Torsion of a huge subserosal uterine leiomyoma: A challenging case of acute abdomen.

Torsion of a uterine leiomyoma is an extremely rare, albeit life-threatening surgical emergency. A 28-year-old woman presented with acute abdominal pain. Imaging revealed a torsed subserosal uterine leiomyoma which was managed surgically and the diagnosis confirmed intraoperatively as well as on histopathology. Contribution: While intraoperative findings remain the primary means of diagnosis, radiologists should be familiar with the potential imaging findings of leiomyoma torsion as timely intervention can greatly improve patient outcome.

Breastfeeding and Contraceptive Methods in Women With Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-COV-2) Infection in Peripartum Period.

Objective: This study aimed to assess the exclusive breastfeeding and contraceptive methods among women delivering within 1-week of a positive test for severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) infection. Materials and methods: In this study, 106 women with SARS-CoV-2 infection who were either asymptomatic or had mild disease were included. They were admitted for maternity care at a tertiary center between May to September 2020. The data was collected during their hospital stay and subsequently by telephonic or in-person interviews at 4-6 weeks and 8-10 weeks postpartum for contraceptive use, breastfeeding and use of facemask and hand-hygiene. Results: Sixty-three (59.4%) women had vaginal delivery and 43 (40.6%) required cesarean-section. Only one of the 98 newborns who were tested for SARS-CoV-2 turned out positive. Initiation of breastfeeding was delayed by an average of three days due to preparing the Reverse transcription polymerase chain reaction (RT-PCR) report. Exclusive breastfeeding was practiced by 69% and mixed feeding by 26%.Pre breastfeeding hand hygiene and facemask use declined after discharge (100% to 53.75% at 8-10 weeks postpartum). Out of 106, 86 (81%) women used no contraception at 8-10 weeks postpartum, continued with post-placental-IUD in 8/106 (7.5%) and tubal-sterilization during cesarean in 8/106 (7.5%) cases. Only 4/106 (4%) adopted alternative methods like barrier contraception. Conclusion: The practice of exclusive breastfeeding remains unchanged among women who suffered from SARS-CoV-2 infection in the peripartum period while uptake of postpartum contraception was minimal except for the women who opted for long term contraceptive methods in the immediate postpartum period.

Spontaneous vaginoperitoneal fistula as a rare complication of carcinoma ovary: a case report.

BACKGROUND: Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. CASE PRESENTATION: A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. CONCLUSION: Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.

Obstetric outcomes in pregnant women with seizure disorder: A hospital-based, longitudinal study.

OBJECTIVE: To study the association of seizure disorder with adverse obstetric outcome in terms of maternal and perinatal complications. MATERIALS AND METHODS: This longitudinal study was conducted at Maulana Azad Medical College, New Delhi over 15 months among women attending the antenatal clinic (ANC) outpatient department. Fifty pregnant women with seizure disorder with their first ANC visit before 28 weeks were recruited as the case group, excluding patients with eclampsia. The control group included 120 matched healthy pregnant women. After obtaining informed consent, subjects were recruited and followed till one week postpartum and obstetric outcomes were analyzed. RESULTS: Women with seizure disorder had significantly increased incidence of severe preeclampsia (cases =8%, controls =0%, p<0.001), antepartum hemorrhage (cases =4%, controls =0%, p<0.001), babies with early neonatal complications such as asphyxia (cases =4.1%, controls =0.5%, p=0.04), respiratory distress (cases =14.5%, controls =5.1%, p=0.02), necrotizing enterocolitis (cases =2.0%, controls =0%, p=0.04), early neonatal death (cases =2.0%, controls =0%, p=0.04) and Neonatal Intensive Care Unit admission (cases =20.8%, controls =8.6%, p<0.001) when compared with women without seizure disorder. No significant difference was observed in rates of induction of labor, cesarean section, abortion, congenital anomalies in babies, still births. Conclusion: Women with seizure disorder are at higher risk of hypertensive disorders, antepartum hemorrhage, and early neonatal complications. CONCLUSION: Women with seizure disorder are at higher risk of hypertensive disorders, antepartum hemorrhage, and early neonatal complications. Appropriate obstetric, pediatric and neurology care is required during preconception, pregnancy, labor, delivery, and postpartum.

An unusual case of synchronous carcinoid of ovary and gall bladder.

Multifocal carcinoid is a known phenomenon. We present a rare combination of an ovarian carcinoid synchronous with gallbladder carcinoid. This rare combination has not been reported so far. An asymptomatic 45-years-old perimenopausal lady was diagnosed to have a metastatic ovarian cancer, but on laparotomy she was found to have a primary synchronous metastatic gall bladder as well. On histopathological evaluation she was found to have two separate primary carcinoids. Subsequently the patient received chemotherapy and is completely asymptomatic on follow up. Further research needs to be undertaken and guidelines need to be formulated for management of these cases.

Prevalence and associated risk factors for postpartum depression in women attending a tertiary hospital, Delhi, India.

BACKGROUND: Maternal mental health is a largely ignored issue in the Indian population. Considering the high prevalence of postpartum depression, mental health assessment and screening of high-risk cases should be a part of routine antenatal care. AIM: To study the prevalence of women at risk for peripartum depression using Edinburgh Postnatal Depression Scale (EPDS) score in a tertiary teaching hospital in New Delhi, and to study the associated risk factors in the Indian population. METHOD: Five hundred and six (506) peripartum women were interviewed using a structured questionnaire, which included sociodemographic details like socioeconomic status, family structure, relationship with husband and mother-in-law, past obstetric history and gender of children, any history of previous psychiatric illness and outcome of current pregnancy in terms of mode of delivery, gender of newborn and neonatal complications. EPDS scoring was done using a Hindi translated version. Data were analysed using Epi Info version 3.32. RESULTS: Thirty one (6%) out of 506 women scored ≥ 10 on the EPDS. Birth of female child, nuclear family structure and poor marital relationship were found to have a statistically significant correlation with peripartum depression. CONCLUSION: The 6% prevalence of women at risk of peripartum depression in our study, which is similar to other such studies, is significant and hence maternal mental health assessment should be made a part of routine antenatal and postnatal care.