We describe a 29-year old pregnant woman with history of primary hypothyroidism and impaired glucose tolerance presenting in her third trimester with preeclampsia and virilization. Initial investigations revealed markedly elevated serum testosterone, 17 hydroxy-progesterone and a non-suppressed serum cortisol following overnight dexamethasone. Imaging of the adrenals proved normal. At lower segment caesarean section, she had markedly enlarged ovaries with multiple haemorrhagic cysts; compatible with hyperreactio luteinalis. At two months postpartum, there was complete resolution of biochemical hyperandrogenemia with normalization of ovaries. Other causes of virilization such as late onset congenital adrenal hyperplasia, Cushing's syndrome and placental aromatase deficiency were excluded.
Objective: To evaluate the feasibility of different management options of ectopic pregnancy in a local setup. Methods: This was a descriptive cross sectional study carried out at the Teaching Hospital, Peradeniya, Sri Lanka. All the patients who were diagnosed to have ectopic pregnancy during the study period of one year (2008) were included. The data collection was completed at the time of discharge of each patient. Information included, age, parity, period of gestation, clinical presentation, risk factors for ectopics, diagnosis (transvaginal scan and beta hCG) and type of treatment options (open surgery, laparoscopy, medical management and expectant management). A descriptive analysis of data was done in 21 patients with ectopic pregnancies. Results: Twenty one ectopic pregnancies were managed during the study period. A majority of cases (clinically stable patients with small gestational sac) 76% (16/21) were managed using treatment options, with continuous monitoring of each patient other than open surgery. Four clinically unstable patients and one patient with a large ectopic sac were subjected to laparotomy, while 8 clinically stable patients were offered laparoscopy, 7 systemic administrations of methotrexate and expectant management. Conclusions: It was found that most of the cases could be managed by treatment options other than open surgery. Early detection, clinical stability and size of the ectopic sac were
Spontaneous rupture of uterine vessels during pregnancy is a life-threatening condition though, it has a rare occurrence. This case report discusses about a 32-year-old lady at 16 weeks of gestation presented with spontaneous rupture of uterine artery and she was managed with emergency laparotomy with suturing of ruptured artery. She had delivered a healthy baby after 37 weeks of gestation by a caesarean section due to pregnancy induced hypertension at 36 weeks of gestation.
Spontaneous rupture of uterine vessels during pregnancy is a life-threatening condition though, it has a rare occurrence. This case report discusses about a 32-year-old lady at 16 weeks of gestation presented with spontaneous rupture of uterine artery and she was managed with emergency laparotomy with suturing of ruptured artery. She had delivered a healthy baby after 37 weeks of gestation by a caesarean section due to pregnancy induced hypertension at 36 weeks of gestation.
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