Journal of South Asian Federation of Obstetrics and Gynaecology

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2018 | October-December | Volume 10 | Issue 4S1

EDITORIAL

PELVIC CONGESTION SYNDROME

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:1] [Pages No:0 - 0]

Keywords: Embolization, Pelvic congestion syndrome (PCS), Pelvic venous reflux (PVR), Transvaginal USG (TVS), Varicosities

PDF  |  DOI: 10.5005/jsafog-10-4-iv  |  Open Access |  How to cite  | 

Abstract

Pelvic congestion syndrome (PCS) is a common but poorly understood gynecological disorder characterized by noncyclical dull aching lower abdominal or pelvic pain usually in multiparous females in reproductive age group as a result of pelvic vein varicosities. This pain gets intensified during prolonged standing, menstruation and pregnancy due to congestion and dilatation of pelvic veins.   Transvaginal ultrasonography (TVS) with Doppler of pelvic veins is the investigation of choice for diagnosis of PCS and transcatheter embolization of the affected veins (generally ovarian vein) is the effective treatment for PCS.

Original Article

Jai Kishan Goel, Akansha Mani, Rahul Goyal, Milan Jaiswal, Shanti Sah

Cervical Cytology and its Correlation with Cervicovaginal Infection in Antenatal Patients: A Study in a Tertiary Care Hospital

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:4] [Pages No:293 - 296]

Keywords: Cervical intraepithelial neoplasia, Human papillomavirus, Pap smear, Wet mount

PDF  |  DOI: 10.5005/jp-journals-10006-1611  |  Open Access |  How to cite  | 

Abstract

Aim: To study cervical cytology and cervicovaginal infection in antenatal women. Objectives: To find out by pap smear for inflammatory, atypical squamous cells of undetermined significance (ASCUS), atypical glandular cells of undetermined significance (AGUS) and premalignant lesions in antenatal women.   • To find out cervicovaginal infection by wet mount among antenatal women.   • Correlation of cervical cytology with cervicovaginal infection. Materials and methods: Five hundred antenatal women, irres- pective of gestational age, were enrolled as subjects in this prospective clinical study for blood investigations, wet mount examination of cervical discharge and pap smear. Results: Out of 500 smears, 385 women were having inflammatory smears out of which 301 were having bacterial vaginosis followed by 89 vaginal candidiasis followed by 12 were having trichomoniasis, in which 339 had a preterm delivery. Conclusion: Antenatal visits are a potential opportunity to perform screening by Pap smear and wet mount study to prevent preterm labor and improve perinatal mortality.

Original Article

Suzanna Daud, Akmal ZM Zahid, Bahiyah Abdullah, Mariam Mohamad

Knowledge and Practice of Seat Belt Use among Pregnant Women

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:5] [Pages No:297 - 301]

Keywords: Accident, Antenatal, Car, Car restraint, Pregnancy, Seat belt

PDF  |  DOI: 10.5005/jp-journals-10006-1612  |  Open Access |  How to cite  | 

Abstract

Aim: Our study aims to determine the prevalence of seatbelt use in pregnancy and associated factors of the correct seat belt use. Materials and methods: This is a cross-sectional survey of the pregnant women who presented to the antenatal clinic of a tertiary medical center for 12 months. Patients were selected by using a systematic random sampling method. Face-to-face interview by trained interviewers was done to collect data, based on 11 questions survey. Participants’ knowledge on correct placement of both the lap and shoulder belt was assessed using a representative diagram. Results: Eighty pregnant women participated in the interview. Their mean age was 30 (± 3.85) years old, 76.3% of them attained post-secondary school education, and the majority (68.8%) was multigravida. Only 20 (25%) women knew the correct use of the seatbelt. There were no significant associations between knowing the correct use of seatbelt with the women\'s age (p = 0.18), educational level (p = 0.10), gravidity (p = 0.21), gestation (p = 0.44) and status of ever receive information on seatbelt usage (p = 0.07). The highest source of information was from printed materials A total of 66 (82.5%) women drove during pregnancy and 74 (92.5%) were passengers. Six of the participants were neither a driver nor a passenger as they were public transport users. More than half (57.6%) of the drivers will always use a seatbelt, but only 43.2% will always use a seatbelt when they were passengers. More than 80% of those who did not always wear a seatbelt either as drivers or passengers stated feeling uncomfortable as a reason for noncompliance. Conclusion: There is lacking in awareness of the importance and correct seat belt use in pregnancy among the pregnant women. Steps should be taken to increase the correct usage of seatbelts to reduce maternal and fetal mortality due to road traffic accidents.

