Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute.  At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory.

Broad Ligament Fibroid: A Case Series.

Fibroids are most common benign tumors of the uterus, mostly situated in the body of the uterus. Rarely, they arise from extra-uterine sites with broad ligament fibroids being uncommon. Although by clinical examination and newer imaging modalities, we can easily know about size, number, and origin of these tumors and any anatomical distortion of surrounding vital organs, but some time it is very difficult to differentiate pre-operatively between large broad ligament leiomyomas and ovarian/adnexal pathology specially if cystic degeneration or necrosis is present in leiomyoma. We report four patients with broad ligament fibroids to emphasize the importance of their location, the diagnostic difficulties, and surgical complications they can pose.

Induction of Labor: A Review.

Induction of labor is a common obstetric procedure, and is indicated when the benefits to either mother or fetus outweigh those of continuing the pregnancy. Cervical assessment (Bishop score) at the time of initiation is the best independent predictor of induction success. Although multiple agents are available for labor induction, the most commonly used methods are mechanical methods, prostaglandins and oxytocin. Indication for induction of labor, clinical presentation, safety, cost and patient preference may be used in selecting the method of induction. The goal of labor induction must always be to ensure the best possible outcome for mother and newborn.

Unusual Presentation of Acrochordon.

Objective: An acrochordon, is a small, soft, common, benign, usually pedunculated neoplasm that is found particularly in persons who are obese. Acrochordons have been reported to have an incidence of 46% in the general population. Most acrochordons vary in size from 2 to 5 mm in diameter, although larger acrochordons upto 5 cm in diameter are sometimes evident. They may occur singly or in multiples and they are most often found in intertriginous areas (e.g., axillae, neck, eyelids). We report an unusual presentation of acrochordon in a 38-year-old multipara who presented with complains of some mass in the private parts since three months. She was diagnosed to have acrochordon of the clitoris.