A study to compare the diagnostic accuracy of GeneXpert MTB/RIF/assay and its comparison with liquid culture in clinically suspected cases of genital tuberculosis attending outpatient department of tertiary center

Background: Tuberculosis is a major health issue globally despite a declining trend in mortality with effective diagnosis and treatment, an estimated 10.4 million persons developing active TB each year with 1.33 million deaths. Objective of this study was to evaluate role of GeneXpert MTB/RIF/assay in diagnosis of female genital tuberculosis in suspected cases of tuberculosis.Methods: It was a cross sectional study done in department of obstetrics and gynecology in S. N. Medical college Agra for a period of 2 year (July 2017 to October 2019). 70 cases were selected from OPD of department of obstetrics and gynecology, S. N. Medical College Agra who met the inclusion and exclusion criteria after taking proper consent. In all selected cases endometrial biopsy sample was taken using endometrial biopsy curette in premenstrual period. All samples of endometrial biopsy were taken under all aseptic precaution from both corneal ends, anterior and posterior wall and lower part of uterus using endometrial biopsy curette and sample was collected in two separate sterile vials having normal saline and was sent for GeneXpert MTB/RIF/assay and liquid culture simultaneously.Results: Out of total 70 clinically suspected cases of female genital tuberculosis in between 20-45 years of age cough with expectoration 94% was the most common respiratory symptom followed by fever 81%, weight loss 56% and anorexia 54%. Prevalence of genital tuberculosis in active pulmonary tuberculosis patients was 30%. Irregular menstruation, vaginal discharge and pelvic pain were present in 69%, 60% and 52% patients respectively.Conclusions: The overall sensitivity of CBNAAT was 22% and specificity was 77%. The overall sensitivity of liquid culture was 28% and specificity was 71%.

Progressing haemolysis, elevated liver enzymes, low platelet count syndrome: near miss case

A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine).

Term Pregnancy in an Achondroplastic Dwarf: A Case Report.

Achondroplasia is a rare disorder occurring in 1 in 15,000 to 1 in 40,000 live births. However, it is the commonest disorder among more than 100 different types of dwarfism. It is inherited as an autosomal dominant trait but most cases (80%) are due to mutations of fibroblast growth factor receptor 3 (FGFR3). These individuals have normal mental and sexual development and life-span may also be normal. However, problems such as pre-eclampsia, polyhydramnios, respiratory compromise, contracted pelvis necessitating lower-segment cesarean section, prematurity and fetal wastage, etc., have been reported. General anesthesia is preferred to regional anesthesia because of spinal abnormalities. The aim of this report is to describe the surgical management of these patients discussing the surgical consideration and emphasizing the difficulties encountered. Such a patient is considered high-risk in terms of anesthesia and obstetric outcome. A case of achondroplasia with pregnancy is reported. A 28-year-old achondroplastic parturient underwent cesarean section under general anesthesia for contracted pelvis. We did not encounter problems related to cesarean section. The most important point is the careful preoperative assessment. Anesthesia plan should be specified to individual basis.

Progesterone and Prevention of Preterm Labor.

Objectives: To evaluate the effect of vaginal progesterone in the prolongation of duration of pregnancy in women at highrisk of developing preterm labor. Material and methods: This is a prospective case-control study carried out in the Dept. of Obstetrics and Gynecology, SN Medical College, Agra on 100 patients chosen from inpatient and outpatient department (50 cases and 50 controls). Women with singleton pregnancy having history of preterm labor, uterine malformation, prophylactic cerclage, currently suffering from premature pains were given daily vaginal progesterone 200 mg from 24 weeks and discontinued at 34 weeks of gestation. In both groups rate of preterm labor and neonatal outcome was determined. Results: The incidence of preterm labor in progesterone group was 17.8% and in control group 36%, p value is <0.05. Conclusion: Administration of progesterone in women at high-risk of developing preterm labor reduces the incidence of preterm labor, neonatal mortality and morbidity and increases baby weight <2.5 kg.

Pregnancy Outcome in Women with Dengue Infection in Northern India.

Background: Dengue is the most prevalent mosquito-borne infection worldwide. Vertical transmission after maternal dengue infection to the fetus and pregnancy losses in relation to dengue infection have been reported. Objective: The aim of the study was to assess the maternal and fetal consequences of dengue fever (DF) infection during pregnancy. Methodology: A retrospective analysis of all pregnant women with DF was done over a period of 1 year. Clinical, laboratory, maternal and fetal outcomes and early neonatal outcomes were collected from patients with confirmed dengue infection. Result: An upward trend was observed with a striking feature of severe thrombocytopenia in 36% cases. Oligohydramnios and low birth weight were the most common and peculiar outcomes. Preterm delivery with increased risk of cesarean section was noted. Vertical transmission occurs in pregnancy but no evidence of congenital anomaly could be traced.

Assessment of Cesarean Section Scar Strength: Still A Challenge.

Objective: To assess the integrity (strength) of cesarean scar of uterus during interval period (nonpregnant state) by ultrasonography (USG), hysterography and hysteroscopy and their correlation. Material and methods: The study was conducted in the Dept. of Obstetrics and Gynecology and Dept. of Radiology, SN Medical College, Agra. Three hundred nonpregnant women with cesarean section in past were recruited to undergo USG, hysterography and hysteroscopy along with proper history and other routine examination. The thickness and appearance of anterior uterine wall especially at scar area was noted down during investigations. Results: The mean scar thickness was more (11.59 ± 1.33 mm) in women with only one cesarean section in comparison of women having more than one cesarean section (9.08 ± 9.2 mm). Healthy abdominal scar healed with primary intention correlated with good uterine strength. More breaking on hysterography was associated with thin scar on USG. When scar area was found irregular and wide on hysteroscopy the thickness of scar was less on USG also. Conclusion: A prospective idea of uterine scar strength can be obtained by careful history taking, local examination of abdominal scar as well as p/v findings along with USG, hysterography and hysteroscopy in nonpregnant women. If findings are suggestive of weak scar, a lady can be counsel for planned cesarean section in her future pregnancy in spite of trial for vaginal birth after cesarean. Accordingly, if she can afford further risk and cesarean section, she should become pregnant otherwise should avoid further confinement in future.