Original Article

Nidhi Jha, N Gopal

A Study on Maternal and Perinatal Outcome in Referred Obstetric Cases of Gestational Age More Than 28 Weeks in a Rural Medical College Hospital

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:8] [Pages No:302 - 309]

Keywords: Maternal outcome, Perinatal outcome, Referred cases

PDF  |  DOI: 10.5005/jp-journals-10006-1613  |  Open Access |  How to cite  | 

Abstract

Background: Indian women of a child bearing age (15–45 years) constitutes 22% of the population. They are a vulnerable special group. The risk is due to pregnancy and childbearing. To decrease this risk and improvement of the maternal and perinatal outcome, a referral system has been introduced which decreases the risk by improving service delivery at the tertiary center level, by reducing the workload, by strengthening the infrastructure in the peripheries and by the effective utilization of this by the patients. Major causes of referral to a tertiary center includes preterm labor, preeclampsia, eclampsia, previous CS, Rh negative blood group, antepartum hemorrhage, postpartum hemorrhage and sometimes due to lack of manual resources. Liking the different levels of care was an essential element of primary health care from the very beginning. Objectives: To identify the primary reasons and pattern of obstetric case referral to our hospital and to study the maternal and perinatal outcome in those cases. Materials and methods: One hundred and fifty consecutive obstetric referred cases of more than 28 weeks gestation admitted to Sri Adichunchanagiri Hospital and Research Centre were analyzed for the maternal and perinatal outcome. Results: In this study of the total studied patient\'s majority were in the group 21–25 years constituting about 60.6%. Nearly 38.7% of the referral was from THQ covering the areas like Nagamangala, Kunigal, Turuvekere and Channarayapattana. 28.7% were from PHC, 12% were from CHC, 6.7% from district hospital and 14% of the referral were from private hospital. Analyzing at the quality of referral according to the predefined criteria only 48% of the cases had adequate referral whereas about 28% of the cases had poor referral most of which were from the PHCs. About 58.8% of the patients delivered vaginally, with about 41.2% of the patient delivered by cesarean section. In the vaginally delivered cases 8.7% was instrumental delivery, 1.4% was breech delivery and 10.7% patient delivered after induction. In the present study major indication of the cesarean section include dystocia 29.1%, fetal distress with or without meconium aspiration 20.9%, hypertensive disorders of pregnancy 17.7%, repeat section 11.3%, malpresentation 8.1% and others 12.9%. About 86.1% of the referral has been made with an obstetric indication.12.6% of the referral had a medical indication for referral. Only 1.3% of the cases had a lack of manual resource as an indication for referral. Preterm labor and PROM accounted for about 20% of the referral. Hypertensive disorders were the next commonest cause of referral of about 13.3% of the cases. In the present study, there were a total of 126 live births, 5 stillbirths and 7 early neonatal deaths making the perinatal mortality rate (PNMR) of 95.23 per 1000 live births. Perinatal outcome was best for patients with age group of 21–25 years and was worst for the age group for more than 30 years. Interpretation and conclusion: Although better than the national data, there is indeed no doubt that rural health care infrastructure is falling short of the existing requirement. However, educating the population about the existing health care delivery system and sensitizing the public toward improving maternal and child health would go a long way in optimally utilizing the existing infrastructure and improving the maternal and perinatal outcome.

