Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.

Maternal and perinatal outcome in eclampsia at a tertiary care center

Background: Preeclampsia is the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient. The objective of this study was to study the prevalance of eclampsia at PGIMS, Rohtak. To study the clinical profile, maternal and perinatal outcome in eclamptic patients.Methods: This is a retrospective study and case records of all eclampsia cases were analysed from the study period of January 2018 to December 2018.Results: There were 113 cases of eclampsia out of 11,661 deliveries and prevalence of eclampsia was calculated to be 0.96%. Majority of the patients were not registered 95.57%. 58% of patients were Primigravidas. 56% of the patient in the age group of 21-25 years. Antepartum, intrapartum and postpartum eclampsia were 71%, 1.7% and 27% respectively. Caesarean section was the preferred mode of delivery and was performed in 57% cases. ICU admission was required in 25% and remaining cases were managed in general/eclampsia ward. All patients received MgSO4 by Zuspan regimen. 12% patient developed HELLP syndrome and pulmonary oedema developed in 6% patient. There were a total of 3.5% maternal deaths during the study period. Total percentage of perinatal deaths due to eclampsia was 23%.Conclusions: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality. This is due to lack of proper antenatal care, low socioeconomic condition and lack of education. Regular antenatal checkup, early recognition and proper management are vital to tackle this challenge. MgSo4 is the anticonvulsant of choice and Zuspan regimen of MgSO4 is effective in the management of eclampsia.

Study of medical disorders in pregnancy among in patients at a tertiary care hospital in Haryana, India

Background: Pregnancy is a physiological condition in which various changes occur in pregnant women just to accommodate growing fetus. Pregnancy is a stress test for woman and may unmask certain underlying chronic diseases like, DM, hypertension which were silent or asymptomatic prior to pregnancy. This study was done to know the incidence, type and demographic profile of medical disorders in pregnancy among in patient at a tertiary care hospital.Methods: It was a retrospective study conducted on 578 patients of medical disorders in pregnancy admitted in a tertiary care hospital from January 2017 to December 2017. Data collected from record room and analysis done.Results: Total antenatal admissions were 4721. Incidence of medical disorders was 12.24%. Majority of women were in age group 20-30 years (65.5%). Low-parity (P0, P1). Hypertensive disorders in pregnancy was commonest reported disorder (42.3%), followed by hematological disorder (38.7%), liver disorder 5%, endocrine disorder 4.8%, epilepsy 3.8% and HIV 2.6% in present study.Conclusions: Hypertensive disorders were commonest medical disorder followed by hematological, liver, endocrine and epilepsy. All medical disorders in pregnancy to be managed by team approach.

Clinical study of ectopic pregnancy at tertiary care center in Haryana, India

Background: Ectopic pregnancy is a life threatening condition in the first trimester of pregnancy. Diagnosis can be done by clinical examination, serum β-HCG and ultrasonography. This retrospective study was done to know the incidence, risk factors, and management of ectopic pregnancy.Methods: It was a retrospective study conducted on 75 patients of ectopic pregnancy admitted at tertiary care hospital in Haryana from February-2017 to January-2019. Data collected from record room and analysis done.Results: Total deliveries were conducted were 5064. The incidence of ectopic pregnancy was 1.48%, majority of the women were in the age group of 21-30 (68%), multi-parous (77.32%). The most common risk factor was abortion 33.33%, f/b tubal ligation was 13.13%, medical management of ectopic pregnancy done in 30.66%, 8% were managed by laproscopically and 58.66% by laparotomy.Conclusions: Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy.

Lactate dehydrogenase levels in preeclampsia and its correlation with maternal and perinatal outcome

Background: Hypertensive disorder of pregnancy occurs in approximately 6-8% of all pregnancies. The most serious consequences for the mother and the baby are the result of preeclampsia and eclampsia. Lactate Dehydrogenase (LDH) is an intracellular enzyme. Recently LDH has been suggested as potential marker to predict severity of pre-eclampsia. The objective of the present study was to compare the serum lactate dehydrogenase levels in women with preeclampsia and normal pregnant women and to correlate lactate dehydrogenase levels with maternal and perinatal outcome in preeclampsia.Methods: An observational prospective study was conducted on 200 antenatal women attending the labour room emergency. Women with singleton pregnancy and cephalic presentation, from 28 weeks onwards were enrolled in the study. Out of 200, 100 were normal pregnant women and 100 were preeclamptic women. Serum LDH levels were measured in all women and maternal and perinatal outcome was assessed in terms of LDH levels.Results: Higher levels of LDH was observed in pregnant women with preeclampsia (627.38±230.04 IU/l) as compared to normal pregnant women (224.43±116.61 IU/l). The maternal complications were found to be maximum in women with LDH > 800 IU/l.  Abruption was the most common complication. The perinatal mortality and neonatal deaths were found to have significant correlation with high LDH levels.Conclusions: Maternal and perinatal complications were associated with higher LDH levels in preeclampsia patients. Serum LDH levels can be offered to all patients of preeclampsia and can be used to predict the prognosis of preeclampsia.