Journal of South Asian Federation of Obstetrics and Gynaecology

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2019 | November-December | Volume 11 | Issue 6

EDITORIAL

SV Singh

Corona Virus Disease (COVID-19) and Pregnancy: What Obstetrician Should Know

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:337 - 339]

PDF  |  DOI: 10.5005/jp-journals-10006-1744  |  Open Access |  How to cite  | 

Original Article

Santosh Kumar Dora, Atal B Dandapat, Benudhar Pande, Ganeshram Bhoi, Bhawana Tiwari

A Prospective Study to Compare the Maternal and Fetal Outcomes among Sickle Cell Disease and Trait Women

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:340 - 344]

Keywords: Sickle cell anemia, Sickle cell crisis, Sickle cell disease, Sickle cell trait

PDF  |  DOI: 10.5005/jp-journals-10006-1724  |  Open Access |  How to cite  | 

Abstract

Introduction: We conducted a prospective trial to compare the maternal and fetal outcomes between the sickle cell disease (SCD) and sickle cell trait (SCT) pregnant patients. Materials and methods: From December 2015 to December 2016, a total of 59 patients were diagnosed with SCD and 119 patients with SCT. All the fetal and maternal parameters were compared between them. Results: A total of 17 (28.8%) SCD and 5 (4.2%) SCT patients presented with painful crisis. Acute chest syndrome developed in 9 (15.3%) of SCD and 1 (0.8%) of SCT cases. Hemolytic crisis was seen in 4 (6.8%) of SCD patients. The incidence of hypertension, preeclampsia, jaundice, blood transfusion during pregnancy, and IUGR among the SCD and SCT patients were 11 (18.6%) vs 5 (4.2%) (p = 0.000), 19 (32.2%) vs 7 (5.9%) (p = 0.000), 15 (25.4%) vs 0 (0%) (p = 0.000), 36 (61%) vs 8 (6.7%) (p = 0.000), and 33 (55.9%) vs 21 (17.6%) (p = 0.000), respectively. The mean periods of gestation of delivery were significantly lower, i.e., 36.5 ± 2.76 weeks for SCD patients compared to 38.2 ± 2.1 weeks for SCT patients (p = 0.000). Ten (16.9%) of SCD and one (0.8%) of SCT patients had intrauterine death. Average birth weights of babies delivered were 2142 ± 557.45 g and 2684 ± 551.23 g for SCD and SCT patients, respectively. Conclusion: Sickle cell anemia causes an increased risk to both mother and fetus. Sickle cell disease women are more prone to develop sickle cell crisis as well as increased obstetrical complication. A preconceptional counseling of all sickling women with a multidisciplinary approach can prevent many of the maternal and fetal complications during pregnancy.

Original Article

Samia Husain, Rahila Imtiaz, Sonia Husain, Rubina Izhar

Utilization of Blood and Appropriateness of Blood Transfusion in a Department of Obstetrics and Gynecology in Karachi

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:345 - 348]

Keywords: Blood utilization, Maximal surgical blood ordering schedule, Transfusion

PDF  |  DOI: 10.5005/jp-journals-10006-1725  |  Open Access |  How to cite  | 

Abstract

Aim: To assess the utilization of blood and appropriateness of blood transfusion using utilization indices in the gynecology and obstetrics department of a tertiary care center. Materials and methods: A retrospective observational study was carried out in Gynae unit 3 of Abbasi Shaheed Hospital from July 1, 2016, to December 31, 2016. For this study, case records of all women who had an elective or emergency procedure were compiled and reviewed. The blood utilization indices, cross-matched to the transfusion ratio (C/T ratio = number of units cross-matched/number of units transfused), transfusion probability (%T = number of patients transfused/number of patients cross-matched × 100), and transfusion index (TI = number of units transfused/number of patients cross-matched) were calculated for all. Results: A total of 598 patients underwent major elective and emergency surgical procedures in the department. These patients were requested to prepare 1,074 units of blood. From a total of 1,074 units cross-matched, 374 were transfused. Thus, only 34.8% of the cross-matched blood was utilized. Of the 598 patients for whom blood was cross-matched, only 279 (46.65%) patients were transfused. The overall blood transfusion indices of the requested blood, C/T ratio, %T, and TI, were 2.87, 46%, and 0.62. Conclusion: Our study showed underutilization of blood in terms of cross-matched to the transfusion ratio but the probability of transfusion and the transfusion index were appropriate. Clinical significance: Blood ordering practices need to be reviewed periodically in all units.

