Complex mullarian duct abnormality in a young female: a theraputic dilemma

Genital outflow tract obstruction is a rare cause of primary amenorrhoea. Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. If the septum is complete, the menstrual flow will be obstructed causing primary amenorrhoea. The septum is basically a membrane of fibrous connective tissue with both muscular and vascular components formed anywhere along the vagina during embryological development. Here we present a case of 18 year old female who presented with primary amenorrhea, cyclical lower abdominal pain and menouria since 5 years. There was no history of attainment of menarche. The clinical examination revealed a small, blind ending lower vagina with a tough transverse membrane separating the lower portion from the upper genital tract. The ultrasound examination revealed a normal size uterus with hematometra. The magnetic resonance imaging of pelvis confirmed the presence of hematometra and transverse vaginal septum. Transverse vaginal septum resection followed by abdomino-perineal cervicoplasty was done in this patient

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Background: Objective of current study was to assess the effect of GnRH antagonist on follicular development, premature luteinization, uterine biophysical profile and pregnancy rate in controlled ovarian stimulation with clomiphene and gonadotropins for intrauterine insemination in women with unexplained infertility.Methods: Randomised controlled trial. Minimal stimulation protocol with or without GnRH antagonist was compared. Setting: Infertility clinic, PGIMER, Chandigarh. Patients: Couples with unexplained infertility, age of female partner between 20-39 years. Intervention: GnRH antagonist 0.25 mg since follicle size 14 mm till hCG administration. Main outcome measures: Follicle characteristics, premature luteinisation, uterine biophysical profile and pregnancy rate.  Results: The mean number of follicles recruited in group A was 2.32 ± 1.01 while that in group B (receiving GnRH antagonist) it was 4.10 ± 1.69. Statistically significant increase in total biophysical profile score was observed in periovulatory phase in the antagonist group. 40% women in group A had premature luteinization whereas only 4% women in group B suffered from premature luteinization. 20% women who received GnRH antagonist conceived against only 6% in group A, this difference however was not statistically significantConclusions: GnRH antagonist has a role in increasing the number of follicles recruited. Furthermore, GnRH antagonist can improve the total uterine biophysical profile score by improving the endometrial thickness, endometrial pattern, blood flow and decreasing the impedance to the blood flow in uterine artery. The drug can potentially help in improving pregnancy rates by decreasing the rate of premature luteinisation. 

Combined factor VIII and IX deficiency: role in puberty menorrhagia: a case report

The prevalence of menorrhagia in adolescent populations with bleeding disorders varies between 14% to 48%. Hereditary bleeding disorders are an important cause of puberty menorrhagia and the consequences can be life threatening. We report a case of 12 years old girl, known case of Factor VIII and IX deficiency who presented to our centre with menorrhagia at menarche. This case is reported as combined factor deficiency is a rarity. Early diagnosis, consultation with haematologist and appropriate treatment are essential

Malignant mixed germ cell tumor of ovary: a rare case report

Ovarian germ cell tumors are very rare and affect mainly young girls and women. One of the most remarkable advances in oncology is in the treatment of malignant ovarian germ cell tumors. The two histological groups are: dysgerminomas and non dysgerminomatous tumors. We report a case of a 29 years old multiparous woman who presented with persistent pain abdomen and was diagnosed to have a malignant mixed germ cell tumor comprising of both dysgerminoma and yolk sac tumor (endodermal sinus tumor).

