Large cervical fibroid: a rare case report

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases.

Pregnancy in sickle cell thalassemia: double trouble!

This is a case report of 20-year-old multigravida (G2P1L0) belonging to tribal community presented at 30 weeks of gestation with severe anemia, fever, arthralgia and jaundice with multiple blood transfusions in the past and with previous pregnancy outcome being stillborn and was not evaluated for the same. A diagnosis of sickle cell β+Thalassemia (SCD crisis) was made and managed vigilantly by multidisciplinary approach and had full term vaginal delivery with good perinatal outcome and finally both mother and newborn were discharged in stable condition. This highlights the overall increase in maternal and fetal complications in pregnancy with sickle cell thalassemia. Thus health education, screening, early intervention with multidisciplinary approach and regular follow up prevents maternal morbidity and mortality

Analysis of ectopic pregnancy in a tertiary care hospital

Background: Ectopic pregnancy is a life threatening obstetrics emergency in early trimester associated with increased risk of morbidity and mortality if not timely intervened. High index of clinical suspicion is required for early diagnosis specially in reproductive age group women presenting with history of amenorrhea. Aim was to analyse the incidence of ectopic pregnancy, its risk factors, clinical presentation and management of ectopic pregnancy. Methods: A retrospective observational study was conducted on ectopic pregnancy cases admitted in a tertiary care institute over a period of 5 years from January 2018 to December 2022. A total of 221 cases of ectopic pregnancy were analysed for parameters like age, parity, gestational age, clinical presentation, risk factors, intervention and outcome. Results: There were 221 ectopic pregnancy cases during the study period with incidence of 4.3/1000 deliveries. The mean age was 24 years with the mean gestational age of 6.83±1.25 weeks. The commonest risk factor identified was any previous pelvic surgeries (49.32%), PID (11.76%), history of abortion and use of IUCD (8.14%). The triad of ectopic pregnancy (pain abdomen, history of amenorrhoea, bleeding PV) was found in 35.29%. Ectopic pregnancy was ruptured in 148 cases (66.96%) and unruptured in 73 cases (33.03%). Majority of the ectopic pregnancy was tubal ectopic and most common site was Ampulla (47.06%) followed by isthmus (23.98%). 96% of the cases were managed by surgical intervention and two maternal deaths were found during the study period. Conclusions: Proper evaluation of risk factors9and early diagnosis will help in preserving fertility and also reducing8morbidity and mortality. Majority of the cases were in ruptured condition, rendering8conservative management was impossible. Therefore awareness of its determinants can aid in8early detection of more number of such cases8in unruptured condition especially in8peripheral center, leading to early referral

Pregnancy in Ellis Van Creveld syndrome women: a rare case report

Ellis Van Creveld (EVC) syndrome also known as chondroectodermal dysplasia is a rare genetic disorder characterized by congenital heart defect, short ribs, polydactyly, dwarfism, deformed teeth and genu valgum. It is a rare disease with approximately 150 cases reported worldwide. The exact prevalence in India is not known, but the syndrome seems more common among Amish population of Pennsylvania in the United States of America (USA). Heart defects occur in about 60% of cases. Cognitive and motor development is normal. It shows autosomal recessive trait with variable expression. The patients with this syndrome rarely survive into adulthood but here we report a case of 25 years old pregnant lady with Ellis Van Creveld syndrome

Wernicke’s encephalopathy: obstetric diagnostic challenge! (a rare complication of hyperemesis gravidarum): a case report and review of literature

Wernicke’s encephalopathy (WE) is an acute neurological disorder caused by a deficiency in thiamine. It is characterized by triad of altered mental status, ataxia and ophthalmoplegia. Most of the cases reported were secondary to long-term alcohol use. We reported a rare case of WE due to hyperemesis gravidarum in a 29-year-old P1L1A1 women at 22 weeks of gestation who had spontaneous abortion. Patient manifested with features of mental confusion, nystagmus, and gait ataxia. Diagnosis was established after MRI findings suggestive of WE in thalamus. Patient clinically improved after treatment with thiamine. We emphasize the importance of thiamine supplementation to women with hyperemesis to prevent life threatening complications.

Rare case of active lupus nephritis with mixed connective tissue disease in pregnancy

This was a case report of a 32 years old pregnant woman with 9+6 weeks of gestation presented with hyperemesis gravidarum who was diagnosed of lupus nephritis with mixed connective tissue disorder (MCTD) 7 months back. Renal biopsy-lupus nephritis class 4 with activity score of 9/24 and chronicity score of 0/12. She was advised contraception in view of active lupus nephritis with MCTD but she presented to us with 9+6 weeks gestation with conception being within 20 days of her last dose of cyclophosphamide. She was managed with oral immunosuppressants by constant supervision of obstetricians and nephrologist. The management of MCTD and lupus nephritis in pregnancy presents a diagnostic and therapeutic challenge for providers. Women with prior lupus nephritis and MCTD can have safe, successful pregnancies with excellent, immaculate, collaborative care between obstetricians, nephrologists, and multidisciplinary staff.

