Fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis

Background: The objective of this study was to determine fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis.Methods: This study was prospective observational descriptive study of 130 women, which was conducted in the department of obstetrics and gynaecology, Deen Dayal Upadhayay Hospital, New Delhi. Statistical analysis was performed using the z test when appropriate. A p value of <0.05 will be considered statistically significant.Results: Spontaneous onset of labour was present in 48.5% of patients, induction was done in 31.5% of patients and in rest 20% of patients LSCS was indicated. Normal vaginal delivery occurred in 97 of 130 patients while emergency LSCS done 33 of 130 patients. Emergency LSCS was done in 16 of 33 patients due to foetal distress. Pre-term delivery and PROM occurred in 8.5% and 9.2% of patients respectively while PPH occurred in 12.3% of patients. Among the 130 cases included in present study 34 patients (27.2%) had fetal distress, 41 patients (31.5%) had MSL and 40 neonates (32.0%) required NICU. 16 neonates out of 130 (12.8%) had birth weight below 2.5 kg. Apgar score was <7 after 5 min in 31 neonates.Conclusions: Ursodeoxycholic acid (UDCA) is useful in relieving symptoms and decreasing the biochemical markers.

Prevalence of metabolic syndrome in women with polycystic ovary syndrome attending a tertiary care hospital in West Delhi, India

Background: The aim of the present study was to evaluate the prevalence of metabolic syndrome in women with polycystic ovary syndrome (PCOS).Methods: All the women attending the gynae out-patient department of our hospital were screened for polycystic ovary syndrome as diagnosed by the Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group, 2004. Two hundred women with PCOS underwent screening for metabolic syndrome as defined by the national cholesterol education program adult treatment panel III (ATPIII) (2001) definition and the prevalence of metabolic syndrome was compared with two hundred age and BMI matched healthy control subjects. A multivariate logistic regression analysis was applied, and significant predictors identified for the prediction of metabolic syndrome.Results: The prevalence of metabolic syndrome among PCOS patients was 42 % in present study group as compared to 14 % in control group (p=0.01). The prevalence of metabolic syndrome was even higher in obese PCOS Vs non obese PCOS (52 % Vs 28.6 %). But even non-obese PCOS had higher prevalence of metabolic syndrome as compared to controls (28.6 % Vs 14 %).Conclusions: The study suggests a high prevalence of metabolic syndrome in patients with PCOS & thus it is important to screen all PCOS patients for manifestations of metabolic syndrome & its cardiovascular sequelae

Obstructive mullerian anamolies: a case series

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly

Two interesting cases of gestational trophoblastic disease with methotrexate failure

Gestational trophoblastic disease is group tumours that are more sensitive and respond well to a wide variety of chemotherapeutic regimes. Presented here are two interesting cases one with life threatening bleeding requiring hysterectomy and other with persistent disease post evacuation. Both being low risk were treated with single agent methotrexate, but failed to respond. They responded to alternative chemotherapy. Methotrexate resistant is seen even in low risk group

Concurrent bilateral ectopic pregnancy: a rarity

Bilateral ectopic pregnancy is a rare twin gestation with only a few cases reported in the literature. We report a 30 year old woman without any high risk factor for ectopic pregnancy, who had concurrent bilateral ectopic pregnancy. A 30 year old female presented to the Gynecology emergency department complaining of vaginal bleeding and abdominal pain. The presumptive diagnosis of ruptured left sided ectopic pregnancy was made on basis of clinical findings and ultrasound finings. An emergency laparotomy was done revealed a hemoperitoneum of 1.5 liters, a ruptured left tubal pregnancy with active bleeding and right tubal un-ruptured ectopic was found. A bilateral salpingectomy was performed. Histopathology confirmed presence of chorionic villi in both tubes. In theory, laparoscopic salpingostomy is the best surgical approach in bilateral tubal pregnancy. However, bilateral salpingectomy may be necessary when both tubes are extensively damaged or are actively bleeding. Successful pregnancies have been reported after conservative surgical treatment of bilateral ectopic, but the risk of recurrence is high. Our decision for an emergency laparotomy followed by bilateral salpingectomy was based on the fact that the patient presented with acute abdomen and was haemodynamically unstable and there was extensive bilateral tubal damage. As the incidence of ectopic pregnancies is increasing concurrently with the incidences of pelvic inflammatory disease and use of assisted fertility techniques; it may be that these “rare ectopics” will become less uncommon

