Posterior reversible encephalopathy syndrome in preeclampsia

Background: Posterior reversible encephalopathy is a clinico-radiological syndrome marked by headache, altered mental status, seizures, visual disturbances, and extensive white-matter changes, also known as hyper perfusion encephalopathy, brain capillary leak syndrome, and hypertensive encephalopathy. This syndrome was a possible consequence of several medical conditions but especially in pregnancy it is associated with pre-eclampsia and eclampsia. Objective of this study was to know the incidence and analyze the clinical features, biochemical, and radiological abnormalities in posterior reversible encephalopathy syndrome (PRES) as a complication of preeclampsia.Methods: This was a one-year cross-sectional analytical study conducted at NRI general hospital, Chinakakani, Guntur of patients with the diagnosis of PRES. Data was obtained from medical records and analyzed them in terms of mean for continuous variables and percentages for categorical data.Results: Total no of patients diagnosed as PRES were 16 out of 127 patients of preeclampsia. Among them, 14 presented with eclampsia, and two presented with severe preeclampsia and imminent symptoms of eclampsia. Headache was the most common symptom (100%). PRES occurred at a peak SBP of ≥160 mmHg in 75% cases and peak DBP of ≥110 mmHg in 50% cases. Serum lactate dehydrogenase (LDH) level was ≥600 in 56.25% and serum uric acid level ≥6 in 50% of patients of PRES. The drug of choice was magnesium sulfate.Conclusions: Neuroimaging abnormality is a definitive component in the diagnosis of PRES. These cerebral abnormalities are vital components in the pathogenesis of eclampsia. Considerable number of patients of preeclampsia might develop PRES even without eclampsia, with mild elevation in BP, serum LDH, and serum uric acid levels

Pregnancy in Takayasu arteritis - maternal and fetal outcome

Background: Takayasu arteritis is a rare medical disorder of primary vasculitis of unknown etiology. It affects reproductive age women. It is rare disease and associated with serious maternal and fetal complications and long term morbidity.Methods: Retrospective analysis of patients with diagnosed Takayasu arteritis, to know the impact of disease on maternal status and evaluate fetal outcome. The objective of this study was to know the maternal and fetal outcome in pre-diagnosed cases of Takayasu arteritis. The necessity of accurate measurement of pulse and blood pressures in all the limbs in a suspected case of hypertension in antenatal women at any period of gestation and TYPE the disease accordingly. 3. To evaluate the typing of TA on maternal and fetal outcome.Results: All the 4 patients with TA had medical complication like hypertension in the form of chronic hypertension and pre eclampsia that needed good monitoring of BP in all 4 limbs.Conclusions: As the typing of disease increased, more medical and obstetric complications were noticed

Pseudoaneurysm of uterine artery: as a cause of secondary post partum haemorrhage

Background: Secondary PPH is rare and life threatening, if the cause is not properly identified. Cases should be subjected for USG doppler to exclude rare entities such as pseudoaneurysm of uterine artery and AV malformations. Pseudoaneurysm of uterine artery is a rare entity to produce secondary PPH, but once identified can be effectively treated, provided facility of uterine artery embolisation is available.Methods: Here in we report 6 cases of secondary post partum haemorrhage where 5 were treated by uterine artery embolization, for recurrent attacks of bleeding following caesarean section with no identifiable cause and referred to our institution. We subjected them for USG doppler study - diagnosed to have pseudo aneurysm in 6 cases and further managed by angiography, followed by uterine artery embolisation.Results: Out of 6 cases, all cases were diagnosed of having pseudoaneurysm of either Right or Left uterine artery. 5 were subjected to uterine artery embolization. Out of the 5 cases, 4 responded well and in one case following coil embolisation as bleeding through collaterals still observed, hysterectomy had to be done. For 6th case because of haemodynamic unstability hysterectomy had to be done.Conclusions: Uterine artery embolization is an effective and reliable method for control of haemorrhage in pseudoaneurysm. One should have doubt about pseudoaneurysm in cases of secondary PPH where the bleeding is recurrent and cause not acertainable and to be referred in time where the facility of uterine artery embolization is available

Comparison of RMI 3 and RMI 4 in pre-operative evaluation of ovarian masses

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3.

Study on HELLP syndrome - maternal and perinatal outcome

Background: HELLP Syndrome is a serious obstetric complication in pregnancy characterised by haemolysis, elevated liver enzymes and low platelet count. Incidence is 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia and eclampsia. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and Eclampsia and to analyze the severity, complications, maternal and perinatal outcome.Methods: It is a 16 months period retrospective study of 102 cases of preeclampsia and eclampsia admitted in NRIMC and GH in OBGY Department with more than 28 weeks gestation. Of these, 91 cases had preeclampsia and 11 cases had eclampsia. Out of these, 15 cases developed HELLP Syndrome. The available history, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complications and outcome in HELLP syndrome.Results: Of 91 cases of Preeclampsia, 12 cases (13.18%) developed HELLP syndrome and out of 11 cases of Eclampsia, 3 cases (27.27%) had HELLP Syndrome. Majority of the cases belonged to 21-25years age group and were mostly from lower Socio economic status. The present study showed 60% maternal morbidity and 6.6% maternal mortality and the perinatal morbidity and mortality was 46.6% each.Conclusions: HELLP Syndrome is a severe variant and a dreadful complication of Preeclampsia and Eclampsia, it needs early diagnosis and timely intervention in the form of termination of pregnancy to arrest further progress of pathophysiology leading to complications