A rare case of isolated fallopian tube torsion

Isolated torsion of fallopian tube is a rare occurrence. Diagnostic difficulty gets compounded in adolescents because the most commonly used imaging study in young, usually sexually inactive, population is transabdominal ultrasonography which may show normal ovaries, leading clinicians to abandon a diagnosis of adnexal torsion. Other imaging modalities such as CT scan or MRI are less useful for a rapid diagnosis because of the risk of radiation exposure, cost, or lack of ready availability. Delays in diagnosis may increase the likelihood of necrosis of the fallopian tube which would result in salpingectomy as was the case in our case report. Here authors present one such case, wherein one 12 year old girl who attained menarche at 10 years of age presented with acute paraumblical pain and vomiting without any fever, bowel and bladder disturbances. On examination there was tenderness in right iliac fossa. Her USG report was unremarkable. She initially was put-on broad-spectrum antibiotics but without any amelioration of symptoms. Diagnosed as appendicitis by surgeon, she was taken up for laparoscopic appendicectomy. However, it turned out to be a case of fallopian tube torsion, wherein the tube had become gangrenous for which salpingectomy was done

An unusual case of postoperative ascites after cesarean section

Post-operative ascites following caesarean section is rarely reported in pregnancy. Ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections and trauma. Authors report a case of post-operative ascites following caesarean section performed at around 37 weeks of gestation. The patient was normotensive. The diagnosis and treatment of ascites as well as the pregnancy outcome is presented. Literature review of ascites in pregnancy is discussed as well. This case was that of an idiopathic ascites with no definitive cause. An allergic or inflammatory peritoneal reaction may be the most likely cause for this complication

Role of IV administered Iron sucrose with recombinant erythropoietin in the treatment of moderate and severe iron deficiency anemia in the third trimester of pregnancy

Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.

Comparison between laparoscopy and laparotomy in the management of ectopic pregnancy: a retrospective study

Background: Ectopic pregnancy is one of the most important causes of maternal mortality and morbidity in the first trimester of pregnancy. Objective of this study was to compare the safety, feasibility and advantage of laparoscopic approach with that of laparotomy in management of ectopic pregnancy.Methods: A retrospective study was conducted at two tertiary hospitals over a period of two years i.e.; from Aug 2015 to July 2017. Seventy-five patients who had histopathology confirmed tubal ectopic pregnancy were divided into two groups; laparoscopy (Group I, no-39) and laparotomy (Group II no-36). The main outcome measures were operative time, blood loss, and requirement of blood transfusion, requirement of analgesia and duration of hospital stay.Results: Seventy-five patients of ectopic pregnancy who were managed surgically were studied. There were 39 cases in laparoscopy group and 36 cases in laparotomy group. The incidence of ectopic pregnancy was 1.56% (out of all deliveries over 2 years). Ampullary region was the commonest site of ectopic pregnancy (74.6%). No difference was found in the two groups regarding age, site of tubal pregnancy, pre op Hb status and haemoperitoneum. Mean operating time was significantly shorter in the laparoscopy group 39 min (range 30 - 52 min) versus 50 min (range 40-60 min) in the laparotomy group. There was no difference between the groups regarding the treatment with blood products and perioperative complications. Hospital stay was significantly longer in the laparotomy group (3.5 days) as compared to 2 days in laparoscopy group. The duration of post op analgesia requirement was also longer in laparotomy group (4 days) as compared to 2 days in laparoscopy group.Conclusions: Laparoscopic management of ectopic pregnancy is a safe, effective and beneficial option in the hands of an experienced laparoscopic surgeon even in cases of massive haemoperitoneum. It definitely offers the advantage of shorter duration of surgery, faster post op recovery, shorter duration of hospital stays and lesser requirement of post op analgesia

“EFFECT OF BODY MASS INDEX ON PREGNANCY OUTCOME” - A PROSPECTIVE STUDY

Background: Mothers who are overweight or obese during pregnancy and childbirth, are known to be at risk of significant antenatal, intrapartum, postpartum, and neonatal complications. Objectives: The objective of the study was to evaluate the impact of high pre pregnancy body mass index (BMI) (&lt;12 weeks of gestation) on the occurrence of maternal pregnancy outcome. A longitudinal observational study was carried out in a tertiary care hospital. In Group I, 50 antenatal women with gestational age &lt;12 weeks BMI 18.5–35 kg/m2 and having singleton pregnancies were included in the study, while 50 women with normal BMI formed the Group II. Both groups were followed up throughout pregnancy and post-natal to assess complication during pregnancy, labor, and puerperium. Results: The mean BMI in Group I and Group II was 27.516 kg/m2 and 21.433 kg/m2. The prevalence of anemia was 40% and 26% among two groups. Antenatal and post-natal complications were gestational diabetes mellitus (Group I - 28% and Group II - 6%), preeclampsia (Group I - 16% and Group II - 2%), required induction of labor (Group I - 26% and Group II - 6%), preterm labor (Group I - 4% and Group II - 16%), and meconium staining of liquor (GroupI-20% and GroupII-12%), and the difference was statistically significant among two groups. Newborn complications were weight ≥2.5 kg (Group I - 74% and Group II - 48%), neonatal intensive care unit admission requirement (Group I - 26% and Group II - 17%), and the difference was statistically significant among two groups. Other complications which were not statistically significant among two groups were oligohydramnios (Group I - 2% and Group II - 4%), polyhydramnios (Group I - 6% and Group II - 4%), and appearance, pulse, grimace, activity, and respiration score at 1 min &lt;7 (Group I - 14% and Group II - 6%). Conclusion: Pregnancy complications related to maternal BMI is a growing problem. Both lean and obese mothers carry an increased risk of adverse perinatal outcome. Given the major economic and medical consequence of pregnancy in these women, all attempts should be made to maintain a normal BMI in women of childbearing age. Pre-pregnancy counseling, health programs and appropriate multidisciplinary management should be done

Pubic Symphysis Diastasis: A Case Series and Literature Review

Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis sometimes with an audible crack at the time of delivery. Unbearable pain on moving from side-to-side and on performing any weight-bearing activity (such as walking or climbing stairs) precludes ambulation in the immediate postpartum period. This could be accompanied by disruption of the sacroiliac joint, hemorrhage, or urine incontinence in severe cases. Radiography, ultrasound, and magnetic resonance imaging are the diagnostic modalities that aid confirmation of diagnosis. The magnitude of separation does not correlate well with the severity of symptoms. Treatment modalities range from conservative management (including analgesics, pelvic binders, transcutaneous nerve stimulation) and chiropractic management to orthopedic interventions such as external fixation or open reduction and internal fixation. Since postpartum pain is frequently dismissed as attributable to labor and childbirth, the diagnosis of pubic symphysis diastasis is often delayed and sometimes missed altogether. Since there is no consensus in the scientific literature on the definition, etiopathogenesis, and management of this rare complication, we attempted to review the literature on the subject and present a series of two cases

Basaloid squamous cell carcinoma of the uterine cervix: a rare aggressive variant of cervical malignancy

We describe a rare and interesting case of a basaloid squamous cell carcinoma (BSCC) of the uterine cervix with bilateral pelvic lymph node metastasis. Our case is of particular interest because it is a rare type of neoplasm with high metastatic potential in a very short history of symptoms and early clinical staging