Classic congenital adrenal hyperplasia: a delayed presentation

Congenital adrenal hyperplasia [CAH] is a rare congenital disorder, which in cases of female genotype may result in virilization. Specific enzyme deficiencies in adrenocorticoid hormones biosynthetic pathway lead to excess androgen production causing virilization. Classic type presents early in infant life as salt losing or simple virilizing type, whereas non classic form presents late at puberty or in adult life. Depending on the type of classic CAH, type of adrenocorticoid deficiency, extent of virilization and genotype, surgical corrective procedures, glucocorticoid and mineralocorticoid replacement therapy are the mainstay of management. We present here a case of classic congenital adrenal hyperplasia of simple virilizing type, which presented later in childhood

Morbidly adherent placenta: can we limit the aftermath?

Morbidly adherent placenta is a grave complication of pregnancy referring to a pathological adherence of placenta to uterine wall with a reported incidence of 1:2500 deliveries. Women with previous two caesarean sections and placenta previa are at greater risk and also those with previous damage to uterine wall. This commentary discusses the pathophysiology, diagnosis and management of the condition in local perspective

Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae

To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage [APH]. Cross-sectional, analytical study. Gynaecology Unit II, Civil Hospital, Karachi, from August 2007 to July 2009. Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of pregnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing >/= 500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level < 0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 [p < 0.01]. Near-miss cases were also significantly higher in abruptio placentae, 22.27% verus 11.18% [p < 0.01]. Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae [p < 0.05]. Abruptio placentae carry significantly higher perinatal mortality and near-miss morbidity than placenta previa

Current criteria for selection of abdominal versus vaginal hysterectomy at civil hospital, Karachi

To determine the frequency of abdominal and vaginal hysterectomies and to evaluate the categorization of hysterectomy cases for abdominal or vaginal route at Civil Hospital Karachi. A cross-sectional, 12-month [2008] prospective comparative study was designed at Civil Hospital Karachi involving abdominal hysterectomy [AH] and vaginal hysterectomy [VH]. Data were extracted on a specially designed proforma including fields for age, parity, menopausal status, indication and route for hysterectomy, uterine size, and previous history of caesarean section, puerperal sepsis, tubal ligation, and laparotomy for gynecological indications. In this study, 107 [18.3%] abdominal and vaginal hysterectomies were done for benign gynecological causes. There was no case of laparoscopically assisted VH [LAVH]. Mean age [57.61 years] and parity [8] for VH were greater than those of AH [48.11 years] and 5, respectively. VH was predominantly done on atrophic uteri [25 [75.76%]]. AH was performed on 20 [27.02%] bulky uteri; in 53 [71.63%], the uterus was larger. Uterovaginal prolapse was the sole [100%] indication for VH with concomitant dysfunctional uterine bleeding [DUB] in 4 [12.13%] cases. The main indications for AH were fibroids in 28 [37.84%], DUB in 30 [40.54%], followed by adenomyosis and endometriosis in 10 cases [31.51%] each. Factors predisposing to pelvic adhesion and uterine immobility were present in 16 patients [18.85%] who underwent AH and 3 [9.09%] with VH. AH was commonly performed on less parous and perimenopausal women with larger uteri while VH was chosen for elderly, more parous women with atrophic and prolapsed uterus

Transverse testicular ectopia with persistent mullerian duct syndrome

A case of crossed testicular ectopia is presented in a patient with left inguinal hernia. Examination revealed two separate testes like structures palpable in the left hemiscrotum right side was empty. A provisional diagnosis of TTE was made. Chromosomal analysis revealed a normal XY male pattern with no abnormalities. Bilateral inguinal explorations were performed. Both the testes were present in the left inguinal canal along with an indirect left inguinal hernia. The cord structures were united in the midline by midline by persistent Mullerian duct remnants. Herniotomy was performed and left testis was placed in a newly constructed dartos pouch in the scrotum. Right testis was also placed in a dartos pouch constructed in the right hemiscrotum through a septal window