Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups.

Direct Immunofluorescence Profile Of Lichen Planus - A Fresh Look On Old Disease. A Study Of 15 Cases

Introduction: Lichen planus (LP) is a chronic inflammatory mucocutaneous diasease that is often diagnosed on the basis of clinical &/or histopathologic findings. However, it has some characteristic direct immunofluorescence (DIF) findings that can help in diagnosing confusing cases.Aim:We analyzed DIF findings in skin biopsy in LP compared to histopathology. Materials & methods: A skin biopsy of lesion was taken from 15 cases of LP(13 classic LP & 2 LP pigmentosus) & subjected to histopathology & DIF examination. Results:The sensitivity of histopathology and DIF was found to be 100% & 93.3% respectivelyfor the diagnosis of LP & LPP.

Angiomatoid Fibrous Histiocytoma In An Elderly Male: An Unusual Presentation With Review Of Literature

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor occurring mostly in children, adolescents, and young adults. Clinically and radiographically, it is difficult to differentiate AFH from hematoma, soft tissue hemangioma, and malignant fibrous histiocytoma. Here, we present the clinical, radiologic, and pathologic findings of a case of AFH due to its rarity in a 67-year-old man. The patient underwent wide surgical excision with a provisional diagnosis of sarcoma. On pathological examination, the lesion demonstrated solid-cystic nodules of histiocytes with blood-filled cysts, a dense hyaline fibrous pseudo capsule, and a very focal peripheral lymphoplasmacytic infiltrates. The tumor cells showed strong positivity for CD68, variable positivity for CD34, Desmin, EMA, negativity for CK and a low Ki67 index.

Chromohysteroscopy Role In Evaluation Of Intrauterine Cavity Lesions In Perimenopausal Women Of Aub

Aim: To evaluate the role of chromohysteroscopy in detection of intracavitary lesions in perimenopausal women with abnormal uterine bleeding. Methods: This was a prospective study conducted in 100 perimenopausal women with AUB who underwent transvaginal sonography, conventional hysteroscopy and chromohysteroscopy. Atotal of 34 cases in our study group underwent hysterectomy and specimens were sent for histopathology. Histopathological examination was carried out by a clinical pathologist who was blinded regarding hysteroscopic findings. Diagnostic accuracy of hysteroscopy and chromohysteroscopy in detection of intracavitary lesions was then studied keeping histopathology as the gold standard.Results: 2Mean age of the study group was 43.49 ± 3.42yrs, average parity was 3 and mean BMI was 25.41± 3.41 Kg/m. 40% cases presented with menorrhagia, 38% with polymenorhagia, 9% with metrorrhagia and 4% with postmenopausal bleeding. Hysteroscopy revealed normal cavity in 59 cases, intracavitary lesions were detected in 26 cases (submucous fibroids in 14, endometrial polyps in 11, and growth with areas of necrosis in one case), synechiae in 2 cases and diffuse endometrial disease was suspected in 17 cases (hyperplastic in 13 cases and polypoidal in 4 cases. On chromohysteroscopy, most of the intracavitary lesions (72%) either did not stain or the uptake was very minimal giving an unstained appearance in comparison to the surrounding endometrium. The lesions thus got demarcated and separated from the surrounding endometrium. The conventional hysteroscopic, chromohysteroscopic and histopathologic findings were then compared with each other. The diagnostic accuracy of conventional hysteroscopy in detecting polyps was found to be high (Sensitivity-85.71 %, specificity- 92.59%, positive predictive value- 75.0%, negative predictive value- 96.15% ; P<0.001). Its diagnostic accuracy in detecting submucous fibroids was also high (Sensitivity-92.31 %, specificity- 90.47%, positive predictive value 85.71%, negative predictive value- 95.00 %;(P<0.001). The diagnostic accuracy of chromohysteroscopy in detecting intracavitary lesions as unstained areas was also found to be significantly high (Sensitivity-80.0 %, specificity- 78.57%, positive predictive value- 84.2%, negative predictive value- 73.34% ; (P<0.01).Conclusion:The diagnostic accuracy of both hysteroscopy and chromohysteroscopy in detecting intracavitary lesions is high. However, differential staining on chromohysteroscopy made these lesions look more prominent and easily identifiable to the observer.

Rupture of Gravid Bicornuate Uterus as a Rare Cause of Acute Abdomen: A Case Report.

Pregnancy in rudimentary horn of uterus is a rare and fatal complication of mullerian duct anomaly. We report one such female presenting with acute abdomen and amenorrhea to highlight the importance of keeping this in differential diagnosis of acute abdomen of women of child bearing age.

Overview of benign and malignant tumours of female genital tract.

Female genital tract is most common site for tumours in females. The most common type of female genital tract cancers are – cervical, ovarian and endometrial carcinoma. There are other less common tumours including tumours of vagina, vulva and fallopian tubes. The Uterine corpus represents the second most common site for malignancy of the female genital systems. Cervical carcinoma is the second most common cancer in women worldwide. Tumours of the ovary represent about 30% of all cancers of female genital tract. Cancer of the vagina is relatively rare, accounting for about 1%- 2% of gynaecological malignancies. Tumours of the fallopian tube are much less common than the corresponding ovarian neoplasms. In view of major importance of the subject, this review study was undertaken to understand the topic in a better prospective.

