Endometrial stromal sarcoma: a rare tumour

Endometrial stromal sarcomas (ESS) are rare endometrial tumours arising from stroma of endometrium i.e. connective tissue of endometrium rather than glands. Usually a pre-operative diagnosis is difficult. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is main line of treatment. Adjuvant hormone therapy in the form of progesterones, GnRH analogues, aromatase inhibitors are effective for prevention of recurrences as these tumours are invariably positive for oestrogen & progesterone receptors. Surgical excision, radiotherapy, hormone therapy are recommended for recurrences. We report a 52 yrs widow with undifferentiated endometrial stromal sarcoma weighing 3.75 kg with a short history of 3 months diagnosed only after histopathology

The prevalence of pruritus gravidarum and its relation with intrahepatic cholestasis of pregnancy

Background: Pruritus is a common complaint amongst pregnant woman, affecting 20% of them. This can be physiological or due to some specific dermatological conditions. Among them Intrahepatic cholestasis of pregnancy is most common cause and is characterized by pruritus with derranged liver enzymes and raised serum bile acid levels in the absence of any other liver pathology. It is associated with increased fetomaternal morbidity. Methods: This was a prospective study, conducted at Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar in the Department of Obstetrics and Gynaecology with collaboration of Dermatology Department, from March 2021 to Aug 2022. After taking ethical approval, informed consent, detailed history, clinical and biochemical assessment was done and fetomaternal outcome was recorded. Results: Prevalance of pruritus was 20.8% amongst pregnant women, of which 24% patients were diagnosed having intrahepatic cholestasis of pregnancy (ICP) and 76% were labelled as NON ICP patients. Among NON ICP patients prevalence of pruritic urticarial papules and plaques of pregnancy was 32.10%. Majority intrahepatic cholestasis of pregnancy patients had moderately affected quality of life. Majority of pruritic patients had normal bilirubin levels and all intrahepatic cholestasis of pregnancy patients had raised serum Alanine transaminase, Aspartate transaminase, bile acids values. Meconium stained liquor, preterm delivery, Low birth weight, cesarean rates, NICU admissions rates were higher in intrahepatic cholestasis of pregnancy patients. Conclusions: Pruritus in pregnancy is a common condition. Dermatological opinion along with liver function tests should be done to know about the cause and severity of pruritus. Intrahepatic cholestasis of pregnancy (ICP) affects perinatal outcomes. So patients should be closely monitored to improve the fetomaternal outcome

Study and analysis of maternal serum alpha-fetoprotein levels as a biomarker of placental adherence in low lying placenta

Background: The objective was to study and analyze maternal serum alpha-fetoprotein levels as a biomarker of placental adherence in low lying placenta. Methods: This was a prospective observational study analysing the conditions and the data of 80 cases with low lying placenta in a tertiary care hospital. The analysis was done for the association of MSAFP with MRI, perinatal and maternal outcome. Results: The level of MSAFP was found higher in 12 out of 13 cases (93.3%) of placenta previa with placental adherence. There was significant surgical intervention (80%) and increased maternal morbidity (68.8%) in the study group with placental adherence and raised MSAFP respectively. Conclusions: MSAFP is an important biomarker for prognostication of placental adherence in low lying placenta

Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to surgical evacuation of first trimester embryonic demise

Background: Objective: To compare the efficacy & safety of Nitric Oxide (NO) donor, isosorbide mononitrate (ISN) to that of misoprostol, applied vaginally as tablets for cervical ripening prior to suction evacuation of first trimester embryonic demise.Methods: This is a prospective, randomized, double blind controlled trial conducted at tertiary level teaching hospital. 50 women with first trimester embryonic demise with closed cervix requiring suction evacuation were divided randomly into two groups of 25 women each. In group A, tab. isosorbide mononitrate 80 mg and in group B, tab. misoprostol 400 µg was applied vaginally. Both the drugs were repeated every three hourly up to a maximum of four doses or until reaching cervical dilation of 8 mm. Cervical dilatation was assessed at baseline & every three hours after each dose. A set of questionnaire was used for the appearance of side effects. Once 8 mm cervical dilatation achieved, suction evacuation was done. Total volume of blood lost at suction evacuation was measured.Results: Frequency of doses, induction to ripening interval & intra operative blood loss was significantly higher with isosorbide mononitrate as compared to misoprostol. Headache & palpitation were main side effects of isosorbide mononitrate. The percentages of successful & failed inductions were comparable in both the groups.Conclusions: Misoprostol is better cervical dilator prior to suction evacuation in first trimester embryonic demise with minimal side effects which are acceptable to the patient

