce the occurrence of uterine rupture

Colorectal cancer in pregnancy mimicking tuberculosis

Colorectal cancer in pregnancy is extremely rare and presentation may mimic symptoms of pregnancy or abdominal tuberculosis delaying diagnosis. We hereby report a case presenting to us in late pregnancy misdiagnosed as a case of abdominal tuberculosis

Misoprostol for induction of labour: a comparative study of various routes of administration

Background: Oxytocin has been used for labor induction since very long, but with high rates of failed induction. The objective of this study is to compare the safety and efficacy of various routes of misoprostol for induction of labor at term. Design: Prospective randomized study was done at the department of obstetrics and Gynecology at the PGIMSR ESI Basaidarapur, New Delhi between August 2009 and July 2011.Methods: 150 pregnant women were randomized into three groups each to receive 50 mcg of Misoprostol via oral, sublingual and vaginal routes respectively. Doses were repeated 6 hourly for a maximum of 3 doses till the patient entered active stage of labor (clinically adequate contractions of 3/10 min of >40 s duration, and cervical dilatation of with 4 cm). Statistical analysis was done using chi-square test and ANOVA (one-way analysis of variance).Results: Mean number of dosage required for successful induction were significantly less in the vaginal group than oral and sublingual groups (in oral groups A were 2.1±0.42, sublingual 1.4±0.34, vaginal 1.1±0.29). The induction to delivery interval was significantly less in vaginal group than oral and sublingual groups (Group A oral 21.06±9.22 h, group B sublingual 16.81±8.08 h, group C vaginal 12.9±5.16 h 0.016 significant). Rate of caesarean was least in the vaginal group 12% vs 20% in oral and 26% in sublingual. All the three groups showed satisfactory neonatal outcomes.Conclusions: This study shows that vaginal route of administration of misoprostol is preferable to oral route and sublingual route for induction of labor when used in equivalent dosage of 50 mcg 6 hourly, however all three routes are well tolerated with favorable neonatal outcomes

Significance of pre-treatment panoramic radiographic assessment of edentulous patients-A survey

Objectives: The present study was undertaken to review the significance of pre-treatment panoramic radiographic assessment of edentulous patients, in the dental patient population of Haryana, India. Study Design: In this study a total of 525 completely edentulous patients were selected randomly. A panoramic radiograph was taken using Panoramic machine (Rotagraph plus) and all the radiographs were evaluated by 2 oral radiology specialists for the following clinically significant radiographic findings: retained root fragments, embedded teeth, radiolucencies, radiopacities and location of the mental foramen at the crest of the residual alveolar ridge. The data were analyzed using the chi square test. Results: A total of 245 radiographic findings were seen in 168 (32%) patients. Out of total 525 cases 16.4% (n=86) patients had submucosal or intrabony root stumps, 4.8% (n=25) had embedded teeth, 2.5% (n=13) had radiolucencies, 9.9% (n=52) had radiopacities and 1.7% (n=9) had mental foramen at the crest of the residual alveolar ridge. Conclusion: The results of this study suggest that Routine radiographic examination of completely edentulous patients is critical before construction of complete denture. © Medicina Oral S. L

A Rare Manifestation of Cysticercosis Infestation

There are many causes of urticaria, which may vary from infections to malignancy. Among the infections, infestations by cysticercosis (larval stage of the tapeworm called Taenia solium) is an important cause. The present report is of forty four years old female who presented with urticaria and swelling on face. The swelling was later diagnosed as cysticercosis by noninvasive ultrasonography. The urticaria subsided after the treatment of cysticercosis. We report this case for rarity of its presentation. Key words: cysticercosis, chronic urticaria, Taenia solium, ultrasonograph

Unraveling Prostaglandin and NLRP3 Inflammasomemediated Pathways of Primary Dysmenorrhea and the Role of Mefenamic Acid and Its Combinations

Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1β. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea

Case Report A Rare Case of Flare-Up of PID in Infertility Treatment

Case Presentation. Mrs. X, 35 years old, case of primary infertility, was diagnosed to have genital tuberculosis on the basis of PCR positive and hysterolaparoscopy findings and received category I ATT for 6 months. Following ATT completion, her USG revealed no evidence of tuboovarian mass or hydrosalpinx. Since her tubes were patent, she underwent 3 cycles of ovulation induction and 2 cycles of IUI. The women presented with acute PID, five days after IUI, and was conservatively managed. She again presented 24 days after IUI with persistent low grade fever and abdominal pain. Suspecting relapse of genital tuberculosis, she was started on category II ATT. She had acute episodes of high grade fever with chills 2 weeks after starting ATT and MRI revealed bilateral TO masses suggestive of pyosalpinx. Emergency laparotomy was done, pus was drained, and cyst wall was removed and HPE was suggestive of chronic inflammation with few granulation tissues. ATT was continued for one year and the woman improved. Conclusion. The possibility of flare-up of PID (pelvic inflammatory disease) in treated case of tuberculosis undergoing infertility management should be kept in mind and aggressive management should be done

A Rare Case of Flare-Up of PID in Infertility Treatment

Case Presentation. Mrs. X, 35 years old, case of primary infertility, was diagnosed to have genital tuberculosis on the basis of PCR positive and hysterolaparoscopy findings and received category I ATT for 6 months. Following ATT completion, her USG revealed no evidence of tuboovarian mass or hydrosalpinx. Since her tubes were patent, she underwent 3 cycles of ovulation induction and 2 cycles of IUI. The women presented with acute PID, five days after IUI, and was conservatively managed. She again presented 24 days after IUI with persistent low grade fever and abdominal pain. Suspecting relapse of genital tuberculosis, she was started on category II ATT. She had acute episodes of high grade fever with chills 2 weeks after starting ATT and MRI revealed bilateral TO masses suggestive of pyosalpinx. Emergency laparotomy was done, pus was drained, and cyst wall was removed and HPE was suggestive of chronic inflammation with few granulation tissues. ATT was continued for one year and the woman improved. Conclusion. The possibility of flare-up of PID (pelvic inflammatory disease) in treated case of tuberculosis undergoing infertility management should be kept in mind and aggressive management should be done