Background: Iron deficiency is the most common cause of anaemia in pregnancy amounting to almost 50% of pregnant ladies in India. All pregnant women, irrespective of haemoglobin status, should receive prophylactic doses of iron from second trimester. Iron sucrose has an advantage of being cost effective and readily available. The objective of this was to study the efficacy of injection Iron Sucrose in treatment of iron deficiency anaemia in pregnancy. Methods: About106 patients were given in injection iron sucrose in pregnancy, who had intolerance to oral iron or were non-compliant, in pre calculated (Ganzoni's formula) doses and were followed up with rise in hemoglobin and ferritin after 6 weeks and at term. Results: Statistically significant increase in hemoglobin levels was observed at 6 weeks after initiation of treatment (9.689±0.821 gm% vs 10.906±0.775 gm%) as well as at term (mean 10.981±0.690 gm%). The serum ferritin levels too increased significantly at term (26.7 ng/mL±12.92 vs 65.34 ng/mL±15.73). Conclusions: Present study demonstrates that iron sucrose is an excellent option to treat iron deficiency anemia in patients where oral iron therapy has either failed or not suitable. It significantly increases hemoglobin levels in the study population. It is readily available in the market and can be infused on an outpatient basis.
Cerebral venous sinus thrombosis is a rare neurologic emergency during pregnancy. Life threatening complications can be prevented if it is detected and treated well in time. A 24 years P2L3A2 lady, who had undergone elective caesarean delivery developed sudden onset severe episodic parieto-occipital headache and bilateral diminution of vision on 4th post-partum day. She had no known risk factors for thrombosis. There was no history suggestive of sepsis or pre-eclampsia. On clinical examination her blood pressure was found to be very high (164-180/104-110 mm Hg). There was no sensory or motor deficit. Relevant haematological and biochemical investigations were within normal limits. Urinary protein was negative. With a provisional diagnosis of imminent eclampsia, she was put on antihypertensive and Magnesium Sulphate. However, in view of persistence of the symptoms even after 24 hours, contrast-enhanced computed tomography (CECT) was done, which revealed venous infarction in occipital cortex and subcortical white matter. Magnetic resonance (MR) venography confirmed thrombus in left transverse and sigmoid sinuses. Thus, definitive treatment in the form of heparin in therapeutic doses was started. Antihypertensive was continued and prophylactic anticonvulsant was added in view of presence of the infarction. Patient responded well. Vision improved, and headache resolved completely. The patient was discharged on antihypertensive, anticonvulsant and vitamin K antagonist (Warfarin sodium) with an advice of regular follow-up. Cerebral venous thrombosis (CVT) is an uncommon entity and a high index of suspicion is needed to diagnose it at an earlier stage for timely initiation of treatment and prevention of complications. Prognosis in pregnant cases is better than that during a non-pregnant state.
Gestational trophoblastic neoplasia (GTN) is a subset of gestational trophoblastic disease (GTD) which has a propensity to invade locally and metastasize. Patients with low risk GTN generally respond well to single agent chemotherapy (methotrexate (MTX) or actinomycin-D (ACT-D). However, high risk cases may develop resistance or may not respond to this first-line chemotherapy and are unlikely to be cured with single-agent therapy. Therefore, combination chemotherapy is used for treatment of these cases. Here we present a 25 years old P2 L2 A1 lady, who was initially treated at a peripheral hospital with multiple doses of Injection methotrexate with a working diagnosis of persistent trophoblastic disease. She didn’t respond to this treatment and reported to our centre for further management. On evaluation she was found to be a case of high risk GTN (invasive mole) (I:8) for which she was put on combination chemotherapy in the form of Etoposide-Methotrexate-Actinomycin-Cyclophosphamide-Oncovin (EMA-CO) regime. She responded to this treatment and is presently asymptomatic and is under regular follow up.
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