Original Article

Samar Rudra, Ashu Yadav

Efficacy of Diabetes in Pregnancy Study Group India as a Diagnostic Tool for Gestational Diabetes Mellitus in a Rural Setup in North India

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:349 - 352]

Keywords: Diabetes in Pregnancy Study Group India, Gestational diabetes mellitus, International Association of the Diabetes and Pregnancy Study Group, World Health Organization

PDF  |  DOI: 10.5005/jp-journals-10006-1731  |  Open Access |  How to cite  | 

Abstract

Objective: To study the efficacy of Diabetes in Pregnancy Study Group India (DIPSI) as a diagnostic tool for gestational diabetes mellitus (GDM). Introduction: A simple, convenient, and patient-friendly method of diagnosing GDM by DIPSI criteria has been questioned by many workers. Hence, this study was undertaken to compare DIPSI to gold standard International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria to determine diagnostic accuracy of DIPSI. Materials and methods: This cross-sectional study was conducted in the department of obstetrics and gynecology in a rural medical college in North India. It included 800 pregnant women with gestational age 24–28 weeks, who underwent plasma glucose (PG) evaluation 2 hours after the challenge of 75 g glucose load irrespective of their fasting state (DIPSI criteria for GDM). After 7 days, standard 75 g OGTT was done in all women irrespective of previous PG value. Blood glucose was tested by glucose oxidase peroxidase method. Accuracy of the DIPSI result was compared with OGTT using cutoffs as per standard criteria for the diagnosis of GDM. Results: Of all 800 cases, 48 cases either did not report for the second visit in time or could not tolerate oral glucose. Of the remaining 752 cases analyzed, 620 cases found to be normal both by DIPSI and IADPSG criteria, 81 patients detected to have GDM by both criteria. In 30 patients, DIPSI detected GDM, but IADPSG criteria values were within normal limit. A total of 21 patients found to be GDM by IADPSG criteria, but DIPSI values were within normal limit. When compared with IADPSG, DIPSI found to have a sensitivity of 79.41%, specificity of 95.39%, positive predictive value of 72.97%, negative predictive value of 96.73%, and diagnostic accuracy of 93.23%. Conclusion: In conclusion, DIPSI method of screening antenatal women for GDM is found to be simple, cost-effective, easy to perform, patientfriendly, and convenient. On comparing results to gold standard IADPSG, DIPSI shows high specificity and acceptable sensitivity. A statistical analysis has shown that if a cutoff value of blood sugar is lowered to 136 from 140, the sensitivity and specificity of DIPSI criteria improve further.

Original Article

Sathya Selvarajan, Jothimalar Ramalingam, Zachariah Bobby

Serum Progesterone Measurement in Diagnosis of Ectopic Pregnancy

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:353 - 355]

Keywords: β-Human chorionic gonadotropin, Ectopic pregnancy, Gestational age, Pregnancy, Progesterone, Serial measurement, Serum biomarker, Ultrasonography

PDF  |  DOI: 10.5005/jp-journals-10006-1732  |  Open Access |  How to cite  | 

Abstract

Aim: The implantation of the fertilized ovum outside the normal uterine cavity is termed an ectopic pregnancy (EP). Progesterone an important hormone in the regulation and maintenance of pregnancy has been studied with limited validation as a biomarker of this condition. The aim of this study was to determine whether a measurement of progesterone could discriminate an EP from a normal pregnancy. Materials and methods: Serum levels of progesterone were measured by direct chemiluminescence in 140 women with EP and 140 women with normal pregnancy at Sri Ramachandra Medical College and Research Institute, Chennai, India. Statistical analyses were performed using SPSS software version 16.0, and a p value of less than 0.05 was considered significant. Results: The mean progesterone level in EP was 6.4 ng/mL. This was significantly lower than the value of 24.6 ng/mL in normal pregnancy. Receiver operating characteristic (ROC) curve analysis revealed that at a cutoff of 16.22 ng/mL, progesterone was able to distinguish an EP from a normal pregnancy with a sensitivity of 98.6% and specificity of 87.1%. Conclusion and clinical significance: Progesterone measurement in women in early pregnancy can be used to rule out an EP. Especially in the time window of 4–6 weeks of gestation where ultrasonography is inconclusive, we have to rely on biomarkers like progesterone to resolve the treatment modalities at the earliest.

