Rupture of Couvelaire uterus-a very rare case report

Couvelaire uterus is a complication seen in some severe forms of abruptio placentae. A careful watch and early identification can prevent grave maternal and fetal outcome. In literature, there are very few cases reported of rupture of Couvelaire uterus as it is a very rare entity. Our study highlights a case of 24 year old with nine months amenorrhea presented with abruption placenta and intrauterine fetal death. Diagnosis of ruptured Couvelaire uterus made and the same was repaired and managed. We were able to save the mother successfully

Study of sociodemographic profile and pattern of gynaecological malignancies in a tertiary care center

Background: Gynaecological malignancies are second most common cancer of females after cancer breast. Carcinoma cervix is the commonest gynaecological malignancy in developing countries while in developed countries, ovarian cancer is the commonest gynaecological malignancy. Appropriate screening and timely diagnosis can save many lives. The objective of this study was to study socio-demographic profile of patients presenting with gynaecological malignancy. And to study presenting symptoms and pattern of gynaecological malignancies in themMethods: It was a retrospective record based study from December 2011 to December 2015. Various parameters from Case records of patients with gynaecological malignancies who visited outpatient department of unit IV were retrieved and analysis done.Results: In our study, most of the patients (30.52%) belonged to age group of 51-60 years, were multiparous (94.21%), Illiterate (67.3%) and belonged to rural background (65.28%). Most of the patients of cancer cervix had their presenting complaint as post-menopausal bleeding (48.38%), followed by excessive white discharge (33.87%). Majority of patients (65.26%) had cancer cervix, were in FIGO stage II .Commonest histopathological type was squamous cell carcinoma.Conclusions: Most common gynaecological malignancy in India is carcinoma cervix. Proper screening and timely diagnosis can save many lives

Metastatic Bilateral Malignant Ovarian Tumors Associated with Pregnancy

SummaryObjectiveKrukenberg tumors in pregnancy are extremely rare. Only three cases have been reported, two of which were diagnosed postpartum.Case ReportA 20-year-old, primigravida with bilateral malignant ovarian tumors, who received no prior antenatal care, was presented with intestinal obstruction at 5 months' gestation. Pregnancy was preserved, and bilateral oophorectomy, omentectomy with resection of sigmoid colon growth, and colostomy were performed. The patient aborted spontaneously and postoperatively, and was treated with adjuvant chemotherapy.ConclusionBecause platinum-based chemotherapy can be safely given during pregnancy, hysterectomy can be avoided in cases of bilateral malignant ovarian tumors if the uterus is not grossly involved, so allowing preservation of an existing pregnancy

Correlation of lateral placental location with development of preeclampsia

Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia

Study of medical disorders in pregnancy among in patients at a tertiary care hospital in Haryana, India

Background: Pregnancy is a physiological condition in which various changes occur in pregnant women just to accommodate growing fetus. Pregnancy is a stress test for woman and may unmask certain underlying chronic diseases like, DM, hypertension which were silent or asymptomatic prior to pregnancy. This study was done to know the incidence, type and demographic profile of medical disorders in pregnancy among in patient at a tertiary care hospital.Methods: It was a retrospective study conducted on 578 patients of medical disorders in pregnancy admitted in a tertiary care hospital from January 2017 to December 2017. Data collected from record room and analysis done.Results: Total antenatal admissions were 4721. Incidence of medical disorders was 12.24%. Majority of women were in age group 20-30 years (65.5%). Low-parity (P0, P1). Hypertensive disorders in pregnancy was commonest reported disorder (42.3%), followed by hematological disorder (38.7%), liver disorder 5%, endocrine disorder 4.8%, epilepsy 3.8% and HIV 2.6% in present study.Conclusions: Hypertensive disorders were commonest medical disorder followed by hematological, liver, endocrine and epilepsy. All medical disorders in pregnancy to be managed by team approach

COMPARISON OF COMBINED ORAL CONTRACEPTIVES AND CYPEROTERONE ACETATE-ETHINYL ESTRADIOL COMBINATION ON CLINICAL AND HAEMATOLOGICAL PARAMETERS IN POLYCYSTIC OVARIAN SYNDROME (PCOS)

