Management of non-tubal ectopic pregnancies: rural tertiary care centre experience

Non-tubal ectopic pregnancies are rare but potentially life-threatening conditions. Nearly 95% of ectopic pregnancies are implanted in the various segments of fallopian tube. The remaining 5% implant in non-tubal sites like ovary, cervix, rudimentary horn, cesarean scar, abdominal and even heterotopic. Seven patients with non-tubal ectopic pregnancy at rural tertiary institute at Dr. RPGMC Tanda, from February 2020 to January 2021 were included in the study. Demographic details, symptoms, beta human chorionic gonadotrophin (β-hCG) levels, ultrasound findings, management and treatment outcomes were presented. Medical treatment and surgical procedure, alone or combined, resulted in effective treatment in women with early diagnosis of non-tubal ectopic pregnancy and two patients had live birth (heterotopic and abdominal pregnancy). In our study, we report two cases of ovarian pregnancy, one case of rudimentary horn successfully managed surgically, one case of LSCS scar pregnancy managed medically with methotrexate followed by suction and evacuation, one case of cervical pregnancy managed by D&C, one case of heterotopic pregnancy managed surgically and abdominal pregnancy managed surgically. In this paper we report a single centre experience in the management of non-tubal ectopic pregnancy Early diagnosis of ectopic pregnancy especially non tubal ectopic, requires a high index of suspicion and availability of point of care, transvaginal USG. Accurate diagnosis and timely intervention will help reduce maternal morbidity, mortality and preserve future fertility

Pregnancy outcome in pre-gestational and gestational diabetic women: a prospective observational study

Background: India is considered the world capital of diabetes, proper care and management of the same is the demand of society. The present study is carried out to identify the disease burden of GDM/ overt DM among antenatal cases. The main objective was to study the maternal and fetal outcome of diabetes complicating pregnancy.Methods: The present study was conducted at Dr. Rajendra Prasad Government Medical College at Tanda, District KangraHP from October 2015 to September 2016. All antenatal cases were screened for diabetes by OGTT 75 gm, 2-hour blood glucose level as per DIPSI guidelines and labelled as GDM/ overt DM. Those who fulfilled selection criteria were enrolled in the study. A total of 6452 cases who attended antenatal clinic during the study duration and were screened were selected for the study. 116 cases were found to have GDM / overt DM. Seventy-nine had GDM with OGTT>140 mg/dl (DIPSI guidelines) and 37 had overt DM with 2 hours PP >200 mg/dl (WHO criteria). Total 100 cases comprised of study group were followed till delivery to study maternal and fetal outcome.Results: The prevalence of diabetes in pregnancy was found to be low 1.79%. GDM was found to be more prevalent than overt diabetes in pregnant women (66% versus 34%). Among the antenatal maternal complications observed missed abortion (11.8% versus 1.55; p=0.026), polyhydraminos (26.4% versus 10.6%; p=0.04) and preterm labour (17.6% versus 4.5%; p=0.003) were significantly more common in overt diabetics than GDM cases. IUFD (8.8% versus 0; p=0.014) was also significantly more common in overt diabetics than GDM case. RDS was found significantly higher in neonates of overt diabetics as compared to GDM mothers (14.7 % versus 1.5%; p=0.009).Conclusions: Early detection and good glycemia control by MNT and insulin, regular antenatal check-ups, patient counselling and compliance, intrapartum fetal monitoring and early neonatal care are keys to improved outcome.

Augmented shelf-life and regeneration competence of activated charcoal (AC) supplemented synthetic seeds in Cymbidium pendulum (Roxb.) Sw.

A protocol for their long term storage at low temperature has been developed using synthetic seeds technology in Cymbidium pendulum (Roxb.)Sw. in present piece of work. This species is known as an important ornamental and medicinal orchid. Protocorm Like Bodies (PLBs) were used as propagules for encapsulation. They were raised on Basal M medium [1], in addition with inorganic plant growth regulators such as [Indole-3-acetic acid (IAA); Indole-3-butyric acid (IBA) and Naphthalene acetic acid (NAA); 6-Benzyl amino purine (BAP); Kinetin (KN) at 1mg/l concentrations. Different combinations were compared for their efficacy in supporting large scale production of elite propagules for encapsulation. Among these NAA proved to be the best as it supported 99.5% of asymbiotic seed germination in to largest PLBs (2.2mm) with highest chlorophyll content at 2.15µg/mg. PLBs were encapsulated in 3% sodium alginate and di-hydrated salt calcium chloride (100mM). Resultant synthetic seeds were observed for their viability after different period of storage at 250C and 40C. Role of AC if added to nutrient matrix in extended storage of synthetic seeds with better conversion at mass scale has been the main focus of the study. Interestingly, AC supplemented synthetic seeds could be stored for 480 days with 10.5% conversion and showed fairly good regeneration or production of secondary PLBs.&nbsp

Postoperative vault hematoma following vaginal hysterectomy: case reports

Postoperative vault hematoma is almost a universal consequence of gynaecologic surgery. It usually occurs after vaginal or abdominal hysterectomy. At one end there can be are minimal collection of peritoneal fluid or blood which is clinically insignificant whereas at the other end is the hematoma and abscess requiring active intervention for the patient to recover. We here present two cases of vault hematoma following vaginal hysterectomy which were reported to our institution in recent times. In both cases hematomas were infected. Ultrasonography was used to accurately identify and define the extent of hematomas. The patients underwent vault exploration and drainage. Post-operative period remained uneventful. Postoperative vault hematoma can be diagnosed in the early postoperative period of gynaecologic surgery. It is important to consider the possibility of vault haematoma in patients with persistent fever and vaginal bleeding after hysterectomy. The hematoma cavity can be easily entered to drain hematoma or abscess completely, expediting the recovery of the patient. Refining surgical techniques will significantly reduce the risk of vault hematoma.