A case control study to compare laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy.

Background: Laparoscopic Assisted Vaginal Hysterectomy (LAVH) has become increasingly popular as a definite alternative to abdominal hysterectomy. Objective: To compare operative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). Study design: Retrospective case control study. Materials and Methods: Data from medical records of 29 cases and 29 controls were reviewed and recorded. Study design: Retrospective case control study. Setting: A tertiary care hospital at Bareilly (UP). Subjects: Twenty nine patients who underwent LAVH between 01 October 2010 and 30 September 2011 were recruited as cases and controls were 29 patients, who underwent TAH during the same period. Inclusion criteria were that patients be matched in a case control manner for age, weight, diagnosis, and uterine size. Results: Basic characteristics such as age, parity, weight and uterine size of cases and controls were comparable. Mean operative time was 139±11 minutes for LAVH group which was significantly longer than 99±9 minutes for TAH group. Mean blood loss during surgery in LAVH group of patients was 250ml and it was 275 in abdominal hysterectomy patients, however observed differences were not significant. Mean Hb drop after 24 Hrs of surgery was 1.4g/dl in LAVH group and it was 1.6g/dl in TAH group and differences was not significant. Number of doses of injectable analgesics used per patients was significantly more in TAH group (2.3) in comparison to LAVH (1.2). Overall complication was 14% in LAVH and 10% in TAH and differences were not significant. The mean hospitalization was significantly shorter for LAVH group 2.7 days compared to 5.5 days in TAH group. Conclusion: LAVH had longer operative time but with shorter hospital stay in comparison with TAH.

Clinico-microbiological profile of women with vaginal discharge in a tertiary care hospital of northern India .

Background: The complaint of vaginal discharge is very common, particularly in south East Asia. An accurate diagnosis is recommended, based on knowledge of the epidemiology of lower genital tract infections, consistent application of laboratory tests and, where needed, microbiological. Objective: To find out socio-demographic variables associated with the complaint of vaginal discharge, to study the microbiological profile of women presenting with complain of vaginal discharge and characteristic of discharge. Materials and Methods: The present cross sectional study was conducted in one of the tertiary care hospital of Bareilly district. The respondent were the female in reproductive age group (15- 49yrs) attending Obstetrics & Gynaecology OPD with history of vaginal discharge. Vaginal swabs were collected from women with history of discharge and sent to microbiology department in Amie’s medium. Analysis of Variance test was applied as a test of significance. Results: A total of 270 women with vaginal discharge were studied. Bacterial vaginosis was the commonest disorder seen (36.68%). Effect of age on Candida infection, literacy status on Candida, Bacterial vaginosis and Pseudomonas infection and marital status on Klebsiella infection was found to be statistically significant. Vaginal discharge was found to be excessive (87.8%), continuous (64.8%) and foul smelling (60.4%) in majority of women. Consistency of discharge was told to be Curdy (44.4%), Mucopurulent (22.2%) and thin (33.3%). Conclusion: There is need for creating community awareness about health care facilities and instills self concern in women for their own health needs.

Prevalence and determinants of anemia in pregnancy at private hospital of Bareilly District.

Back ground: Anemia in pregnancy continues to be the major public health problem in the world & is the commonest medical disorder in pregnancy that has a varied prevalence, etiology and degree of severity in different populations. Objective: To find out the prevalence of anemia amongst pregnant women and socio-demographic factors associated with anemia in pregnancy. Methods: The present cross sectional study was carried out in obstetric and gynae OPD of one of the private hospital of Bareilly district during the month of Jan.2010 to May2010. Chi square test was applied for statistical analysis. Results: prevalence of anemia was 43.38% Anemia was found to be more prevalent in women age more than 30 years (80.39%), illiterate (49.53%), working (83.82%) & those belonging to Muslim community. Multiparous women (45%), women with poor personal hygiene (48%) and non-vegetarian diet were slightly more anemic as compare to their contrary one. Conclusion: Despite the measures taken to control anemia in pregnancy in the last two decades, the severity of nutritional anemia continues to remain a public health issue of great magnitude, suggesting that these measures have been largely ineffective.

Caesarean myomectomy: Prospective study.

