Objective To determine the maternal and perinatal outcome after expectant management of severe pre-eclampsia between 24 and 34 weeks of gestation. Method The maternal and fetal status was monitored by an intensive, non-invasive method among 94 women with severe pre-eclampsia between 24 and 34 weeks of gestation who were scheduled for expectant management in the OICU at a tertiary care center. Pregnancy prolongation and maternal and perinatal morbidity and mortality were analyzed by the Student 't' test and the Mann-Whitney U test. Results The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at \30 weeks. Increasing gestational age correlated with a reduction of RDS. Maternal morbidities were significantly higher among those managed at\28 weeks. But, there was no maternal mortality. Conclusion Expectant management of severe preeclampsia at 30-34 weeks in a tertiary care center of a developing country is associated with good perinatal outcome and risk reduction for the mother.
Scar endometriosis is an uncommon condition in which endometrial tissue grows in a previous surgery wound site. The triad of scar endometriosis includes the history of caesarean section or any other gynecological surgery, cyclical waxing, and waning pain accompanied by the patient's menstrual cycle and a tumor inside/near the scar site. Here, we present a case report in which the patient presented with endometriosis at the previous caesarean section scar site. She had classical clinical and imaging characteristics for scar endometriosis. However, histopathology was not diagnostic for the same. The pathogenesis, presentation, diagnosis, and management are discussed briefly. The diagnosis of scar endometriosis is based on clinical presentation and imaging. Fibrosis on histopathology is an important component of endometriosis that cannot be overlooked.
At 19 weeks 6 days ultrasonography of a 31-year-old G2P1L1 revealed a small echogenic area seen in the subvalvular apparatus of the mitral valve (anterior mitral leaflet) suggestive of cardiac rhabdomyoma (CR). At 28 weeks of gestation there was mild increase in the size of the CR (13 × 6 mm). There was no evidence of hemodynamic compromise. The interval growth of the fetus was satisfactory. The family tree of three generations was examined and revealed no evidence of Tuberous Sclerosis. She delivered a live 34 weeks 2.2 kg male baby with 8 and 9 Apgar scores at 5 and 10 minutes respectively. Baby suddenly developed cyanosis and died 24 hours after birth. The fetal autopsy confirmed the diagnosis of CR. Genetic analysis of neonatal blood revealed no evidence of TSC mutation suggestive of tuberous sclerosis.
Background Ca cervix is the most common cancer among women in developing countries. In developed countries, screening is done by Pap smear which is resulting in drastic decrease in ca cervix which is not so in developing countries due to various reasons. So visual inspection of cervix can be cost effective screening procedure if its efficacy is proved in low resource countries. OBJECTIVE: To determine which screening method is efficient in detecting premalignant & malignant lesions of ca cervix in resource poor settings. METHODS: Pap smear was done in all 600 women, along with this VIA in 200 women, VILI in 200 women was done. Either pap or VIA or VILI positive cases were selected for colposcopy followed by biopsy if positive findings were there on colposcopy. 10% of either screening negative cases were subjected for biopsy to know false negative rate from each group. Main outcome measures: comparison of all three screening methods (pap smear, VIA, VILI) in terms of sensitivity, specificity, PPV, NPV in comparison with gold standard colposcopic guided cervical biopsy. RESULTS: The aided visual inspection has more PPV than pap smear, The sensitivity of all three screening methods were comparable. The specificity & NPV of pap smear were high. CONCLUSION: So the aided visual inspection can be used as screening method in detection of premalignant and malignant lesions of cervix in place of papsmear especially in rural setting.
Background: Delivery of fetal head through uterine incision is often the major technical problem during low transverse cesarean section when the presenting part is unengaged. Techniques to deliver head under special circumstances are traumatic to both mother and fetus. This study aims to establish the role of vectis in extraction of fetal head during lower segment cesarean section (LSCS) and to assess associated difficulties or untoward effects of use of vectis over manual method.Methods: The study was undertaken in PESIMSR, Kuppam, Andhra Pradesh over two years. Vectis was used in extraction of fetal head in LSCS in 100 cases of full term pregnancy and maternal and neonatal outcomes were compared with 100 cases of manual extraction.Results: Incision-delivery time interval was similar in both vectis and manual extraction method (p value of 0.390). Vectis group did not require any fundal pressure for extraction of head where as 100% of women in manual extraction group required fundal pressure (p value: <0.001) which is statistically significant. The length of abdominal incision for majority of cases in vectis group was smaller and statistically significant compared to manual extraction group (p value of 0.001). Neonatal outcomes were similar in both the groups.Conclusions: As per our study, usage of vectis has shown significant advantage in reducing maternal discomfort caused due to fundal pressure and length of abdominal incision required, with negligible difference in neonatal and other maternal outcomes in comparison to manual method of extraction.
A 20 years old primigravida who presented to us at 36 weeks 3 days gestation with labor pains. She was perceiving fetal movements well, booked and immunized at a private hospital in Hosur. On examination, she was 7 cm dilated, well effaced, breech at 0 station. She was taken up for emergency lower segment cesarean section (LSCS) in view of primi with breech and mother not willing for vaginal delivery. An alive term 3.5 kg female paraphagus dicephalus twins was extracted. Extraction was difficult. Apgar was 3 at 1 minute and 5 at 5 minutes. The babies died after 45 minute. External examination showed that the twins were conjoined from the level of thorax downward. The twins had two heads, two upper limbs and a shared thorax, abdomen, pelvis and a single female external genitalia and single pair of lower limbs with CTEV (dicephalus, dibrachius, dispinous, thoraco-omphalopagus twins). How to cite this article Kirtan K, Doopadapalli D, Shailaja N, Krishna L, Bhat BS. An Interesting Case of Undiagnosed Conjoined Twins. Donald School J Ultrasound Obstet Gynecol 2015;9(3):327-330.
To evaluate the role of non-descent vaginal hysterectomy in advancing gynaecological practice and to study the safety and feasibility of performing vaginal hysterectomy for non-prolapsed uterus as primary route in benign gynaecological condition. METHODS: A prospective study of 120 cases was conducted at the department of obstetrics and gynaecology of PES institute of medical sciences and research from January 2012 to December 2014 120 patients planned for hysterectomy for a wide range of benign indications like fibroid uterus, AUB, adenomyosis were chosen for non-descent vaginal hysterectomy. Data regarding age, parity, uterine size, and estimated blood loss, length of operation, intra-operative and postoperative complications and hospital stay were recorded. RESULTS: A total of 120 cases were selected for non-descent vaginal hysterectomy. Among them 113(94.16%) cases successfully underwent non-descent vaginal hysterectomy. Majority were aged 40-45 years (53.33%) with 8 nullipara and 21primipara. Commonest indication was fibroid (58%) and largest uterine size was 16 weeks. Different morcellation techniques were used in more than 10weeks sized uterus. Adnexal surgeries were performed in 11 cases without much difficulty. In uncomplicated cases average blood loss was 200 ml and operating time was 60minutes. Most of the patients were discharged by 4 th post-operative day, 7 patients were converted to abdominal route due to various difficulties, 3 patients had bladder injury and 1 patient was subjected to laparotomy due to hemoperitoneum post operatively. CONCLUSION: Proper training and proper case selection can lead a gynecologist to consider the vaginal approach as the standard route for hysterectomy and good patient compliance
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