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

Background: Infertility is one of the most common problem for which couple seeks medical attention. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients.Methods: For this retrospective study, patient with the diagnosis of primary infertility were recruited. Patients admitted between the periods 2014 to 2016 were included. Pertinent data related to infertility were collected from the case records and entered in predesigned performa.Results: Patients with primary infertility 246 (82%) diagnosed to have pelvic pathology. The most common cause of infertility was ovarian 122 (36.63%), Uterine 66 (19.82%), tubal 84 (25.22%) and unexplained infertility in 103 (30.93%) women. Patients with PCOS 76 (22.82%) and endometriosis 46 (13.81%) treated with drilling and endometriotic cystectomy. In 32 (9.60%) of patients hysteroscopic cannulation was done. For distal tubal blockage fimbrioplasty was performed in 38 (11.41%) of women. Pelvic adhesions diagnosed in 26 (7.80%) women. patients diagnosed with uterine septum 42 (12.61%) required hysteroscopic septal resection. During the evaluation of infertility 70 (21%) of women diagnosed to have incidental pelvic pathology treated according to pathology.Conclusions: Hysterolaparoscopy is emerging as a valuable technique for complete assessment of female infertility and also helps in treatment according to the cause

Review of obstetrical emergencies and fetal out come in a tertiary care centre

Background: Obstetric emergencies can occur suddenly and unexpectedly. Obstetrics is unique in that there are two patients to consider and care for, a mother and a baby or fetus. Identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness can reduce the incidence of obstetric emergencies. Present study was carried out to know the incidence, nature and outcome of obstetric emergencies.Methods: Retrospective study of obstetric emergencies admitted to Obstetrics and Gynaecology department of Indira Gandhi Institute of Medical science, Patna from March 2015 to September 2017.Results: The common clinical presentation was Ectopic Pregnancy (19.64%), Heart Disease (16.64%), Abortion (13.69%), Severe Anaemia (16.66%), Purpureal Sepsis (9.52%), Sever pregnancy induced hypertension (3.57%), Eclampsia/ HELLP Syndrome (2.38%), Multiple Pregnancy (1.19%) Malignancy Disorder with Pregnancy (2.97%) and HIV in pregnancy (0.59%). Intervention done include Dilation and evacuation (13.69%), Caesarean section (28.57%), Vaginal delivery (22.62%), Caesarean Hysterectomy (2.38%), Exploratory Laparotomy (20.83%) and conservative management in (11.90%) of patients. Maternal outcome include shock due to rupture ectopic and post-partum (16.68%), Blood Transfusion done in (27.99%), Septicaemia (15.48%), ICU admission (8.92%), HDU (12.5%), Pulmonary oedema (6.54%), DIC (4.16%), CCF (3.57%), Ventilatory Support (1.78%) and Maternal Mortality (2.38%). Fatal outcome includes live birth (58.8%), NICU Admission (27.45%), Ventilatory Support (7.84%) and Neonatal mortality (5.88%).Conclusions: High risk pregnancy identification and proper antenatal, intranatal and postnatal care will reduce the incidence of obstetrical emergencies. Peripheral health care system need to be strengthen and early referral need to be implemented for better maternal and fetal outcome

Comparison of hemodynamic responses of intravenous dexmedetomidine and esmolol infusion during laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is one of the commonest surgery performed under general anesthesia in this set up but maintaining the hemodynamic stability is challenging in these patients. The present study was conducted to comparatively analyse the hemodynamic variations using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years, of ASA grade I or II of both gender, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized into three groups of 30 patients each. Patients of Group A received esmolol infusion (loading: 1mg/kg and maintenance: 5-15µg/kg/min), patients of Group B received dexmedetomedine infusion (loading: 0.7µg/kg and maintenance: 0.4µg/kg/hr) and Group C (control group) received normal saline infusion. Patients were monitored for changes in heart rate, ECG, systemic blood pressure and EtCO2, at baseline, at 5 min and 10 min after giving study drug bolus, after induction, intubation, skin incision and CO2 insufflation. Thereafter, these changes were recorded at 15 min intervals till the end of surgery.Results: It was observed that perioperative use of dexmedetomidine and esmolol infusions maintained better hemodynamic stability as compared to the normal saline in control group. Though the patients in esmolol group showed less fluctuations in BP and HR (as compared to control group), but, stability was better in the patients of dexmedetomidine group at all-time intervals.Conclusions: Dexmedetomidine infusion was a better option for maintaining hemodynamic stability in comparison to emolol infusion during laparoscopic surgeries

