Primary pelvic hydatid cyst: a rare case report

 Primary pelvic hydatid cyst disease is a zoonotic parasitic disease most frequently caused by Echinococcus granulosus or Echinococcus multilocularis. Primary pelvic hydatid cyst is a rare entity. A 39-year-old, para 3 living 3 presented to casualty with acute pain abdomen and a suprapubic mass. Patient gave history of acute lower abdominal pain since 4 days associated with vomiting. On examination, a palpable mass around 18 weeks size, firm to hard in consistency with ill-defined margins and restricted mobility and suprapubic tenderness. Lower limit could not be reached, extending from right iliac fossa to midline. Per vaginum findings suggestive of mass deviated to right side with fullness in right fornix. No cervical motion tenderness. The pre-operative tumor marker levels were as follows: CA125=12.44 U/mL (normal=0-35), CEA=0.09 ng/mL (normal=0-2.5). CA19.9=16.79 U/mL (normal=1.2-30). Erythrocyte sedimentation rate (ESR) was found to be 82 mm in the first hour. Transabdominal ultrasound suggestive of adnexal mass? ovarian with moderate ascites. Urinary bladder seen separately. Contrast enhanced computed topography (CECT) suggestive of complicated right para-ovarian /ovarian cystic mass like cystadenoma. Exploratory laparotomy was done and specimen (uterus, cervix, omental biopsy and peritoneal washings) was sent for Histopathological report. Histopathological examination of the haematoxylin and eosin-stained section revealed ruptured brood capsule releasing daughter cyst. Post-operative period was uneventful. Patient received full course of anti-helminthic treatment

Ectopic ovarian pregnancy following in vitro fertilization: case report

Ovarian pregnancy is a rare form of extrauterine ectopic pregnancy. Risk factors such as reproductive treatments and infertility have been identified in recent studies. In this article, we present a case of ovarian ectopic pregnancy occurring following in vitro fertilization treatment and a fresh embryo transfer. The diagnosis of ovarian pregnancy was made during transvaginal sonography performed due to suspected ectopic pregnancy. Ovarian ectopic pregnancy is a rare clinical phenomenon. Late diagnosis and lack of appropriate intervention may have catastrophic results. Several mechanisms and risk factors are proposed, and their acknowledgment may improve early diagnosis and prevention of complications

Condom catheter: a simple and efficacious alternative of hysterectomy in postpartum haemorrhage

Background: The aim of this study was to evaluate the effectiveness of the condom catheter in treating postpartum hemorrhage refractory to medical treatment.Methods: This prospective study included 21 women with postpartum hemorrhage treated with a condom catheter as a conservative therapeutic option.Results: The condom catheter was successful in controlling hemorrhage in 90.4% of the women. It was effective in all women with vaginal delivery (11 of 12) and highly effective in women with uterine atony who did not respond to medical uterotonic treatment (6 of 7 women).Conclusions: Its ease of use and high effectiveness make the condom catheter a useful approach for the conservative management of acute postpartum hemorrhage. This device reduces bleeding, shortens the hospital stay and avoids the need for surgical management

Maternal and perinatal outcome in term singleton breech presentation at term pregnancy

