Uterine rupture in pregnancy is very rare and potentially catastrophic for both mother and foetus. The most common cause of uterine rupture is giving away of previous caesarean uterine scar. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present a rare case of a spontaneous complete uterine rupture in a non-labouring unscarred uterus of a 33-year-old nulliparous woman at 35 weeks of gestation. She presented with lower abdomen pain and decreased foetal movements at Institute of Obstetrics and Gynaecology, Chennai. Even before getting into labour, patient suddenly collapsed, and emergency laparotomy was proceeded in view of suspicious concealed abruption. There was frank hemoperitoneum along with a dead baby in the abdominal cavity. There was rupture of uterine fundus extending from one cornual end to the other and closure of uterine rent proceeded. Spontaneous rupture of uterus occurs when there is an upper segment uterine scar. She had a past history of eventful uterine curettage which was the risk factor for uterine rupture.
INTRODUCTIONSexually transmitted infections (STIs) are a major global cause of acute illness, infertility and long-term disability associated with severe medical and psychological consequences. WHO estimated that 340 million new cases of syphilis, gonorrhoea, chlamydia and trichomoniasis have occurred throughout the world in 1999 in men and women aged 15-49 years. The largest number of infection occur in the region of South East Asia followed by African countries 1 .There are more than 20 pathogens that are transmissible through sexual intercourse. Many of them are curable by appropriate antimicrobial treatment. ABSTRACT Background: Sexually transmitted infections (STIs) present a huge burden of disease and adversely affect the reproductive health of people. The disease prevalence is about 6% in India. This study is done to determine the prevalence of STIs in women of reproductive age (15-49yrs) attending gynaec outpatient block at Institute of Obstetrics and Gynaecology, Chennai and to identify the risk factors. Methods: It is a prospective analytical study conducted at IOG from Febraury 2010 to January 2011 where 1000 women of reproductive age attending gynec op were included of which 500 women were asymptomatic and 500 women were symptomatic for STIs. A well-structured proforma was prepared for selection of women, history, examination, investigations and treatment. Asymptomatic women were also screened and treated. Partners were also screened and treated. Depending upon the statistical data, the risk factors were identified and analysed. Results: Overall prevalence of STI was 27.2% of which 22.5% was in symptomatic group and 4.7% in asymptomatic group. Bacterial vaginosis was the commonest STI. The important risk factors identified were age group between 26-30 years, high risk sexual behaviours, poor socioeconomic factors, poor menstrual hygiene and lack of contraception. Conclusions: STIs cause major health problem and it is important to diagnose and treat them at the earliest. The importance of STIs has been more widely recognised since the advent of the HIV/AIDS epidemic, and there is good evidence that their control can reduce HIV transmission. Women diagnosed with one STI should be screened for other STI due to coexistant infections. Screening and treatment of partners and follow-up tests of cure should be performed wherever possible.
Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives.
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