Introduction: Polycystic ovarian syndrome (PCOS) is an endocrine disorder with multiple etiology and affecting women in reproductive age group. It has become a major problem in modern era and requires a multimodality of treatment. Material and Methods: The study was conducted on 100 PCOS patients attending PGIMS, Rohtak outpatient department to compare the efficacy of combined oral contraceptives (COCs) and cyperoterone acetate-ethinyl estradiol (CPA-EE) combination on clinical and hematological parameters. This was a prospective interventional study conducted for one and half year. Patients were followed at one, three and six months of treatment and comparison was made from baseline to six months of treatment. Results: Both the drugs showed improvement in acne and hirsutism while no effect was seen on acanthosis nigricans, and anthropological parameters (basal metabolic rate, waist circumference, and waist hip ratio). Serum testosterone levels and sonographical parameters (ovarian volume, necklace appearance) also improved. On the contrary both the drugs deteriorated blood sugar levels and lipid profile of the patients on successive follow ups. However on comparison COCs deteriorated blood sugar levels more as compared to CPA-EE and CPA-EE deteriorated lipid profile (triglyceride and cholesterol levels) more than COCs. CPA-EE also improved the serum testosterone levels more when compared to COCs. Conclusion: Any of the drugs can be used in the treatment of PCOS patients but with caution in diabetic and hyperlipidemic patients

Comparative study of gabapentin and isoflavone in menopausal vasomotor symptoms

Objective: This study was planned to compare the effects of gabapentin and isoflavones in menopausal vasomotor symptoms. Materials and Methods: This prospective comparative study was conducted on 100 patients with complaints of hot flashes, divided into two groups of 50 each. Group I received 900 mg of gabapentin and Group II received 60 mg of isoflavones daily for 3 months. The patients were interviewed to calculate hot flash, global and depression scores and were rescored after 2, 4, 8, and 12 weeks. The primary outcome measure was a change in the hot flash score from baseline. The secondary outcome was an improvement in sleep, depression, and lipid profile. Data were analyzed using Chi-square test and Student's t-test. Results: Both groups showed significant improvement in hot flash score at the end of 12 weeks (82% Group I, 74% Group II; P = 0.076). Statistically significant difference was seen at 12 weeks in sleep quality in favor of gabapentin (P = 0.011) and in depression in favor of isoflavones (0.026). Isoflavone had significant improvement in cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides profiles after 12 weeks (P < 0.001, 0.009, 0.024 and <0.001, respectively) as compared to gabapentin. Conclusion: Isoflavone and gabapentin are equally effective in the treatment of hot flashes; however, isoflavones have better response in patients who have associated with complaints of depression and gabapentin is better who have associated sleep disturbance

Successful Pregnancy Outcome by Caesarean Section in Woman with Arthrogryposis Multiple Congenita (AMC)

Arthrogryposis Multiplex Congenita (AMC) is a symptom complex of congenital joint contractures associated with neurogenic and myopathic disorders. It is diagnosed at birth and often progresses to a state of significant disability. Pregnancy in a woman with AMC is at high risk due to diminished pulmonary reserve, increased risk of thromboembolism and anesthesia. Successful pregnancy in patients with AMC is very rare and only five cases have been reported in literature. Present case is being reported due to its rarityL&apos;arthrogrypose congénitale multiple (ACM) est un symptôme complexe des contractures articulaires congénitales liées aux troubles neurogènes et myopathiques. Il est diagnostiqué à la naissance et progresse souvent jusqu&apos;à un état d&apos;incapacité significative. La grossesse chez une femme qui souffre de l&apos;ACM est à haut risque dû au réserve pulmonaire réduit, un risque élevé de la thromboembolie et de l&apos;anesthésie. La grossesse réussite chez les patientes atteintes de l&apos;ACM est très rare et il n&apos;y a que cinq cas qui ont été signalés dans la littérature. Ce cas présent est signalé à cause de sa raret

Antepartum Eclampsia and Partial HELLP Syndrome in a Patient with Bell's Palsy

Bell's palsy affects pregnant women three times more often than nonpregnant women, with majority of cases occurring in the third trimester (71%) and early postpartum period (21%). Bell's palsy during pregnancy has been associated with preeclampsia, with 22% of these women developing preeclampsia. A 26-year-old G3P1 L1A1 diagnosed with Bell's palsy 2 weeks earlier, presented at 33-week period of gestation with a chief complaint of progressive bilateral pedal edema for 1 week, blood pressure (BP) - 150/100 mmHg and dipstick urine - 3+. Laboratory screening of HELLP syndrome was normal. Six days later, she had an episode of generalized tonic–clonic convulsion, magnesium sulfate was given, and emergency laboratory investigations revealed partial HELLP syndrome (platelet - 80,000, serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase - 281/222 U/L) with normal coagulation profile. Lower segment caesarean section was performed with delivery of a 2ks neonate with APGAR of 7/10 and 9/10 at 1 and 5 minute respectively. Postoperative day 3, all laboratory reports including magnetic resonance imaging brain were normal. BP was stabilized and she was discharged on the third postnatal day, with some right-sided residual facial weakness. All obstetricians must be aware of association of Bell's palsy with hypertensive disorders of pregnancy and aggressively screen for the same as soon as diagnosed, to prevent complications such as eclampsia and HELLP. Since Bell's palsy is not associated with adverse perinatal outcomes, it should not prompt obstetricians for hastening deliveries prematurely