A study of complications in case of unicornuate uterus with rudimentary horn

Background: To analyse gynecological and reproductive morbidities associated with unicornuate uterus with noncommunicating rudimentary horn.Methods: This is a retrospective study of 20 cases of unicornuate uterus with noncommunicating rudimentary horn found on laparotomy in a duration of 5 years (Oct 2011-Oct 2016).Results: Out of 20 patients, two teenagers presented with dysmenorrhoea and pain abdomen and had haematometra in the noncommunicating rudimentary horn which was excised. Eight had pregnancy in the noncommunicating rudimentary horn of which all presented after rupture and five were admitted in a state of shock. Ten patients had pregnancy in the hemiuterus with complications inherent to the condition.Conclusions: Unicornuate uterus with noncommunicating rudimentary horn is associated with poorest outcomes among all uterine anomalies and a high index of suspicion is needed to diagnose this condition and thus to save the woman from catastrophic complications

A comparative study of perineal morbidity in vaginal delivery with and without episiotomy

Background: The objective was to determine the occurrence of perineal morbidity in women who delivered vaginally with an episiotomy versus those who delivered without.Methods: Primigravid women were enrolled into the study on documentation of full dilatation of the cervix and randomized into either the study group (delivered without an episiotomy) or Control Group (delivered with an episiotomy). All labours were carefully monitored with intermittent auscultation of foetal heart rate and partograph was plotted for everyone. Labour was augmented with oxytocin infusion if required. Good perineal and para urethral support at the time of crowning of the head and during delivery of the baby was given for patients of both the groups. Right mediolateral episiotomy was given for the control group. Perineum was then examined and if any lacerations were noted it was sutured, if necessary, as per standard protocol (vicryl rapide was used). Episiotomy was sutured in 3 layers with vicryl rapide.Results: The total number of patients studied was 300 – equally distributed in both the groups. The age group of the patients and birth weight of the babies were comparable. In the study group, 22.0% patients had no lacerations in the perineum. Inspite of an episiotomy, 15.34% had anterior and posterior perineal lacerations and in that 4.67% patients had anal sphincter tear. 9 patients had more than 50% of EAS torn but none of them complained of incontinence during their follow-up. 68.37% patients in the control group had persistent perineal pain for more than one week versus 19.42% in the study group. 4.27% patients in the control group had persistent pain whereas no patients in the study group had pain more than 2 months.Conclusions: Short term perineal morbidity is significantly lower in parturients who delivered without an episiotomy and that episiotomy did not offer protection against sustaining severe perineal lacerations

A study of maternal near miss cases at tertiary medical college of Jharkhand, India

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near-miss cases five-factor scoring system was used. In 2009 WHO working group has standardized the criteria for selecting these cases.Methods: The study was conducted in the Department of Obstetrics and Gynecology at RIMS, Ranchi, Jharkhand, India, which is a tertiary care centre. For each case of near miss, data were collected on demographic characteristics including gestational age at the time of sustaining the near-miss morbidity, nature of obstetric complications, presence of organ-system dysfunction/failure, ICU admission and timing of near-miss event with respect to admission.Results: During the twenty-four months of the study period, 20000 deliveries at the institution and 480 women were identified as near-miss obstetrical cases by five factor scoring system. The prevalence of near-miss case in this study was 2.4%. Near-miss per 1000 delivery was 24%. Maternal death to near miss ratio was 1:7.2. The leading causes of maternal near miss were hemorrhage (42.5%) and hypertensive disorder of pregnancy (23.5%) The morbidity was high in unbooked cases.Conclusions: Maternal near miss is good alternative indicator of health care system

Youssef’s Syndrome - a complication of corrective surgery for mullerian anomaly

The presence of cervicovaginal agenesis with unicornuate uterus is a very rare mullerian anomaly. Presence of functioning unicornuate uterus poses as a great challenge for gynecologist, because a successful repair could restore normal menses and may preserve the patient’s fertility. Though, a complication of this surgery (utero-vaginal anastomosis) is Youssef’s Syndrome. We, hereby report a case of 16 year old unmarried female with complete cervicovaginal agenesis with unicornuate uterus, who initially underwent vaginoplasty (McIndoe’s) along with uterovaginal anastomosis in order to preserve her uterus, but subsequently required hysterectomy due to Youssef’s Syndrome

