Septicaemia in pregnancy: a case report

Necrotizing fasciitis (NF) is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. It is a severe, potentially fatal infectious disease which rapidly extends from the subcutaneous tissue along the superficial and deep fascia causing vascular occlusion, ischemia, and necrosis of tissues. A 30-year-old gravida 2 para1 living 1 woman, at 32 weeks of gestation with previous caesarean section and recently diagnosed diabetes, hypertension was admitted to our hospital with signs and symptoms of severe sepsis with pruritic black lesions over abdomen and perineum. Patient was in a morbid state in our hospital. During clinical examination, fetal heart sound was not localised suggestive of intrauterine fetal demise (IUFD), with ulcerative lesions over abdomen and vulva. Patient was immediately taken for surgical intervention and was suggestive of ruptured uterus with extrusion of fetus in abdominal cavity with cellulitis of abdominal and vulva. During initial laboratory examinations, diabetes mellitus was diagnosed. Patient was kept on ventilatory support and was vitals were stabilised. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient’s postoperative course was uncomplicated and skin defect healed by second intention of healing. The following case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections

Study of safety and efficacy of injection ferric carboxymaltose in iron deficiency anemia in pregnancy

Background: Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anemia (IDA) is associated with significant maternal, fetal and infant morbidity. Ferric carboxymaltose (FCM) may be better tolerated than the conventional blood transfusions and oral iron supplements. The study was designed to assess the safety and efficacy of IDA correction with intravenous (I.V.) FCM in pregnant women with mild, moderate and severe anemia in their second and third trimesters and their post-partum period. Methods: Prospective observational study; Treatment effectiveness was assessed by repeat hemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.Results: Intravenous FCM infusion significantly increased Hb values above baseline levels in all women. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. No serious adverse effects were found Conclusions: Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anemia in peri-partum period

Case series: transverse vaginal septum with vaginal atresia

This study includes case series of three cases of transverse vaginal septum with vaginal atresia. Cases presented with either primary amenorrhea or hypomenorrhea or secondary amenorrhea with complaints of cyclical abdominal pain. On examination, all cases had well developed secondary sexual characters, blind vaginal pouch with enlarged uterus felt on per rectal examination. Hormonal profile of all three cases was within normal limit. Karyotyping was done for all three cases, results were 46 XX. Radiological findings were that all cases had hematocolpos and one case had OHVIRA syndrome i.e.; absent right kidney with didelphys uterus with right hemivagina transverse septum. Management of all three cases included resection of transverse vaginal septum with vaginoplasty. Transverse vaginal septum was dissected and was used to create neovagina. Post-operatively, patients were advised to use phantom dilator, for 3-4 times in a day for atleast 3 months, to avoid vaginal stenosis. Cases were followed in OPD every monthly for 3 months, dysmenorrhea was relieved and patients were menstruating regularly with moderate flow for 3-4 days

A prospective study of 20 cases of maternal outcome in morbidly adherent placenta in tertiary care hospital

Background: Morbidly adherent placenta with its variants is one of the most feared complication causing high morbidity and mortality in obstetrics. Aim of this study is to help in identifying high risk pregnancies, planning line of management of morbidly adherent placenta. The objective of the study wad to evaluate the risk factors, different modes of management, maternal outcome in case of morbidly adherent placenta.Methods: A prospective study for one year was done to describe the incidence, causes, treatment, complications, and maternal morbidity and mortality associated with morbidly adherent placenta.Results: A total of 20 cases of morbidly adherent placenta were studied over one-year span at our Institute. Most of the women with morbidly adherent placenta were in the age group of 26-30years (55%).The most common aetiology of morbidly adherent placenta was previous caesarean scar with placenta praevia (85%). In majority, placenta accreta found. Total abdominal hysterectomy done in 12 patient and subtotal hysterectomy in 6 cases. Trial haemostasis with uterine sparing in 2 cases out of which one case underwent total hysterectomy due to massive haemorrhage on same day. Associated Bladder repair in adherent placenta with invasion of bladder was needed in 10% cases. There was 1 maternal death noted in this study.Conclusions: Leading cause of morbidly adherent placenta is previous caesarean section with placenta praevia, high index of suspicion, early antenatal diagnosis, planned surgery at high care centre with multi-disciplinary expertise, anticipation of blood volume transfusion, Delivery of foetus without manipulating placenta are key steps to reduce morbidity and mortality in morbidly adherent placenta. The decision to perform hysterectomy and conservative management to be individualized. Timely decision is the key to get success in morbidly adherent placenta as in other obstetric emergencies

Comparison of conventional pap smear with liquid based cytology, and assessment of the effectiveness and feasibility of liquid-based cytology over conventional pap smear in rural tertiary care centre

