Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.
Lipoma is the most common benign tumour in hand. Lipoma in hand of size more than 5 cm is classified as Giant Lipoma. Lipoma of larger sizes is rare in hand because of accessibility and lesser subcutaneous tissues. Large lipoma interferes in the hand functions. Lipoma in dominant hand is usually noted early and gets operated. This case is of 65 year old female patient who reported with the swelling in right hand for past 25 years. The size of the lipoma was big and asymptomatic till the presentation. The swelling was investigated and surgically removed which was diagnosed histopatholoically as Intermuscular Thenar Lipoma .
Case report 30 year old woman known to have Charcot-Marie- tooth disease was booked at 9 weeks of her first pregnancy. Her grandmother, mother, sister, cousin all had CMT disease. As she was aware of the mode of inheritance she didn't want to undergo any pre-natal investigation. Neurologist and anaesthetist opinion was sought and normal delivery was planned. An ultrasound at 28 weeks showed a normal growth. She had a consultant led care in the hospital. She had membrane sweep at 39 weeks of gestation. Induction of labour was done at 40 weeks of gestation. The labour was progressed normally and spontaneous vaginal delivery was achieved. Discussion CMT is one of the most common heterogeneous groups of inherited peripheral neuropathies. CMT1 is caused by mutation in one of several gene expressed in Schwann cells. Electrophysiologic studies show slowing of nerve conduction. CMT1A is characterised clinically by variable degree of motor and sensory impairment which is progressive. Some patients are almost asymptomatic, while others lose their ability to walk. Pre-natal diagnosis is feasible using this molecular genetic method or using multicolour fluorescence in situ hybridisation [FISH]. In our case the woman didn't want to undergo this. Presentation abnormalities, prematurity, growth restriction occurs more frequently in CMT patients when compared to general population which is not in our case. The disease can get worse in pregnancy but didn't in this case.
Background: Women with congenital uterovaginal agenesis have normal development of all secondary sexual characteristics. They face the cruel fact of being unable to bear children and enjoy sexual satisfaction. Good neo vaginal reconstruction is important in improving functional and psycho social impacts to womanhood. The aim of the study was to compare the three commonly done surgical procedures for vaginal reconstruction.Methods: All the vaginal agenesis patients who attended Department of plastic surgery Madras Medical College, Chennai during the period from August 2004 to April 2007 were included in our study.Results: In Abbe McIndoe procedure, graft take was full in all 7 cases with good cosmetic appearance. Flaps survived in all 10 patients underwent pudendal thigh flap surgery. 2 patients underwent horse shoe shaped labia minora flaps. The cosmetic appearance was fair because of the distortion of the labia. The mean vaginal depth obtained was 8 cm and width was 2 cm.Conclusions: Cosmetic appearance was good in patients who underwent McIndoe procedure as the genitalia were not distorted. Contracture rate was more in patients who underwent McIndoe procedure especially who were irregular in using stents. Flap procedure especially pudendal thigh flaps which has the least contraction rate is the preferable treatment option for such patients.
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