Objectives: To study the clinical profile of the patients presenting with neurological disorders during pregnancy and puerperium.
Background: Tubal sterilization is considered a permanent method of contraception. The risk of failure of tubectomy is only 0.1-0.3%. Most often the pregnancy following tubal sterilization is ectopic gestation.Methods: 35 cases of post sterilization ectopic gestation were evaluated during a period of January 2014 to December 2015 at Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh, India.Results: Number of post sterilization ectopic gestation were (n=35) 33%, in 105 ectopic gestations during this period. 93% were in the age group of 20-30years with a mean age of 30.5years. 82% were gravida three who underwent sterilization with two living children. 62% of women presented with 4-6 weeks of amenorrhoea. 97.14% underwent minilaparotomy and out of which 74% were performed in Government hospitals. Puerperal sterilizations constituted 85%. In all cases ectopic gestation occurred within 10years of undergoing sterilization and all cases presented with hemoperitoneum. Site of rupture is ampulla in 31.4% of cases. Length of remaining tube is 7-8cm in 60% of cases.Conclusions: History of tubal sterilization does not rule out the possibility of ectopic gestation even when many years after the tubectomy. Adopting correct technique can reduce the failure rates. Woman should be counselled about the possibility of intra and extra uterine gestation at the time of performing tubectomy.
Sertoli-Leydig cell tumor or "Androblastoma" or "Arrhenoblastoma" is a rare virilizing tumor of ovary, mostly with masculinizing features. Many but certainly not all tumors are hormonally active. Although classified under malignant tumors the degree of malignancy is less than that of ovarian carcinoma in general. Unilateral oophorectomy was done and the patient recovered well with diminution of masculinizing features.
CASE REPORT: A 20yrs old G3,P1, L1, A1 with h/o previous cesarean section with 5months of amenorrhea presented to Government General Hospital, Kakinada, AP, India with bleeding PV and pain abdomen since 16 days. On enquiry it was found that she underwent medical termination of pregnancy 20 days back at a private hospital for five months of pregnancy followed by profuse bleeding per vagina and D&E was done for the same complaint 16days back followed by intractable bleeding on table. She was transfused with one unit of blood and referred to Government General Hospital, Kakinada.At the time of admission patient was pale with a BP 110/70mmHg, pulse 76/min and afebrile. On examination suprapubic transverse scar was present with tenderness over suprapubic region. Uterus is around 14-16 weeks size. Per vaginal examination revealed opened cervical so with bleeding through os, uterus 14-16weeks size tender, mobile, fornices are free.On Investigations her hemoglobin was 6gm%, with normal clotting profile. Sonography revealed retained products of conception and MRI showed a rent of about 2x1 cm in the lower uterine segment with a low intense are suggestive of blood clot. 3units of compatible blood transfused. As there is no bleeding patient was discharged after observing for 10 days.After 1 week patient came to hospital with bout of bleeding with pallor and BP 90/60mmHg and one unit of blood transfused. In view of recurrent bleeding episodes emergency laparotomy was planned.On opening the peritoneum bladder was drawn up and densely adherent to lower uterine segment. Uterus contracted with ballooned out lower uterine segment. A rent of 2cm found in the lower uterine segment. While dissecting the lower uterine segment bladder was injured and repaired with suprapubic cystostomy. On cut section around 500gms clots were present in lower uterine segment and cervical canal. Postoperative period was uneventful and patient discharged on 7 th postoperative day with supra pubic catheter in situ. Cut section of uterus showing blood clot over scar rupture
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