Background: Breech presentation is defined as a fetus in a longitudinal lie with the podalic at the pelvic brim. There are three types of breech presentations: frank breech, complete, incomplete breech. The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3-4% at term, as most babies turn spontaneously to the cephalic presentation. Studies have shown that the prevalence of term breech presentation varies globally. In India the incidence was shown to be, 2.1%, and in other Asian countries it was found to be around 2.9 -4.5%. Its incidence is around 25% at 28 weeks of gestation and it reduces to 4% by term. If patients are carefully selected, breech presentation can be delivered vaginally. However, the risk of neonatal complications still persists. sometimes the planned vaginal delivery has to be converted into emergency cesarean section. Such probability varies from 17.4 to 51%. Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology department of SAMC and PGI, Indore, Madhya Pradesh from 1st April, 2021 to 31st October 2022. Ethical approval was taken from the institutional review committee. All term pregnant women (≥37 weeks) aged 18 years and above, admitted to the maternity and labor ward with the diagnosis of singleton breech presentation during the study period were included in the study. The patients were identified as having breech presentation on admission using physical examination and ultrasound. Those women who presented with antepartum hemorrhage, uterine rupture, fetuses with major congenital anomalies and intrauterine deaths were excluded from the study. After through exclusion sample of 70 people were included in study. Results: During the study period, 896 deliveries were conducted in this hospital. Among them, 70 (7.86%) of the deliveries were singleton breech delivery. The age of the participants in the study ranged from 16 to 45 years, with a mean age of 27.07±8.56 years. Most of them had elective cesarean section, and few had emergency cesarean section. The most common indication for emergency cesarean section was footling presentation. Most of the new-borns were males, mean weight of new-borns 2.75±0.5 kg. 21.9% neonates required admission in neonatal intensive care unit, 2.8% mothers developed wound infection and 10% had post-partum haemorrhage. Conclusions: Proper guidance, education and strict adherent to principles and steps of breech delivery, like monitoring taking up call for emergency c-sections, having proper NICU setup, trained doctors will help in reduction of complications. A protocol for the management of breech delivery and a regular training facility for junior health professionals to conduct assisted vaginal breech delivery are highly recommended

Comparison of maternal and perinatal outcome in pregnancy with altered thyroid profile and euthyroid patients: a prospective, observational and case control study in a tertiary care centre

Background: Thyroid disease is one of the commonest endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of complications. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction on maternal and perinatal outcome.Methods: This prospective, observational hospital-based case-control study carried on women coming for antenatal check-up in a Tertiary Care Hospital in INDORE from May 2018-December 2018. 50 known booked antenatal (case) patient with established thyroid disorder, more than 32 week of gestation, and 50-matched euthyroid patients (control) were taken.Results: Women suffering from overt and subclinical hypothyroidism and hyperthyroidism are nulliparous in 72% cases as compared to 32% in euthyroid patient. Increased maternal age was associated with higher incidence of thyroid dysfunction. Normal vaginal delivery by spontaneous labour seen in 56% of euthyroid, while it is reduced with thyroid dysfunction. 38% of altered thyroid profile patient undergo induction of labour and 24% cases undergo caesarean section as compared to control (17%). Adverse fetal outcome like intrauterine growth retardation, preterm birth and ICU admission seen increased with thyroid dysfunction  as compared to euthyroid patients.Conclusions: Thyroid dysfunction in pregnancy, although has a low incidence, but is associated with adverse maternal and fetal implications. Thus, thyroid screening should be done in antenatal period to improve fetomaternal outcome

Assessment of thyroid dysfunction in women with menstrual disorders in reproductive age group

Background: Thyroid disorders are among the most common endocrine disorders in the world. Thyroid dysfunction can disrupt a variety of metabolic and physiological processes, including the menstrual cycle. The purpose of this study was to discover a pattern of thyroid dysfunction in women with menstrual disorders. Methods: It is a cross-sectional study that includes 116 women. With reproductive age menstrual disorder. Thyroid dysfunction was tested in women who had menstrual problems. Serum free triiodothyronine (T3), free thyroxine (T4), and thyroid stimulating hormone (TSH) levels were used to assess thyroid function. Results: The mean age of study patients was 25.7±6.8 years. The most common menstrual disorder was irregular cycle 72.5%, amenorrhea 21.9%, and menorrhagia 5.6%. The majority of the patients were between the ages of 15 and 24 (51.1%), followed by 25-34 (36.1%) and 35-45 (12.9%). The mean free T3 and T4 levels were 2.911.05 pg/ml and 1.420.57 ng/dl, respectively. TSH was 2.0 mIU/L on average (IQR, 1.0-4.0). Thyroid dysfunction was observed in 25.8% of the women (n=60). Subclinical hypothyroidism (14.2%, n=33) was the most common thyroid dysfunction, followed by subclinical hyperthyroidism (6.9%, n=16), overt hyperthyroidism (3%, n=7), and overt hypothyroidism (1.7%, n=4). Conclusions: The study reveals that women with menstrual disorders frequently have thyroid dysfunction, particularly subclinical hypothyroidism. In order to rule out thyroid disorders as potential etiological agents for menstrual disturbances, it may therefore be advantageous to screen patients with menstrual disorders for thyroid function