Relaparotomy in obstetrics and gynecological surgeries: a retrospective study in a tertiary care hospital

Background: Relaparotomy is biggest dilemma to the surgeon as well as to the patient to undergo second surgery in a short span of time. It may be required due to post-operative complications as lifesaving procedure. Objectives of this study are to determine the risk factors, indications, management and outcome in obstetric and gynecological surgeries in a tertiary care hospital attached to Mysore Medical College and Research Institute (MMCRI), Mysore.Methods: It is a retrospective observational study for the duration of 5 years from January 2016 to December 2020 in Cheluvamba Hospital attached to MMCRI, Mysore.Results: Incidence of relaparotomy was 0.11%; 0.1% for obstetric indication and 0.06% for gynecological procedure most common indication for relaparotomy was atonic postpartum hemorrhage (PPH) (35%) followed by burst abdomen (26%), uterine scar dehiscence 13%. Time interval between primary and secondary surgery is <24 hours in 57% of cases mainly due to obstetric hemorrhage. About 74% of patients post relaparotomy were stable and 26% patients needed intensive care unit (ICU) admission. Out of 23 relaparotomy cases 4 patients died with mortality rate of 17% (all relaparotomies were related to obstetric causes) with zero mortality rate for relaparotomies done for gynecological case. The major cause of death was found to be multiorgan dysfunction syndrome (MODS).Conclusions: Relaparotomy is lifesaving procedure; early recognition of complications, good primary surgery, good surgical techniques, meticulous hemostasis and strict asepsis can prevent relaparotomy

A five-year retrospective study of cervical fibroids in a tertiary care centre

Background: Cervical leiomyomas or fibroids are rare benign pelvic tumors. The symptoms vary from urinary retention, frequency, dyspareunia, intermenstrual bleeding, rarely mimicking procidentia or can cause uterine inversion. This study was conducted in a tertiary hospital to find out clinical presentation, prevalence of cervical fibroids.Methods: This study is a retrospective study where Women ranging from 20 to >60 years age attending gynecology OPD of Cheluvamba hospital tertiary care centre attached Mysuru medical college and research centre, Mysuru for abdominopelvic mass, pain, menstrual abnormalities over a period of 5 years (January 2012 to December 2016) were included the study. Socio-demographic profile, detailed menstrual history, reason for attending hospital and previous treatment taken prior to the hospital visit were recorded. Pregnant women with fibroids were excluded from the study. Parameters like type and size of cervical fibroid, mode of treatment, postoperative morbidities, histopathological reports were studied and interpreted in this study.Results: In this study total 20 women who presented with menorrhagia or with abdominopelvic mass had cervical fibroid. Of 20 patients 10 (50%) belonged to age group 31-40 years, 9 (45%) patients were of 41-50years age and 1 (5%) patient was >60 years age. The 16 (80%) patients presented with menorrhagia. Metrorrhagia was the commonest menstrual pattern seen in 15 (75%) women. Asymptomatic fibroids with abdominopelvic mass were seen in 4 (20%) women. The size was 12-28 weeks. Polypectomy was done in 1 (5%) woman and abdominal hysterectomy was done in 19 (95%) women. None of the patient had postoperative morbidity or mortality. histopathological reports in 17(85%) showed leiomyoma without degeneration while 3 (15%) cases showed degenerative changes.Conclusions: Further research is needed to find out biological factors causing fibroids including diet, stress, environmental and racial influences. Routine screening, early detection, increase awareness by early reporting to the hospital will reduces morbidity and improves quality of life socioeconomically

A two-year analysis of uterine rupture in pregnancy

Background: The aim of our study is to analyze cases of rupture uterus in pregnancy by evaluating the risk factors, type and site of rupture, management, and maternal and perinatal outcome associated with it at a tertiary care hospital, allied with Mysore medical college and research institute, Mysore.Methods: A retrospective study was conducted in the department of obstetrics and gynecology at Cheluvamba hospital allied with Mysore medical college and research institute, Mysore from January 2013- December 2014. All patients attending obstetric emergency care unit at Cheluvamba hospital, Mysore from January 2013 to December 2014 were included in the study. Cases in which emergency caesarean section were performed for suspected rupture uterus was isolated. Amongst them, the relevant history, intra-operative findings and postoperative morbidity and mortality was studied. Those cases in which successful trial of labor was given was also examined and documented.Results: A total of 28,574 deliveries were conducted at Cheluvamba hospital for the year 2013. During this period, 7455 (26%) cases of lower segment caesarean section were performed. Amongst them, 20 cases of complete uterine rupture were seen with 147 cases of incomplete rupture or scar dehiscence. 16 cases (80%) of them had a prior scar and the remaining 4 cases (20%) had primary or non-scar rupture. Thus the incidence of scar rupture is 0.26%. The incidence of scar dehiscence was 1.97%. 144 cases had VBAC. The incidence of VBAC in our institution was 1.93%. 95% of cases were multigravida, 30% were unbooked and 65% were referred. The main risk factor was scarred uterus (80%). However 20% of cases, primary rupture were seen due to injudicious use of oxytocics (10%) grand multiparity (5%) and forceps in delivery (1%). Repair of uterus was done successfully in 16 cases (80%), 4 cases had to undergo peripartum hysterectomy (20%). There were 2 maternal deaths and 7 still births.Conclusions: Rupture uterus is still a significant cause of maternal and perinatal morbidity and mortality. Early diagnosis, immediate resuscitation with rapid replacement of blood loss is key to management of such cases

Headache in pregnancy-a diagnostic dilemma: an unusual case of advanced glioblastoma multiforme in pregnancy: a case report and review of literature

This was a case report of a twenty year old patient with a obstetric score of G2P1L1 with 28 weeks of gestation presented with persistent intractable headache leading to a diagnostic conundrum. Magnetic resonance imaging of the brain revealed an advanced glioma in the right frontal lobe with a mass effect and a midline shift for which emergency surgical resection was sorted followed by chemoradiation which eventually lead to a satisfactory obstetric and perinatal outcome.Glioblastoma multiforme is a rare diagnosis during pregnancy which carries unique challenges to the mother, foetus and the health care providers. A combined effort from a multidisciplinary team is the key for a successful outcome