Non-obstetric vulval hematoma is not so uncommon

Non-obstetric vulval haematoma is infrequently seen following blunt trauma to perineum. We, here present a series of six cases of non-obstetric vulval haematoma which were reported in our institution in recent years. Evacuation of haematoma and repair of lacerated tissues were successfully performed. Our experience confirms that prompt surgical intervention is the best modality in treating such patients as it reduces the associated morbidity and minimize hospital stay

Heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as the coexistence of intrauterine and extrauterine gestation. The incidence is low and estimated to be 1 in 30,000 of spontaneous pregnancies though it is becoming commoner with assisted reproductive technique. It can be a life-threatening condition and can be easily missed with the diagnosis being overlooked. We present a rare case of spontaneous heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation

Maternal and fetal outcome among pregnant women presenting with thrombocytopenia

Background: Thrombocytopenia complicates about 7-8% of all pregnancies. It is an under-explored condition in Indian women during pregnancy, so the study was planned to find out the prevalence and causative factors of thrombocytopenia during pregnancy and to review management strategies for the best feto-maternal outcome.Methods: This prospective study was conducted in the department of obstetrics and gynecology at Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh. 546 antenatal women were screened, 65 women who were diagnosed with thrombocytopenia, were included in the study.Results: The incidence of maternal thrombocytopenia in our study was 8.4%. 63% of the women had mild thrombocytopenia while 35.4% and 1.5% of women were moderate and severe thrombocytopenic respectively. The mean maternal platelet count was 106907±30136.52/µL whereas the mean neonatal platelet count was 175307.7±33834.87/µL. The incidence of fetal thrombocytopenia was 3.1%. Amongst 65 thrombocytopenic women 1.5% had HELLP Syndrome, 26.3% had PIH and 68.2% had gestational thrombocytopenia. 27.7% were delivered by LSCS and 72.3% were delivered vaginally. The most common indication of LSCS was acute fetal distress with MSL (55%) followed by breech (25%), failed induction (10%), and the rest (10%) for other obstetrical indications. 30% women required induction of labor with misoprostol for various obstetrical indications. The most common indication for induction was mild pre-eclampsia (45%) followed by IUGR (25%), PROM (15%) and post-date (15%).The mean baby weight in our study was 2.84±0.32 kg. Out of 65 neonates, 6.15% neonates required NICU admission. One neonate died at first post - op day because of respiratory distress syndrome. APGAR score <7 in 1 and 5 min were seen in 6.15% of neonates. Only 8% neonates were small for gestational age.Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, TTP, HUS and acute fatty liver of pregnancy)

Ovarian stromal tumor with minor sex-cord element with virilizing menifestations: a rare case report

Sex cord stromal tumor is a rare variety of ovarian tumor. These tumor have association with testosterone production which lead to virilisation in females. Here we report a case of 40yrs old female P2 L2 who presented with clinical signs and symptoms of virilisation: deepening of voice, hirsutism (Ferriman Gallwey score24), clitoromegaly, and breast atrophy. In this patient, serum testosterone and TSH levels were raised.  An ovarian mass was detected on ultrasonography. Exploratory laparotomy proceeds, total abdominal hysterectomy with bilateral salpingo-opherectomy was done. On histopathological examination the ovarian mass turned out a sex-cord stromal tumor of fibroma thecoma group-cellular fibroma with minor sex-cord like elements. Post-operatively her serum testosterone level declined and signs and symptoms of virilisation started regressing.

Myomectomy during cesarean section: is it a contraindication these days?

Myomectomy during the cesarean section is a debatable procedure because of raised risk of associated uncontrollable hemorrhage and postoperative morbidity. 38 years, elderly primigravida, who conceived after primary infertility with large leiomyoma in the lower uterine segment, underwent myomectomy during the cesarean section. Her intra-operative hemorrhage was within normal limits and post-partum period was uneventful. Conclusion of this study is Safety and feasibility of myomectomy along with cesarean largely depends upon the case selection, experience of the obstetrician and backup ICU and transfusion facilities

Extremely rare giant retroperitoneal fibrolipoma: A case report

Lipomas are common benign adipose tumors generally located at superficial locations. Mostly they measure a few centimeters in size; however, giant lipomas measuring more than 10 cm in size or weighing 1000 g are also seen. Deep seated lipomas are rather infrequent out of which retroperitoneal location of giant lipoma is rare. Fibrolipoma is one of the uncommon variant of lipomas. A giant retroperitoneal fibrolipoma is extremely rare and only five case reports of such tumors are there in the literature. We herein present one such case in a 36-years-old female