This is an audit on medical management of patients with urinary stress incontinence (USI) with Duloxetine. The objective of this audit is to assess the efficacy & tolerability of duloxetine in patients with USI. The audit has shown good efficacy of the medication but due to poor tolerance most of the patients could not continue with it for long. Patient selection, commencing duloxetine at a lower dose and counselling about its side effects are important consideration. Although surgery is also the mode of treatment for USI, the medical treatment is reserved for patients who are elderly and not fit for surgery.
Vasa praevia is a real nightmare for obstetricians if not diagnosed prenatally. We report five cases of vasa praevia with different presentations and outcomes. In the first case, vasa praevia was not diagnosed during the antenatal period and the baby was stillborn due to ruptured fetal vessels. In the other four cases, vasa praevia was diagnosed in antenatal period and all the cases had good outcomes. In one case there was evidence of marginal and velamentous cord insertion in the same placenta. Pregnancies were terminated in three cases by elective caesarean section with good perinatal outcome. In one case vasa praevia and placenta praevia resolved in third-trimester, and the baby was delivered vaginally. In all cases placental location was low lying at second-trimester anomaly scan. Hence it is important to check placental site cord insertion and presence of blood vessels near internal os in high risk cases in the second and third-trimester.
Congenital mesoblastic nephroma (CMN) is a rare renal tumor, but the commonest tumor of early infancy. It can be detected prenatally as a renal mass and is associated with prematurity, polyhydramnios, and neonatal hypertension. We report a case of congenital mesoblastic nephroma which presented as a large unilateral solid renal mass detected at 33 weeks of gestation associated with oligohydramnios and small for gestational age (SGA) fetus. Ultrasound features were a large hypoechoic mass arising from the upper pole of the Left kidney measuring 52 9 43 9 32 mm. Inside the mass there were incomplete septae and a few cystic areas, likely hemorrhagic areas, with minimal peripheral vascularity. The mass was surrounded by a hyperechoic capsule. The left adrenal gland could be imaged separately. The baby was delivered by a lower segment cesarean section (LSCS) at 38 weeks of gestation. After birth, the baby presented with a mass per abdomen with no other symptoms and no hypertension. CT scan and ultrasound guided biopsy confirmed the finding of the cellular variant of congenital mesoblastic nephroma. Left radical nephrectomy with adrenal gland conservation was performed on day 8 of life. Postoperative adjuvant chemotherapy was administered. On follow-up, the baby is asymptomatic with no relapse or metastasis. Fetal CMN and Wilms tumor have overlapping ultrasound features and are difficult to differentiate on prenatal ultrasound. Prenatal detection of fetal renal tumors and timely neonatal management improve perinatal outcome.
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