RESEARCH ARTICLE

Amy I Soenggono, Zulvayanti , Tita H Madjid, Wiryawan Permadi, Jusuf S Effendi

Correlation of Progesterone Receptor B in Endometrial Tissue of Menstrual Blood in Patients with and without Endometriosis

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:6] [Pages No:310 - 315]

Keywords: Degree of endometriosis, Endometriosis, Menstrual blood, Progesterone receptor B, Quantitative real-time-polymerase chain reaction

PDF  |  DOI: 10.5005/jp-journals-10006-1614  |  Open Access |  How to cite  | 

Abstract

Background: Endometriosis is a progressive chronic gynecological disease. There are indications that endometriosis patients have lower progesterone receptor B (PR-B) levels. Menstrual blood contains the same mRNA derived from endometrium cells. The objective of this study was to analyze the different levels of PR-B in the menstrual blood of women with endometriosis compared to nonendometriosis. Materials and methods: A case control study was conducted on 42 women administered to the Gynecology and Reproductive Endocrinology and Fertility Clinic FKUP/Dr Hasan Sadikin Hospital and its networks from December 2016 to January 2017. Through interviews, physical examination and investigation, patients were classified as those with endometriosis and non-endometriosis patients as controls. Surgery was performed to obtain lesion biopsy for endometriosis degree determination and storage. Quantitative RT-PCR for the PR-B mRNA in the menstrual blood samples was performed. Based on the histopathology results and diagnostic confirmation, differences in the PR-B levels in menstrual blood endometrium for endometriosis cases and non-endometriosis women were assessed. Differences in the PR-B levels between endometriosis patients with mild and severe degrees were also investigated. Results: In patients with endometriosis, the mean and median levels of PR-B was significantly lower than non-endometriosis (p <0.05). ROC analysis resulted in a cutoff value of ≤1.1355 μg/dL with 90.5% sensitivity, 81% specificity and 85.7% accuracy for prevalence odds ratio (POR) at 7.85. The PR-B levels strongly inversely correlated with the degree of endometriosis (rs = –0.817; p <0.001). Conclusion: The levels of PR-B in eutopic endometrial tissue of menstrual blood in patients with endometriosis is lower than those in nonendometriosis women. A higher degree of endometriosis is correlated with lower levels of PR-B in patients with endometriosis.

RESEARCH ARTICLE

Rizal Sanif, Wahyu Sulistiadi, Heriadi Manan, Rachmat Hidayat

Cost-effectiveness Analysis on Advanced Cervical Carcinoma Patients at Dr Mohammad Hoesin General Hospital Palembang, South Sumatra, Indonesia

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:5] [Pages No:316 - 320]

Keywords: Advanced cervical carcinoma, Chemotherapy, Chemoradiation, Cost-effectiveness analysis

PDF  |  DOI: 10.5005/jp-journals-10006-1615  |  Open Access |  How to cite  | 

Abstract

Introduction: The management of advanced cervical carcinoma still faces many obstacles in developing countries like Indonesia, and this has an impact on the efficacy of treatment and delays in treatment. Objective: To compare the cost-effectiveness on advanced cervical carcinoma management between among patients treated with fully dosed chemotherapy once every in three weeks, and chemoradiation combination therapy in divided doses chemotherapy with radiation every week. Methods: A retrospective study has been done from January to December 2014 at Mohammad Hoesin, General Hospital in Palembang. There were 105 patients newly diagnosed with advanced cervical carcinoma who fulfilled the criteria inclusion and divided into two groups; 66 patients were in the chemotherapy group and 39 patients were in the chemoradiation group. The total cost from diagnosis to treatment was analyzed by using activity-based costing (ABC) and cost-effectiveness ratio (CER) methods between chemotherapy and chemoradiation. Result: This study showed that there were 64.76% of patients revealed a positive reaction to the chemoradiation and 57.57% to the chemotherapy. These differences wsere caused by the price of medical devices (62.48 % for chemotherapy, 67.6628% for chemoradiation). On the other hand, the operational cost for chemotherapy was cheaper than of chemoradiation, 1, 502, 444, 446 IDR and 1, 591, 510, 404 IDR, respectively. The maintenance cost of chemotherapy was lower than the maintenance cost of chemoradiation. The total budget of chemotherapy for cervical carcinoma management (43, 345, 805) was cheaper than of the total budget of chemoradiation therapy (80, 644, 767). The CER for chemoradiation is lower than the CER for chemotherapy in terms of complete, partial or progressive clinical responses. Conclusion: It can be concluded that the use of chemoradiation modality was more effective than the use of chemotherapy.

