Role of transvaginal sonography in the diagnosis of early pregnancy failure

Background: The most crucial period of intra uterine life are the first twelve weeks of gestation, where history and clinical examination may often be inconclusive. Ultrasonography plays an important role in confirming the pregnancy, its site and viability. The objective of this study was to determine the first trimester ultrasonographic findings of a normal intrauterine pregnancy, early pregnancy failure and to have a comparative evaluation of transvaginal with transabdominal ultrasonography in the diagnosis of early pregnancy failure.Methods: Cross sectional study done in the Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital from 1st June 2019 to 31st May 2020. Data were collected from 80 patients presenting to the Antenatal and Gynaecology OPD of Silchar Medical College, with positive urine beta HCG test with signs and symptoms suggestive of early pregnancy. The study was conducted during the said study period. General physical and pelvic examination done for in the cases provisional clinical diagnosis and subjected to ultrasound. Sonography by both abdominal and transvaginal method was done and findings were compared.Results: 70% of cases in this study came out to be of normal pregnancy while 30% of the total cases were of abnormal pregnancy. Various fetal developmental markers such as gestational sac, yolk sac, fetal pole, fetal heart motion, double decidual sac sign were visualised in better number of cases by transvaginal sonography than by abdominal. Amongst cases of abnormal pregnancy, parameters such as detection of abnormality in shape of gestational sac, abnormality in yolk sac were found to be better seen with transvaginal sonography than with transabdominal sonography. Measurements of mean sac diameter, crown rump length were found to be similar by both the methods.Conclusions: Combination of abdominal sonography and transvaginal sonography complements the defects of two methods and thus improves the accuracy of diagnosis. Thus it can be said that transvaginal sonography should not be used as a substitute but as a conjunct with abdominal sonography for better visualization, improved diagnosis thereby leading to better management of the patients

Rare case report of mermaid baby: sirenomelia

Sirenomelia or mermaid baby is a rare and fatal congenital anomaly. It is characterized by varying degrees of fusion of lower limbs, thoracolumbar spinal anomalies, sacrococcygeal agenesis, genitourinary malformations, lower gastrointestinal tracts anomalies (e.g. renal agenesis, absent bladder, anorectal atresia) and absent internal genitalia. Most of the cases are associated with Potter’s facies and pulmonary hypoplasia. The incidence of the disease was 0.8-1 case/1,00,000 births and male to female ratio being 3:1. We reported a case of 19 years old primi at 35 weeks 3 days of gestation with history of tobacco intake during pregnancy who delivered a 1.24 kg baby with single fused lower limbs with a rudimentary tail and multiple congenital anomalies .There was also evidence of Potter’s facies .The baby died within 20 mins after birth. Sirenomelia is a rare but lethal congenital anomaly. Prevention is possible and when diagnosed antenatally, termination should be offered

Invasive mole diagnosed as vascular malformation of uterus: a case report

Gestational trophobalstic neoplasia encompasses invasive mole, placental site trophoblastic tumor, epitheloid trophoblastic tumor and choriocarcinoma. Here we report a 27 year old woman with invasive mole with severe anaemia who was initially misdiagnosed as a case of incomplete abortion with vascular malfomarmation of uterus. In view of uncontrolled bleeding per vaginum, nonspecific ultrasound findings and H/O failed dilatation and evacuation, exploratory laparotomy was decided upon and intraoperative finding was invasive mole. Hysterectomy was done