Introduction: Contrary to previous belief many studies published now have shown that myomectomy during cesarean section (CS) is a safe procedure with no significant increased risk of intra and postoperative complications. Methods: This prospective study was carried out in antennal mothers from May09 to Sep 10 in a tertiary care hospital of Uttar Pradesh after taking institutional ethical committee approval. Diagnosis of myoma was confirmed by ultrsonography. Only those mothers were included in the study who gave the informed consent to participate in study. Cesarean myomectomy was planned in all mothers having myoma. Operative time, intraoperative haemorrhage and length of hospital stay of mothers having myoma were compared to matched pregnant women with CS alone (28cases). Data were collected on a questionnaire and analyzed by appropriate test of significance. Results: Out of 966 antenatal mothers registered during the study period myoma was detected in 14(1.18%) cases. Mean age mothers of having myoma were 27.08 years and 61.54% were primigravida and only 23.08 % were third gravida. In 61.54% mother’s parity was zero and only 15.39 % mothers were having parity two. Mean haemoglobin was 10.56 gm%. In all cases presentation of foetus was vertex. In 92.3% mothers location of myoma was at anterior wall and subserous and in 7.7% cases it was fundal . Size of myoma was less than 3.0 Cm in 38.50 cases , 3.1 Cm to 5.0 Cm in 23.1% cases and more than 5.1 Cm in 38.4% cases. There was no significant difference in operative time, intraoperative haemorrhage and length of hospital stay in comparison to matched pregnant women with CS alone. Postnatal period was uneventful and complication like PPH was nil in all in cesarean myomectomy cases. Conclusion: caesarean myomectomy can be safely performed in majority of patients with myomas without any serious or life threatening complication.

Primary renal fibrosarcoma: a rare case report and review of literature.

Primary renal fibrosarcoma is a rare tumor. We describe a case of primary renal fibrosarcoma in a 54-year-old male who presented with abdominal lump and intermittent hematuria.

Plexiform schwannoma of scalp: a case report with brief review of literature.

Plexiform schwannoma is a morphologically distinct and rare variant of schwannoma. It occurs most commonly in head and neck region and measures less than 2 cm in size. It is a benign tumor and malignant transformation has not been reported. We are presenting a case of plexiform schwannoma occurring on scalp and measuring 8cm in size because of its rarity and unusual size.

Spindle cell neoplasm of skin: diagnostic dilemma.

Poorly differentiated, spindle cell malignancies, on sun damaged skin frequently pose a diagnostic challenge for pathologists. The vast majority of these neoplasms ultimately are diagnosed as either atypical fibroxanthoma (AFX), spindle cell melanoma (SCM), and very rarely as spindle cell squamous cell carcinoma (SCSCC), leiomyosarcoma or angiosarcoma. Light microscopic clues may suggest one of these neoplasms, but subtle and overlapping characteristics often render precise diagnosis impossible based on morphological features alone. Immunohistochemistry therefore is necessary to firmly and accurately diagnose the majority of spindle cell malignancies on sun damaged skin. Aim of this case report is to highlight the practical approach to such diagnostic dilemmas.

Cytomorphology of a case of primary cutaneous B-cell lymphoma.

Primary cutaneous lymphoma designates a heterogenous group of disorders arising from skin T and B cells with no evidence of extra cutaneous disease at the time of diagnosis and six months thereafter. We report the cytomorphological features of a case of primary cutaneous lymphoma, B cell type in a 60 year old female presenting with multiple large bosselated red coloured swellings all over the scalp. Clinical examination revealed no other swelling or lymphadenopathy. On cytology a diagnosis of B-cell cutaneous lymphoid hyperplasia (B-CLH) was given, however cutaneous lymphoma could not be ruled out. On biopsy and immuno-histochemistry a diagnosis of primary cutaneous lymphoma B cell type was made. Patient was started on specific chemotherapy of lymphoma to which she responded completely. Here we highlight the cytomorphologic, histopathological and immunohistochemical features of this rare lesion with a particular emphasis on the diagnostic dilemma encountered on cytology.

Mature teratoma with loops of colon: a case report.

Teratomas showing organoid development of intestine are rare. Such cases are mostly described in ovary and sacrococcygeal region. We describe the clinical, radiological and pathological findings of an unusual case of teratoma with colonic loops in a three months old child in retroperitoneal location.

Antemortem diagnosis of gastrointestinal mucormycosis in neonates: report of two cases and review of literature.

Gastrointestinal mucormycosis has been reported more frequently in adults than in children. Due to high mortality diagnosis is usually made at autopsy. Only 3 cases of neonates surviving this disease have been described. We report two cases of preterm neonates presenting clinically with symptoms of necrotizing enterocolitis (NEC), but lacking radiological characteristics of NEC where histopathology confirmed the diagnosis of gastrointestinal mucormycosis involving caecum and appendix.

Cytomorphological features of nodular hidradenoma highlighting eccrine differentiation: a case report.

We report a case of nodular hidradenoma in a 90 year old male, presenting with an eyelid swelling. The cytomorphological features are described with special emphasis on cytoplasmic granularity and tubule formation as an important feature in diagnosing and differentiating eccrine tumors from other adnexal neoplasms on FNAC.

Sarcoma-like mural nodule in an ovarian mucinous cystadenoma: a case report.

Mural nodules are rare lesions seen in the walls of mucinous cystic tumours of ovary and are exceptionally rare in other ovarian neoplasms. The histological pattern of these mural nodules varies greatly from the mucinous tumours themselves. A rare case of a sarcoma like mural nodule is presented here which has microscopic resemblance to malignancy but is associated with good clinical outcome.

Botryoid rhabdomyosarcoma of mesentery--a case report.

Botryoid rhabdodmyosarcomas are described predominantly in hollow visceral organs. We present case of an embryonal (botryoid) rhabdomyosarcoma arising in mesentery of a two year old male child.