RESEARCH ARTICLE

Vineeta Gupta, Amrita Makhija, Nidhi Kumari, Rashmi Kumari

Comparative Study of Vaginal and Cesarean Section Delivery for Fetuses in Breech Presentation

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:7] [Pages No:321 - 327]

Keywords: Breech presentation, Cesarean breech delivery, Vaginal breech delivery

PDF  |  DOI: 10.5005/jp-journals-10006-1616  |  Open Access |  How to cite  | 

Abstract

Objective: The present retrospective study was carried out to compare the maternal and fetal outcome in patients with breech presentation who delivered vaginally versus who delivered by cesarean section. The study also provided us with an opportunity to analyze the demographic and clinical profile between the two groups. Materials and methods: The study was conducted in the Obstetrics Unit of Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Indiresh Hospital, Dehradun throughout 2 years. All patients admitted to the labor room with a singleton fetus in breech were included in the present study. All the patients were studied for their demographic profile, parity, gestational age, high-risk factors, mode of delivery, an indication of cesarean delivery and neonatal outcome. Maternal and neonatal outcome was compared between the patients who delivered vaginally versus who delivered by cesarean section using standard statistical methods. Results: A total of 266 patients with breech presentation were included in the study, of which 95 (35.71%) were delivered vaginally, 118 (44.36%) underwent emergency cesarean section and 53 (19.92%) had an elective cesarean section. Out of 266, 145 (54.51%) women were nulliparous and 121 (45.49%) were multiparous. Both emergency and elective cesarean rates were more frequent in nulliparous women. The average period of gestation increased from 34.03 ± 4.04 weeks in the vaginal breech delivery group to 37.71 ± 2.48 weeks in the emergency cesarean group and 39.17 ± 0.92 weeks in the elective cesarean group. The most common indication for emergency cesarean delivery was refusal for the trial of vaginal delivery present in 52.54% and elective cesarean delivery it was primigravida with the breach in 47.17%. The average birth weight of vaginally delivered babies was 1.819 ± 0.70 kg, for those delivered by emergency cesarean section it was 2.540 ± 0.66 kg and for those delivered by elective cesarean section it was 2.942 ± 0.50 kg. A total of 218 Apgar scores were compared excluding 37 patients who presented with IUD, 9 stillbirths and 2 patients with gross congenital malformations. It was noted that 65.38% of vaginally delivered babies had Apgar score of more than 7 at 5 minutes of birth as compared to 87.61% of babies delivered by emergency cesarean section and 100% of babies delivered by elective cesarean section. Overall 85.32% of babies had Apgar score more than 7 at 5 minutes of birth. There was no maternal mortality and no significant maternal morbidity in the different groups. Conclusion: The present study concludes that planned vaginal delivery of both preterm and term breech in a carefully selected patient can be conducted after proper counseling of the patient with strict intrapartum monitoring and presence of obstetricians trained in the art of conducting breech deliveries.

RESEARCH ARTICLE

Poonam Jaiswal, Sunita Agrawal, Arun K Dora

Outlet Forceps Delivery: Role in Modern Obstetric Practice

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:7] [Pages No:328 - 334]

Keywords: Fetal outcome, Instrumental delivery, Maternal injuries, Outlet forceps, Prospective cohort study

