Background: Adnexal torsion accounts for 2.7% of gynecological emergencies. Early diagnosis can help prevent irreversible damage to ovary. Objective of this study was to analyze the clinical, radiological and pathological characteristics of surgically proven cases of ovarian torsion. Methods: Observational study was carried out from January 2006 to June 2014. Medical records of 38 cases of adnexal torsion were selected and analyzed retrospectively for age, parity, risk factors, clinical presentation, presence of leukocytosis, gray scale ultrasound and colour Doppler features, management, pathological results and postoperative outcome. Results: Adnexal torsion occurred most commonly in reproductive age group (mean 27.89 years) of whom 3 were pregnant. 42% had known risk factors commonly prior pelvic surgery (52.63%) and prior tubal ligation (31.58%). Symptoms include sudden abdominal or pelvic pain (94.74%), vomiting (60.53%) and fever (21.05%). Gray scale USG showed mixed echogenic mass (36.84%), homogenously echogenic cyst (34.21%) anechoic cyst (26.32%) and free fluid (23.68%). Doppler showed absent arterial and venous flow in 52.63%. Cases were managed by detorsion & cystectomy (42.11%), unilateral salpingooophorectomy (47.37%), bilateral salpingooophorectomy (5.26%) and TAH with BSO (5.26%). Histopathology revealed benign serous epithelial tumors (31.58%), mucinous tumors (21.05%), mature teratoma (10.53%), corpus luteal cyst (5.26%), follicular cyst (2.63%) paraovarian cyst (13.16%), endometriotic cyst (2.63%) and ovarian hemangioma (2.63%). Conclusions: High index of suspicion &prompt surgical intervention is necessary to preserve ovarian function even if Doppler shows vascularity. Though detorsion and cystectomy is the choice, salpingooophorectomy may be needed in infracted ovaries and older women. Higher incidence of serous & mucinous tumors in our study suggests reappraisal of ovary sparing surgery for all patients as advocated by few.
Background: High-risk pregnancy is one in which the mother, foetus or the newborn has an elevated risk of experiencing an adverse outcome. These high-risk women form a special vulnerable cohort that can be identified in the antenatal period using a simple, easy to use, cost-effective tool- a maternal risk scoring system. Early identification of these high-risk mothers will facilitate effective intervention strategies to deal with the complications.Methods: This study was carried out on 300 pregnant women with gestational age more than 28 weeks. Detailed history, examination and necessary investigations were done and then using the Modified Coopland scoring system, each pregnant woman was assigned a risk score and stratified into 3 risk groups- low risk (0-3), moderate risk (4-6) and high risk (≥7) and followed up till delivery and 7 days postpartum. Subsequently, the maternal and perinatal outcomes were compared with their respective scores.Results: In this study, 14.66% patients belonged to the high-risk category. Statistically, a significant difference was noted in the number of low-birth-weight babies, in 5 minutes APGAR score <7 and in NICU admissions in the high-risk group compared to the low-risk group. Overall perinatal mortality was 13.33/1000 live births. In the high-risk group, a significant difference was seen in the occurrence of PPH and the need for operative delivery.Conclusions: Significant association between high-risk pregnancy and the poor maternal and perinatal outcome was noted. Therefore, a simple, cost-effective high-risk pregnancy scoring system such as the one proposed in this study can be used to identify potential high-risk pregnancies, provide them with tertiary care facilities and also corrective measures can be undertaken to prevent or minimize the complicating factors.
INTRODUCTIONEctopic pregnancy results when a fertilized oocyte implants outside the endometrial cavity. It is the leading cause of morbidity and mortality for women during first trimester of pregnancy. Ectopic pregnancy accounts for approximately 2% of all pregnancies. Recent reports indicate that the incidence of ectopic pregnancy has increased six fold during the last 30 years.1,2 This apparent increase in ectopic pregnancy owes to a true increase in disease due to increase in number of patients with risk factors, heightened awareness by clinicians and earlier diagnosis of cases that otherwise would have spontaneously resolved. 95% of ectopic pregnancies occur in fallopian tube and out of which 55% occur in ampulla, 20-25% isthmus, 17% fimbriae, 2-4% in interstitial segment, Other sites of ectopic pregnancy are
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