ABSTRACT
Ectopic pregnancy is a pregnancy in which the developing blastocyst implants outside the endometrial cavity. An estimated 1.3%-2.4% of pregnancies end up outside the uterus. With prompt diagnosis and efficient treatment, the risks of morbidity and mortality associated with ectopic pregnancy can be reduced. For the treatment of carefully chosen ectopic pregnancies, methotrexate therapy, a folic acid antagonist that is highly toxic to rapidly replicating tissues, produces outcomes comparable to surgery. We describe six cases of ectopic pregnancy which were successfully treated with methotrexate and on follow-up two of them successfully conceived to term delivery. For patients who are physically fit enough, medical management of an ectopic pregnancy with methotrexate should be the first line of treatment to lower surgical morbidity and mortality. Following the administration of the medication, the patient is monitored with a clinical symptom interview and weekly plasma human chorionic gonadotrophin levels checks. When initial human chorionic gonadotrophin levels are extremely high, complete resolution of an ectopic pregnancy can take 6-8 weeks instead of the usual 2-3 weeks. Early diagnosis of ectopic pregnancies is necessary to improve their prognosis. Ectopic pregnancies can be managed medically with methotrexate to preserve fertility. Compared to surgical management, methotrexate therapy appears to have more advantages.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Gestational trophoblastic disease is an uncommon group of pregnancy-related disorders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy. CASE FINDINGS: A 52-year-old woman Para 2 Living 3, 3â¯years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total abdominal hysterectomy and bilateral salphingo-opherectomy, followed by 2â¯cycles of chemotherapy. DISCUSSION: Trophoblast disease of pregnancy disease includes a unique tissue group with a wide range of endocrine and angiogenic functions derived from placental trophoblasts. They are associated with uncommon, interrelated conditions, which differ according to the following parameters: invasion, regression, metastasis, and recurrence rate. Beta HCG remains initial investigation to be taken in patients suspecting trophoblastic disease. CONCLUSION AND RECOMMENDATIONS: Gestational trophoblastic disease should be considered in the differential diagnosis of peri and postmenopausal vaginal bleeding. Long term follows up with beta HCG needs to be done to detect recurrence.
ABSTRACT
INTRODUCTION: Lotus birth is seldom practiced, with its prevalence being not well documented. There is no clear existing guideline or pathway for this practice. Safety in delivery as well as caring for newborn and her mother is of paramount importance. Hence, clarity for Lotus delivery in any set up is indispensable. CASES FINDINGS: We have described on case series approach to women who opted to delivery without detachment of placenta. We have described delivery characteristics, neonatal clinical course, cord, and placenta management. In year 2022 at our center, we have received two cases of lotus delivery. CONCLUSION AND RECOMMENDATION: Lotus birth is a new way of delivery in our country despite of low prevalence, it is indispensable for all cadres that deal with delivering mothers to be aware for better outcomes. It has been noted that, the risk for neonatal infection increases with this practice.