Vulval swelling: A diagnostic dilemma

Vulval swellings have always caused dilemmas in diagnosis and more so when they are huge in size. Sebaceous cysts are known to occur as a result of blocked pilo-sebaceous gland and duct or as a result of any injury to the skin. Face, neck, chest, back, scalp, and ears are known sites, however, they also occur over private parts. They are mostly asymptomatic but cause intense pain and discomfort if infected. Symptomatic cysts warrant removal

Magnesium sulphate therapy in eclampsia and pre-eclampsia

Background: Maternal and perinatal mortality and morbidity remains high during pregnancy in the presence of eclampsia, it can have severe adverse effects on mother and the fetus. So, its management should be a top priority. The objective of the present research was to study the effect of magnesium sulphate in control of imminent eclampsia and eclampsia.Methods: 19 cases of eclampsia and 185 cases of imminent eclampsia were treated with standardized magnesium sulphate. The outcome measures in terms of recurrence of convulsions, maternal and neonatal outcome, etc. were seen.Results: Most common age group in both the groups were 21-30 years (i.e. 78.9% with eclampsia and 75.7% with imminent eclampsia). In both the groups, majority of the women were primigravidae. In eclampsia group, 9 (47.4%) women had 1 episode of convulsion, 8 (42.1%) women had two episodes of convulsions, 1 (5.3%) women each had 3 and 4 episodes of convulsions, while there were no convulsions in imminent eclampsia women (‘t’ value = 28.558, df=202, p=0.000). Vomiting and headache (94.7%) were the most common premonitory symptoms in eclampsia group, followed by edema in 68.4% women, while in imminent eclampsia 64.9% women had headache, 57.8% women had edema and 43.2% had vomiting. Recurrence of convulsions were seen in 4 (21.1%) women of the eclampsia group even after giving maintenance dose and additional dose of magnesium sulphate. 1 (5.3%) death was seen in eclampsia group and none in the imminent eclampsia group. Neonatal mortality in eclampsia group (47.4%) was higher than imminent eclampsia group (11.7%), which was statistically significant (Z value = 3.05, p=0.002).Conclusions: Magnesium sulphate regimen was effective in control of convulsions in eclampsia and as prophylaxis in imminent eclampsia

Role of oral micronized progesterone versus vaginal progesterone for prevention of preterm labour

Background: Preterm birth remains a significant problem in obstetric care, affecting women and babies world-wide. Progesterone has an essential role in maintaining pregnancy by suppression of the calcium–calmodulin–myosin light chain kinase system. This study reflects the use of progesterone in preventing preterm birth.Methods: The data were collected as a retrospective study from SAMC and PGI Obstetric and Gynaecology Department.Results: With the use of Oral micronized progesterone out of 15 cases, term delivery 9 cases i.e. 60% and preterm delivery 6 cases i.e 40% and, with the use of vaginal progesterone suppository out of 15 cases, term delivery 11 cases i.e.73.3%, preterm delivery only 4 cases i.e 26.7%.Conclusions: Progesterone appears to be safe and efficacious in reducing the risk of preterm birth as well as NICU admissions, and neonatal morbidity and mortality in high risk patients. However, there is limited information available relating to longer-term infant and childhood outcomes, the assessment of which remains a priority. Further, trials are required to assess the optimal timing, mode of administration and dose of administration of progesterone therapy when given to women considered to be at increased risk of early birth