Repeated broad ligament hematomas managed by uterine artery embolization: time to execute

Selective arterial embolization (SAE) of the uterine arteries is an alternative to surgery when medical management fails in cases of intractable posrtpartum haemorrhage. It is highly efficacious with low complication rate. Here we report a case of repeated broad ligament haematoma managed by selective uterine artery embolization. Present case 28year old P4L4 was referred from a district hospital as post LSCS case with broad ligament haematoma. Patients general condition was very poor at the time of admission. She underwent laparotomy twice and finally uterine artery embolization for repeated broad ligament haematoma and responded. Massive obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. The threshold for uterine artery embolization (UAE) in women with obstetric haemorrhage should be low, as it is coupled with a high clinical effectiveness rate, low complication rate and preservation of fertility. However, it requires an infrastructure, multidisciplinary approach, as well as speedy and effective interaction between various specialties

Is it time to move up? Feasibility of medical abortion between 9-13 weeks of gestation

Background: Medical termination of pregnancy act helps to reduce incidence of illegal abortion its dreaded complication like maternal mortality to analyze the safety, efficacy and acceptability of medical regimen in 9-13 weeks of pregnancy.Methods: A prospective study was carried out for a period of two and half years. All patients between 9-13 weeks of pregnancy seeking medical termination of pregnancy were given either medical regimen or surgical abortion depending on patients’ preference. Medical regimen consisted of 200 mg of mifepristone followed by 600 mcg of misoprostol after 48 hours. If required 2nd and 3rd dose of misoprostol was repeated. Surgical abortion was done under sedation after cervical priming with misoprostol.Results: Out of 353 cases of medical termination of pregnancy, 92 cases (26.1%) were between 9-13 weeks of pregnancy. Two cases were excluded as surgical abortion was indicated in them. Out of 90 cases, only 30 cases (33.3%) were willing to participate in randomized controlled trial if needed. Out of 90 cases, 50 (55.6%) preferred surgical abortion, while 40 (44.4%) cases preferred medical abortion. Out of 40 cases of medical abortion, 5% cases required surgical curettage, while 3.8% cases required repeat curettage in surgical group. Minor complication rate was comparable in both groups except for prolonged bleeding, which was significantly higher in medical abortion group. Major complication in the surgical group was uterine perforation (1.9%). After completion of procedure, both group satisfied with same procedure, 92% in medical abortion group and 89% in surgical abortion group.Conclusions: Medical abortion is a safe and effective alternative to surgical abortion between 9-13 weeks of gestation.  It should be included routinely at these gestations, thus increasing women's choice. However randomized controlled trial for medical versus surgical abortion between 9-13 weeks will be difficult to initiate

Hepatitis E virus: the current scenario

SummaryHepatitis E infection, caused by the hepatitis E virus (HEV), is a common cause of acute hepatitis in developing countries with poor sanitation and hygiene. The virus is classified into four genotypes (1–4) with one serotype. Genotypes 1 and 2 exclusively infect humans, whereas genotypes 3 and 4 also infect other animals, particularly pigs. In endemic areas, large outbreaks of acute hepatitis caused by viruses of genotype 1 or 2 frequently occur due to fecal–oral transmission, usually through contamination of drinking water. With a high attack rate in young adults (aged 15–45 years), the disease is particularly severe among pregnant women (20–30% mortality). HEV appears to be a zoonotic disease, with transmission from pigs, wild boars, and deer, or foodborne. Chronic infections are rare, except in immunosuppressed persons, such as organ transplant recipients. A subunit vaccine has been shown to be effective in preventing the clinical disease, but is not yet commercially available. Our understanding of HEV has undergone major changes in recent years and in this article we review the currently available information with regard to the molecular biology, pathobiology, and epidemiology of HEV infection. We also review the current therapeutic interventions and strategies being used to control HEV infection, with emphasis on possible approaches that could be used to develop an effective vaccine against HEV

A rare case of term viable abdominal pregnancy with review of literature

Abdominal pregnancies are rare types of ectopic pregnancies with high rates of maternal and perinatal morbidity and mortality. Abdominal pregnancy accounts for up to 1.4% of ectopic pregnancies. We report a case of term live abdominal pregnancy without malformation with implantation of the placenta into the uterus and anterior abdominal wall, discovered during a planned obstetric hysterectomy indicated for placenta accreta. Abdominal pregnancy is a serious and potential life-threatening condition. Diagnosis and management can be difficult especially in developing countries. A high index of suspicion is key for timely diagnosis and intervention to prevent life-threatening complications

ANTIOXIDANT ACTIVITY OF HALOPHILA OVALIS AND HALOPHILA BECCARII (HYDROCHARITACEAE): TWO IMPORTANT SEAGRASS SPECIES OF CHILIKA LAGOON, INDIA

