Dysgerminoma: a case report on rare malignant tumor

Dysgerminoma is a malignant germ cell tumour (GCT) accounting for less than 1% of ovarian neoplasm. It is analogous to seminoma in males. It is a tumour of young age, affecting women of reproductive age group. In most of the cases, due to its clinical features of it is often, misdiagnosed as abdominal tuberculosis. It is one of the rare tumours, which have excellent response to chemotherapy and radiotherapy. It is tumour in whom, surgery followed by radiotherapy and chemotherapy gives excellent prognosis even in advanced stage. This is a rare case report of 16-year-old girl with primary amenorrhoea, abdominal mass and pleural effusion, when undergone staging laparotomy � had ovarian tumour with torsion which histopathologically came out to be, dysgerminoma.

A rare case of congenital methemoglobinemia in pregnancy

When iron in haemoglobin is replaced from Fe+2 (ferrous) to Fe+3 (ferric), it leads to formation of methemoglobin. Normal levels of methemoglobin are <1%. This is maintained by redox balance between activity of NADH methemoglobin reductase enzyme and amount of oxidised hemoglobin. When levels of methemoglobin are increased, it leads to methemoglobinemia. Methemoglobin has less affinity to bind to oxygen & results in left shift of oxygen杊emoglobin dissociation curve. As most of the cases of congenital methemoglobinemia are asymptomatic, it is often diagnosed first time during pregnancy. Here we report a case, Primigravida with 38 weeks of gestation posted for emergency LSCS i/v/o meconium-stained liquor, who had SPO2 of 84%, was clinically asymptomatic, vitally stable and with ABG, CXR, ECG and 2DECHO normal. Efforts to find out the cause of reduced oxygen saturation led to diagnosis of rare hemoglobinopathy, methemoglobinemia.

A study of fetal outcome in patients with premature rupture of membranes with gestational age more than 28 weeks

Background: Premature rupture of membranes is rupture of membranes before the onset of labour irrespective of gestational age. If it occurs before 37 weeks, it is called as preterm premature rupture of membranes (PPROM). Once PROM delivery is inevitable, so neonatal prognosis depends on gestational age at which PROM occurs. Neonatal complications include prematurity and its complications mainly, also pulmonary hypoplasia due to severe oligohydramnios, skeletal and joint deformities to foetus due to compression, increased risk of neurodevelopmental impairment and neonatal white matter damage. PROM is a still one of the most difficult and controversial problems in obstetrics.Methods: A prospective longitudinal study was conducted in Department of Obstetrics and Gynaecology at a tertiary care hospital from 2021 to 2023 (18 months). A total of 275 patients admitted with complaints of per vaginal leaking with gestational age more than 28 weeks were studied. A multivariate analysis was used to find association between PROM and foetal outcome.Results: In this study, 57% (157) new-borns had birth weight >2.5 kgs, 60% (166) new-borns had APGAR score 8/10, 71% (196) new-borns were term, 40% (109) had NICU stay, 6% (17) had respiratory distress syndrome (RDS), 3% (8) had neonatal sepsis, 2% (6) had neonatal hypoglycaemia and perinatal mortality rate was 1% (3).Conclusions: Once there is PROM, delivery is imminent. Neonatal outcome can be improved significantly after administration of steroids and antibiotics. To get that time short term tocolysis can be used. During that time foeto-maternal monitoring should be done for early detection of chorioamnionitis. Looking after preterm infants puts an immense pressure on family, economy and health care resources. The prevention of PROM is difficult so more focus should be on management of PROM.

Unruptured tubal ectopic pregnancy with very high levels of beta HCG: a rare case report

When the fertilized ovum is implanted outside the endometrial cavity, it is termed as ectopic pregnancy. The most common site being fallopian tube. The commonest site to be affected is ampulla of the fallopian tube followed by isthmus. Fimbrial and interstitial are rare sites for ectopic pregnancy. The incidence of ectopic pregnancy is increased over couple of decades. Important causes include PID, previous history of ectopic pregnancy, h/o tubal reconstructive surgery, h/o artificial reproductive techniques like IVF, use of IUD’s, h/o of tubal ligation etc. Fallopian tubal ectopic usually ruptures at duration of 7-8 weeks gestation. A ruptured tubal ectopic pregnancy can lead to massive haemorrhage leading to tachycardia, hypotension endangering life, which requires emergency surgical intervention & transfusion blood and blood products. Ectopic pregnancy with beta HCG <5000 IU/L, Gestational sac <4 cm, & vitally stable, can be managed medically with methotrexate, whereas higher levels of beta HCG, Gestational sac > 4 cm with live ectopic pregnancy and vitally unstable becomes obstetric emergency which should be managed surgically. Thorough clinical examination, use of ultrasonography and beta HCG levels, helps in timely diagnosis and management of ectopic pregnancy which can be lifesaving. This is a rare case report of unruptured live fimbrial ectopic pregnancy with very high levels of beta HCG (>50,000 mIU/ml), which was managed surgically.

A study of maternal outcome in patients with premature rupture of membranes with gestational age more than 28 weeks

Background: Premature rupture of membranes is rupture of membranes before the onset of labour irrespective of gestational age. PROM is associated with variety of maternal complications from chorioamnionitis, unfavourable cervix, dysfunctional labour to caesarean rates, postpartum haemorrhage and endometritis in mother. PROM is a still one of the most difficult and controversial problems in obstetrics.Methods: This was a prospective longitudinal study conducted in a tertiary care hospital from 2018 to 2020 (18 months). Total 275 patients admitted with complaints of per vaginal leaking with gestational age more than 28 weeks were studied. A multivariate analysis was used to find association between PROM and maternal outcome.Results: PROM was common in women belonging to low socio-economic status (68%). Most of the cases were unbooked (73%), primigravida (42%) belonging to age group 21-25 yrs. (46%), and had gestational age more than 37 wks. (71%). 62% of cases delivered vaginally while remaining underwent LSCS, most common indication being oligohydramnios (35%). Post partum fever (14%) was most common morbidity followed UTI (7%).Conclusions: In present study, PROM was common in unbooked cases and women belonging to low socioeconomic status. Asymptomatic bacteriuria was most common predisposing factor. Maternal morbidity corresponds to duration between PROM and delivery. Early diagnosis and appropriate management reduces hospital stay and maternal morbidity.