Uterine inversion - an obstetrician’s nightmare: a series of 3 cases of uterine inversion and a review of management options

Acute puerperal uterine inversion is an extremely rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity and beyond. Although the causes of uterine inversion are unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. We present here a series of three cases of uterine inversion managed in our hospital over a period of 3 years. Our first case, Mrs XYZ referred to our hospital after vaginal delivery followed by postpartum collapse. The patient was in hypovolemic shock with 2nd degree uterine inversion. Second case, Mrs ABC referred to our hospital after vaginal delivery and mass coming out of the vagina. The patient had postpartum haemorrhage with 2nd degree uterine inversion. Our third case, Mrs DEF, c/o full term vaginal delivery at our hospital with 2nd degree uterine inversion with postpartum haemorrhage. In all three cases, the patients were explored in the OT under general anaesthesia and uterine reposition was done vaginally. Two of the patients required mechanical ventilation post operatively and all the patients required blood and blood product transfusion. The clinical management, treatment options and surgical nuances of management of uterine inversion are discussed

Mucinous cystadenoma of ovary: are mammoths really extinct?

The most common ovarian tumours are epithelial tumours. 80% of all tumours are benign, 10% borderline and 10% are malignant. Mucinous tumours represent 8-10% of the epithelial tumours; they may reach enormous size filling the entire abdominal cavity. We report here a case of a huge benign mucinous cystadenoma in a 57-year-old female. Ultrasound and MRI scan showed a large left ovarian cyst. CA-125 was 132 IU/ml. She underwent total abdominal hysterectomy and bilateral salpingo-opherectomy with appendicectomy and infracolic omentectomy. Her post-operative course was unremarkable

Evaluation of efficacy of injection ferric carboxymaltose in pregnant women

Background: Iron deficiency anaemia (IDA) continues to be a very common problem in developing countries leading to a spectrum of adverse events in pregnant women. The objective of this study was to determine the efficacy, side effects and tolerance of ferric carboxymaltose as compared to available iron preparations for the prophylaxis and treatment of mild to moderate iron deficiency anaemia during pregnancy.Methods: One-year clinical study (from June 2017 to May 2018). A total 100 patients were enrolled after matching inclusion and exclusion criteria. The efficacy assessment was performed during 4, 8, and 12 weeks of starting therapy. If the patient is not responding to therapy in either arm as documented by no rise or fall in haemoglobin levels patients may be removed from study for other therapy. Treatment duration up to 12 weeks. Safety and efficacy follow-up visit at 4, 8 and 12 weeks. Institutional ethics committee permission was taken.Results: On intra-group comparisons there was significant increase in haemoglobin levels at 8 and 12 weeks in oral iron group as compared to day 1 haemoglobin levels while there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared to day 1 haemoglobin levels. On intergroup comparisons between oral and IV iron group, there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared oral iron group haemoglobin levels.Conclusions: Intravenous iron therapy with ferric carboxymaltose causes significant improvement in haemoglobin more quickly and more effective in correcting iron deficiency anaemia in pregnancy compared to oral treatment in terms of increase in haemoglobin levels at 4, 8 and 12 weeks. Intravenous ferric carboxymaltose is safe and effective option for pregnant women with iron deficiency anaemia

Chorioangioma with pre-eclampsia and IUGR: a case report

Chorioangioma is a non-trophoblastic benign tumour of the placenta, arising from the primitive chorionic mesenchyme with an estimated incidence of 0.6% diagnosed antenatal on ultrasound imaging. Small chorioangiomas are often asymptomatic with a frequency of about 1%, giant chorioangiomas more than >5 cm in diameter, are rare seen in 1:3500 to 1:16000 births and are associated with maternal and fetal complications. We report a case of 23-year-old, primigravida 36.4 weeks of gestation with pre-eclampsia with asymmetrical intrauterine growth restriction (IUGR), ultrasound suggestive of large placental chorioangioma 8×6.8 cm. This patient despite having large tumour and being diagnosed late at 35 weeks had a favourable maternal and fetal outcome. Histopathology confirmed the diagnosis

Perioperative concerns and outcomes in obstetric patients undergoing lower segment caesarean section in the wake of the COVID-19 pandemic: a retrospective analysis

Background: In the current COVID-19 pandemic, pregnant women are considered high risk due to adverse maternal and foetal complications that are known to occur with antepartum viral infections. In addition to immunological changes in pregnancy that alter the response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, the disruption of routine antenatal services as a result of the pandemic has also adversely affected expectant mothers.Methods: We conducted this retrospective observational study as a comprehensive comparative analysis of the method of delivery in COVID positive women, the choice of anaesthesia and maternal and foetal outcomes in women undergoing lower segment caesarean sections with COVID infection as well as the COVID negative patients during the first wave of the pandemic.Results: The rate of caesarean section was comparable between the two groups. The rates of general and regional anaesthesia did not change with COVID positive status. However, we found that meconium-stained liquor with foetal distress as an indication for lower segment caesarean section (LSCS) was markedly higher in COVID positive patients. There was also a significantly higher requirement for ICU admission and ventilator support in the positive patients as a result of COVID-related complications. No significant difference was observed in the maternal and neonatal mortality rate between the two groups.Conclusions: In our experience, COVID-19 positive status did not impact the rate of LSCS, but significantly increased the need for intensive care