Neglected case of Imperforated Hymen presenting as Massive Hematocolpos with Large Protruding Introital Mass and Acute Urinary Retention

The clinical presentation of imperforate hymen varies significantly from patient to patient depending on the age at diagnosis, but in most cases, the diagnosis is missed in early childhood and therefore, the diagnosis is made after puberty when the patient presents with hematocolpos, hematometra or both. When this happens, the patient may present with unlikely symptoms like urinary retention or bowel obstruction or both. Rarely, a neglected case can even present with multiple complications like acute urinary retention and large protruding introital mass with multiple ulcerations, as happened in our case. Here we discuss case of a 15 years old girl with imperforate hymen and presented with history of lower abdominal pain and distension associated with acute urinary retention. She was treated by hymenectomy and improved dramatically and was discharged on the 6th day post operatively. This case report is presented to address the clinicians regarding the possibility of imperforate hymen with hematocolpos as a differential diagnosis in adolescent girls, particularly those who have not started having their menses in their teens and present with acute urinary retention, so that their external genitalia are carefully examined to exclude the possibility of imperforate hymen as a cause of acute urinary retention due to the hematocolpos

A case of endometrial tuberculosis complicated by Pott’s spine with paraplegia

Extra-pulmonary tuberculosis has shown an increasing trend in developing countries and accounts for 15-20% of total tuberculosis cases in India. Extra-pulmonary cases are usually diagnosed late due to vague and subtle signs & symptoms at a stage when major irreversible tissue damage had occurred. Tuberculosis is a chronic disease with infection remaining dormant for years in body to get activated whenever the immunity decreases. Spinal and cranial TB has the gravest manifestations, while the abdominal, female genital or pelvic TB poses a challenge because of lack of specific diagnostic tests. Here we are reporting a case of endometrial tuberculosis which was diagnosed very late, followed by treatment default and finally got complicated with Pott’s spine with paraplegia due to haematogenous spread. Timely intervention and anti-tubercular treatment improved the symptoms. It stresses on keeping the high suspicion of tuberculosis in unresponsive and persistent general symptoms.

Vulvar myiasis: a rare case report

Myiasis is the parasitic infestation of dipterous larvae (maggots) in humans and other vertebrate animals. Maggots are commonly seen on exposed body parts but it is very rare to find on covered body parts like external genitalia. Diagnosis and treatment are simple. We hereby present a rare case of vulvar myiasis in a young unmarried girl living in rural area in conditions of poor hygiene.

Evaluation of endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal women with abnormal uterine bleeding at tertiary rural centre

Background: Abnormal uterine bleeding is one of the commonest clinical presentation ac-counts for 33% gynaecological consultations and this proportion rises to 70% in perimenopausal and postmenopausal age group in any gynaecology clinic. The most probable etiology of abnormal uterine bleeding relates to the patients reproductive age. Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding in perimenopausal women, but their accuracy has not been compared properly. The aim of study is to evaluate the endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal patients with abnormal uterine bleeding.Methods: Total 96 patients in perimenopausal age group, admitted with chief complaints of ab-normal uterine bleeding were included. All patients underwent transvaginal ultrasonography and hysteroscopy, followed by hysteroscopy guided biopsy and histopathological examination. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for both methods and compared, considering histopathological diagnosis as gold standard.Results: Mean age of patients was 44.05±3.29. Hysteroscopy has high accuracy, sensitivity, specificity, positive predictive value and negative predictive value than Transvaginal sonography for diagnosis of all endometrial and intrauterine pathologies.Conclusions: Hysteroscopy results are more consistent with the results of histopathology. Hysteroscopy and hysteroscopy guided biopsy has been proven as gold standard for endometrial evaluation of patients with abnormal uterine bleeding. TVS can be used as most cost effective first step investigation in cases of perimenopausal bleeding

Comparison between intramuscular and intravenous regimen of magnesium sulfate in management of severe preeclampsia and eclampsia

Background: Objective of current study was to compare between intramuscular (IM) and intravenous (IV) magnesium sulfate regimen in terms of efficacy, side effects, maternal and fetal outcome.Methods: A prospective study was performed on 82 patients from September 2008 to January 2010 and comparison was made between IV and IM group, each group consisting of 17 patients of eclampsia and 24 patients of severe preeclampsia. IV group received continuous IV magnesium sulfate (IV MgSO4) consisting of 4gm of loading dose, administered over 15 minutes followed by maintenance dose of 2gm/hour. The IM group received intramuscular magnesium sulfate (IM MgSO4) according to Pritchard regimen.Results: Recurrence of convulsion in was found in 1/17 (5.88%) of eclamptic patients in IV and 1/17 (5.88%) in IM group which is statistically not significant (P = 1).There was no occurrence of convulsion in any of the cases having severe eclampsia in either group. There was statistically no significant difference in maternal death between the two groups   (IM = 1/41(2.43%) and no mortality in IV group, P = 0.314). Statistically higher incidence (P = 0.034) of sign of impending toxicity such as loss of patellar reflex was seen in IM group as compared to IV group. Other signs of toxicity such as oliguria, respiratory rate depression though more in IM group, were statistically insignificant. There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality.Conclusions: Both the groups are comparable in terms of control and prevention of recurrence of convulsions, maternal and perinatal morbidity and mortality.