HELLP syndrome and its implications on maternal and perinatal outcome

Background: The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2-0.6% of all pregnancies but its incidence increases to 4-12% in severe preeclampsia. In about 15% cases, HELLP syndrome presents without definitive criteria for preeclampsia (atypical preeclampsia). This present study will throw light on incidence, clinical and biochemical profile of patients with HELLP syndrome and maternal and perinatal outcome.Methods: A prospective study was conducted in the department of Obstetrics and Gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, India from January 2016 to August 2017 after approval from institutional ethics committee.Results: In the present study, total 2949 antenatal admissions were there during the course of study. Out of these patients, 352 patients had preeclampsia-eclampsia (11.93%). Out of these 352 patients, 71 complicated with HELLP syndrome (20.17%). 17.9% had partial HELLP and 2.3% had complete HELLP syndrome. 30.16% had only EL, 31.75% had only LP, 87.3% had elevated LDH (depicted hemolysis). 4.76% had both EL and LP, 30.16% had both EL and elevated LDH, 20.63% had both LP and elevated LDH levels. Majority of the patients presented after 36 weeks of gestation. Only 5 patients had HELLP syndrome in the postpartum period. Among partial HELLP patients, 59.02% delivered vaginally and 40.98% delivered by LSCS and among complete HELLP patients 28.6% delivered vaginally and 71.4% delivered by LSCS. Perinatal mortality rate was 43.7%. Severe maternal complications such as PPH, DIC, abruptio placentae, pulmonary edema and renal failure were seen high among HELLP patients.Conclusions: As the incidence is very high, one must be aware of its clinical and laboratory findings so that early diagnosis and treatment can be initiated. Close surveillance of the mother should be continued even after delivery

A COMPARATIVE STUDY OF POSTPARTUM BLOOD LOSS BY VISUAL ESTIMATION METHOD AND BY GRAVIMETRIC METHOD

Objectives: The aim of the study was to estimate postpartum blood loss visually and by gravimetric method and compare the both. Methods: This study was conducted in the Department of Obstetrics and Gynaecology, GMC Amritsar on 100 pregnant women satisfying the inclusion criteria over a period of 1.5 years. Patient’s consent was taken and visual estimation was done by the attending obstetrician and obstetric nurse. Total blood loss was calculated using gravimetric method and was compared to value given by visual estimation. Furthermore, comparison was done between the visual estimation values of the attending obstetrician and the obstetric nurse. Results: Obstetrician observed 21.47% less blood loss than the actual (by gravimetric method) blood loss. Obstetric nurse observed 20.01% less blood loss than the obstetrician and 37.19% less than the actual loss. Conclusion: Visual estimation underestimates the actual blood loss and, hence, an objective gravimetric method should be used for early and effective management of PPH

Intramyometrial ectopic pregnancy-a rare case

Ectopic pregnancies comprise 1-2% of all the first trimester pregnancies. Out of this, 95% are tubal in origin and only 5% are non-tubal. We report a rare type of intramyometrial ectopic pregnancy for which less than 50 cases have been reported so far. A case of intramyometrial pregnancy in 35-year-old primigravida with no previous history of uterine trauma, which is thought to be the main culprit behind its pathophysiology. Effective management in this case preserved the uterus for future pregnancies. Follow up was done till β- HCG levels returned to undetectable state

Geriatric Anemia

Anemia is growing in importance as a public health issue and a biomedical research priority in the geriatric age group but data on the causes and prevalence is not substantial. World health organization (WHO) has defined anemia as hemoglobin concentration (Hb %) below 12 g/dL in women and below 13 g/dL in men. Although it was previously believed that decline in Hb levels might be a normal consequence of aging, later suggested that anemia does reflect underlying poor health and makes elders vulnerable to adverse outcomes. Geriatric anemia has been found to be prevalent in up to 21.1% of patients in Europe and 11.0% of men and 10.2% of women of 65 years and older in the US. There is little literature that explores the various causes of anemia and its association with socio-demographic profile with underlying diseases, hence lesser research has led anemia to go undiagnosed and untreated

Papillary Neoplasm of Breast-Changing Trends in Diagnosis and Management

Papillary neoplasm of breast comprises of seven separate heterogeneous entities ranging from benign, atypical and malignancy including non-invasive and invasive carcinoma. Papillary carcinoma (PC) is seen more commonly in older postmenopausal women with favorable prognosis. PC breast typically presents with bloody nipple discharge and an abnormal mass with radiologic features of intraductal mass. Encapsulated PC and solid PC is to be treated as in situ carcinoma, but distinction of invasive PC from non invasive carcinoma is critical both at microscopic and molecular level. So, surgical excision should be the choice of definitive diagnostic technique in papillary neoplasm instead of core needle biopsy. Furthermore, treatment guidelines for invasive PC also have been framed, but incidence of recurrence and death attributable to various subtypes of carcinoma remained same. So, this is important topic to be addressed to understand the need for further management and outcome of the disease