Combined factor VIII and IX deficiency: role in puberty menorrhagia: a case report

The prevalence of menorrhagia in adolescent populations with bleeding disorders varies between 14% to 48%. Hereditary bleeding disorders are an important cause of puberty menorrhagia and the consequences can be life threatening. We report a case of 12 years old girl, known case of Factor VIII and IX deficiency who presented to our centre with menorrhagia at menarche. This case is reported as combined factor deficiency is a rarity. Early diagnosis, consultation with haematologist and appropriate treatment are essential

Review of obstetrical emergencies and fetal out come in a tertiary care centre

Background: Obstetric emergencies can occur suddenly and unexpectedly. Obstetrics is unique in that there are two patients to consider and care for, a mother and a baby or fetus. Identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness can reduce the incidence of obstetric emergencies. Present study was carried out to know the incidence, nature and outcome of obstetric emergencies.Methods: Retrospective study of obstetric emergencies admitted to Obstetrics and Gynaecology department of Indira Gandhi Institute of Medical science, Patna from March 2015 to September 2017.Results: The common clinical presentation was Ectopic Pregnancy (19.64%), Heart Disease (16.64%), Abortion (13.69%), Severe Anaemia (16.66%), Purpureal Sepsis (9.52%), Sever pregnancy induced hypertension (3.57%), Eclampsia/ HELLP Syndrome (2.38%), Multiple Pregnancy (1.19%) Malignancy Disorder with Pregnancy (2.97%) and HIV in pregnancy (0.59%). Intervention done include Dilation and evacuation (13.69%), Caesarean section (28.57%), Vaginal delivery (22.62%), Caesarean Hysterectomy (2.38%), Exploratory Laparotomy (20.83%) and conservative management in (11.90%) of patients. Maternal outcome include shock due to rupture ectopic and post-partum (16.68%), Blood Transfusion done in (27.99%), Septicaemia (15.48%), ICU admission (8.92%), HDU (12.5%), Pulmonary oedema (6.54%), DIC (4.16%), CCF (3.57%), Ventilatory Support (1.78%) and Maternal Mortality (2.38%). Fatal outcome includes live birth (58.8%), NICU Admission (27.45%), Ventilatory Support (7.84%) and Neonatal mortality (5.88%).Conclusions: High risk pregnancy identification and proper antenatal, intranatal and postnatal care will reduce the incidence of obstetrical emergencies. Peripheral health care system need to be strengthen and early referral need to be implemented for better maternal and fetal outcome

Comparison of hemodynamic responses of intravenous dexmedetomidine and esmolol infusion during laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is one of the commonest surgery performed under general anesthesia in this set up but maintaining the hemodynamic stability is challenging in these patients. The present study was conducted to comparatively analyse the hemodynamic variations using intravenous dexmedetomidine and intravenous esmolol during laparoscopic cholecystectomy.Methods: Study was conducted on 90 adult patients aged 18-60 years, of ASA grade I or II of both gender, scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were randomized into three groups of 30 patients each. Patients of Group A received esmolol infusion (loading: 1mg/kg and maintenance: 5-15µg/kg/min), patients of Group B received dexmedetomedine infusion (loading: 0.7µg/kg and maintenance: 0.4µg/kg/hr) and Group C (control group) received normal saline infusion. Patients were monitored for changes in heart rate, ECG, systemic blood pressure and EtCO2, at baseline, at 5 min and 10 min after giving study drug bolus, after induction, intubation, skin incision and CO2 insufflation. Thereafter, these changes were recorded at 15 min intervals till the end of surgery.Results: It was observed that perioperative use of dexmedetomidine and esmolol infusions maintained better hemodynamic stability as compared to the normal saline in control group. Though the patients in esmolol group showed less fluctuations in BP and HR (as compared to control group), but, stability was better in the patients of dexmedetomidine group at all-time intervals.Conclusions: Dexmedetomidine infusion was a better option for maintaining hemodynamic stability in comparison to emolol infusion during laparoscopic surgeries