Pregnancy following re-stenosis of complete transverse vaginal septum

We report a case of 23 year woman who came to us with 6 weeks pregnancy and complete transverse vaginal septum. Cesarean section along with resection of septum was done. Restenosis of vagina was observed during puerperium. No surgical intervention was done. Spontaneous pregnancy with well- formed vagina was noted after 3 years

Missed tubal ectopic pregnancy in hysterectomised patient: a rare case report

Tubal ectopic pregnancy (EP) in hysterectomised patient is uncommon. It has propensity to be overlooked. We report a rare case of missed tubal ectopic in 46 years old hysterectomised patient. She presented with abdominal pain and adnexal mass on imaging. Diagnosis was only possible intraoperatively owing to overlapping symptoms and imaging features with that of ovarian tumor

Randomised controlled trial to compare safety and efficacy of vaginal versus oral route of misoprostol for induction of labour in term pregnancy with unfavourable cervix

Background: The objective of the study was to compare safety and efficacy of vaginal versus oral route of misoprostol for induction of labour in term pregnancy.Methods: A total of 100 pregnant women with clinical indication for labour induction and poor bishops score were randomly assigned to receive vaginal or oral misoprostol. Group A received 25 μg of misoprostol vaginally (maximum up to 3 doses 4 hourly interval) and group B received 25 μg of misoprostol orally (up to 5 doses 2 hourly interval) in solution form. Maternal and fetal outcomes were compared in both groups to assess the safety and efficacy of vaginal versus oral route.Results: Fifty women received vaginal and 50 women received oral misoprostol. Average interval from induction to active stage was shorter in oral misoprostol (7.42±4.2 hours versus 10.30±5.1 hours) (p=0.006). There was no significant difference (p=0.272) in the average interval from induction to delivery between the vaginal group (14.42±5.01hrs) and oral group (13.14±5.5 hrs). No significant difference in caesarean section rates (p=0.42). Incidence of hyperstimulation was significantly higher (p=0.025) in vaginal group as compared to oral group (18 % vs 4 %). Incidence of nausea, vomiting, vaginal or cervical tears and postpartum hemorrhage were comparable in both the groups. There were no statistically significant differences in neonatal outcomes.Conclusions: Oral misoprostol has a better safety profile than vaginal route as the incidence of hyperstimulation and tachysystole was significantly more in vaginal group, although there were no significant differences in the maternal and neonatal outcomes

Adenomatoid tumor of the uterus; report of a rare incidentaloma

Adenomatoid tumor of the uterus is extremely rare and usually an incidental finding in the uteri removed surgically for some other cause as in the present case. The histogenesis of this tumor has been controversial ever since its discovery, although the most favored and proposed is a mesothelial origin. Grossly it is usually mistaken for a leiomyoma. The tumor may have a variety of histomorphologic patterns with rare bizarre appearances, at times leading to an erroneous diagnosis of metastatic adenocarcinoma

Leiomyoma of vulva mimmicking bartholin cyst

Leiomyoma of vulva are uncommon findings in women of reproductive age group. It is often misdiagnosed as Bartholin cyst as unilateral swelling of vulva in women of reproductive age group is commonly a bartholin cyst or abscess. We describe a case of leiomyoma that clinically mimicked bartholin duct cyst. Identification of leiomyoma or leiomyosarcoma is necessary because of risk of recurrence, need of radiation and or chemotherapy in addition to surgical excision whereas standard treatment for bartholin cyst is marsuplisation

A rare case of broad ligament fibroid in Mayer-Rokitansky-Küster-Hauser syndrome

Mayer-Rokitansky Kuster Hauser (MRKH) syndrome with lieomyoma is a rare disorder. Women with this syndrome have normal 46 XX karyotype, normal secondary sex characteristics and primary amenorrhea. There is a scarcity of cases in the literature where fibroid develops in women suffering from MRKH syndrome. Here, we present a case of an ectopic broad ligament fibroid found in a 41-year-old woman with MRKH syndrome type II. A 41-year-old married nulliparous female diagnosed with MRKH syndrome 20 years back, presented with an abdominal mass. Trans-abdominal ultrasound suggested a large mass on right side arising from paracolic area with heterogeneous echo texture. However, the ovarian vs leiomyoma origin of mass was of diagnostic dilemma. CEMRI confirmed the same findings and ruled out ovarian origin of the mass along with the presence of rudimentary uterus. Following this, the patient was taken for laparotomy followed by total abdominal hysterectomy with bilateral salpingoopherectomy, the fibroid was found to be arising from broad ligament and was removed along with the hypoplastic uterus and bilateral Fallopian tubes and ovaries. The case we presented exhibits the development of leiomyomas in patients with MRKH syndrome, although rare, is always a possibility and should be kept in mind as a differential diagnosis while evaluating an abdominopelvic mass. MRI is an accurate modality both for delineating the mass, confirming its origin as well as diagnosing MRKH syndrome

Schizencephaly: a rare case with early diagnosis, management and review of literature

Schizencephaly or split brain is an uncommon congenital disorder of cerebral cortical development, belonging to the group of cell migration defects. It is characterized by the presence of a cleft in the brain extending from the surface of the piamater to the cerebral ventricles. A 21-year-old primigravida at 19+2 weeks of gestation was referred to our Outpatient department with a level-2 ultrasound done at 18+2 weeks suggestive of schizencephaly. First trimester genetic screening was not done. Quadruple testing was normal. After genetic consultation and poor prognostication by neonatologist, decision for medical termination of pregnancy was taken. Patient underwent medical termination with mifepristone -misoprostol regimen. A female abortus weighing 200 gm was delivered. Gross examination showed only facial malformation in the form of cleft lip and hypoplastic nose. Infantogram did not reveal any skeletal deformity. On fetal autopsy, findings were consistent with the diagnosis of schizencephaly (type 1). Schizencephaly is a rare disorder in prenatal medicine with grave prognosis. Majority of cases are either diagnosed at late gestation or present in the first decade of life. Hence with periodic surveillance during antenatal care and help of ultrasonography, such rare and serious congenital malformations can be diagnosed and managed at an early stage

Study of patients with liver dysfunction during pregnancy and their maternal and perinatal outcomes

Background: Liver dysfunction in pregnancy can be associated with maternal and perinatal morbidity and mortality, therefore early recognition and timely management is of paramount importance to improve the outcome. The studies related to liver dysfunction in pregnancy and its outcome are sparse from this part of India and are retrospective in nature, so present study was planned.Methods: A total of 80 pregnant patients with liver dysfunction were enrolled as per the inclusion criteria after taking informed consent. Patients were investigated depending on the symptoms and pregnancy related complications with an aim to know the probable cause of liver dysfunction. Maternal and perinatal outcomes were noted in these patients.Results: Intrahepatic cholestasis of pregnancy was the most common cause of deranged liver function tests (71.3%) followed by HELLP syndrome (21.3%), viral hepatitis (6.3%) and AFLP (1.3%) respectively. The most common maternal complication seen was preterm labour (33.8%) followed by thrombocytopenia (11.3%), postpartum hemorrhage (7.5%), vaginal wall hematoma (7.5%) and coagulopathy (3.8%). 2 patients (2.5%) required ICU admission and both patients expired due to fulminant hepatic failure. The most common fetal complication was prematurity (33.8%). Intrauterine fetal demise occurred in 10% of the patients and there were 12.5% perinatal deaths observed in our study.Conclusions: The commonest cause of liver dysfunction in our study was IHCP (71.3%) followed by HELLP syndrome (21.3%). In spite of multidisciplinary approach, liver dysfunction during pregnancy was associated with high maternal and perinatal morbidity and mortality

Aggressive Angiomyxoma of the Cervix: A Unique Entity

Introduction: Aggressive angiomyxoma is a mesenchymal tumour which presents rarely; usually in women in reproductive age group, as a mass in the pelvic tissue. Only exceptionally, has it been seen to originate from the uterus and cervix.&nbsp;Methods: We present a case of a 23-year-old woman who complained about abdominal pain and excessive vaginal bleeding three days after a spontaneous abortion. Examination revealed a large polyp arising from the cervix. Histopathologic examination of the polypectomy specimen revealed an aggressive angiomyxoma of the cervix. Immunohistochemistry was performed and the tumour was immunopositive for vimentin, desmin and smooth muscle actin. Management options are discussed, in light of need of fertility conservation.&nbsp;Result: Aggressive angiomyxoma can originate from the mesenchymal tissue of the cervix.&nbsp;Conclusions: Treatment may be individualized with surgery and hormonal treatment. Long term follow up is recommended.</p

Leiomyoma of vulva mimmicking bartholin cyst

Leiomyoma of vulva are uncommon findings in women of reproductive age group. It is often misdiagnosed as Bartholin cyst as unilateral swelling of vulva in women of reproductive age group is commonly a bartholin cyst or abscess. We describe a case of leiomyoma that clinically mimicked bartholin duct cyst. Identification of leiomyoma or leiomyosarcoma is necessary because of risk of recurrence, need of radiation and or chemotherapy in addition to surgical excision whereas standard treatment for bartholin cyst is marsuplisation