Successful outcome of an ovarian ectopic pregnancy

Ovarian pregnancy is rare and a conspicuous variant of ectopic pregnancy and an accurate preoperative diagnosis is very challenging various advances in diagnostic modalities like Transvaginal ultrasonography has evolved in identifying an ovarian pregnancy. We report here one such case of 30 years old with severe lower abdominal pain and bleeding per vaginum following six weeks of amenorrhea confirmed as ovarian ectopic pregnancy consistent with Speigelberg’s criteria on ultrasonography. This case highlights the significance of 3D ultrasonography in the diagnosis. Histopathological report concluded it to be an ovarian ectopic pregnancy

Effectiveness of cervical length screening by transvaginal sonography and use of progesterone for preventing preterm labour

Background: Incidence of preterm labour is about 6-15 % of pregnancies worldwide. It is major public health problem in terms of loss of life, long term disability, and health care cost both in developing and developed countries. The incidence of preterm births in India is estimated to be 11-14 % which means about 3 to 4 million preterm live births annually. Early identification of at risk pregnant women with timely referral will help to decrease the extreme prematurity rate, thereby reducing morbidity, mortality and will have a profound impact on societal and long-term public healthcare costs. So this study where vaginal progesterone was administered in women with short cervix detected by Transvaginal sonography to prevent preterm labour will be helpful in decreasing cases with preterm delivery and hence improve the perinatal outcome.Methods: It is prospective observational study in which 100 ANC patients who were registered at KEM Hospital a tertiary care centre in Mumbai in India at 16-24 weeks of gestation were studied to determine usefulness of 200 mg vaginal progesterone twice daily till 36 weeks in preventing preterm birth in those having cervical length 25mm or less.Results: Among 100 participants in this study, 48 (48%) were primigravida and 52 (52%) were multigravida. Out of 48% primigravida in the present study, preterm labour is prevented in 75% of women by the use of vaginal progesterone and out of 52% of multigravida, it is prevented in 71.2% of women.Conclusions: The study concluded that use of vaginal progesterone 200 mg in women with cervical length 25 mm or less measured by transvaginal sonography (as a good predictor of preterm labour) has useful effect in preventing preterm labour as well as associated neonatal mortality and morbidity. Neonatal survival is critically dependent on maturity of an infant and progressively increases with gestational age. Each day critically impacts on maturity and survival. Thus prevention and/or effective management of preterm labour will improve neonatal outcome and will have a profound impact on societal and long-term public healthcare costs

Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

Background: Anemia refers to reduction in the total circulatory erythrocyte mass which results in decrease in the oxygen carrying capacity of the blood. Patients who require a surgical intervention as regards their complaints are many a times denied fitness because of anemia. Current anesthetic and surgical practice ideally recommend a hemoglobin level of > 10 g/dl or a hematocrit of >30 % for any surgical intervention. Surgery is postponed until cause of anemia is identified and the anemia corrected without resorting to blood transfusions. The current study evaluates other alternatives to increase the hemoglobin as early as possible without resorting to blood transfusion. The efficacy and safety of intravenous iron sucrose along with   the achievement of the desired hemoglobin values for patients posted for elective gynecological surgeries within the next menstrual cycle was evaluated.Methods: This study was an open label, single arm, and prospective study of women with iron deficiency anemia in gynecological disorders. 100 patients attending Gynecology OPD of Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India requiring surgical intervention but not given fitness due to anaemia were the subjects of this study. All patients with surgically treatable conditions with hemoglobin level >7g/dL but < 10 g/dl were the inclusion criteria Selected subjects received intravenous iron sucrose. Maximum dose 200mg/weekX3 weeks initially. At the end of three weeks of starting therapy Hb estimation was done and compared with the baseline levels as regarding the hemoglobin rise. The results were statistically analyzed using the “paired t” test.Results: The requirement of iron-sucrose for the individual patient was calculated based on the weight of the patient. The analysis of iron requirement-sucrose combination showed a mean of 481.7 mg with standard deviation (SD) of 62.72 mg and a range of 378.85 mg. The minimum iron-sucrose requirement was 361.55 mg and the maximum was 740.40 mg The mean Hb (gm%) value before intervention was 8.43 with a standard deviation of 0.56, whereas, the mean Hb (gm %) value after intervention was higher, 10.41 with standard deviation (SD) of .56 the mean Hb (gm %) Increase in 2 weeks was 1.60 with standard deviation (SD) of 0.31, whereas, in 3 weeks was 2.03 with standard deviation (SD) of 0.51. The mean Hb (gm %) increase was higher in participants with 3 weeks, which was statistically significant (p<0.05).Conclusions: Parenteral iron therapy was not safe in the past but iron sucrose has made it the safest and effective therapy. Parenteral iron therapy can be used for patients with Hb level between 6-8mg/dl It is highly efficacious and reliable way to achieve the desired Hb level patient compliance is assured with intravenous iron sucrose patient can be satisfactorily posted for surgery within a period of 3 weeks i.e. within her next menstrual period by reliably and effectively correcting her anemia with intravenous iron sucrose