Objective: The present study was undertaken to evaluate the total phenolic and flavonoid content and the antioxidant property of two important seagrass species namely, Halophila ovalis and Halophila beccarii occurring in Chilika lagoon, Odisha, India. Methods: Total Phenolic Content (TPC) of the extracts of Halophila species was determined by Folin-Ciocalteu method with little modifications and the total flavonoid content (TFC) was measured by aluminum chloride colorimetric assay. The antioxidant activity of different extracts was investigated by DPPH and ABTS radical scavenging activity. IC50 values were calculated for the DPPH and ABTS methods. Result: The study revealed that the methanol extract of H. ovalis has greater antioxidant activity than H. beccarii. Methanol extract of both the species (H. ovalis and H. beccarii) was found to possess high phenolic content at value of 70.25 mg GAE/g of extract and 48.53 mg GAE/g of extract respectively. Similarly flavonoid contents was found highest in methanol extract for both H. ovalis (76.82 mg quercetin equivalent/ g of extract) and H. beccarii (64.28 mg quercetin equivalent/ g of extract). The antioxidant activity of different extracts of these two species were evaluated using DPPH and ABTS radical assay. The methanol extract of both H. ovalis and H. beccarii showed high radical scavenging activity with IC50 values of 37.77 μg/ml and 52.25 μg/ml for DPPH and 25.62 μg/ml and 45.45 μg/ml for ABTS respectively. Conclusion: The study revealed the potential of the Halophila species as natural sources of antioxidants having considerable commercial importance

An Audit of primary ovarian pregnancy in a tertiary care hospital

Background: Ovarian pregnancy is uncommon form of ectopic pregnancy with increasing trend in its incidence. Various risk factors have been implicated like intrauterine contraceptive devices, fertility treatments, pelvic inflammatory disease (PID), and endometriosis.Methods: This is a retrospective observational study done over a period of 10 years from January 2008 to December 2017.All the patients, who were diagnosed as primary ovarian pregnancy based on Spielberg’s criteria, were included in the study.Results: There were 6 cases (6.3%) of primary ovarian pregnancy out of the 95 cases of ectopic pregnancies.  The age of the patients ranged from 28 years to 43 years with a mean age of 31.8 years. Amenorrhea and acute pain abdomen was present in all the patients. Laparotomy was done in all the cases. Excision of the sac with partial ovariectomy was done in 2 cases (33.3%).Oophorectomy with salpingectomy was done in the rest of the 4 cases (66.7%). Histopathological confirmation was done in all the cases.Conclusions: Ovarian pregnancy is uncommon form of ectopic pregnancy with increasing trend in its incidence. Management of choice is laparoscopy. Laparotomy is done if there are signs of rupture

Normal Puerperium

Puerperium is the time following delivery during which pregnancy-induced maternal anatomical and physiological changes return to the nonpregnant state. Puerperium period of 6 weeks can be divided into: (a) immediate – within 24 hours (b) early – up to 7 days (c) remote – up to 6 weeks. The puerperal effects are seen in all organs and particularly in reproductive organs. Infection and haemorrhage are the common postpartum complications. Post partum care is very important. Advice on exclusive breast feeding and contraception is also mandatory after every childbirth

Analysis of the prevalence, etiology, and risk factors of stillbirth from a teaching institute of North Eastern India- a retrospective study

Background: Stillbirth rate is considered a health index. The worldwide stillbirth rate is 18.4/1000 total birth. This study was aimed to evaluate the prevalence and risk factors of intrauterine fetal death in pregnant women in one of the teaching centers in Northeastern India.Methods: This was a retrospective study. All cases of intrauterine fetal death admitted in the department of obstetrics gynecology of our institute were included over two and half years. Information was gathered from the medical records of the patients and data were analyzed.Results: During two and half year’s period, the total number of deliveries was 2696 and the total numbers of stillbirths were 96, hence the stillbirth rate was 35.6/1000. 93 (96.87%) were antenatal stillbirths and 3 (3.12%) were intrapartum stillbirths. 82 (85.41%) women were unbooked. 85 (90.4%) belonged to low socioeconomic status. 67 (69.79%) were preterm. Maximum 39 (40.62%) belonged to 28-35 weeks of gestational age. The most common cause of Intrauterine death (IUD) was antepartum hemorrhage (17.7%). 14 (14.5%) were abruption and 3 were placenta previa. The second most common cause (14.5%) was the hypertensive disorder of pregnancy.Conclusions: The stillbirth rate in our institute is higher than the national average. The most common causes of IUD were antepartum hemorrhage, preeclampsia, prematurity, and malpresentation which can be diagnosed and managed by increasing uptake of antenatal care which will lead to timely identification and proper management of maternal and fetal complications eventually reducing the preventable stillbirths

Diagnosis of Ectopic Pregnancy

Ectopic pregnancy is defined as the implantation of a fertilised egg outside the uterine cavity. The site of ectopic pregnancy are Fallopian tube. Cervix, ovary, peritoneal cavity, or uterine scars. Other two site of implantation are cornual pregnancy and interstitial pregnancy. Diagnostic tests for ectopic pregnancy include a urine pregnancy tests, Serum beta hcG and ultrasound. The instant result of a urine pregnancy test is a useful pointer for the clinician to suspect an ectopic pregnancy. The test is a useful triage tool for clinicians to rule out a pregnancy when the clinical situation is not clear such as a patient who is not sure of dates, does not remember or is in a state of shock and the history cannot be elicited. Ultrasound remains the mainstay of the diagnosis and high index of suspicion and a detailed history are pre-requisite of scanning. Different ultrasonography feature are diagnostic of different site of implantation. For uterine scar pregnancy ultrasonologic criteria are not validated still now

Rhythm and Refrain: In Between Philosophy and Arts (2016)

<p>Pictorial representation of few important host defense response and apoptosis related genes that were differentially expressed (up regulated [green]; down regulated [red]) in HEV replicon transfected cell cultures compared to pcDNA3 only control.</p