Therapeutic plasma exchange for early aggressive management of post-partum hemolytic uremic syndrome: a tertiary care centre experience

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient

Complete axial torsion of the gravid uterus by 180 degrees

Minimal rotation of the gravid uterus, till 45 degrees, is a normal finding in the third trimester of pregnancy. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice. We present a case of uterine torsion in pregnancy diagnosed at caesarean section. A 25-years-old primigravida was admitted with pain abdomen and tenderness over the lower abdomen. She underwent emergency LSCS (lower segment caesarean section) for foetal bradycardia. Intra-operatively, the uterus was rotated 180 degrees right to left. There was an urgency to deliver the foetus due to bradycardia and hence, an incision on the posterior wall of the uterus was made as there was no time to delineate the anatomy. Torsion was corrected and the uterus was sutured. Prompt recognition and management of this condition is necessary for better maternal and foetal outcome. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester with adverse maternal and neonatal consequences

Case series of paediatric adnexal torsion: rare yet urgent entity

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort

Efficacy and safety of the trans-obturator tape for female stress urinary incontinence

Background: To assess the safety and efficacy of Trans-obturator tape (TVT-O) for female stress urinary incontinence (SUI).Methods: A cohort of 35 cases of SUI and underwent TVT-O procedure over a period of 4 years. Pre-operative evaluation included pelvic examination, one hour pad test, urodynamic study, urinary diary and baseline haematological tests. Post-operatively all women had post-void residual volume and were followed up for 3 years.Results: The mean age of the patients was 47±9.5 years. TVT-O alone was done in 58.1% of cases. 41.9% of cases had TVT-O done as a concomitant procedure. The median duration of follow-up was 48 months. The overall objective and subjective cure rate was 92.3% with failure rate of 7.7%, 12.9% of women reported post-operative thigh pain and 6.5% patients had immediate post-operative urinary retention. 16.1% of the patients had post-operative voiding dysfunction. No major complications were encountered in these patients.Conclusions: TVT-O is a safe, easy and effective minimally invasive procedure for female SUI with minimal acceptable complications

Unicornuate uterus and pregnancy outcome: a case report

Mullerian duct anomalies (MDAs) are congenital defects of the female genital tract that arise from abnormal embryological development of the Mullerian ducts. Unicornuate uterus with or without rudimentary horn is developmental anomaly which occurs due to abnormal or failed development of one of the paired mullerian duct or fusion of the ducts. Women with unicornuate uterus have increased incidence of obstetric complications like spontaneous abortions, preterm delivery and intrauterine foetal demise and gynaecological complications like infertility, endometriosis and dysmenorrhoea. A 25 years old, primigravida was admitted at 38 weeks 3 days gestational age with complaints of leaking per vaginum. She was induced with PGE2 gel under antibiotic coverage to prevent chorioamnionitis. She underwent emergency caesarean section for failure to progress and intra-operatively she was incidentally found to have unicornuate uterus with contralateral fallopian tube directly getting attached to the ovary. The baby cried immediately after birth, though it was growth retarded (IUGR). If pregnancy with unicornuate uterus is managed well, it can result in favourable obstetric outcome

Maternal and perinatal outcome in a pregnancy with nephrotic syndrome

The influence of pregnancy on the subsequent course of pre-existing nephrotic syndrome is controversial as also the effect of membranous glomerulonephritis on maternal and perinatal outcome. We describe a case of successful pregnancy outcome in Hepatitis B reactive patient with pre-existing nephrotic syndrome (renal biopsy proven case of Membrano-proliferative Glomerulonephritis). She had regular nephrology consultation and her renal disease was well compensated. After sonographic confirmation of live intrauterine pregnancy at 9th gestational week, patient was given methylprednisolone (5mg once daily). Antihypertensive drugs were also given. At 35 weeks of gestation, patient went in labour and cesarean section was performed in view of previous caesarean section. Feto-maternal outcome was good. The intrapartum and postpartum period was uneventful. Renal functions were well preserved. A vigourous healthy 1.93 kg baby was discharged with mother in a stable condition after receiving hepatitis B immunoglobulin