An Unusual Presentation of a Non-Tender Huge Degenerative Fibroid.

Fibroid is the most common benign tumour occurring in the reproductive age groups, the incidence is around 70%, mainly due to oestrogen. Other risk factors are nulliparity, obesity, early menarche, delayed menopause, family history, and ethnicity. Surprisingly smoking seems to reduce the risk. Other factors reducing the risk are OCP, pregnancy and lactation.Trans-vaginal ultrasound is the gold standard investigation. But MRI is helpful in mapping the site, number, size, depth, nature of lesion and associated pelvic pathology. It also helps in differential diagnosis of fibroid mainly adenomyosis and sometimes both conditions exist together. The most common complaint in fibroids are menstrual problems like menorrhagia, metrorrhagia, dysmenorrhea, infertility, pressure symptoms on bladder and rectum. The patient may become anaemic due to blood loss, our patient in spite of her menorrhagia, her Haemoglobin was nearly normal. Our patient with such a huge fibroid of size of 28 weeks, has no history of pain and the mass found to be non-tender, in spite of extensive cystic degeneration.

A Retrospective Analysis of Patients with Leiomyoma.

A study of 200 women with fibroids was conducted in southern most part of India, Kerala, in order to analyse the prevalence, clinical features and impact on life style.METHODSA group of 200 women in Karuna Medical College and Hospital, Kerala, were studied from the case sheet records during the period April 2019 - Feb 2020. Women included in the study were in the age group of 20 - 60 yrs. Different aspects like age, diet, BMI, family history, socio economic status, comorbidities, lifestyle, smoking history, surgical history, obstetric and menstrual history, pain and intra operative and post-operative findings were analysed.RESULTSPrevalence of uterine fibroids in the age group of 41-50 yrs. is 52.5%. Women with fibroids reported mostly with profuse menstrual bleeding like menorrhagia (44.5%) and metrorrhagia (9%). Pain was noted in 12.5% of women. Dysmenorrhoea was noted in 9% of women. Some women (10%) had no impact on the lifestyle; they were not aware of the presence fibroids. Some 9 % of women had dyspareunia, and infertility was noted in 15 % of women. In some patients, even large fibroids (as big as 24 weeks size) produced no complaints.CONCLUSIONSUterine fibroids sometimes even if they are humongous caused no pressure symptoms and pain. site of the fibroid causes problems and it is not the size of fibroid. Sometimes even huge fibroids can be asymptomatic as seen in few cases.

Prevalence of PCOD in Patients Visiting OPD of Karuna Medical College.

The incidence of polycystic ovary syndrome is found to be very common in patients attending gynaecology department. The incidence is growing rapidly among young adults. PCOS leads to multiple complications. A study of 120 women with PCOS was done in Kerala in India in order to analyse the prevalence, clinical features and impact on life.METHODSCase records of women who were diagnosed as Polycystic Ovarian Disease who attended the gynaecology OPD in Karuna Medical College Hospital in Kerala were randomly selected. Women included in the study were in the age group of 14 – 30 years. The sample size selected was 120. The study was carried out for a period of 12 months in our hospital with the help of the records available. The diagnosis was made as per Rotterdam’s criteria.RESULTS75 women were unmarried and 45 married. 2 of the women had subclinical hyperandrogenism. 70 women have DHEA increased. FSH: LH ratio > 2:1 seen in 84 women. Testosterone was normal. Anti-Mullerian Hormone was raised in 84 women, indicating hyperandrogenism. Serum Prolactin was normal in most women except in 2 women.CONCLUSIONSPCOD leads to many complications like diabetes, Metabolic X syndrome, cardiovascular complications, breast cancer, endometrial cancer and depression. Kerala is considered as the diabetic capital in India. There are several risk factors like, family history, lack of exercise, stress, and high carbohydrate diet. A screening programme for PCOD is essential to prevent the sequelae.

Asymptomatic Leiomyoma- Is It Belly Fat..