Preoperative evaluation of ovarian masses with color Doppler and its correlation with pathological finding

Background: Most ovarian cancers are diagnosed in advanced stages because these tumours may not cause any specific symptoms, particularly in its early stages. Though specific risk actors have been identified there are no reliable screening tests for ovarian cancer. However, improvements in identification of women at high risk for ovarian cancer, as well as improved imaging techniques like the USG and color Doppler along with CT Scan and MRI has increased the likelihood of early detection.Methods: The aim of the study was to evaluate the efficacy of color and spectral Doppler in diagnosing the ovarian malignancy. A Prospective randomised study was conducted at a tertiary care centre where 50 patients with ovarian masses were selected. The study design included thorough history taking and clinical examination followed by evaluation of tumour markers.  USG along with color Doppler evaluation was done followed by surgery and then co-related with histopathology. The color Doppler parameters such as vascularity, distribution of vascularity, pulsatility and resistive index were also evaluated and statistical significance assessed.Results: Color Doppler showed increased vascularity in 100% of malignant tumors in contrast to only 54.24% of benign tumors. Absent blood flow in a solid tumor almost always ruled out the possibility of malignancy. Spectral Doppler helped to assess the nature of the blood vessels picked up on color Doppler. All the patients in the malignant group and 4 patients in the borderline group had PI1.0, 13 were benign and 2 patients had borderline tumours. RI of 0.4 was seen in 26 patients with benign lesions.Conclusions: Color Doppler is a good non-invasive modality to differentiate benign from malignant lesions. Vascularity is most sensitive and RI is most specific. Thus, color Doppler and spectral Doppler tremendously increased the reliability in diagnosing a malignant ovarian tumor. Color Doppler served as an important tool to rule out malignancy in solid tumors if they failed to show any intra-tumoral vascularity. B-Mode USG in combination with color Doppler and spectral Doppler is proposed as the first and foremost diagnostic modality in patients with ovarian tumor, so as to establish the definite diagnosis of malignancy early in the course of the disease

Obstetric hysterectomy: an emergency lifesaving procedure

Background: Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute.Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure.Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death.Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice

A study of fetomaternal outcomes in cases of jaundice at a tertiary care centre

Background: Jaundice in pregnancy is affects a small percentage of pregnant women yet takes a major toll on the health of both the mother and the foetus. The distribution of jaundice in pregnancy varies throughout the world but is seen comparatively more in the developing countries. The course and outcome of liver disorders in pregnancy is altered due to the various hemodynamic, immunological and hormonal changes of pregnancy.Methods: This is a retrospective study conducted in the department of obstetrics and gynecology at Seth G.S. medical college and KEM hospital, Mumbai, Maharashtra, India over one year from January to December 2015. Data of 55 women diagnosed to have jaundice from clinical and biochemical evidences as per records was collected.Results: There were 6780 deliveries; the incidence of jaundice being 0.81%. Most common cause identified was viral hepatitis 34 cases (62%), 24 cases being hepatitis E, followed by cholestasis of pregnancy 13 cases (23.6%) and the rest 8 cases were due to other causes like leptospirosis, malaria, HELLP syndrome, drug induced and chronic liver disease due to portal hypertension.72.7% belonged from the rural set up. 45 patients were referred from peripheral hospitals. Maximum patients were primigravidas and were between the age group 25-29 years of age. 70% babies were low birth weight. 50% babies had intrauterine growth restriction. There were 12 maternal deaths,7 due to hepatitis E. Total vaginal deliveries were 37, 9 patients underwent lower segment caesarean section and 1 patient had instrumental (vacuum) delivery. Most common maternal complication was DIC and postpartum haemorrhage. 18 patients required ICU care, out of which 13 patients were Hepatitis E positive. Ventilator support was required in 73% of the patients admitted to the intensive care unit.Conclusions: Prompt diagnosis, accurate evaluation and a multidisciplinary approach is needed to tackle this high risk pregnancy as it leads to a poor maternal and perinatal outcome