Original Article

Shifa S Ibrahim, Kamaleshwari Kesavaraj, Muthumani Arun, Syed AM Ameen, Raasi Sankar

Review of Cervical Carcinoma Screening Program in Tamil Nadu, the Current Trend and Recommendations from a Histopathologist’s Viewpoint

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:7] [Pages No:356 - 362]

Keywords: Acetowhite, Dysplasia, Human papillomavirus, Vaccine

PDF  |  DOI: 10.5005/jp-journals-10006-1735  |  Open Access |  How to cite  | 

Abstract

Objective: Cervical carcinoma, the commonest carcinoma affecting Indian females, is caused by human papillomavirus (HPV) infection. Primordial prevention and primary prevention with HPV vaccine and cancer screening, respectively, can go a long way in preventing this carcinoma. The health system project in Tamil Nadu has done a commendable job in reducing the disease burden by introducing screening program for cervical carcinoma at the grassroots level way back in 2005. This study was done to evaluate the cervical biopsy specimens received as a part of this program to compute its incidence, compare the incidence among various districts, and suggest future directions based on our observations. Materials and methods: From the visual inspection with acetic acid (VIA)/visual inspection with Lugols iodine (VILI) positive cervical biopsy specimens, 506 were chosen randomly from various districts. Based on histopathological examination, incidence of individual lesions and district-wise incidence were calculated. Predictive factors that determine the progression of these lesions were analyzed based on the literatures. Results: Out of the 506 cervical biopsy specimens, 34 were unsatisfactory. The incidence of high-grade dysplasia peaked around 31–40 years and squamous cell carcinoma peaked among 51–60 years. Madurai ranked high in the incidence of both high-grade dysplasia and carcinoma. Conclusion: Incidence of dysplasia and carcinoma in our study was comparable with that seen in the literatures. Integration of HPV DNA studies into the program can increase the detection rate, detect the progressors, and helps in identifying the HPV species prevalent in an area and formulating cost-effective HPV vaccine cocktail.

Original Article

Ankita Mathur, Lata Rajoria, Aditi Bansal, Sunita Hemani, Jyotsna Vyas

Role of Placenta Accreta Index in Patients with Placenta Previa with Previous Cesarean: A Prospective Study

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:363 - 367]

Keywords: Accreta, Adherent placenta, High risk pregnancy, Increta, Obstetric emergency, Placenta accreta index score, Percreta, Postpartum hemorrhage, Previous cesarean, Ultrasound score

PDF  |  DOI: 10.5005/jp-journals-10006-1738  |  Open Access |  How to cite  | 

Abstract

Objective: This study intends to assess the role of placenta accreta index (PAI) score as a prenatal diagnostic tool for abnormally invasive placenta in cases of placenta previa with a history of prior cesarean. Study design: This is a prospective, noninvasive, and observational study. Setting: This study was conducted in a hospital based in Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur, Rajasthan (India). Sample size and population: Eighty pregnant females presenting at or above 28 weeks of gestation with placenta previa and a history of one or more prior cesarean. Materials and methods: Cases underwent ultrasonography to find out PAI score (published in American Journal of Obstetrics and Gynecology 2014), and findings were analyzed statistically to find out appropriate cutoff value of PAI score. They were correlated with magnetic resonance imaging (MRI) and operative finding, while confirming the diagnosis histopathologically. Main outcome measures: Primary outcome was the cutoff value and diagnostic efficacy of PAI score. Secondary outcomes were fetomaternal outcomes in cases. Results: Severity of placenta accreta increased with increasing value of PAI score. On plotting receiver operating characteristic (ROC) curve, the area under curve (AUC) was found to be 0.958 with a cutoff value of >2. The sensitivity, specificity, positive predictive value, and negative predictive value of PAI score were found to be 92.86, 94.74, 95.10, and 92.30%, respectively. Conclusion: Placenta accreta index score can be a useful tool to anticipate individual patient risk, and a higher PAI score is a strong indicator of placenta accreta. Tweetable abstract: Placenta accreta index score can be used as an ultrasonographic prenatal diagnostic tool for placenta accreta.

