Prediction of pregnancy in artificial reproductive techniques through evaluation of thickness, morphology and vascularity of endometrium

Background: Prediction of pregnancy in Artificial Reproductive Techniques through evaluation of thickness, morphology and vascularity of endometrium.Methods: Endometrial thickness, morphology and sub endometrial blood flow were assessed using trans-vaginal ultrasound on the day of HCG in 200 undergoing IVF/ICSI treatment in the period between October 2009 and December 2014. Statistical analysis was done.Results: There was no difference in the demographic features between pregnant and non-pregnant women. Overall, 80 patients conceived; 46 (57.5%) of them had blood flow in zone III and 30 (37.5%) in zone II. All patients achieved pregnancy had endometrial thickness >8 mm. There was no significant difference in Doppler indices between pregnant and non-pregnant women.Conclusions: When the endometrial thickness is <8 mm, and if there are non-triple endometrial line, pregnancy rate decreases and the absence of colour mapping of the endometrium and subendometrial areas means and absolute implantation failure or a significant decrease of the implantation rate. Conversely, the pregnancy rate increases when the vessels reach endometrium

Role of obstetric colour doppler studies in predicting perinatal outcome in pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel colour Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler in PIH and to analyse their role in predicting perinatal outcome.Methods: This is a study of 150 pregnant women with pregnancy induced hypertension (PIH). These patients were evaluated with colour Doppler and were followed subsequently for any adverse perinatal outcome.Results: Out of 150 cases 70% of cases were found in 20-30 years age group. 98 cases had abnormal uterine artery Doppler indices accounting for 65.3%, while 52 cases had a normal Doppler index accounting for 34.3%. Out of 150 cases, 94 (64.6%) cases had abnormal middle cerebral artery. In our study 53 cases had abnormal umbilical artery Doppler indices accounting for 35.4%, while 97 cases had a normal Doppler index accounting for 64.6%. Out of 150 cases in our study 27 cases had Reversal of a wave in ductus venosus waveform that is in 18%. In this study total 5 cases (35.7%) of perinatal mortality were seen.Conclusions: The knowledge of various doppler parameters may help to improve pregnancy outcome and identification of PIH at earliest gestation age as compared to other antepartum test modalities

Abruptio placenta and its maternal and fetal outcome

Background: Abruptio placenta is one of the common cause of antepartum haemorrhage and is defined as premature separation of normally implanted placenta. It is more common in second half of pregnancy. Abruptio placenta is serious complication of pregnancy and causes high maternal and neonatal morbidity and mortality.Methods: This retrospective study of abruptio and its maternal and perinatal outcome was carried out between July 2016 and October 2017 at Rama Medical College Hospital and research centre.Results: Incidence of Abruptio placenta is 1.6%. It is most common in the women of age group 30-35 years. 75% of cases were associated with severe pre-eclampsia. Live births were 75% while stillbirths were 25%. PPH occurred in 30% of cases. DIC accounts for 25% of the complication.Conclusions: Abruptio placenta is life threatening complication of pregnancy and it is associated with poor maternal and fetal outcome if not managed appropriately. Hence early diagnosis and prompt resuscitative measures would prevent both perinatal and maternal mortality and morbidity

Role of CT enterography in evaluation of small bowel disorders

Background: Small bowel pathologies are an enigma for clinicians and difficult to assess and evaluate for clinicians. In order to establish the efficacy of MDCT Enterography in diagnostic characterisation of small bowel lesions, the current study was undertaken.Methods: A prospective observational cross-sectional study was carried out in a tertiary care hospital. 30 patients with clinically suspected small bowel disease underwent CT enterography using iso-osmotic mannitol as neutral enteral contrast. CT enterography diagnoses were compared with clinical, surgical and histopathological results.Results: CT enterography showed a sensitivity (95.83%), specificity (100%), positive predictive value (100%), negative predictive value (85.71%), accuracy (96.66%) in diagnosis of small bowel diseases.Conclusions: CTE is a non-invasive well tolerated and reliable imaging modality for the depiction of small-bowel diseases. It provides excellent visualization of luminal, mural and extraintestinal findings

A ‘never before’ presentation of a common Mullerian abnormality

Transvaginal septum is one of uncommon Mullerian anomalies which may lead to infertility. We all depend so often on HSG and MRI for investigating these infecund patients. Here we bring out how a distended vaginal cavity with contrast mimicked the uterine cavity on HSG misleading the clinician. The septum was missed on MRI too initially. A simple surgical correction and the patient was able to conceive in her very first cycle

