ABSTRACT
To report the successful conservative surgical management of Ovarian mucinous cystadenoma with silent torsion in a 24 years old pregnant woman in a tertiary care center in Delhi. An antenatal woman came for a routine visit to the OPD of the hospital at 13 weeks gestation. She had a vague, mild pain in lower abdomen since the last four weeks. A cystic mass was discovered during an abdominal examination. Further on sonography, a multisepatated cystic mass was seen, likely to be mucinous cystadenoma. Routine tumor markers came out to be negative. A laparotomy was planned at 15 weeks. On laparotomy a 20 × 15 cm multiloculated cyst with one and half turns of torsion was found. Detorsion, cystectomy of the intact cyst followed by ovarian reconstruction was done after due consent. On histopathological examination the cyst was found to be Benign mucinous cystadenoma. The pregnancy continued without any adverse effects. The woman delivered vaginally at 38 weeks without any feto-maternal complications. She was able to conceive again spontaneously at 18 months post-delivery. After 16 weeks of gestation in the second pregnancy she went to her home town and no further follow-up was possible. This case emphasizes the importance of a thorough examination in all pregnant woman to rule out any adnexal mass separate from the gravid uterus. Big ovarian masses in pregnancy, if not diagnosed can cause growth retardation, preterm deliveries, acute abdomen due to infection, rupture or torsion. Sonography, MRI and tumor markers can facilitate diagnosis before surgery. Torsion and rupture of mucinous cystadenoma need prompt surgery. Wherever possible conservative surgery (detorsion and cystectomy) should be done especially in young women.
ABSTRACT
Mullerian duct fusion anomalies resulting in uterine malformations have prevalence of 3-4%. Among this, bicornuate uterus has a rare incidence of 0.4%. Uterine malformations pose significant threat in terms of obstetric outcomes. We report an extremely rare case of spontaneous conception of twin pregnancy with the fetus occupying each horn of a bicornuate uterus (bicornis unicollis), in a woman with a history of previous caesarean section. She was booked at our hospital and the pregnancy remained uneventful. At 35 weeks she went into spontaneous labour and delivered vaginally without any maternal-fetal complications. The case is unique and the management is worth discussing as till date no protocols or guidelines have been proposed for the mode of delivery of bicornuate uterus with twins with previous cesarean. Only 12 cases of twins with bicornuate uterus have been reported till date. This is the first case in literature in which a successful VBAC has been conducted in a woman with bicornuate uterus with twins with previous caesarean.
ABSTRACT
Background: To study physiological and biochemical parameters to predict serious adverse maternal outcomes and to develop risk score using above parameters.Methods: This prospective study was conducted in 500 high risk pregnant women attending tertiary care teaching hospital. We noted physiological and biochemical parameters as soon as they were available .The primary outcome measures was “severe adverse maternal outcome(SAMO)” in form of one or more among mortality, near miss morbidity and ICU admissions.Results: Out-off 500 women, severe adverse maternal outcomes were seen in 158 (31.6%) women. Most common cause of near miss maternal morbidity was hypertensive disease of pregnancy (62.7%) followed by major obstetric hemorrhage (18.9%). There were 33(6.6%) ICU admission, 23 (4.6%) maternal death and 153 (30.6%) near miss maternal morbidity. The most common cause of maternal death in our study was obstetric hemorrhage. The significant variables after multivariate analysis [temp, pulse, urine protein] were used to devise a Maternal early warning score (MEWS) based on physiological parameters at score value of ≥1/6 was found to have sensitivity of 70% and specificity of 82% in predicting SAMO with AUROC of 0.76. The significant laboratory parameters after multivariate analysis were blood urea, serum creatinine, serum bilirubin and liver enzymes. The obstetric risk score (Maternal risk prediction score MRPS) which incorporated of these laboratory parameters in addition to physiological parameters has sensitivity of 82% and specificity of 75% with AUROC 0.79 value ≥ 2/18.Conclusions: The addition of laboratotory parameters to physiological variables improves performance of risk score to predict SAMO.
ABSTRACT
Aims. To study the role of screening for and treatment of abnormal vaginal flora in early pregnancy; and its correlation with pregnancy outcome.Methods. Eight hundred asymptomatic women seen at the antenatal clinic of Lok Nayak Hospital; New Delhi; India; at 12 - 24 weeks' gestation were screened for abnormal vaginal flora by means of examination of vaginal fluid smears on Gram-stained slides. Two hundred and forty-two women with abnormal vaginal flora were allocated randomly to receive either treatment (vaginal clindamycin and clotrimazole) or no treatment. The presence of abnormal vaginal flora was correlated with pregnancy outcomes in terms of preterm delivery or late miscarriage; premature rupture of the membranes (PROM) and puerperal sepsis.Results. A total of 242 patients with abnormal vaginal flora for whom outcome data were complete were analysed. Intervention in women with abnormal vaginal flora was associated with a decrease in the rate of preterm delivery (30.3 v. 18.6; relative risk 1.65; 95 confidence interval 1.04 - 2.63; p0.05). The advantage did not extend to late miscarriage; PROM or puerperal sepsis; as the decrease in these outcomes did not attain statistical significance.Conclusions. Screening for and treatment of asymptomatic abnormal vaginal flora in early pregnancy significantly reduces the rate of preterm delivery and consequent perinatal morbidity and mortality