PDF  |  DOI: 10.5005/jp-journals-10006-1617  |  Open Access |  How to cite  | 

Abstract

Aim: The dramatic rise of cesarean section rate is a global problem. The forceps delivery has also led to numerous litigations due to poor fetal and sometimes maternal outcome. Still, it is having a prominent role to reduce the rate of cesarean section deliveries. The aim of this study was to assess feto maternal outcome in outlet forceps delivery. Methods: A prospective cohort study of 92 patients who delivered by outlet forceps conducted in the department of obstetrics and gynecology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh, India. The result was analysed for Fetomaternal outcome over a period of 1 years from 15 October 2015 to 14 October 2016. Results: Incidence of Wrigley\'s outlet forceps delivery is 2.76% in our study. The most common indication was nonreassuring fetal heart rate (40.21%). Nearly 70.65% babies had normal APGAR score. 43.48% neonates had birth weight between 2.5–3 kg. Neonatal morbidities found in this study were impression marks over face in 18.47%, convulsions in 6.52%, neonatal hyperbilirubinemia and subconjunctival hemorrhage in 3.26% each, hypoxic ischemic encephalopathy in 2.17% and facial palsy in 1.09% neonates. Only 5.43% neonates required NICU stay of more than seven days. Extended episiotomy was observed in 6.76% and only three patients had atonic PPH. Cervical tear, first-degree perineal tear, traumatic PPH and vulvovaginal hematoma were observed in 2.7% patients each. 1.35% patients had a paraurethral tear, second and third degree perineal tear each. No maternal or fetal mortality due to forceps found in our study. Conclusion: Use of forceps is a safe alternative to cesarean section deliveries. The rates of maternal and perinatal morbidity and mortality in outlet forceps delivery are negligible and comparable to normal delivery in experienced hands.

REVIEW ARTICLE

Tanitra Tantitamit

Different Techniques for Evaluation of Urologic Complication during Laparoscopic Gynecologic Surgery: A Review

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:5] [Pages No:335 - 339]

Keywords: Cystoscopy, Gynecologic surgical procedure, Wound and injuries, Review, Ureter, Urinary bladder

PDF  |  DOI: 10.5005/jp-journals-10006-1618  |  Open Access |  How to cite  | 

Abstract

Aim: To summarize the previous studies in the literature regarding different strategies to detect urinary tract complication during intraoperative cystoscopy. Background: The routine cystoscopy at the time of laparoscopic hysterectomy could be detected almost all bladder and ureteral injuries by visualizing ureteral jet after indigo carmine injection. Since, there was a shortage of Indigo carmine, various alternative methods have been suggested. Review results: In this report, we conducted literature research in which 382 articles were identified. A total of 15 relevant articles were evaluated in full. We provide a review of the existing literature regarding the technique and effectiveness of each strategy in the evaluation of urologic complication during intraoperative cystoscopy. We also summarized and compared the properties, dosing, adverse effect, contraindication and cost among of each method. Conclusion: There is not enough evidence to indicate the best strategy. Further studies are required. However, this information may guide the physicians to choose the most suitable method proper for their practices. Clinical significance: Not enough data to determine which agent is superior to use at the time of cystoscopy. The surgeon should weight risks against benefits of each strategy. Not only the satisfactory but also the feasibility, safety, and costs should be considered.

CASE REPORT

Banumathy Manikkam

Benign Tumor Mimicking Malignancy

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:3] [Pages No:340 - 342]

Keywords: Complex cyst, Malignancy, Neoplasm, Struma ovarii, Tracheostomy

PDF  |  DOI: 10.5005/jp-journals-10006-1619  |  Open Access |  How to cite  | 

Abstract

In routine gynecological practice, benign tumor mimicking malignancies are rarely thought of as differential diagnosis. It is always mandatory to consider malignancy as the first diagnosis so that the clinician\'s approach will be with a bird\'s eye view. The diagnosis of malignancy will have a pronounced bearing mentally for the affected women. We confronted one such interesting case in our institution. The patient had undergone prior surgeries and recovered from serious postoperative complications. In addition, she poses a higher risk for anesthesia. Above all, to counsel the patient and the family about the impact of the current problem is a Herculean task. The scenario takes a different upturn with the histopathology report. The effort by the multidisciplinary team proves fruitful.

CASE REPORT

Nasira Tasnim, Kausar T Bangash, Ayesha Hanif, Aathar Sayed

Frequency of Bacterial Isolates and Antimicrobial Sensitivity Pattern in Urogenital Fistulae: An Eight Years Audit

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:4] [Pages No:343 - 346]

