Anterior abdominal wall endometrioma: a diagnostic dilemma

The presence of functioning endometrium outside the uterine cavity is often encountered in gynaecological practice but an extremely rare entity is its extra pelvic variant is seen sometimes around the umbilicus, anterior rectus sheath vesical region, also rarely seen around the kidney’s nasal mucosa, lungs and the pleura. The incidence of this condition is as low as 0.03% to 0.15%. Endometrioma of the anterior rectus sheath is well documented in literature but because of its rarity may pose a diagnostic dilemma. Reporting herewith a case of anterior rectus sheath endometrioma where medical line of treatment failed and surgical excision was required.

Successful management of a triplet heterotropic caesarean scar pregnancy in spontaneous conception

A cesarean scar ectopic pregnancy -CSEP is a fairly uncommon presentation wherein the conceptus is implanted at the exact scar site of the previous cesarean section deep in the myometrium. Given the relatively rare incidence of CSEP establishing a diagnosis of CSEP can be challenging current standards of therapy have been derived from data obtained from a limited number of patient’s management options for CSEP range from medical line of treatment to surgical interventions such as sonography guided injections to laparoscopic excision or laparotomy or combination of these modalities. Herein we report a rare case of triplet pregnancy with one gestation sac implanted at the site of lower segment scar diagnosed on transvaginal ultrasonography along with MRI who was managed successfully with systemic methotrexate.

Successful management of a patient with severe brady-arrhythmia in peripartum period

Pregnancy is a normal physiological state with hyperdynamic circulation that is characterised by important physiological changes, many of which take place in the cardiovascular system. Few patients with physiological bradycardia may, in the second trimester, feel symptomatic as their blood pressure drops due to a reduction in systemic vascular resistance however, treatment is rarely required. Pathological bradycardia in pregnant women is rare and usually secondary to either Congenital heart block, Myocarditis, or Severe Hypocalcaemia with an incidence as low as 1:20 000 women. Authors present a rare case of severe bradycardia during peripartum period who required LSCS in view of IUGR with Anhydroamnios. On admission her general condition was good her pulse was 42 beats per mins and BP was 170/100 mm of Hg with 1+ protinuria.  A clinical impression of preeclampsia was made. ECG showed sinus bradycardia with no irregularity. 2 DEcho showed no structural lesion in the heart and normal functional capacity so dilated peripartum cardiomyopathy was ruled out. Her serum electrolytes were normal and serum calcium and magnesium was markedly reduced which was corrected. Post operatively on day 4 pulse was mor than 60 and she was transferred out of ICU. The ECG performed on day 6 was normal.