Acute Pulmonary Embolism after Cesarean Section.

Pregnancy is a well-known state of hypercoagubality, increasing the risk of venous thromboembolism (VTE). It is more common with cesarean delivery than vaginal delivery. Pulmonary Embolism (PE) is under diagnosed during pregnancy and postpartum period as majority of signs and symptoms of PE are non-specific. We describe a case of 35-yearold obese female who suffered a syncopal attack following caesarean delivery and was diagnosed to have pulmonary embolism. A high index of suspicion is required for the timely diagnosis and treatment of PE as most of the signs and symptoms of PE are nonspecific. It is important to consider VTE prophylaxis especially in patients with risk factors.

Fetal biophysical profile score and perinatal outcome.

BACKGROUND: Sudden fetal demise, perinatal morbidity and mortality are still some of the major obstetrical challenges. Reduced fetal movements may have some bearing to fetal asphyxia and death, so timely detection of such condition and measures taken can prevent such mishaps. METHODS: A descriptive prospective study was conducted at Tribhuvan University Teaching Hospital, Department of Obstetrics and Gynecology from January to December 2002 in 55 cases to find out the relationship of Biophysical Profile Score with perinatal outcome in pregnant mothers with decreased fetal movement counts at or above 34 weeks of gestational age. The mode of delivery, Apgar score, neonatal admission and perinatal mortality were analyzed. RESULTS: The study demonstrated that most of the fetuses were in good condition with 87% of the cases scoring 8-10 BPS (normal), 6% scoring six (equivocal) and only 7% got four score (abnormal). Having the abnormal BPS of four significantly increased the risk of perinatal mortality by 50% (p=0.000). This study could not detect any significant association between Apgar score and neonatal morbidities, but showed significant correlation between BPS and caesarean section. The patients having lower BPS tended to undergo more caesarean section delivery than patients having normal BPS (p=0.009). CONCLUSIONS: An abnormal BPS of four in cases of reduced fetal movement counts significantly influenced the risk of perinatal death. However reduced fetal movements only did not raise the risk of fetal morbidity and mortality. So BPS should be beneficial to detect the fetuses at risk in the patients having less fetal movements for the proper management at right time.

Simultaneous occurrence of hematometrocolpos and consecutive pregnancies in uterine didelphys : a case report.

Hematometrocolpos drained abdominally at laparotomy done, with suspicion of an ovarian torsion in an adolescent with ipsilateral renal agenesis, was eventually rediscovered to have in coexistent uterine didelphys in a 25 year P3+0 at the time repeat caesrean for breech in the event of third parturition, complicated by partum hemorrhage as in all her previous delivery (first vaginal delivery and retained placenta, second caesarean for obstructed labor by non pregnant half of didelphic uterus). This illustrates how simultaneous occurrence of hematometrocolpos can go unnoticed although there was every reason for this condition not to go unrecognized for the simple fact ofhemivaginal obstruction and hematometra with ipsilateral renal agenesis (on the left side) unaffecting the consecutive pregnancy in the other uterus.

Hypohiderotic ectodermal dysplasia.

We report a case of a six years age girl who presented to our out patients department with the history and findings suggestive of recurrent respiratory tract infections. She was also noticed to have: non homogeneous hyperpigmented patches on the face since three months of age, sparse hair on the scalp and eyebrows, conical peg like teeth and delayed dentition, prominent and low set ears, perpetually flexed third toe bilaterally. Axillary skin biopsy showed adenexal structures and eccrine glands in subcutaneous fat which were reduced in number. The diagnosis made was: Anhydrotic/Hypohidrotic type of ectodermal dysplasia.