Original Article

Chethana Bolanthakodi

Technicity Index: A Quality Indicator to Improve Patient Care

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:368 - 370]

Keywords: Laparoscopic hysterectomy, Minimally invasive surgery, Non-descent vaginal hysterectomy, Technicity Index

PDF  |  DOI: 10.5005/jp-journals-10006-1741  |  Open Access |  How to cite  | 

Abstract

Introduction: Hysterectomy is a common gynecological procedure performed worldwide. Most of the international guidelines state that whenever feasible, they have to be performed vaginally or laparoscopically or with laparoscopic assistance as it is beneficial to patients. But majority are still being done by laparotomy. Minimally invasive surgery (MIS) is being widely adopted nowadays, and we need quality and performance indicators to analyze their benefits. One such indicator is technicity index (TI). Technicity is defined as the number of hysterectomies performed vaginally [non-descent vaginal hysterectomy (NDVH)] and laparoscopically [laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH)] over the total number of hysterectomies performed in a particular health facility, in a year. Objective: To determine the TI from January 2014 to December 2018. Materials and methods: This was a retrospective, observational study in which the approach to all hysterectomies performed during January 2014 to December 2018 was recorded at Father Muller Medical College, Mangaluru. Hysterectomies done for obstetric indications and malignancies were excluded. The routes adopted for all types of hysterectomies were calculated, and the TI was calculated for every year. Results: In total, 2,268 hysterectomies were performed in 5 years, of which 222 (9.7%) were laparoscopic, 301 (13.27%) vaginal, and 1,745 (76.94%) total abdominal hysterectomies. The TI ranged from 17.21% to 29.11%. The average index for 5 years was 23.05%. Conclusion: Technicity index can be used to monitor shift toward minimally invasive procedures in our department. Assessing our level of care is necessary to effectively modify patient care. We can approach a higher TI by allocating resources to teach and provide MIS.

ORIGINAL RESEARCH

Mahishale Arati, Joyner C Mesquita

Association of Premenstrual Syndrome with Body Mass Index, and its Effect on the Quality of Life: A Cross-sectional Study

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:371 - 374]

Keywords: Body mass index, Moos menstrual distress questionnaire, Premenstrual syndrome, Quality of life, SF-36 questionnaire

PDF  |  DOI: 10.5005/jp-journals-10006-1746  |  Open Access |  How to cite  | 

Abstract

Background: Retrospective community surveys estimate that nearly 90% of women have experienced premenstrual syndrome (PMS) at least once. Premenstrual syndrome is more prevalent among younger women. It also affects the quality of life (QOL) negatively to such a degree that work and lifestyle may get affected. Objective: To find the association between PMS and body mass index (BMI) and its impact on the QOL. Materials and methods: A total of 207 females in the 18–25 years age group were screened using Moos menstrual distress questionnaire (MMDQ) for PMS, of which 57 volunteers were diagnosed with PMS. Baseline characteristics were recorded, BMI was calculated, and the QOL of all subjects was measured with the SF-36 questionnaire. Outcome measures: Body mass index, MMDQ, and SF-36 questionnaire were the outcome measures. Results: The results showed a significant association between PMS and physical component summary (PCS; r value = −0.4228, p value = 0.0011) also between PMS and mental component summary (MCS; r value = −0.4326, p value = 0.0008). However, the correlation between PMS and BMI was found to be insignificant.

RESEARCH ARTICLE

Manisha Verma, Sumitra Bachani

Correlation of Digital Vaginal Examination with Transabdominal Ultrasound to Assess Fetal Head Position during Active Labor

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:6] [Pages No:375 - 380]

Keywords: Active management of labor, Antenatal ultrasound, Digital vaginal examination, Fetal head position