A thirty-nine-year-old lady P2 L2 admitted with lower abdominal mass since 3 months had no history of menstrual problems and pressure symptoms.1 The uterus was palpable which was of 34 weeks size. She had a scar in subumbilical region for puerperal sterilization which was done 17 years ago after her second childbirth. Medical and surgical history was unremarkable. Routine investigations like urine examination including culture, CBC, clotting profile, kidney function test, x-ray chest, ECG were within normal limits. PAP smear and vaginal swab were normal. USG shows 14.1 mm x 10.6 cm fibroid occupying posterior fundal wall. There is another fibroid measuring 7.5 cm x 6.5 cm in the anterior wall in the body of uterus, other three small fibroids 5.5 cm x 4.5 cm, endometrial thickness normal, both ovaries appear normal, no hydroureters, no degeneration or calcification were noted.

Dilemma in the Management of Ovarian Cyst in Pregnancy: A Series of Three Different Cases.

The incidence of ovarian cyst in pregnancy is increased due to ovulation induction and dating ultrasound. Mostly they are benign and managed by observation. Surgery is indicated if there are complications or any suspicion of malignancy. Here, we have presented three different cases of ovarian cyst in pregnancy, which was managed by surgery. The first case is a 27-year-old second gravida with para1 live1 with complaints of pain in right iliac fossa at 15 weeks of gestation that was diagnosed as a dermoid cyst of right ovary. She underwent laparoscopic cystectomy. Rest of the antenatal period was uneventful, and she delivered vaginally at term. The second case is 31 year old third gravida with para2 live2 came with complaints of lower abdominal pain around 14 weeks of gestation which was diagnosed as fibroma of ovary for which laparotomy and right salphingo-oophorectomy was done. Rest of the antenatal period was normal, she delivered by caesarean section at term. The third case was 30-year-old second gravid with para1 live1 with left ovarian mass presented at term for which cesarean section along with left salphingo-oophorectomy done.

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum.

Postpartum eclampsia is defined as eclampsia that occurs after delivery within 48 h. Now-a-days, the incidence of antenatal and intrapartum eclampsia is reduced considerably due to good antenatal care, and preeclampsia diagnosed early and treated well. However, postpartum cases nowadays show a unique pattern occurring too late, which can be nearly missed and difficult to diagnose. Postpartum eclampsia has to be differentiated from other causes such as cerebral malaria, cerebral tumor, cerebral hemorrhage, cerebral venous thrombosis, cerebral aneurysm, brainstem syndrome, posterior reversible encephalopathy syndrome, epilepsy, thrombotic thrombocytopenic purpura, strychnine poisoning, chronic hypertension, chronic renal disease and hemolytic uremic syndrome. Postpartum eclampsia requires prompt treatment. Left untreated can result in seizures and other serious complications. Here, we present a unique and interesting case of atypical delayed onset postpartum eclampsia. Hence that such unique cases should not be missed in the diagnosis and management.

Ruptured Uterus in Pregnancy: A Case Report.

Spontaneous uterine rupture in pregnancy is a rare phenomenon especially in the second trimester. When it occurs one has to suspect placenta percreta. Here we had such a case in a 32-year-old lady who had previous caesarean section for fetal distress 7 years ago. Now she got admitted with a history of 4 months of amenorrhea with severe pallor and hypotension. She did not have any uterine contraction before admission, and there is no history suggestive of any interference with the present pregnancy. On opening the abdomen, there was hemoperitoneum and an intact gestational sac was found protruding through the rent at right side of the fundus. Total abdominal hysterectomy was done, and the placenta was found to be placenta percreta, that was confi rmed by histopathological examination.

Lower Uterine Segment Fibroid Complicating Pregnancy: A Case Report.

Th e uterine fi broids are very common in the reproductive age group. During pregnancy, it may undergo rapid growth and red degeneration. It may get infected during puerperium. Most of the fi broids are asymptomatic. Women with fi broids may have infertility, a tendency for miscarriage, pre-term labor, placental abruption, placenta previa, fetal growth restrictions, fetal anomalies, postpartum hemorrhage, uterine dystocia, malpresentations and increased risk of caesarean. Here, we present 26-year-old primigravida who was admitted with 9 months of amenorrhea and anterior lower uterine segment intramural fi broid of size 7.2 cm × 7.1 cm on the right side. She conceived immediately after marriage. All Investigations were normal. She was delivered by a cesarean section. An alive female baby of 2.5 kg with good Apgar score. Th e indication was lower uterine segment fi broid. Th e liquor was meconium stained. Th ere was no sign of intrauterine growth restriction of the baby. Th e Doppler study, cardio-topography was normal before section. Th e post-operative period was uneventful. Th e patient was discharged and came for follow-up after a month and was found to be alright.