ABSTRACT
Background: Ectopic pregnancy is defined as any intra or extra-uterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development. It is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies affecting approximately 2% of all pregnancies. The purpose of this study is to review cases of ectopic pregnancy and determine: incidence, high risk factors, types of clinical presentation, diagnostic methods, management, morbidity and mortality.Methods: The present study, conducted over a period of 2-year, total number of deliveries was 16,144 and total number of ectopic pregnancies was 116. More than half of the cases (56.04%) had one or the other identifiable risk factor. Results: Amongst the various risk factors studied, history of previous pelvic surgery (15.43%), history of Pelvic inflammatory disease (PID) (12.9%), use of Intrauterine contraceptive device (IUCD) (10.3%) and either spontaneous or induced abortion (7.76%) has been found. History of self-administered medical termination of pregnancy (MTP) pill was present in 3.45%. Repeat ectopic pregnancies were seen in 1.72%. There was no identifiable risk factor in 49.63% of cases.Conclusion: Ectopic pregnancy is a major challenge in obstetrical practice because of its varied clinical presentation. It can be diagnosed early by keeping a high index of suspicion. Undue delay in referral reduces significant morbidity and improves the chances of preserving future fertility. Mass education regarding safe abortion practices and post abortal care should be promoted. Unsupervised usage of MTP pill intake should be condemned.
ABSTRACT
Background: Placentation abnormalities such as placenta previa, placenta accreta and vasa previa are associated with antepartum and postpartum haemorrhage, which makes them an important cause of serious fetal and maternal morbidity and even mortality in India. In spite of the significant improvement in obstetric care and management and modern transfusion service, antepartum and postpartum bleeding continues to be a significant cause of very high-risk pregnancy.Methods: This is a retrospective study conducted in department of obstetrics and gynecology, Sir Sayaji Hospital, Baroda, for a period of 2 years from January 2018 to December 2019. All cases of placenta previa and morbidly adherent placenta admitted during pregnancy in this period were included in the study. All case records were obtained and carefully analysed to find out the incidence, various types of placenta previa and adherent placenta, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity and mortality.Results: The prevalence of placenta previa was 0.87% and was more commonly present among multigravida women (80.3%). Most common type of placenta previa was type 1 in 51 cases (35.9%) cases followed by type 2 in 33 cases (23.2%). 29 cases (20.4%) were of complete placenta. Morbidly adherent placenta comprised 4.2%. Single case (0.7%) was of vasa previa. Out of 142 cases, 12 (8.4%) had atonic PPH and 8 (5.6%) cases underwent peripartum hysterectomy, (12.6%) 18 patients had hemorrhagic shock due to severe blood loss. All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.2 kg associated with complete placenta previa in 14 cases and type 3 (incomplete) in 8 cases. There was no maternal mortality in this studyConclusions: Abnormal placentation carries a very high-risk for maternal and fetal outcome. Anticipation, prevention, early detection and appropriate management will result in favorable outcome and will boost the present scenario of management of high-risk pregnancies.
ABSTRACT
Background: Infertility is one of the commonest problems encountered in gynecology. Infertility appears to be a problem in 10-15% of Indian population. Tubal factors account for (20-40%) of infertility. The objective of the study was to demonstrate the role of hystero-salpingography and hystero-laparoscopy in evaluation of tubal factors for female infertility.Methods: Present study was carried out on 70 women attending the gynaecology OPD for investigation of infertility admitted between March 2014 to December 2014 in Gynecology ward, SSG Hospital attached to Government Medical College, Vadodara, Gujarat.Results: Out of 70 patients who underwent HSG tubal block was detected in 34 cases. Out of these 34 cases tubal block was detected only in 17 cases by laparoscopy and chromopertubation. One case which showed patent tubes on HSG had unilateral tubal block on chromopertubation test. Accordingly, sensitivity of HSG for tubal patency comes out to be 0.72, specificity of 0.94, positive predictive value of 97.43%, negative predictive value of 51.61%, positive likelihood ratio of 12.28 and negative likelihood ratio of 0.30.Conclusions: HSG being simple and less invasive technique along with higher specificity and lesser complications. Hystero-laparoscopy is a valuable technique for the complete assessment of female infertility.
ABSTRACT
The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be life-threatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection.