Colposcopy in evaluation of suspected cervical cancer: a prospective, observational study

Background: Cervical cancer is the fourth most frequent cancer in women according to World Health Organization. In India the incidence is approximately 1 in 53 compared with 1 in 100 women in more developed regions of the world. Cervical cancer is eminently preventable by early detection using various screening tests like Pap smear, colposcopy, HPV testing. In this study we aim to evaluate the use of colposcopy in early detection of cervical cancer and also assess risk factors for the same. Primary objective was to study the correlation between colposcopic findings and histopathological analysis with a secondary objective to assess risk factors for development of cervical neoplasia.Methods: The study was carried over a period of 2 years (October 2016 to October 2018) with a sample size of 60 in the department of obstetrics and gynecology at tertiary care centre. Participants who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy findings were correlated with the histopathological findings of the cervical biopsy that was undertaken.Results: Colposcopy impression had sensitivity of 93.8% in predicting the histopathology, specificity was 77.3%, positive predictive value was 60%, negative predictive value was 9% and the diagnostic accuracy was 81.7%. On analyzing the risk factors, it was found that the odds of malignant histopathology were 0.55 times decreasing with each unit increase in age (at first intercourse) (p value<0.05).Conclusions: Colposcopy gives immediate and accurate results and its value as a diagnostic test is undisputable.  The sensitivity of colposcopy is high and hence in high risk population or remote places where women do not turn for regular screening tests, colposcopy can be used primarily as the screening test

Successful management of an Rh alloimmunised twin gestation pregnancy with multiple atypical antibodies with severe fetal anemia

Rhesus-D alloimmunization is characterized by production of antibodies as a result of immune response generated in an individual due to exposure to alloantibodies from different individual. Here we are reporting a case of successful obstetric and perinatal outcome of twin pregnancy with Rh-incompatibility along with other atypical antibodies leading to fetal and neonatal anemia in both the twins. Antenatal management consisted of serial obstetric Doppler to look for Middle cerebral artery blood flow and Peak systolic velocity to detect fetal anemia followed by Intra Uterine transfusion of packed red cells through umbilical vein to treat the same for both the twins. In the presence of multiple atypical antibodies in the maternal serum no compatible blood was available for transfusion for either the mother or the neonates after delivery so NICU management consisted initially of transfusion of intravenous immunoglobulin’s along with steroids to prevent auto and alloantibody reactions but in view of dropping hemoglobin in both twins least incompatible blood was given to both the twins

Acardiac acephalus with malformed donor twin

Some specific cases of Acardiac twins observed in remote parts of India where foetuses have been found to have extra limbs jutting out of chest cavity or abdomen have been given the specific and an attractive name of god baby. The present case under discussion is one such case where an Acardiac twin with Acephalus in the parasitic twin and malformed donor twin with multiple congenital anomalies incompatible with life delivered spontaneously at a tertiary care centre

Conservative management in a case of retained adherent placenta in a primigravida patient

Morbidly adherent placenta is a serious and a catastrophic pregnancy complication. In this condition, the placenta penetrates deeply inside the uterine walls and is not separated after delivery of the baby. Reporting herewith a case of a primigravida who had undergone Emergency lower segment Caesarean section at a private hospital for severe pregnancy induced hypertension with IUGR and then was referred to Tertiary Care hospital with placenta left in-situ due to non-separation of the placenta at the time of caesarean section. Conservative management was given using Methotrexate which is an anti-metabolite alternatively with Leucovorin (Folinic acid) and followed up with serial ultrasonography with Doppler for placental size and volume and beta-HCG levels which showed a decreasing trend respectively

Scar endometriosis: an uncommon surgical aftermath

Endometriosis is a benign condition wherein endometrial tissue lies outside the uterine cavity. Abdominal scar endometriosis is a rare entity following pelvic surgeries caused as a result of deposition of endometrial tissue at scar site. Patient usually presents with triad of presence of mass over scar site, cyclical pain during menses and bleeding. Histopathological examination remains gold standard for diagnosis in which the presence of endometrial glands, stroma and hemosiderin laden macrophages can be seen. We presented a case of 35 years old lady with history of caesarean section done 3 years back who came with complaints of swelling over the scar site and cyclical pain with tenderness present over lump. Ultrasonography revealed presence of firm mass which was removed by wide local excision and histopathology confirmed the diagnosis of scar endometriosis

A near-miss case of obstetric haemorrhage managed successfully

Functioning of health systems with respect to maternal health were previously audited using indicators like maternal mortality ratio. However, maternal morbidity as a consequence of pregnancy-related complications is not accounted for in these indicators. Thus, the World Health Organization (WHO) has formulated a maternal near-miss approach to pregnancy complications for a more thorough evaluation of health care systems across the world. In practical terms, women are said to be maternal near-miss cases when they survive lethal conditions during pregnancy or in the postpartum period. We report one such case of traumatic variety of postpartum haemorrhage subsequent to a lower segment caesarean section with immediate post-operative removal of cervical cerclage threads that resulted in a maternal near-miss case

A series of 6 cases of systemic lupus erythematosus in pregnancy

Background: Systemic lupus erythematosus (SLE) is a type of chronic inflammatory connective tissue disease commonly diagnosed between the ages of 20-30 It is more common in women than in men, especially during the fertile period of a women’s life. In olden days pregnancy in patients with SLE were discouraged due to concern regarding the poor feto-maternal outcomes. However, over the last 10-15 years, medical practice has changed, and in many cases pregnancy is possible with close supervision, and advice tailored according to individual cases. This case series will explain what care need to be taken into consideration prior to conception, ANC period and post pregnancy 100.Methods: This was a retrospective study conducted at Seth G. S. M. C. and KEM Hospital Parel after IEC approval where 6 cases of Systemic Lupus Erythematosus in pregnancy over a period of 1 year in a unit were collected and are presented here with regards to maternal and fetal outcomes.Results: In our case series two patients required Caesarean section for fetal indication and both the babies had congenital heart block and were asked regular follow up in cardiology outpatient department, two patients required medical termination of pregnancy in view of teratogenic drug exposure(cyclophosphamide), one patient had intrauterine growth restriction and had a preterm vaginal delivery with good fetal outcome and no heart block in the baby and the last patient was diagnosed as a case of SLE when baby was found to have heart block in the antenatal period and was later evaluated and diagnosed as a case of SLE.Conclusions: Lupus activity is increased in pregnancy and patients with SLE are at higher risk for spontaneous abortions, fetal death, PIH, preterm delivery and intrauterine growth retardation. Management of these cases requires a multidisciplinary approach involving the obstetrician, rheumatologist, nephrologist and neonatologist

Maternal mortalities due to infectious diseases at a tertiary care centre in India

Background: Maternal death and poor birth outcomes are major public health issues in much of the world. Most of the mortality and morbidity burden around child birth are directly due to obstetrical problems such as haemorrhage. However, there is very little information on the importance of the great diversity of infectious diseases on pregnancy outcome, especially in the tropics. There is poor evidence as to whether obstetrics patients are at a higher risk of diseases that are common causes of fever in the tropical areas and what the impact is on mothers and their offspring, by pathogens and gestational age. Understanding of this fact is impaired as deaths from infectious diseases and deaths in pregnancy are often not evaluated jointly in public health surveillance.Methods: This is a retrospective, observational case series undertaken at a tertiary care centre at Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India during the period of January 2011 to December 2015.This data collection was done by reviewing the maternal death record forms.Results: This study shows that there is significant number (23.58%) of maternal deaths due to infectious diseases. Out of a total of 37266 deliveries over a period of five years, 407 maternal deaths occurred and out of these 96 patients died due to infectious diseases. Among these, deaths due to tuberculosis were seen in 32.29%, hepatitis E 26.04%, pyrexia of unknown origin 9.3%, malaria 8.33%, dengue 6.25%, swine flu 5.2%, leptospirosis 3.12%, and community acquired pneumonia 3.12%, viral encephalitis 2.08%, tuberculosis with HIV 2.08%, amoebiasis and typhoid 1.04% each.Conclusions: Though India failed to achieve the millennium development goal, it fell short of the goal by a small margin. Educational status and the socioeconomic development are major factors that need to be corrected. Effective preventive strategies at personal and community level will definitely reduce the preventable maternal mortalities due to infectious diseases and aid India in achieving further targets

Successful maternal and fetal outcome in an uncorrected case of tetralogy of fallot

Tetralogy of Fallot (ToF) is the most common congenital heart defect which is associated with systemic cyanosis. Pregnancy and delivery cause dramatic alterations in cardiovascular physiology and pregnancy in women with unrepaired TOF may have a worsening in right to left shunt with an increase of the cyanosis. This possesses an elevated risk of maternal and foetal morbidity and even mortality. We report and discuss a case of a 24 years old Primigravida with uncorrected ToF. A multidisciplinary team was involved in the management of the case with the aim to minimize maternal and foetal complications. The target of the management was to perform adequate maternal surveillance by maintaining an adequate oxygen saturation and good haemoglobin levels and perform timely foetal surveillance tests in the form of Obstetric doppler. A caesarean section was performed at 35 weeks and 5 days of gestation without any maternal or fetal complications. Without optimal obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor

Assessment of obstetric and gynaecological problems in females with bleeding disorders

Background: Inherited bleeding disorders are not common but they are lifelong. Their effects on women are far greater than previously realised. Many clinicians are not familiar with these disorders but may encounter such women under acute conditions. Objectives were to study various obstetric and gynaecological problems in females with bleeding disorders and to assess the type of management given for these disorders.Methods: This was a prospective observational study carried out at Department of Obstetrics and Gynaecology at a tertiary care hospital in which 30 women of known bleeding disorder were studied and various obstetric and gynaecological problems including menorrhagia, metrorrhagia, dysmenorrhoea, mid-cycle pain, conception, haemorrhagic ovarian cyst, etc. were identified and studied in them.Results: 30 patients of known bleeding disorder who were found to have obstetric and gynaecological problem were studied. Idiopathic thrombocytopenic purpura constituted the major bleeding disorder (23%), followed by von Willebrand’s disease (17%) in our study. 21 patients had gynaecological problem and the most common gynaecological problem was menorrhagia (62%), followed by hemoperitoneum (10%), mid cycle pain (10%), persistent haemorrhagic cyst (7%), dysmenorrhea (7%) and endometriosis (4%). 20 patients had obstetric problems of which postpartum haemorrhage (59%) was a major problem followed by recurrent pregnancy loss (33%) and infertility (8%). The study concluded that both obstetric and gynaecological problems are common in patients of bleeding disorders and occur in distribution 66.66% and 70% respectively.Conclusions: The study conducted shows that obstetric and gynaecological problems are very common in patients of bleeding disorders and thus optimal management of these problems requires a   multidisciplinary team of approach.