Pregnancy Luteoma - A Rare Case Report

A 22 year old primigravida with full term pregnancy with morbid obesity and short stature presented to us with complaints of labour pains six hours prior to admission. Her dating, anomaly and term growth scan showed a single live intrauterine foetus with foetal heart rate, amniotic fluid and growth parameters corresponding to the gestational age with no significant anomalies and normal adnexa.Following a thorough examination and pelvic assessment, diagnosis of cephalopelvic disproportion was made and the patient was posted for emergency caesarean section. A healthy male baby of weight 3.5 Kg extracted and the placenta and membrane were expelled in toto. Uterus was closed in double layer. On examination of adnexal structures, a right sided ovarian mass of around 10 x 8 x 6 cms of size, solid in consistency and proliferative in appearance was found. Suspecting it to be a malignancy and due to the unavailability of frozen section facility, a right sided oophorectomy was performed, and the specimen was sent for histopathological reporting which revealed a diagnosis of pregnancy luteoma of ovary

A 5-Year Clinical Experience of Haemolysis, Elevated Liver Enzymes and Low Platelet Count (HELLP) Syndrome at a Tertiary Care Teaching Hospital in North Karnataka - A Retrospective Analysis

Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) i.e., HELLP syndrome is a vaguely understood condition of pregnancy which can present with rapid onset. It is commonly associated with pre - eclampsia. HELLP is also known to manifest itself without the clinical features of pre - eclampsia. The present study aims to assess the maternal and foetal complications associated with HELLP syndrome. METHODSThis retrospective study included all the pregnant women who developed HELLP / partial HELLP with gestational age of ≥ 28 weeks. The variables analyzed were obstetric history, menstrual history, antenatal complications, laboratory investigations (haemolysis, ALT / AST, LDH, CBC), mode of delivery, postnatal complications, maternal outcomes and perinatal outcomes. RESULTS72 patients were included in the present study. The mean age of pregnant women with HELLP syndrome was 23.6 ± 4.15 years. The average age of gestation was 33.17 ± 4.02 weeks. 58 % patients were primigravida. As per Mississippi triple-class system 82 % patients had partial HELLP, 18 % had complete HELLP. 4 %, 4 % & 10 % patients had HELLP class I, II & III respectively. Among the total cases, 74 % patients had antepartum onset, 10 % had intrapartum & 17 % postpartum onset of HELLP syndrome respectively. 65 % patients delivered vaginally & rest 35 % underwent caesarean section. High risk factors such as pre - eclampsia (65 %), eclampsia (3 %) & previous history of HELLP (8 %) were noted in study cases. Abruptio placentae (18 %), postpartum haemorrhage (17 %), pulmonary oedema (14 %), renal failure (14 %) & DIC (7 %) were the maternal complications noted. Maternal mortality was 7 %. The major perinatal morbidities noted were prematurity (67 %) & FGR (42 %). Intrauterine death was noted in 19 % babies. Neonatal intensive care (NICU) was required for 58 % babies, of which 42 % had respiratory distress. Neonatal death was noted in 17 %. CONCLUSIONSHELLP syndrome is a life threatening condition of pregnancy which has serious maternal and perinatal morbidities. Prompt referral, timely and appropriate interventions can save lives. Availability of Intensive Care Units (ICU) facilities, dialysis units and blood and its components along with Neonatal Intensive Care Unit (NICU) facilities can remarkably reduce the maternal and neonatal complications.