Background: Cervical cancer is the second most common cancer in women in India. So, detection of its premalignant lesions is of utmost importance, which can be easily done by screening methods. Screening programmes for cervical cancer using the conventional pap smear (CPS) technique have been in place since decades. However, CPS technique has many limitations. To overcome these limitations liquid-based cytology (LBC) was introduced in the mid 1990 as a better tool for processing cervical samples. The aim of present study is to compare CPS with LBC and to assess the diagnostic accuracy and cost effectiveness of LBC in rural tertiary care centre. Methods: The study was conducted over a period of 2 years at Rama medical college, Mandhana, Kanpur. All women presenting to gynaecological OPD with symptoms and signs suspicious of cervical malignancy were selected for paired samples of conventional pap and LBC. Colposcopy and biopsy were sought which correlated with cytologic findings.  Results: A maximum number of cases were in the reproductive age group, most common age of presentation being 40-49 years (27.3%) followed by 30-39 years (25.3%). A majority of patients were presented with a complaint of discharge per vagina 176 (58.7%), followed by pelvic pain 154 (51.3%). Only 4 patients were found to have unsatisfactory smear in LBC (1.33%) while 22 patients had unsatisfactory smear in conventional PAP (7.33%). LBC showed presence of endocervical cells in almost all patients 290 (97.97%). Candida bodies were not evident in LBC smears while the CPS showed presence candida bodies in 4 cases. Conclusions: Both the screening methods are very effective and sensitive in the detection of premalignant lesions with slight discordance of grade on histology. Thus, we conclude that cervical cytology is very effective in the detection of premalignant lesions with the sensitivity of almost 100%. In developing countries such as India, where finances pose a major problem, conventional method is as good as LBC

Huge yolk sac tumor in an adolescent girl: a case report

Germ cell tumours form a minority of all malignancies of the ovary. The common age group affected by yolk sac tumours is 11 to 24 years. Here, we present a case of yolk sac tumour in a 13-year-old girl who came with complaints of abdominal pain, distension and acute febrile illness. Fertility sparing surgery (Unilateral salpingo-oophorectomy) was done while the contra lateral ovary and uterus was conserved followed by combination chemotherapy postoperatively. As pprognosis of yolk sac tumours is highly stage-dependent, an early diagnosis can result in a drastic difference in the final outcome of the treatment of this highly aggressive disease. Besides the rarity of the tumour, the importance of the fact, that a vigilant and informed clinician can make an early and timely diagnosis of this condition even in girls of such a young age and make a drastic difference in the final outcome of the treatment, compels us to present this case

Oxidized cellulose: an unusual cause of post hysterectomy hemorrhage

Haemostatic material made of oxidized cellulose is a bio-absorbable fabric used widely for intraoperative haemostasis and adhesion prevention in surgery. The knit mesh facilitates platelet adhesion and aggregation during surgery. However, rarely it may cause a foreign-body reaction, which is indistinguishable from abscess or granuloma formation. This report describes a case of a local tissue reaction due to oxidized regenerated cellulose followed by vault erosion and vaginal bleeding, mimicking pelvic sepsis post hysterectomy. The signs and symptoms resolved completely following removal of the oxidized cellulose fabric

Interrupted mattress versus continuous subcuticular versus stapler: a comparative study on wound closure outcomes in primary caesarean section with Pfannenstiel incision

Background: Aim of the study was to compare the suture techniques using interrupted mattress and continuous subcuticular and stapler in terms of wound closure time; pain in stitch line on post-operative day 3, 5 and 7 and patient satisfaction. Methods: All patients fulfilling the inclusion criteria, were divided into 3 categories (interrupted mattress, subcuticular and staples) by random selection. Assessment parameters being skin closure time; induration and discharge on day 4 and 8; pain score using visual analogue scale on day 3, day 5 and 7; wound gaping and Patient satisfaction in terms of cosmesis using Likert’s scale after 4-6 weeks. Results: The skin closure time in mattress, subcuticular sutures and staples are found to be 8.891±1.343; 11.390±1.438 and 1.518±0.502 respectively. Pain on day 3, 5 and 7 were: severe pain was maximum seen in staples group (n=21) as compared to 7 patients in subcuticular group and 6 in mattress group. Wound complications were seen least in mattress group. One patient (1.20%) had wound gaping in mattress group, 3 (3.65%) of the patients in subcuticular group and 5 (6.17%) in staples group had wound gaping. Patient dissatisfaction rate was higher in staples group (8.64%) as compared to 6.09% patient in subcuticular group and 4.8% in mattress group. Conclusions: The mattress suturing technique has least wound related complications and most patients satisfaction. Staples are quick in application and subcuticular technique gives a good scar, but is associated with similar complications as staples.