Transperineal ultrasonography in stress urinary incontinence

Background: The aim of our study is to assess, using transperineal ultrasonography, amount of bladder neck mobility using rotational angles; represented by the difference in the anterior (α angle) and posterior urethral angles (β angle) and proximal pubourethral distance at rest and straining, in stress urinary incontinence and control group, to ascertain if there are significant differences in their values between the groups.Methods: In all, 24 women with SUI (SUI group) and 20 continent women (control group) were included. Transperineal ultrasonography was performed at rest and straining (Valsalva manoeuver), and the threshold value for the urethral angles (α and β angles) and proximal pubourethral distance for each group were estimated.Results: A significant difference was found in calculating the numerical value of the increment of both α and β angles in both groups, at rest and at straining (rotation angle α and rotation angle β (Rα and Rβ)). Higher rotation angles were seen in the SUI group for both the α angle and the β angle compared with those of the control group; mean (SD) Rα SUI 29.37±7.46 vs. controls 10.83±3.46°; and Rβ SUI 27.97±7.47 vs. controls 13.00±3.16°; p<0.01. There was also significant difference in proximal pubourethral distance (<0.01) during resting and straining phases in patients with SUI.Conclusions: Rotational angles and pubourethral distance helps in evaluation of stress urinary incontinence and reduces the need of urodynamic studies

A retrospective study on ectopic pregnancy aspiration by transvaginal ultrasound at Institute of Kidney Diseases And Research Centre

Background: Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). To prevent severe morbidity and mortality its prompt diagnosis and appropriate management is important. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic Inj. Methotrexate. Methods: This study is a hospital based retrospective cohort study from January 2014 to December 2022 on patients who presented to Institute of Kidney Diseases and Research Centre (IKDRC) with unruptured ectopic pregnancy confirmed with ultrasound and β HCG. All the patients were analyzed according to history, clinical presentation, investigations, treatment and complications. Results: β-HCG day 1 or 2 post procedure dropped in all cases but in variable levels ranging from 1.3% to 85.88%, while the drop during days 7-10, was more significant and reassuring; ranged from 48.69% to 98.95%. Conclusions: By aspiration of ectopic gestational sac transvaginally under ultrasonographic guidance it is able to preserve the integrity of uterus and fallopian tube and thus the future fertility. The study will educate other healthcare professionals.

A successful outcome of pregnancy with Berger disease

With the increasing prevalence of chronic kidney disease (CKD) in the general population, female patients of fertile age with impaired kidney function are becoming more common. The presence of CKD in pregnant patients has been associated with poorer pregnancy outcomes. IgA nephropathy is the most common glomerulonephritis worldwide. The outcome of pregnancy in patients with CKD is related to impaired glomerular filtration rate and the degree of proteinuria. In non-aggressive IgA nephropathy, there is traditionally a slow progression to chronic kidney failure in 25–30% of cases during a period of 20 years. Women with immunoglobulin g A nephropathy (IgAN) are at higher risk of hypertension, preeclampsia, and fetal loss; the prognosis is worse for those who have advanced chronic kidney disease and proteinuria. Here we present two case reports who successfully delivered having aggressive IgA nephropathy and chronic hypertension in pregnancy.

Study of intravenous ferric carboxy maltose in iron deficiency anemia in women attending gynecological clinic - safety and efficacy

Background: Several intravenous iron preparations are available for the treatment of iron deficiency anemia (IDA). Some of these require multiple small infusions to prevent labile iron reactions while iron dextran (DEX) is associated with a risk of potentially serious anaphylactic reactions. Ferric carboxymaltose (FCM), a nondextran intravenous iron, is an effective and a safe option which can be administered in high single doses without serious adverse effects.Methods: It was a prospective study including 150 women of age >18 years with a definitive diagnosis of IDA and Hemoglobin (Hb) between 7-10 gm% from December 2013 to October 2014.Out of these, eleven women were lost to follow up and were excluded from the study. Intravenous FCM (500-1000mg) was administered and the improvement in Hb levels and iron stores was assessed after 3 weeks of total dose infusion.Results: Out of 150, 139 women were included in the study. Most of the women were in the age group of 30-39 years (38.12%). Most of the patients (74.10%) had mild anemia. Mean Hb levels increased over a period of 3 weeks after FCM administration from 8.70±1.04 gm% to 11.07±1.02 gm% which was statistically significant. Other parameters like S.TIBC (Serum total iron binding capacity), S. Ferritin, S. Iron also suggested a significant improvement after FCM administration. No serious life threatening adverse events were observed with FCM.Conclusion: Intravenous FCM is an effective and a safe treatment option for IDA and has an advantage of single administration of high doses without serious adverse effects

Caesarean section under spinal and epidural anesthesia in complete atrioventricular block without a pacemaker: a rare case report

Complete heart block (CHB) during pregnancy is rarely encountered. Management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist, and neonatologist. Treatment varies from medical management to temporary or permanent pacemaker insertion. Complete atrioventricular block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. We successfully managed caesarean section in a pregnancy with complete atrioventricular block under spinal and epidural anesthesia without a pacemaker. Asymptomatic pregnant women with congenital complete atrioventricular block can tolerate caesarean section under spinal and epidural anesthesia without a pacemaker

Luteoma in pregnancy: a rare cause of threatened preterm labour!