Maternal and perinatal outcomes of rupture uterus at rural tertiary care institution: a retrospective study

Background: Rupture of the pregnant uterus is a life threatening, preventable obstetric complication associated with high maternal and fetal mortality and morbidity. The objective of this study was to determine the incidence, maternal and perinatal outcome of rupture uterus at a rural tertiary care institution.Methods: Retrospective study included all uterine rupture cases booked or unbooked in hospital over a period of 6 years from January 2009-December 2014. In all patient’s case files, labour room and theatre records were reviewed and analyzed. Uterine rupture cases were categorized into complete and incomplete. Complete rupture was defined as full thickness uterine wall defect and incomplete rupture as small uterine wall defect. Only complete uterine rupture cases were included in the study. Cases with uterine dehiscence or other partial defects of uterine wall were excluded.Results: Total of 57 cases of uterine rupture was managed during the 6 years study period. In this period there were a total of 28,607 deliveries, giving a ratio of 1:502 and incidence of uterine rupture was calculated to be 0.199%. There were 43 (75.4%) rupture in scarred and 14 (24.56%) rupture in unscarred uterus. Majority (52.63%) were in age group 21-30 years, 42.10% cases were in age group 31-40 years. Maximum (91.2%) patient were between paraity 1 and parity 4, at 36-40 weeks of gestational age. 89.5% unbooked, 59.6% of rupture were managed with scar repair, 36.84% had bilateral tubal ligation done along with scar repair. 40.3% underwent hysterectomy (subtotal 29.82% and total abdominal hysterectomy 10.52%). Commonest complication was anemia for which multiple transfusions were given. In 5.3% bladder repair was done. Maternal mortality due to rupture was 8.77%. Perinatal mortality was 85.9%.Conclusions: Incidence of rupture is very high in our rural tertiary center. Mortality and complications due to rupture can be decreased by regular antenatal visits, early referral, taking timely and active interventions and blood transfusions

Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patientsMethods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.

Intravenous infusion of tramadol - a safe labour analgesia

Background: Tramadol has less maternal sedative effect and less neonatal depression, combines the mechanism of action of opioids and tricyclic antidepressants, now widely used for postoperative and obstetric analgesia. The aim the present study was to assess the efficacy and safety of intravenous infusion of tramadol as a safe analgesia for labour.Methods: The study was conducted on hundred primigravida with vertex presentation in active phase of labour. The following points were noted, (1) the time of onset of pain relief; (2) the degree of pain relief. (3) Maternal and foetal adverse effects.Results: Good relief of pain in 27 patient and moderate relief of pain in 16 patient and mild relief of pain in 7 patients was observed. The average time of onset in pain relief was 13 minutes. Majority of the parturients did not suffer from any adverse effects in our study.Conclusions: The tramadol hydrochloride intravenous infusion is safe and effective analgesia for labour

Low dose Mifepristone (100 mg) for medical termination of pregnancy

Background: Abortion is the most common entity in the practice of obstetrics and gynaecology. Different methods and modes have been opted for until now to find an effective regimen with the least complications. We have tried the minimal dose (100 mg) of Mifepristone (PO) instead of the presently recommended 200 mg for medical abortion in early first trimester cases. Objectives: The objective of the study was to determine the efficacy of low dose (100 mg) Mifepristone for medical termination of early pregnancy with oral Misoprostol 800 μg, 24 hours later. Design: A prospective analytical study was conducted on a population of 82 early-pregnant patients who have requested medical abortions. Method: Pregnant women of less than 56 days gestation age from their last menstrual period, requesting medical abortion were selected over a period of 14 months from January 2007 to March 2008. They were given 100 mg Mifepristone orally on Day-1, followed by 800 μg Misoprostol orally 24 hours later on Day-2, keeping the patient in the ward for at least 6 hours. Abortion interval, success rate, post-abortion bleeding and side-effects were noted. Success was defined as complete uterine evacuation without the need for surgical intervention. Results: The total success rate of this minimal dose Mifepristone regimen was 96.25%. Pain and nausea were the predominant side-effects noted. In total 72 (90%) women had completely aborted within 5 hours of taking Misoprostol. Three (3.75%) women only required suction aspiration, hence termed as failed medical abortion. The abortion interval increased with the gestation age. All three failures were of the more-than-42-day gestational age group. The overall mean abortion interval was 4.68 ± 5.32 hours. Conclusion: Mifepristone 100 mg, followed 24 hours later by Misoprostol 800 μg orally, is a safe and effective regimen for medical abortion