ABSTRACT
Background: Of all the cancers in women, about 10% manifest in the reproductive age group. These can be broadly classified as gynaecological cancers and non-gynaecological cancers; Among the non-gynaecological cancers besides haematological cancer, breast, thyroid, colon, bone and CNS are seen rarely. Clinical acumen in diagnosis and management of these rare cancers that appear during pregnancy or before pregnancy are difficult due to insufficient guidelines and rarity of the conditions.Methods: A retrospective analysis of rare cancers during a period of 10 years in this hospital was performed. Data concerning the gestational age at delivery, birth weight, mode of delivery and complications and the management of the cancers during the pregnancy were collected.Results: Among the 41 women with these rare non-gynecological, non-hematological cancers, 13 pregnancies were in women with prior history of cancers and 28 pregnancies were with current history of cancer. Majority of these cases with prior history were thyroid cancers who had uneventful pregnancies and delivered normally. Among pregnancies with current history of cancer, breast, CNS, GIT, and head and neck were the cancers with 5-6 cancers in each category. About 50% of these cancers were delivered early between 31-35 weeks to facilitate optimal treatment. Cancers with guarded prognosis diagnosed before 20 weeks had a termination of pregnancy.Conclusions: Cancers during pregnancies are rare and their care must be individualized.
ABSTRACT
Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.
ABSTRACT
Background: Obstetric outcome in women with advanced maternal age (AMA) is not usually studied especially in India.Methods: This study was a case control study. The cases were pregnancy in 100 women at 40 years of age and beyond and there were two control arms of 100 each of ages 20-29 years and 30-39 years. The demography, maternal complications, delivery outcomes and neonatal outcomes were compared.Results: Women with AMA were mostly multiparous and had higher Body Mass Index (BMI). Hypertensive disease in pregnancy was more common in AMA but the difference was statistically significant. Women with AMA were more likely to have gestational diabetes (p ≤0.011), more likely to have anemia (p=0.038), more likely to have preterm birth (p=0.001), other medical complications compare to the control group (p=0.005). They were also more likely to have Lower Segment Caesarean Section (LSCS) (p ≤0.001) and have postpartum complications. The birth weight of the neonate was significantly decreased in the AMA group (p <0.001). The neonates were also more likely to be admitted to Neonatal Intensive Care Unit (NICU) (p ≤0.006).Conclusions: Adverse maternal and neonatal outcomes were seen despite individualized and optimal obstetric care. Thus, these women need preconceptional counselling.