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Background: Arteriovenous malformation is abnormal connection between an organ’s arterial and venous circulation. In acquired AVM, history of uterine procedure seems inevitable. Their clinical feature is usually vaginal bleeding. It is diagnosed by 2-D ultrasonography combined with colour doppler. Most of the time they resolve spontaneously; however, if left untreated, uterine artery embolization or hysterectomy comes in hand. The purpose of this study was to evaluate the role of TVUS and colour doppler in the diagnosis and follow-up of treated cases of uterine AVM. This study also aims to evaluate different modalities to manage uterine AVM.Methods: This was a retrospective study done at tertiary care centre from January 2018 to December 2019 to assess the presentation, treatment, and clinical pictures of patients with uterine AVM that were diagnosed with TVUS. Authors reviewed both (1) clinical data (2) ultrasound data of patients. The diagnostic criteria were “subjective” with a rich vascular network in the myometrium with the use of colour Doppler images and “objective” with a high PSV of 20 cm/sec in the vascular web.Results: Thirteen patients met the diagnostic criteria mentioned above. Out of that 100% presented with on and off bleeding per vaginum. Recent and remote history of uterine procedures were in found in 84.6% (n=11) of cases. UAE was done in 53.8% (n=7) cases. Thirty-three (33%) (n=5) cases spontaneously resolved when closely monitored with serial imaging and serum beta- HCG levels. Hysterectomy was needed in 7.4% (n=1) of patients of AVM.Conclusions: Uterine AVM occurred after unsuccessful pregnancies or uterine procedures. Triage of patients for expectant treatment, hormonal treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the AVM, appears to be a good predictor of outcome.
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Background: The objective of this study was to wether perineal tear predicted by scoring of severity of striae gravidarum. The objective of this study was to predict perineal tear by simple non-invasive method and help to prevent maternal morbidity.Methods: Three hundred ninety four patients delivered normally were included in this study. Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between striae and perineal tear as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) was obtained.Results: In present study population mean age was 25.16 years ranging from 16-40 , mean gravidity was 2.16 ranging from 1 -8 ,average baby birth weight was 2.713 kg ranging from 1.62-4.58 The only predictors of perineal tears that were found to be statistically significant in our study were severity of striae gravidarum and episiotomy given or not. In patients with moderate to severe striae there was tear in 90 patients as compared to 29 patients with no or mild striae. 224 patients belonging to no or mild striae group delivered without any perineal tear whereas 51 patients in moderate to severe striae group delivered without tear. Out of these 51 patients 5 were given episiotomy. 2 patients who were given episiotomy had perineal tear as compared to 117 patients who were not given episiotomy. This shows that patients who had an episiotomy were less likely to have perineal tear in most cases.Conclusions: This study demonstrates a significant relation between severity of striae gravidarum and perineal tear. The findings suggest that striae gravidarum assessment may be used in the clinical setting even by paramedical staff as a simple and noninvasive tool to better define women at risk for perineal tear.
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Background: Magnesium may be physiologically important in blood pressure regulation whereas changes in magnesium levels could contribute to the patho-etiology of hypertension. The objective of the present study was to study the level and effect of magnesium in eclamptic pregnant women.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI. The concentration of total serum magnesium was measured by atomic absorption spectroscopy.Results: Mean age, mean gestational age, mean total hospital stays, mean BMI, mean systolic BP and diastolic BP was 24.3 years with 5.1 SD, 36.4 week with 3.3 SD, 7.8 days with 2.4 SD, 28.9 wt/ht2 with 4.8 SD, 146.5 mmHg with 14.7 SD and 95.9 mmHg with 11.2 SD respectively. Mean magnesium level was 1.9 mmol/L with 2.2 SD.Conclusions: Hypomagnesemia is present in eclamptic pregnant women. In developing countries like India, sufficient dietary supplementation should be given above the recommended dietary allowances in pregnancy at least in susceptible pregnant women.
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Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome.Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded.Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series.Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.
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Background: Eclampsia, a common medical emergency of pregnancy mainly seen in 5% to 10% of all pregnancies. The objective of the present study was to study the effect of eclampsia on maternal and perinatal outcome.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI.Results: Almost 84.0% participants were belonged to age group of 20 to 30 years age, 54.0% were belonged to rural area and 92.0% were belonged to lower socio-economical class, 88.0%% participants were registered as emergency case, 34.0% participants were stayed more than 10 days at hospital and 36.0% were completed ANC visit. Almost 24.0% participants were anemic, 6.0% pre-eclampsic and 4.0% have tween pregnancy. Severe hypertension at the time of admission were noted in 50.0% participants followed by absent knee jerk (12.0%), proteinuria (78.0%) and edema (62.0%) respectively. Maternal mortality and still birth observed in 2.0% and 18.0% cases respectively.Conclusions: Early age, lower socio-economic class, anemia, less ANC clinic visit, higher hospital stay and primigravida observed more among study participants and these factors may play an important role in the pathogenesis of eclampsia.
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Background and Objectives: Leprosy is a chronic infectious disease caused by Mycobacterium leprae involving skin and peripheral nerves. Depending upon the immune status of the patients there are different clinico-pathological presentation.Despite having been declared eliminated in December 2005 from India as a public health problem, the prevalence of leprosy exceeds 1/10000 population in certain districts/states of India. According to 4thWorld Health Organization report, India accounts for 60% of the world’s new leprosy cases. Thisis due to stoppage of active surveillance after reaching elimination levels. A spurt in its prevalence motivated us to carry out the study.Our aim is to diagnose and typing of leprosy by histopathology and to correlate the clinical and histopathological diagnosis as per Ridley-Jopling Scale to facilitate accurate therapy.Material and methods: The prospective study was carried out in the pathology department of AMC MET Medical College, L.G. Hospital, Maninagar, Gujarat form January 2016 to December 2017, after ethical clearance from institutional ethics committee.All the punch biopsy specimens of suspected patients of leprosy were subjected to histopathological examination. Result:A total of 90 cases were studied. Among the clinically suspected cases 67 were positive for leprosy. Male to female ratio was 3.5:1, the age ranged from4 to 80 years. Maximum cases were classified as borderline lepromatous leprosy(22) and least cases of midboderline leprosy(2) and indeterminant leprosy(2). Maximum clinico-histopathological correlation was seen in tuberculoid leprosy (100%) and indeterminant leprosy(100%). Conclusion:Combining clinical, histopathological and microbiological diagnosis of leprosy is important for proper treatment of the patient and prevention of complications.
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Objective: The aim of this study is to determine the efficacy of methotrexate treatment for ectopic pregnancies in our settings, which will in-turn help us reduce maternal mortality and morbidity. Material and methods: This was a retrospective study of 40 cases of unruptured ectopic pregnancy treated with methotrexate in civil hospital, Ahmedabad. Clinical presentation, treatment, progress, outcome, side effects and future fertility follow-up were analyzed using database from May 2008 to June 2012. Results: The success rate of methotrexate therapy in our study was 85% (n = 35) and 15% (n = 06) required surgical intervention compared to reported success rate of 67-100% published in various studies. The mean average time of resolution of ectopic pregnancy was 32 days for a single dose and 58 days for repeat second doses. Successful fertility outcome with intrauterine pregnancy was observed in three patients. Conclusion: Methotrexate treatment of ectopic pregnancies is safe and effective with no major side effects. Intramuscular methotrexate has the advantage of tubal conservation and saves patients from surgical intervention. Our study showed single dose methotrexate to be an effective treatment option for selected patients with unruptured tubal ectopic pregnancy.