Pregnancy luteoma is a rare non-neoplastic tumor-like mass of the ovary. They are usually asymptomatic and found incidentally during ultrasound imaging or surgery. Rarely do they present with pain abdomen mimicking threatened preterm labor. They regress spontaneously after delivery. We presented a case of a 29-year-old G4A3 with twin pregnancies and chronic hypertension who presented with acute flank pain, constipation, and occasional hardening of the uterus. A provisional diagnosis threatened preterm labor with suspected ureteric colic and cystitis was made. The patient was initially managed on the same line but on a detailed in-patient evaluation her ultrasound revealed bilateral multicystic ovaries with few hypoechoic areas inside it mostly suggestive of ‘luteoma of pregnancy’. The patient had acne, hirsutism, and chronic hypertension well controlled on antihypertensives. The patient delivered twins successfully by cesarean section and luteoma and symptoms were resolved postpartum after 4 months. Recognition of this entity is important so that malignancy can be ruled out and unnecessary surgery, with concomitant risk to both the mother and the fetus, is avoided

A successful pregnancy outcome after mitral valve replacement: a case report

Valvular heart disease can be acquired or congenital. Although the incidence of rheumatic heart disease is on the decline, the number of patients with congenital heart disease who survive into adulthood has grown substantially over the past 30 years. Therefore, a large number of patients with valvular heart disease will be of childbearing age. Here we presented a case of second gravida who was diagnosed with rheumatic heart disease and had undergone mitral valve prosthesis and tricuspid valve repair delivered a healthy live male baby weighing 2.250 kg

Acute pyelonephritis in pregnancy: a case series at Institute of Kidney Diseases and Research Centre

Acute pyelonephritis is one of the most common indications for antepartum hospitalization, estimated at approximately 9.7% of all indications for predelivery hospitalization, and when diagnosed, conventional treatment includes intravenous fluid and parenteral antibacterial administration, and careful monitoring of fluid balance. Here, we present four cases of acute pyelonephritis in pregnancy treated and patient successfully delivered with healthy babies

Intraoperative cystoscopy in major gynaecological surgeries: necessary skill for a gynecologist

Background: The goal of this study is to find out: how important it is to utilize intraoperative cystoscopy liberally in normal gynaecological procedures to detect urinary tract injuries, how long it takes to do intraoperative cystoscopy and what problems are linked with cystoscopy.Materials: The study is from the year 2016 to 2022 involving around 1221 patients. In a tertiary care facility, retrospective observational research was conducted. The study comprised patients receiving all gynaecological and urogynaecological operations. Malignancy was ruled out. Following gynaecological surgery, a 20-F-30-degree telescope was used to perform a cystourethroscopy. To record case information, a study proforma was created.Results: Intraoperative cystoscopy detected four bladder injuries during anti-incontinence surgery (TVT) and hysterectomy. After a thorough laparoscopic hysterectomy with normal cystoscopy, one patient returned one month later with right ureteric injury. A urinary tract infection struck fifteen people shortly after surgery. After surgery, one patient suffered flank pain and a fever for 48 hours. There was no sign of urinary tract injury on a CT-IVP scan. She was handled with care.Conclusions: For early diagnosis of urinary tract injuries, gynaecologists should have a low threshold for performing intraoperative cystoscopy during gynaecological procedures. Early detection and treatment of urinary tract injuries reduces the patient's morbidity, with a successful repair outcome at the time of detection. Performing an intraoperative cystoscopy during gynaecological procedures allows for this

Role of cetrorelix in the prevention and treatment of ovarian hyperstimulation syndrome: a prospective case control study

Background: Ovarian hyperstimulation syndrome (OHSS) has intrigued clinicians for many years because of its devastating consequences. As an iatrogenic condition resulting from elective ovarian stimulation in the quest for pregnancy, the need to completely prevent the syndrome is evident. Gonadotropin releasing hormone (GnRH) antagonist Cetrorelix has found to be effective in treatment of OHSS and some studies have found it to be helpful in prevention of this condition. Hence, we designed a hospital-based study to investigate the effect of Cetrorelix in preventing and treating OHSS in in-vitro fertilization – embryo transfer (IVF–ET) patients at risk of OHSS undergoing long and short protocol. Methods: The study includes total 102 patients undergoing controlled ovarian stimulation COS for IVF/ICSI. All cases were stimulated using long and short protocol. Depending on whether a GnRH antagonist was given after ovum pick-up (OPU) the patients were divided in two groups: Cetrorelix (antagonist) group (n=51) and control group (n=51). The study group was treated with Cetrorelix 0.25 mg for 5 days commencing on the day of ovum pick up. Results: Incidence of mild OHSS was significantly higher (p=0.01) whereas moderate to severe OHSS was significantly lower in the antagonist group (p&lt;0.05). None of the patients had critical OHSS. Conclusions: GnRH antagonist Cetrorelix administration in early luteal phase in patients undergoing long or short protocol is effective in prevention and treatment of OHSS