To study the correlation between endometrial thickness on transvaginal sonography and endometrial histopathology in women with postmenopausal bleeding

Background: Endometrial carcinoma is the most common malignancy of the female genital tract, ranking second to carcinoma cervix. It occurs primarily in postmenopausal women. Majority of women with endometrial cancer present with postmenopausal bleeding (90%) but in only about 15% of women is endometrial cancer the cause of postmenopausal bleeding. The objective of current study is to study the correlation between endometrial thickness on transvaginal sonography and endometrial histopathology in women with postmenopausal bleeding and whether endometrial thickness > 4mm is more suggestive of hyperplasia or carcinoma.Methods: The cases were selected from amongst the patients attending gynaecology OPD, who had history of postmenopausal bleeding or spotting per vaginum and were subjected to TVS followed by endometrial sampling by brush cytology Diagnostic Hysteroscopy  was done which was   followed by fractional curettage. The material obtained by sampling studied for endometrial histopathology.Results: Atrophic endometrium’s followed by proliferative endometrium was the most common histological findings and 9% patients had adenocarcinoma. Mean endometrial thickness on TVS was 5.97mm for atrophic histology and 11.95 mm for carcinoma.Conclusions: Postmenopausal bleeding, should always be taken seriously, no matter how minimal or nonpersistent it is, because though majority of causes underlying postmenopausal bleeding are benign, endometrial carcinoma may be seen in around 10% cases. So, patients with PMB must undergo thorough evaluation by endometrial sampling which cannot be replaced by transvaginal sonography which though has more sensitivity to detect endometrial thickening, at the same time, has low specificity for detection of malignancy

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

Uterine necrosis in a case of B-Lynch brace suture

B Lynch is a conservative surgical procedure for Atonic PPH not responding to medical line of treatment very few complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified on 16 day postpartum. A 24 year old primigravida underwent a primary low transverse cesarean section at term indication being primigravida with breach presentation intra-operatively there was torrential blood loss and uterus remained flabby despite treatment with uterotonics drugs delayed absorbable suture was used to place B-Lynch suture for control of the hemorrhage and had sepsis for which she had to undergo obstetric hysterectomy

Urinary calcium to creatinine ratio to predict preeclampsia and use of calcium supplementation to prevent preeclampsia

Background: Incidence of preeclampsia is around 5-10% of all pregnancies, and in developing countries around 4-18%. There is hypercalciuria during normal pregnancy, while pre-eclampsia is associated with hypocalciuria and low urinary calcium to creatinine ratio. Low calcium intake has been hypothesized to cause increase in blood pressure. The present study was carried out to investigate significance of urinary CCR in prediction of preeclampsia & role of calcium supplementation in reducing preeclampsia.Methods: 100 pregnant patients were divided into two groups, 50 cases and 50 controls. A spot urine sample was collected for estimation of CCR at around gestational age of 20-24 weeks. Cases were given 2 gm of calcium supplementation. Controls were 1 gm calcium .Then at each visit both the groups, were evaluated for symptoms of preeclampsia. Urinary calcium to creatinine ratio was calculated and those with ratio 0.04 were considered test negative.Results: The test (urinary CCR 0.04) in 84 patients and in those only 5 developed pre eclampsia. Urinary CCR had sensitivity of 63.63%, specificity of 94.87%. Out of 50 cases, only 3 developed preeclampsia. Out 0f 50 controls, 11 developed preeclampsia.Conclusions: Urinary CCR between 20-24wks of gestation will be an effective screening method for impending pre-eclampsia. Calcium supplementation (2gms/day) can help in prevention of preeclampsia