Case report on toxicity of methotrexate in tubal ectopic pregnancy

Ectopic pregnancy is defined as pregnancy outside uterine cavity. Of all ectopic pregnancy, tubal ectopic is most common. Most cases today are diagnosed early and hence timely treatment is possible. In stable patients, medical line of management with methotrexate can be used. With early diagnosis and medical line of treatment, use of injectable methotrexate is on rise. Being aware of characteristics of methotrexate like mechanism, dosage, side effects and contraindications, appropriate patient selection and watchful monitoring will help reduce methotrexate induced toxicity

To study the role of hysteroscopy and laparoscopy in the evaluation of infertility

Background: Infertility is defined as a lack of conception after at least 12 months of unprotected intercourse. Hysteroscopy and laparoscopy are the two methods widely used in assessing tubal patency, endometriosis, for diagnosis and treatment of polycystic ovaries, tub ovarian mass, peritubal adhesions. This study strives to undertake an in depth analysis of infertility with the help of hysteroscopy and laparoscopy to give a lucid picture to establish a diagnosis and subsequent treatment for the same.Methods: This is a prospective study carried out in department of obstetrics and gynaecology at Dr. Babasaheb Ambedkar Central Railway Hospital, Mumbai in the year 2008. Women within the age of 20 to 40 with infertility were included in the study.Results: There were 50 patients in the study out of which 35cases were of primary infertility and 15 cases of secondary infertility. Most common age group was between 26 to 30 years in 42% cases. Hysteroscopy could detect abnormality in 12 cases (24%) and the most common finding being fibroid. Laparoscopy could detect pathology in 74% of cases and the commonest pathology being PCOS (28%).Conclusions: Hysterolaparoscopy is a very good diagnostic tool for identification of certain problems like endometriosis, adhesions near adnexa etc. which are difficult to diagnose by other imaging modalities and even it can be used as the operative tool in certain situations while undergoing diagnostic test

Successful maternal and fetal outcome in a case of BOH with APLA positive status

The Antiphospholipid antibody syndrome is an autoimmune disorder that occurs when body’s immune system makes antibodies that attack and damage the tissues. These antibodies that mistakenly attack phospholipids found in the lining of the blood vessels result in formation of clots. The effect of thrombophilia on pregnancy is uncertain. Here we discuss a case of preterm abruption at 30 weeks of gestation in a patient with Lupus positive status in a patient without preeclampsia

Maternal and fetal outcome of heart disease in pregnancy: an audit in a tertiary hospital in India

Background: There has been a rising incidence of pregnancy complicated by heart disease in India. The importance of heart disease in pregnancy lies in its high morbidity and mortality in both maternal and fetal outcomes combined with lack of enough established guidelines in its management.Methods: A study was done in department of obstetrics and gynaecology, KEM hospital, Mumbai from January 2016 to April 2017 retro prospectively studying the different manifestations of heart disease in pregnancy and the maternal and fetal outcomes.Results: During the study period, there were 6500 deliveries in the study center and of them 135 presented with heart disease. Of the 135 cases observed, 100 cases came under the inclusion criteria and were included in the study. The incidence of heart disease in pregnancy in the current institute is 2%. In the 100 cases, 55% were seen to have Rheumatic heart disease, 32% with cyanotic and acyanotic congenital heart disease and 13% with other conditions such as peripartum cardiomyopathy and mitral valve prolapse. Maternal outcome shows 44 patients delivered vaginally, 21 by assisted vaginal delivery and 35 required caesarean section. Maternal adverse cardiac events comprised of heart failure seen in 11 cases, ICU admissions required in 14 patients and maternal mortality in one case. Neonatal outcome comprised of 31 preterm births, still births 2, low birth weight seen in 41 and 16 needing NICU admissions.Conclusions: Early diagnosis and prompt management with a multidisciplinary approach is fundamental in managing a case of heart disease in pregnancy

Maternal and foetal outcome in term patients with previous one lower segment cesarean section

Background: In modern day obstetric practice we encounter increasing number of patients with history of caesarean section because of rise in primary caesarean due to changing trends in their indications. There is increasing fear and anxiety by obstetricians for managing these cases from medico legal point of view. Present study was done to look at the feto-maternal outcome and for   appropriate mode of delivery and overall  to conduct the proper management of patients with previous one  lower segment caesarean section so as to achieve the goal of healthy mother and baby at the end of pregnancy.Methods: This is a Retrospective observational study carried out at G S Medical College and KEM Hospital, Parel Mumbai 12 Maharashtra India from January 2015 to December 2015. All patients enrolled in study were with H/O previous lower segment caesarean section. Classical CS, inverted T incision other medical complications were excluded. Patients were evaluated thoroughly by history and examination and mode of delivery was decided. Informed consent was taken of the patients who were fit for VBAC ie Vaginal Birth after caesarean section. Antenatal, intrapartum and post-partum records were evaluated. Women who were given trial of VBAC, progressed into labour spontaneously. Labour was constantly supervised by competent staff and meticulously monitored by CTG.Results: All the patients were counselled throughout their ANC period for VBAC Out of 7680 confinements 588 patients with previous one LSCS were encountered and among these patients 311 consented for vaginal birth and 277 underwent elective LSCS. From the 311 patients who consented for VBAC 165 delivered successfully 146 required Emergency LSCS. In VBAC group, 8 patients required foceps and in 2 patients required vaccum .There were 42 patients who underwent emergency LSCS for scar tenderness from which 10 patients had scar dehiscence and one patient had rupture uterus.Conclusions: Successful vaginal delivery in patients with history of previous caesarean is associated with better outcomes than emergency caesarean section and hence proper counseling in ANC period and selection of patients for trial of VBAC is necessary, especially in underdeveloped nations where limited resources and facilities of feto-maternal monitoring are available