PDF  |  DOI: 10.5005/jp-journals-10006-1726  |  Open Access |  How to cite  | 

Abstract

Introduction: An accurate intrapartum assessment of the fetal head position (FHP) is considered important for the management of both normal and abnormal labors. The position of the fetal head influences the obstetric outcomes such as labor dystocia, choice of instruments for assisted delivery, and the success of vaginal delivery. It is well accepted that the FHP is an important determinant of success of vaginal delivery, with the occiput anterior (OA) positions favoring mostly good labor outcomes, while the occiput posterior (OP) and occiput transverse positions having a higher rate of instrumental delivery or cesarean section.5–7 Digital vaginal examination (DVE) for determination of FHP can be subjective and inaccurate. This study was aimed to compare transabdominal ultrasound with DVE for determination of FHP during active labor. Materials and methods: This is a prospective observational study at Vardhman Mahavir Medical College and Safdarjung Hospital. Low-risk pregnant women in active labor with singleton fetus in vertex presentation were enrolled in the study. Digital vaginal examination and transabdominal sonography were done for the assessment of FHP in the first and second stages of labor and prior to instrumental vaginal delivery. Labor and neonatal outcomes were recorded. Statistical analysis: Categorical variables were presented in number and percentage, and continuous variables were presented as mean ± standard deviation (SD) and median. Qualitative variables were correlated using Chi-square test. Interrater κ agreement was used to find out the strength of agreement between FHP by DVE and ultrasonography (USG). A p value of <0.05 was considered statistically significant. The data were entered in MS Excel spreadsheet, and the analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The absolute agreement between DVE and transabdominal sonography for determining FHP was 55.82% in the first stage of labor, and the composite accuracy was 77.01% when FHP in DVE was assigned as correct within ± 45° in transabdominal sonography (κ = 0.538 and p ≤ 0.0001). The absolute agreement between DVE and transabdominal sonography for determining FHP was 66.27% in the second stage of labor, and the accuracy was improved by 20.30% when FHP in DVE was assigned as correct within ± 45° in transabdominal sonography (κ = 0.606 and p ≤ 0.0001). Ultrasound was able to correctly diagnose and facilitate instrumental delivery in the OA and occiput transverse positions. Κ showed moderate concordance (0.560). Majority (96%) of the women chose transabdominal ultrasound as the preferred modality for the FHP assessment as it is less obtrusive procedure than DVE, while 4% women had an equivocal response. Conclusion: Digital vaginal examination can fail to detect the correct FHP due to the presence of tense bag of membranes, caput succedaneum, and molding in active labor. A higher percentage of the occiput transverse and OP positions can be misdiagnosed on vaginal examination. Transabdominal ultrasonography (TAS) should be used to correctly determine the FHP in such conditions. Clinical significance: Transabdominal ultrasonography should be used to confirm the FHP prior to instrumental delivery and cesarean section, which will facilitate correct application and prevent intrapartum complications.

RESEARCH ARTICLE

Shailesh Pande, Sunmeet Matkar, Anurita Pais, Gauri Pradhan, Yamini Jadhav, Chaitali Parab, Bharat Kalthe

Frequency of Chromosomal Abnormalities in Products of Conception: A Retrospective, Large-scale, Single-center study

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:381 - 384]

Keywords: Fluoroscent in situ hybridization, Laboratory research, Products of conception, Recurrent pregnancy losses

PDF  |  DOI: 10.5005/jp-journals-10006-1743  |  Open Access |  How to cite  | 

Abstract

Background: The cause of miscarriage is successfully elucidated by analyzing the cytogenetic analysis of the retained products of conception (POC). From our understanding, we have not come across any large population-based study in India that analyzed the POC for identifying the cause of miscarriage. Objectives: This laboratory-based research study aimed at finding the incidences of chromosomal defects from large number of POC samples received from tertiary care laboratory. Materials and methods: The current study comprises retrospective analysis involving cytogenetic reports of large number of cases (n = 1,732) undertaken at the Department of Cytogenetics, Metropolis Healthcare Laboratory, Mumbai, India, between January 2014 and December 2016. Results: Karyotypes with no abnormal findings were recorded in 82.97% cases, whereas aneuploidy was detected in 17.03% cases. Among the aneuploidy cases, they were further categorized into monosomy X (38.14%), trisomy (36.02%), double trisomy (0.85%), triploidy (15.25%), tetraploidy (8.90%), and derivatives (0.85%). Among the total study cases, 76.33% and 23.67% showed female pattern and male pattern, respectively. Conclusion: Evaluation of POC is of immense help for the cases with history of recurrent/repeated pregnancy loss (RPL)/losses. Early detection of chromosomal aberrations will support the treating physician toward correct reasons for RPL. Also, it also helps to rule out the possibility of gonadal cell mosaicism in cases with RPL having a normal karyotype. Cases with abnormal findings are highly recommended for genetic counseling.

