Sildenafil citrate to improve colour doppler indices in patient with pre-eclampsia: a path less taken

Presented a case of high-risk pregnancy of an elderly primigravida who had abnormal colour doppler indices. Addition of sildenafil citrate lead to improvement of colour doppler indices and growth parameters, thus prolonging the period of gestation by 6 weeks. This led to decreased neonatal ICU stay and reduction in neonatal morbidity

Primary ovarian ectopic pregnancy: early diagnosis is the key

Ectopic pregnancy means implantation of the embryo outside the uterine cavity. It may occur in the fallopian tubes, ovaries or the cervix. Primary ovarian ectopic is a very rare condition. In such cases preservation of ovary is extremely important, particularly in patients with infertility. We report a case of primary ovarian ectopic which was managed conservatively in a patient of primary infertility. Preservation of ovary is extremely important, particularly in patients with infertility

Pyometra in the postpartum: a forgotten complication

We report a case of 37 years old women who conceived after in vitro fertilization (IVF). Her antenatal course was uneventful. On delivery there was placenta acreta. She later presented in the postpartum period with pyometra. She was managed with conservative treatment. We believe that the placental bed sutures and the sloughing placenta could have led to sterile pyometra in this patient. This rare but important complication need to be kept in mind specially in high risk women with thin endometrium, h/o IVF, cervical encerclage, and placenta acreta

A retrospective interventional study for evaluation of efficacy and safety of sildenafil citrate in improving intrauterine growth restriction and oligohydramnios using ultrasound Doppler velocimetry

Background: Intrauterine growth restriction (IUGR) is one of the major reasons for neonatal morbidity and mortality. Oligohydramnios is a common finding in IUGR. In majority of these cases diminished utero-placental blood flow is observed. However, in spite of this understanding and identification of high-risk patients, the management options are limited. Sildenafil citrate, a phosphodiesterase type-5 inhibitor improves utero-placental perfusion.Methods: We present a retrospective interventional study involving 50 adult pregnant women diagnosed with early-onset IUGR (n=38) and oligohydramnios (n=12). Vaginal sildenafil citrate 25 mg t.i.d. was started from the day of diagnosis till delivery. Primary efficacy endpoints included changes in Doppler parameters i.e., amniotic fluid index (AFI), uterine artery (UA)- pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (S/D ratio). Secondary endpoints included live birth, birth weight, Apgar score at birth, neonatal survival to hospital discharge and adverse maternal side effects.Results: There was a statistically significant improvement in UA-PI, RI and S/D ratios (p<0.0001) in all cases. In oligohydramnios cases, treatment showed a statistical significant increase in AFI score (2.86±1.33 cm). The mean birth weight on delivery was 2200 gm with good Apgar scores. No major adverse effects were reported by women using sildenafil citrate vaginally.Conclusions: Sildenafil citrate, by increasing utero-placental perfusion, improves uterine artery Doppler patterns, AFI, fetal weight and overall better neonatal survival rates by reducing neonatal morbidity and mortality. Sildenafil citrate may hold a promising treatment strategy for management of IUGR and oligohydramnios

Ureteric Injury During Transvaginal Oocyte Retrieval (TVOR) and Review of Literature

We report a case of ureteric injury during transvaginal oocyte retrieval (TVOR), which was identified immediately (on the operation table) and managed successfully in the same sitting. A 28-year-old woman with primary infertility underwent in-vitro fertilisation (IVF) in a private centre. Because of the policy of doing an ultrasonography post-procedure, she was diagnosed immediately with vaginal vault haematoma and ureteric injury. A double-J catheter was inserted under cystoscopic guidance. A major complication was averted by the timely diagnosis of ureteric injury and its appropriate management. To conclude, given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureteric injury. Early diagnosis of complications (by knowing and anticipating potential risks of procedure) leads to efficient management by timely intervention