A successful outcome of pregnancy with Berger disease

With the increasing prevalence of chronic kidney disease (CKD) in the general population, female patients of fertile age with impaired kidney function are becoming more common. The presence of CKD in pregnant patients has been associated with poorer pregnancy outcomes. IgA nephropathy is the most common glomerulonephritis worldwide. The outcome of pregnancy in patients with CKD is related to impaired glomerular filtration rate and the degree of proteinuria. In non-aggressive IgA nephropathy, there is traditionally a slow progression to chronic kidney failure in 25–30% of cases during a period of 20 years. Women with immunoglobulin g A nephropathy (IgAN) are at higher risk of hypertension, preeclampsia, and fetal loss; the prognosis is worse for those who have advanced chronic kidney disease and proteinuria. Here we present two case reports who successfully delivered having aggressive IgA nephropathy and chronic hypertension in pregnancy.

Caesarean section under spinal and epidural anesthesia in complete atrioventricular block without a pacemaker: a rare case report

Complete heart block (CHB) during pregnancy is rarely encountered. Management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist, and neonatologist. Treatment varies from medical management to temporary or permanent pacemaker insertion. Complete atrioventricular block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. We successfully managed caesarean section in a pregnancy with complete atrioventricular block under spinal and epidural anesthesia without a pacemaker. Asymptomatic pregnant women with congenital complete atrioventricular block can tolerate caesarean section under spinal and epidural anesthesia without a pacemaker

A retrospective study on ectopic pregnancy aspiration by transvaginal ultrasound at Institute of Kidney Diseases And Research Centre

Background: Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). To prevent severe morbidity and mortality its prompt diagnosis and appropriate management is important. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic Inj. Methotrexate. Methods: This study is a hospital based retrospective cohort study from January 2014 to December 2022 on patients who presented to Institute of Kidney Diseases and Research Centre (IKDRC) with unruptured ectopic pregnancy confirmed with ultrasound and β HCG. All the patients were analyzed according to history, clinical presentation, investigations, treatment and complications. Results: β-HCG day 1 or 2 post procedure dropped in all cases but in variable levels ranging from 1.3% to 85.88%, while the drop during days 7-10, was more significant and reassuring; ranged from 48.69% to 98.95%. Conclusions: By aspiration of ectopic gestational sac transvaginally under ultrasonographic guidance it is able to preserve the integrity of uterus and fallopian tube and thus the future fertility. The study will educate other healthcare professionals.

A successful pregnancy outcome after mitral valve replacement: a case report

Valvular heart disease can be acquired or congenital. Although the incidence of rheumatic heart disease is on the decline, the number of patients with congenital heart disease who survive into adulthood has grown substantially over the past 30 years. Therefore, a large number of patients with valvular heart disease will be of childbearing age. Here we presented a case of second gravida who was diagnosed with rheumatic heart disease and had undergone mitral valve prosthesis and tricuspid valve repair delivered a healthy live male baby weighing 2.250 kg

Luteoma in pregnancy: a rare cause of threatened preterm labour!

Pregnancy luteoma is a rare non-neoplastic tumor-like mass of the ovary. They are usually asymptomatic and found incidentally during ultrasound imaging or surgery. Rarely do they present with pain abdomen mimicking threatened preterm labor. They regress spontaneously after delivery. We presented a case of a 29-year-old G4A3 with twin pregnancies and chronic hypertension who presented with acute flank pain, constipation, and occasional hardening of the uterus. A provisional diagnosis threatened preterm labor with suspected ureteric colic and cystitis was made. The patient was initially managed on the same line but on a detailed in-patient evaluation her ultrasound revealed bilateral multicystic ovaries with few hypoechoic areas inside it mostly suggestive of ‘luteoma of pregnancy’. The patient had acne, hirsutism, and chronic hypertension well controlled on antihypertensives. The patient delivered twins successfully by cesarean section and luteoma and symptoms were resolved postpartum after 4 months. Recognition of this entity is important so that malignancy can be ruled out and unnecessary surgery, with concomitant risk to both the mother and the fetus, is avoided

Acute pyelonephritis in pregnancy: a case series at Institute of Kidney Diseases and Research Centre

Acute pyelonephritis is one of the most common indications for antepartum hospitalization, estimated at approximately 9.7% of all indications for predelivery hospitalization, and when diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration, and careful monitoring of fluid balance. Here, we present four cases of acute pyelonephritis in pregnancy treated and patient successfully delivered with healthy babies