Keywords: Bacterial isolates, Urinary tract infection, Vesicovaginal fistula

PDF  |  DOI: 10.5005/jp-journals-10006-1620  |  Open Access |  How to cite  | 

Abstract

Objective: To determine the frequency of urinary tract infection, distribution of microorganisms and their antimicrobial susceptibility pattern in urogenital fistula patients. Place and duration of study: Eight years (April 2007–June 2015) at Mother And Child Health Centre, Shaheed Zulfiqar Ali Bhutto Medical University–Pakistan Institute of Medical Sciences (SZABMU–PIMS), Islamabad, a regional fistula center. Study design: Descriptive study. Patients and methods: All fistula patients entertained in MCH Center PIMS from April 2007 to June 2015 underwent detailed evaluation workup including baseline investigations. The specimen of urine was taken in sterile culture bottle and sent to a laboratory for biological evaluation. The data of all the patients was prospectively maintained from 2007–2015 and was analyzed using the statistical package for social sciences (SPSS) version 21. The main outcome measures included the frequency of urinary tract infection, distribution of bacterial isolates, and their susceptibility to antibiotics. Results: During the study period 407 patients presented with urogenital fistula. The majority, n = 322, 79.1%, patients were of the reproductive age, i.e., below 40 years. The majority n = 342, 84% were Illiterate and n = 383, 94% were housewives. The culture result was available in 259 (64%). Of these bacterial isolates were found in 169 (65.2%) patients, Candida species in 8 (3%) patients while no organisms were found in remaining patients. Of 169 bacterial isolates, gram-negative isolates were found in 160 (94%) patients followed by gram-positive isolates in 6 (3.5%) and both, gram positive and gram negative isolates in 3 (2%) patients. Klebseilla and E.coli was the most frequently occurring organisms (33% and 29%, respectively) followed by Pseudomonas. The highest sensitivity of bacterial isolates was found for Amikacin, imipenem, piperacillin, and tazobactam. The highest resistance was seen for amoxicillin + clavulanic acid, third generation antibiotics, quinolones, and nalidixic acid. Conclusion: Urinary tract infection is prevalent among urogenital fistula patients. The resistance to most commonly prescribed low-cost oral antibiotics highlight the importance of prescribing antibiotics according to culture and sensitivity pattern and avoidance of injudicious use of antibiotics in fistula patients.

CASE REPORT

Palaniappan Narayanan, Lakshmanan Sakthikumar, Sivasundari Maharajan, Priyanka Mehta

Making Mothers out of Grandmothers

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:4] [Pages No:347 - 350]

Keywords: Advanced maternal age, Cesarean section, Placenta previa, Ventricular fibrillation

PDF  |  DOI: 10.5005/jp-journals-10006-1621  |  Open Access |  How to cite  | 

Abstract

Background: Almost 1 in 12,000 births result in a maternal cardiac arrest; the incidence of which is higher among women with factors such as hypertension, diabetes, hemorrhage, abnormal placentation, and advanced maternal age. Case description: A 48-year-old primigravida, known hypertensive and diabetic and conceived by fetal embryo transfer was referred at 29 weeks and 1 day of gestation with painless bleeding P/V and was diagnosed with placenta previa. She was managed conservatively and given steroids for fetal lung maturity and magnesium sulfate for neuroprotection. She had a similar episode 10 days later, and 2 days after this, in the middle of the night she had profuse painless bleeding, and fetal heart rate of twin 2 was nonreassuring. The patient was taken up for emergency cesarean section and given general anesthesia. After delivery of the twins, the patient developed ventricular fibrillation. She was resuscitated within 3 minutes and monitored in the ICU. Both the twins were of low birthweight and admitted in the NICU. The patient gradually recovered and was discharged on postoperative day 9. The babies were discharged 1 month after birth. Conclusion: The cause of the ventricular fibrillation was multifactorial and involved autonomic imbalance, hypovolemia, the stress of advanced maternal age and comorbidities such as hypertension and diabetes mellitus. Clinical significance: It is important to be aware of the etiolo- gy and management of a cardiac arrest and blood loss during pregnancy and labor. C-sections must be avoided as much as possible in an advanced maternal age group.