Timing feedback-inhibition of the male reproductive hormone axis

Hormonal methods of male contraception have addressed feedback-inhbition of the cascade of hormones that has evolved to regulate sperm production but high concentrations of testosterone (T) in the blood have not worked satisfactorily. We hypothesized that an episodic event, such as degranulation of gonadotropin-releasing hormone (GnRH) neurons in the hypothalamus, could be as well inhibited by episodic interference as by continuously-applied suppression. We used a computational model of hypothalamus-pituitary-gonad axis described by Veldhuis et al. to test the hypothesis that episodic administration of T would inhibit GnRH and/or luteinizing hormone (LH) secretion. A set of stochastic differential equations model feedback as well as feed-forward actions of GnRH, LH and T. The model predicted feedback-inhibition of GnRH pulses in a dose and frequency dependent manner when transdermal patches or injections delivering pulsatile T were applied. Since the published model did not address the effect of chronic GnRH deprivation on the viability of pituitary gonadotrophes, we introduced a function to address this issue. Incorporation of this function in the model allowed the prediction of a &#x201c;holiday period&#x201d; in the contraceptive regimen, during which exogenous T would not be needed to protect from conception. Pulsatile T delivered by real-life transdermal delivery system applied as per a parsimonious regimen reduced secretion of LH and T and fertility. The vitality function, proposed to account for survival and proliferation of pituitary gonadotrophes correlated with in vivo observations as extensive apoptosis in the anterior pituitary was observed after application of transdermal T

Ruptured ovarian artery aneurysm in puerperium: a rare occurrence

We present a rare case of Ovarian Artery Aneurysm in a puerperium. It was managed by endocopic banding of the ovarian artery following failed attempts at endovascular embolisation. The patient remained stable on three months follow up. The pathogenesis of this rare condition is also discussed.

Gravid uterus in post caesarean incisional hernia: a rare occurrence

Incisional hernia following section caesarean is a not so uncommon a complication following sepsis in the postoperative period. An ever rising primary caesarean rates in many developed countries like USA and emerging economies like China is leading to rising trend of incisional hernia following c-section. The contents of hernial sac in these cases are usually small gut loops or omentum. Only about a dozen cases having gravid uterus as hernial content have been recorded in literature. Paucity of cases has meant that there are no established guidelines for its management, which is totally individualized. We report here a very rare case of protrusion of gravid uterus in post caesarean incisional ventral hernia and its successful management resulting in delivery of a healthy baby

Unusual clinical presentation and complications following preoperative embolization of a large adrenal tumor

Authors present a case of a young female presenting with secondary amenorrhea which on further investigation revealed a large intra-abdominal mass, likely arising from the left adrenal gland. As the tumor was highly vascular with large feeders, she was referred for pre-operative embolization to reduce the blood loss during surgery. Post embolization, the patient suffered from an unusual complication of tumor rupture along with excessive secretion of catecholamines resulting in myocarditis and myocardial infarction. Patient ultimately died of the myocardial infarction. Preoperative embolization of a large, hypervascular adrenal mass lesion is not devoid of unusual complications like tumor rupture and subsequent cardiovascular complications even if the tumor is hormonally inactive. This complication is extremely rare and has never been reported in adrenal tumors after embolization

Diagnostic accuracy of an integrated approach using conventional ultrasonography, and Doppler and strain elastography in the evaluation of superficial soft tissue lesions

Introduction: To assess the diagnostic accuracy of an integrated approach using conventional ultrasonography, colour Doppler ultrasonography, and elastography strain ratios in tandem in the evaluation of superficial soft tissue lesions. Material and methods: Sixty-five subjects were included in this prospective cross-sectional study. Greyscale features and Doppler parameters were recorded. Strain elastography of the non-vascular and non-cystic lesions was performed and strain ratios were calculated. Fine-needle aspiration or biopsy of all the lesions was performed depending on their site and condition. Inter-rater k agreement was used to determine the strength of agreement between imaging-based diagnosis and histopathological diagnosis. A diagnostic test was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. A p value of < 0.05 was considered statistically significant. Results: Multiple superficial soft tissue lesions were studied, the majority of which were lipomas, vascular anomalies, and epidermoid cysts. The diagnostic accuracy was very high and varied from 92.31% to 100% for various masses. The imaging-based diagnosis was in agreement with the histopathological diagnosis in 86.15% (n = 56) and disagreement in 13.85% (n = 9) of the cases (p < 0.007). There was very good inter-rater agreement between the imaging-based diagnosis and histopathological diagnosis (κ = 0.818). Conclusions: The combined use of conventional ultrasonography, colour Doppler, and elastography strain ratios provides a very effective non-invasive tool for the diagnosis of superficial soft tissue lesions and may negate the need for unnecessary biopsies. The advantage of this integrated approach using various ultrasound techniques needs no further emphasis