Twin-Twin transfusion syndrome: a case report

Twin to twin transfusion syndrome is a rare but serious complication of monochorionic twin pregnancy. It is characterized by the development of abnormal placental vascular communication from one foetus (donor) to the other foetus (recipient). If left untreated it led to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosing and treatment. Authors report a case of twin to twin transfusion syndrome in 24 years old primigravida with gestational age of 18 weeks 5 days diagnosed on ultrasound.

Graves hyperthyroidism in pregnancy: a rare presentation

Hyperthyroidism in pregnancy is much less common occurring in 0.1-0.2% of women with Grave’s disease being the most common cause accounting for 90% of the cases. It is important to diagnose hyperthyroidism in pregnancy because fetal loss in untreated patients is high and may even be life threatening for the mother. We are presenting a case of 29 years old G3P2L1 who presented to our emergency with amenorrhea of 7 months and history of loose stools for the last 20 days. It was associated with generalized weakness. She also had history of palpitations, weight loss and sleep disturbances. She was a known case of hyperthyroidism for the past 1-2 years and was already taking anti-thyroid drugs. B/L exophthalmos was apparently present. Patient was severly anaemic with haemoglobin of 5.5gms/dl. Ultrasound showed fetal demise at 28weeks. Patient was given 3 units of blood transfusion and was induced with prostaglandins. She delivered a dead male baby weighing 1.2kgs. Her postpartum period was uneventful. Timely diagnosis of graves hyperthyroidism and its optimal treatment throughout pregnancy is vital in reducing maternal, fetal and neonatal complications.

Cryptomenorrhoea due to imperforate hymen: a case report

Imperforate hymen is a rare obstructive congenital anomaly of the female genital tract which arises as a result of complete failure of canalisation of the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. Its prevalence is 0.05%-0.1%. We are presenting a case of 14 years old girl who came with complaints of lower abdominal pain since 10 days not associated with nausea, vomiting and diarrhoea. She had not attained menarche but her secondary sexual characters were developed with breast, pubic and axillary hair in tanner stage 4. MRI revealed hematocolpos and hematometra with imperforate hymen. Hymenotomy was performed and 300-400 ml of thick tarry colour blood was drained. Her postoperative period was uneventful, and patient was discharged in satisfactory condition. On follow up after 1 month, patient resumed normal menses.

Comparison of Amsel’s criteria and Nugent’s criteria for diagnosis of bacterial vaginosis in tertiary care centre

Background: Bacterial vaginosis is an imbalance in the ecology of the normal vaginal flora which is characterized by depletion of lactobacilli, and proliferation of anaerobic bacteria. It most often manifests clinically as a vaginal pH of > 4.5, presence of thin whitish homogenous vaginal discharge, detection of “clue” cells and presence of an amine odour after the addition of 10 percent potassium hydroxide. These anaerobic bacteria through specific products stimulate the decidual tissue causing an increase of cytokine level, release of phospholipase A2 and prostaglandins leading to preterm labor, premature rupture of membranes, chorioamnionitis and development of PID following abortion. To compare Amsel Criteria and Nugent Criteria for diagnosis of bacterial vaginosis.Methods: A cross sectional study involving 260 patients with preterm and term labour was conducted at a tertiary care hospital in North India. BV was determined to be present or absent on the basis of Amsel’s criteria and Nugent’s criteria. Pearson’s chi-square test was used to demonstrate the difference between both groups with respect to various categorical data.Results: Amsel’s criteria and Nugent’s criteria were reliable diagnostic methods. As compared to Nugent scoring system, Amsel’s criteria had sensitivity of 75%, specificity of 95%, positive predictive value of 90% and negative predictive value of 86%.Conclusions: Although the Amsel’s criteria is a convenient and inexpensive method of diagnosing bacterial vaginosis, it is not always reliable. Nugent’s criteria is considered as a gold standard for the diagnosis of bacterial vaginosis but it requires an experienced slide reader and considerable time and skill. If lab equipment is not available as in many developing countries, the diagnosis of BV can be simplified by using a combination of any two Amsel’s criteria like vaginal pH and whiff test which had highest sensitivity and specificity (90.19% and 97.78%) respectively as seen in present study.