Conservatively managed spontaneous splenic rupture in pregnancy with severe preeclampsia: an interesting case report

Spontaneous splenic rupture during pregnancy can be catastrophic with most of the cases needing splenectomy. We presence an interesting case of conservatively managed spontaneous splenic rupture in pregnancy. A 24-year-old G2P1L1 with 35 weeks gestation with previous LSCS severe preeclampsia and severe anaemia was referred from a peripheral centre. On examination, she was vitally stable with marked pallor and pedal oedema. Abdominal wall oedema and ascites was present, uterus was 28 weeks with FHS localised by Doppler. After 2 hours, patient complained of continuous pain abdomen. It was tense, tender with FHS non-localised, uterine fundus could not be made out. USG revealed a retroplacental hematoma of 3.5×2.2 cm with free fluid in the abdomen. Differential diagnosis of rupture uterus and abruptio placenta were made. Emergency laparotomy was done. Intraoperatively, 800 cc fresh hemoperitoneum was present, previous scar was intact and a live baby delivered by LSCS. Uterus, bilateral tubes and ovaries were normal. After the uterus was closed, fresh intraabdominal bleeding was still present. With the help of general surgeon, exploration was done and two long superficial splenic tears (grade 2 splenic injury) with continuous oozing were identified. Contact pressure was applied by gauze. Bleeding stopped and omental wrapping around spleen was done. Abdomen was closed after putting drain and patient was shifted to ICU for monitoring. After 27 days, patient was discharged in a stable condition. Thus, spontaneous splenic rupture should be considered in the diagnostic differential of hemodynamic instability in a case of severe preeclampsia. Emergency laparotomy before the setting of collapse and DIC are vital steps to save the spleen and improve feto-maternal survival

Maternal and perinatal outcome in eclampsia at a tertiary care center

Background: Preeclampsia is the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient. The objective of this study was to study the prevalance of eclampsia at PGIMS, Rohtak. To study the clinical profile, maternal and perinatal outcome in eclamptic patients.Methods: This is a retrospective study and case records of all eclampsia cases were analysed from the study period of January 2018 to December 2018.Results: There were 113 cases of eclampsia out of 11,661 deliveries and prevalence of eclampsia was calculated to be 0.96%. Majority of the patients were not registered 95.57%. 58% of patients were Primigravidas. 56% of the patient in the age group of 21-25 years. Antepartum, intrapartum and postpartum eclampsia were 71%, 1.7% and 27% respectively. Caesarean section was the preferred mode of delivery and was performed in 57% cases. ICU admission was required in 25% and remaining cases were managed in general/eclampsia ward. All patients received MgSO4 by Zuspan regimen. 12% patient developed HELLP syndrome and pulmonary oedema developed in 6% patient. There were a total of 3.5% maternal deaths during the study period. Total percentage of perinatal deaths due to eclampsia was 23%.Conclusions: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality. This is due to lack of proper antenatal care, low socioeconomic condition and lack of education. Regular antenatal checkup, early recognition and proper management are vital to tackle this challenge. MgSo4 is the anticonvulsant of choice and Zuspan regimen of MgSO4 is effective in the management of eclampsia

Tuberous sclerosis in pregnancy: a rare genetic disease requiring multidisciplinary approach in pregnancy

Tuberous sclerosis complex (TSC) is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Penetrance in genetics is the proportion of individuals carrying a particular variant (or allele) of a gene (the genotype) that also express an associated trait (the phenotype). Due to the wide phenotypic variability in TSC, the disease is often not recognized. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International tuberous sclerosis complex consensus conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumour suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. Authors present with a rare case report of a patient with TSC presenting at term

Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years

Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality

Delicate threads: A case study on velamentous placenta and its clinical significance

Velamentous placenta insertion is a rare and potentially serious pregnancy complication involving the abnormal attachment of the umbilical cord to the fetal membranes rather than to the placenta.This case report details the management of a 23-year-old primigravida at 38 weeks of gestation who presented to the labor room in spontaneous labor.Initial examination revealed a term-size uterus, vertex presentation, and moderate contractions,with a fetal heart rate of 144/min. Despite an unremarkable start to labor, persistent fetal heart decelerations post-amniotomy led to the discovery of velamentous insertion of the placental cord.This case discusses the challenges, decision-making process, and outcomes associated with this rare condition, ultimately resulting in an uneventful postoperative period and successful discharge on the 5th day for both mother and baby

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Uterovesicovaginal fistula following placenta percreta: case review and management options

We report case of uterovesicovaginal fistula following caesarean section with review of management options. The case presented with continuous dribbling of urine with cyclical menouria immediately following dilatation and curettage for retained placental bits. Cystoscopy along with hysteroscopy and methylene blue instillation through the cervix confirmed the diagnosis. Patient was put on prolonged bladder drainage for three months. The fistulas healed spontaneously requiring no further surgical management. All over the world prevalence of the utero-vesical fistula is increasing with frequent use of caesarean section

Polymorphous low-grade adenocarcinoma of the salivary glands - A review

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