Acute pancreatitis in pregnancy: a challenge for the clinician

Acute pancreatitis is one of the very rare events in pregnancy associated with high maternal and fetal morbidity and mortality. We are presenting a case of acute pancreatitis in a 25 year old G2P1L1 at 33 weeks of gestation with previous LSCS who presented to us with hypertension, epigastric pain, vomiting. Investigations revealed hyperamylysemia, hypertriglyceridemia and deranged liver enzymes. After examination and investigations, diagnosis of acute pancreatitis with pregnancy was made. She underwent caesarean section for obstetric hemorrhage and was put in intensive care for 3 days. She was discharged after. 1 week and is under regular follow up for past 6 months

Correlation of clinical, biochemical and radiological characteristics with histopathology of ovarian masses: hospital based descriptive study

Background: Ovarian cancer is an important cause of morbidity and mortality in the middle aged women. A systematic study of all ovarian tumours encountered in a large institute over a period of years is more likely to produce a significant amount of useful data regarding the clinical manifestations, the incidence of various types of ovarian tumours and the type of treatment offered. In this study we correlate various clinical presentations, ultrasound features, and various tumour marker levels with histopathology of ovarian masses.Methods: The study was conducted in the department of obstetrics and gynaecology in collaboration with department of radiology and pathology and lab medicine, Deen Dayal Upadhyay hospital from April 2015 to December 2016.Results: In the present study, 97 ovarian masses have been operated out of total 708 gynaecological surgeries in the obstetrics and gynaecology department of Deen Dayal Upadhyay hospital over the stipulated period. Prevalence of ovarian masses was 13.7%. Most of the ovarian masses were prevalent in the reproductive age group i.e. 21-40 years of age group in the present study though malignant masses were commonest in post-menopausal age group in the present study. 2 out 11 malignant ovarian masses were in the age group of 10-20 years which were dysgerminoma and immature teratoma respectively. Intra-operative findings like presence of mural nodule, haemorrhage and necrosis, ascites, papillary excrescences and omental caking were also found to have strong correlation with malignancy.Conclusions: A detailed preoperative workup and a simple tool loke RMI can differentiate between benign and malignant masses pre-operatively especially in post-menopausal women

Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS

Epitheloid leiomyoma of vulva: a diagnostic dilemma

Smooth muscle tumours are uncommon lesions of vulva. This case reflects the rare clinical presentation of leiomyoma of vulva, which commonly mimics bartholin gland cyst at presentation. A 25 year old P1L1 presents in GOPD as a painless non tender nodule at right labia majora, which gradually increased in size over last 2 years. Wide local excision was done. Histopathology revealed epitheloid leiomyoma of vulva. Recurrence is rare in benign cases

Clinical Profiles of Dengue Infection during an Outbreak in Northern India

Introduction. Dengue fever is an arboviral disease, which is transmitted by mosquito vector and presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Unless we are aware of these presentations, diagnosis as well as early initiation of treatment becomes difficult. We studied the various clinical presentations of dengue infection during an outbreak of disease in 2015. Materials and Methods. A total of 115 confirmed cases of dengue infection from Department of Medicine of Deen Dayal Upadhyay Hospital, New Delhi, were enrolled in this observational study. Results. The common signs and symptoms of dengue infection were fever, headache, body ache, backache, retro-orbital pain, bleeding manifestations, and rash in 100%, 87%, 86%, 58%, 41%, 21%, and 21%, respectively. Nonspecific or warning signs and symptoms included vomiting, weakness, abdominal pain, breathlessness, vertigo, sweating, and syncope. Other possible signs and symptoms of coinfections, comorbidities, or complications included diarrhea, sore throat, and neurological manifestations. There were seven patients with coinfections and four with comorbidities. The final diagnosis of these patients was DF (73%), DHF (16.5%), DSS (1.7%), and EDS (4.3%). Among EDS patients, the atypical presentations included encephalopathy, lateral rectus nerve palsy, acalculous cholecystitis, and myocarditis. Four patients required ICU care and there was no death in this study. Conclusion. Knowledge of atypical presentations is a must for early diagnosis and timely intervention to prevent life-threatening complications