REVIEW ARTICLE

Bhadana Priyanka, Kiran Abha, Richi Khandelwal, Khandelwal Madhu

Novel Therapies in Management of Stress Urinary Incontinence

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:385 - 388]

Keywords: Genital prolapse, Incontinence, Levator ani, Menopausal problems, Pelvic floor dysfunctions, Pelvic floor muscle exercise, Pelvic organ prolapse, Stress, Urodynamic studies

PDF  |  DOI: 10.5005/jp-journals-10006-1730  |  Open Access |  How to cite  | 

Abstract

Female urinary incontinence (UI) is a common problem affecting 40% of women, but it is usually understated. It not only is a medical problem but has a larger impact on a women’s social and psychological life. It is often not reported by women especially Indian women as they tend to accept it as a part of aging or a consequence of childbirth. In this review, we would be focusing on female stress UI (SUI) and newer therapies that can help improve the symptoms and lifestyle of such women. Pregnancy, childbirth, menopause, obesity, advanced age, and race and ethnicity are some common risk factors for SUI. The underlying mechanism includes pudendal nerve denervation, loss of ligamentous support of the urethral complex leading to dysfunction of the levator ani muscles, endopelvic fascia, and muscular urethra causing UI. Many treatment options are available for treating UI, such as lifestyle changes, pelvic floor muscle training (PFMT), bladder training, and electromagnetic stimulation of the pelvic floor muscles, and the surgical procedures—Burch colposuspension and bladder‐neck slings and their various modifications. Traditionally, surgery forms the mainstay of management but now focus is towards minimally invasive and non-surgical techniques which could improve the quality of life in such patients. Newer therapies for SUI Management includes the drug-duloxetine, laser therapy and stem cell therapy.

CASE REPORT

Rajeev Agarwal, Apoorva P Reddy, Ankita Kaushal

Umbilical Cord Constriction: A Case Report

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:389 - 391]

Keywords: Constriction, Cord anomaly, Cord compression, Intrauterine foetal death, Still birth, Umbilical cord

PDF  |  DOI: 10.5005/jp-journals-10006-1727  |  Open Access |  How to cite  | 

Abstract

The reason for sudden antenatal death syndrome (SADS) are not well established. Umbilical cord accidents (UCA) are one of the causes of SADS. In UCA, umbilical venous and/or umbilical arterial flow is compromised and leads to intrapartum death of the foetus. Presenting here is a case report of cord constriction leading to late second trimester intrauterine foetal death.

CASE REPORT

Olivia Daniel, G Usha Rani, PSNRS Sirisha

Cervical Pregnancy: Modes of Management

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:392 - 396]

Keywords: Ectopic pregnancy, Management, Methotrexate

PDF  |  DOI: 10.5005/jp-journals-10006-1736  |  Open Access |  How to cite  | 

Abstract

Aim: To identify the various conservative methods available for the management of ectopic pregnancy. Background: Cervical pregnancy is a rare variant of ectopic. It is associated with high morbidity and mortality. Earlier hysterectomy was the treatment of choice. But now, various conservative methods are used to preserve fertility. Here, we present four cases, each managed with a different method. Case description: This was an analysis of cervical ectopic pregnancies in our hospital. The diagnosis of cervical pregnancy was made using transvaginal ultrasound. Serum β-human chorionic gonadotropin (β-hCG) levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Medical management involved administration of systemic or intra-sac instillation of methotrexate, with or without intra-amniotic potassium chloride, suction and evacuation with the use of Foley’s tamponade, and uterine artery embolization. Conclusion: This article shows that the conservative management is safe and effective. Clinical significance: Ectopic pregnancy can be managed with the conservative methods other than resorting to hysterectomy.

CASE REPORT

Marie Christine Valerie Mendoza

Large Port Site Hematoma Following Laparoscopic Surgery and Its Management

[Year:2019] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:397 - 399]

Keywords: Complication, Laparoscopy, Port site hematoma

PDF  |  DOI: 10.5005/jp-journals-10006-1739  |  Open Access |  How to cite  | 

Abstract

Background: Acute hemorrhage and delayed hematoma formation from laparoscopic port sites are uncommon but can be potentially significant complications. They become evident in days 2 to 6 postoperatively, manifesting as visible bruises, excessive pain, or an asymptomatic drop in hematocrit. Bleeding into the abdominal wall leading to giant abdominal wall hematoma requiring blood transfusion, prolonged hospitalization, and emergency surgical procedures is rare. Case description: A woman who had successful second look laparoscopic surgery following debulking surgery for ovarian malignancy developed a large subcutaneous hematoma. She presented after 25 days of discharge from the hospital and was managed by incision and drainage. Results: Exploration of the wound was done with evacuation of blood clots amounting to 300 cc. There was no identifiable bleeding point. The patient had an unremarkable postoperative course after the incision and drainage and was discharged after 2 days. Conclusion: Sound techniques of port placement along with a thorough understanding of the anterior abdominal wall anatomy are crucial to prevent laparoscopic port site hematoma.

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