Partial molar pregnancy associated with a normal appearing foetus: a case report and review of the literature

Partial molar pregnancy is a rare entity in which there is usually a triploid abnormal foetus associated with a large placenta with cystic changes. The incidence of a normal diploid foetus and a partial molar placenta is extremely rare. Here we report a case of partial molar pregnancy in which a normal appearing foetus with diploid karyotype coexist. In this case a 24yr old primigravida at 20 week 3days gestation presented with 3-4 episodes of vaginal bleeding and generalised swelling of body since one month. On evaluation she was found to have moderate anaemia, proteinuria, raised serum β hcg and USG showed a single live foetus with thickened cystic placenta covering the internal os. After counselling patient was put up for hysterotomy. The product of conception and placenta were sent for histopathology and karyotyping which confirmed partial hydatidiform mole with trisomy 21 foetus. Patient had uneventful post op period and was followed up with serial β hcg measurement which fell to undetectable levels within two months.

A study to assess the occurrence and factors of maternal near-miss among women admitted in maternal unit in selected hospitals of Kolkata, India

Background: Assessment of the occurrence of maternal near-miss (an event in which a woman comes close to maternal death, but survive), identify the factors of maternal near-miss and to find out the association between determining factors and selected sample characteristics of maternal near-miss women.Methods: A descriptive survey is carried out among purposively selected women admitted in the maternity unit of two tertiary hospitals of Kolkata. Data are collected by face-to-face interview using valid and reliable semi-structured interview schedule to identify factors of maternal near-miss. WHO selected maternal near-miss proforma (2011) is used for assessment of occurrence of maternal near-miss by using record analysis.Results: The occurrence of maternal near-miss is identified as 100 out of 1669 women admitted in maternity unit. Eclampsia occurred maximum (27%) followed by severe pre-eclampsia (19%), severe PPH (6%) among potentially life-threatening conditions. Multigravida (65%), multipara (54%), non-booked cases (5%), duration of labour more than 18 hours (65%), caesarean section (78%), referred cases (79%), maternal type 1 delay (53%) and type 2 delay (67%) all are the factors mainly responsible for developing maternal near-miss. Significant association present between reproductive and obstetrical factors and maternal education, marital age (p<0.01). Significant association is also present between maternal delay factors and residence, maternal education, monthly family income, marital age (p<0.01).Conclusions: Exploring the factors of maternal near-miss may help to identify the factors early, which in turn will prevent the condition. Lesson can be learned from cases of near-miss which can serve as a useful tool in reducing maternal mortality ratio

A study of thyroid dysfunction in dysfunctional uterine bleeding

Background: The objective of the study was to evaluate the prevalence of thyroid disorder in dysfunctional uterine bleeding and to assess the menstrual pattern in women with thyroid disorders.Methods: The present study was conducted on 104 patients who presented with dysfunctional uterine bleeding in gynecology OPD/IPD Department of Obstetrics and Gynecology, SCBMCH, Cuttack, India.Results: Among the 104 women 16 (15.3%) had hypothyroidism, 3 (2.8%) had hyperthyroidism and 75 (72.1%) were euthyroid and 10(9.6%) subclinical hypothyroidisim. Menorrhagia was the most common menstrual disorder in hypothyroidism and oligomenorrhoea in hyperthyroidism. In the present study the age group of 41-50 year and multyparity (para-2) and commonest are menorrhagic 42 (40.38%). Menorrhagia in hypothyroidisim 15 (72.4%) cases and oligomenorrhoea in hyperthyroidisim 3 (10.3%).Conclusions: Thyroid dysfunction should be considered as an important aetiological factor in menstrual disturbances and thyroid assessment should be done in all patients with menstrual irregularities. Therefore, to conclude any type of menstrual abnormality should be considered as a possible presenting symptom of thyroid dysfunction and it may even indicate subclinical abnormality, evaluation of thyroid would avoid unnecessary surgeries and exposure to hormones

Isolation and characterization of organisms in high vaginal swab culture in preterm pregnancy (28-37 week)