CASE REPORT

Hemlata Kuhite, Sharayu Mirji, Sangeeta Shingatgeri, Ganesh Shinde

A Rare Case of Morbidly Adherent Placenta in a Primigravida

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:4] [Pages No:351 - 354]

Keywords: Adherent placenta, Conservative management, Primigravida, Uterine artery embolization

PDF  |  DOI: 10.5005/jp-journals-10006-1622  |  Open Access |  How to cite  | 

Abstract

Aim: To report the occurrence of adherent placenta in the absence of prior risk factors and discuss the various management options especially conservative management. Background: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. Morbid adherence of placenta has evolved into one of the most serious problems in obstetrics. The incidence has increased tenfold in the past 50 years due to the increasing number of cesarean sections and has reached seemingly epidemic proportions. The American College of Obstetricians and Gynaecologists cites the incidence to be as high as 1 in 533 deliveries. Case report: We report a case of placenta increta in a primigravida successfully managed by a conservative method with injection methotrexate followed by uterine artery embolization. Conclusion: Selected cases of morbidly adherent placenta can be successfully managed conservatively. With proper selection of cases and adequate monitoring, modern conservative techniques have made preservation of fertility possible. Clinical significance: Only four cases of the adherent placenta in primigravida without any risk factors have been reported in the literature. Fertility preservation is a major concern in the management of these patients.

CASE REPORT

Latika Chawla, Sandeep Mathur, Sunesh Kumar

Growing Teratoma Syndrome: An Enigma

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:3] [Pages No:355 - 357]

Keywords: Conversion, Immature teratoma, Ovarian mature teratoma

PDF  |  DOI: 10.5005/jp-journals-10006-1623  |  Open Access |  How to cite  | 

Abstract

The phenomenon of growing teratoma syndrome (GTS) is a curious entity well recognized in testicular nonseminomatous germ cell tumors (NSGCT), but rare in ovarian immature teratomas. It involves the conversion of immature to mature components during or after chemotherapy with further growth in the size of the lesions but containing only mature elements on histopathology, which could be clinically confused with malignant recurrence. Treatment involves complete surgical excision. Prognosis is usually favorable if the disease if completely resected, however mortalities even though rare have been reported. We herein describe two rare cases, with clinical features, diagnosis, complications, and management of the condition.

CASE REPORT

Keeranmayee Mishra, Chirag Parikh, Malini Desai, Tushar Shah, Pallavi Ninama

Cesarean Scar Pregnancy: A Case of Conservatively Managed Clinical Rarity

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:3] [Pages No:358 - 360]

Keywords: Cesarean scar pregnancy, Ectopic, Methotrexate, Ultrasound

PDF  |  DOI: 10.5005/jp-journals-10006-1624  |  Open Access |  How to cite  | 

Abstract

Background: Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy in which implantation occurs in the scar of a previous cesarean section. Due to increased incidence of cesarean section and first-trimester scan worldwide, more and more cases are diagnosed and reported nowadays. Case report: A 25 years G3P2A0L2 patient with previous two LSCS was referred and admitted in an emergency with chief complaints of one and half months amenorrhea followed by bleeding per vaginum for 2 days preceded by intake of MTP pills 8 days back. Her general condition was fair. The patient was investigated with routine investigations, transvaginal ultrasound, Doppler and beta hCG. Ultrasonography (USG) and color Doppler findings were suggestive of cesarean scar pregnancy. Conservative management with methotrexate was done with strict follow-up. The GSAC completely resolved by 72nd and day of diagnosis. Second look scopy at the time of tubal ligation reaffirmed the diagnosis and resolution of the scar pregnancy.

CASE REPORT

Rama Garg, Parneet Kaur, Namita Chopra

A Rare Case of Placenta Accreta Presenting as Placental Polyp

[Year:2018] [Month:October-December] [Volume:10] [Number:4S1] [Pages:3] [Pages No:361 - 363]

Keywords: Myometrium, Placenta accreta, Placental polyp

PDF  |  DOI: 10.5005/jp-journals-10006-1625  |  Open Access |  How to cite  | 

Abstract

Placental polyp is an intrauterine polypoidal or pedunculated mass of placental tissue retaining for an indefinite period after delivery or abortion. Because of its rarity, the literature contains few references, and there are great varieties not only on its diagnosis but also the management. We present a rare case of placenta accreta presenting as a uterine polyp. This is the only one case diagnosed at our hospital and managed conservatively.

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