Background: The study was performed to isolate, identify and determine the antibiotic sensitivity profile of the pathogens in the genital tract of preterm pregnant women (28 week- 37 week) gestation to the prevention of preterm delivery, pPROM, chorioamnionitis, neonatal, puerperal and maternal- foetal infections.Methods: The present perspective study in S. C. B. medical college, Cuttack was conducted in department of Obstetrics and Gynaecology from January 2014 to September 2015 in 100 patients with singleton pregnancy. The cases for study were selected randomly from the patients attending O and G OPD or admitted to the labour room or antenatal ward. Each of the patients was informed about the type, quality, and consequence of the study as well as their role in this particular participation. Valid consents were obtained from each patient who showed their cooperation. Under available aseptic conditions high vaginal swabs were collected with a commercially available collection and transport system for isolation of pathogens present in the genital tract of preterm pregnant women having gestational age 28 week-37 week. The samples were examined in the Department of Microbiology in S. C. B. medical college, Cuttack.Results: We have isolated the most common organism in preterm pregnancy is the E. coli amounting 34% followed by Candidial spp. 21%. Then comes Enterococci scoring 10%, then Staphylococci 8%, Gardenerella vaginalis 7%. Eventually Group B Streptococcus 5%. However, there is about more number of culture negative cases (no growth -24 %) according the department of Microbiology of this college. From the above study we got more number of aerobic vaginitis in contrast to bacterial vaginitis. The prevalence of pPROM was associated with E. coli i. e. 30%. Second are Enterococci having 20%. Candidial spp. Scores 18%. Gardenerella vaginalis takes 12%. However, organisms like Staphylococci and GBS comes last with a score of 6% and 2% respectively.Conclusions: As preterm birth is more associated with mother having genital infections. Our study awards the champion cup to the E. coli as it is associated with maximum number of preterm birth cases i.e. 30%. Candidial spp. comes with the number about 21% causing both symptomatic and asymptomatic infection. Enterococci and Staphylococci almost have same prevalence of preterm birth viz. 12%

Maternal and perinatal outcome of eclampsia in a tertiary care centre

Background: Eclampsia is associated with devastating maternal and fetal complications. The main objective was to study the perinatal and maternal outcome and the causative factors for the mortality and morbidity in eclampsia patients admitted to this hospital and to explore the factors contributing to the alarming situation.Methods: 218 eclampsia cases admitted to the labour room in Department of Obstetrics &amp; Gynaecology, SCB Medical College Cuttack, Odisha, India from Jan 2013 to Sept 2014 enrolled for the study.Results: In this study 218 eclampsia cases were studied. The incidence of eclampsia in S.C.B.MCH during study period was 1.39%. Most of the patients were primigravida accounting 83.48% out of which 74.31% were antepartum, 14.22% were intrapartum and 11.47% were postpartum. 44.04% of cases had no ANC and 40.36 irregular ANC. Occurrence of onset of eclampsia at &lt;34 weeks GA 27.53%, 35-37 weeks 43.12 % and &gt;38 weeks 29.35%. Most of patients were from rural area (97.50%) and having low socioeconomic status (83.94%) and illiterate. Out of 218 cases 46.33% patients had vaginal delivery, 3.21% patients had vaginal delivery with instrumentation.Conclusions: There is a need of proper antenatal care to prevent eclampsia and the need for intensive monitoring of women with eclampsia throughout hospitalization to improve both the maternal and perinatal outcome

Clinico-Microbiological Profile and Treatment Outcome of Infectious Scleritis: Experience from a Tertiary Eye Care Center of India

Medical and microbiology records of seventeen patients (17 eyes), diagnosed as scleritis of infectious origin were reviewed; to study clinical features, predisposing risk factors, microbiologic profile and treatment outcome of infectious scleritis. The mean patient age was 52.3 ± 19.75 years. Twelve patients (70.6%) had history of trauma/prior surgery. Isolated organisms included Staphylococcus species (spp) (n = 5), Fungus (n = 4), Nocardia spp (n = 3), two each of atypical Mycobacterium spp and Streptococcus pneumoniae and one Pseudomonas aeruginosa. Treatment included intensive topical antimicrobial in all eyes and systemic medication in 15 (88.2%) patients; surgical exploration was needed for 13 (76.5%) patients and scleral patch graft was done in four (23.5%) patients. Lesions resolved in all patients and none required evisceration. The presenting log MAR visual acuity of 1.77 ± 1.40 and improved to 0.99 ± 0.91. (P ≤ 0.039) after treatment with a mean follow up of 22.57 ± 19.53 weeks. A microbiological confirmation, appropriate medical and/or surgical intervention has a good tectonic and visual outcome