Navigating Diagnostic Challenges: Heterotopic Pregnancy Versus Hyperdecidual Reaction in Ectopic Gestation.

In the intricate field of obstetrics and gynecology, few scenarios present as complex a diagnostic challenge as the differentiation between heterotopic pregnancy, hyperdecidual reaction, and ectopic pregnancy. These conditions, while distinct, often blur together in clinical presentation, necessitating a nuanced understanding to achieve accurate diagnosis and timely intervention. A heterotopic pregnancy is a rare and potentially life-threatening condition in which a woman simultaneously carries two pregnancies in different locations. One pregnancy is typically located within the uterus (an intrauterine pregnancy), while the other is located outside the uterus, most commonly in one of the fallopian tubes (an ectopic pregnancy). This condition is sometimes referred to as a combined intrauterine and extrauterine pregnancy. The diagnosis of heterotopic pregnancy can be challenging because the symptoms can mimic those of a normal intrauterine pregnancy or an ectopic pregnancy. A combination of clinical symptoms, physical examination, and imaging studies, such as transvaginal ultrasound, can help in the diagnosis. After surgical or medical treatment, close monitoring and follow-up with a healthcare provider are essential. The remaining intrauterine pregnancy will need careful observation to ensure it continues to develop normally. However, in some cases of ectopic pregnancy, there will be hyperdecidual reaction within the uterus, which may sometimes create confusion with intrauterine pregnancy. Here, a case of ectopic pregnancy that was radiologically misdiagnosed as heterotopic pregnancy is presented to highlight the possibility of ectopic pregnancies being misdiagnosed as heterotopic pregnancy due to the hyperdecidual reaction. The index case underwent laparoscopic salpingectomy for tubal ectopic and dilatation and evacuation for suspected failed intrauterine pregnancy. The histopathological report of the intrauterine products of conception confirmed it to be decidua without any trophoblastic tissue.

BMI and Polycystic Ovary Syndrome: Demographic Trends in Weight and Health.

Introduction Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in adolescence and reproductive age. The distribution of PCOS across different body mass index (BMI) categories can vary, and research has shown associations between PCOS and weight status. This study tries to evaluate the distribution of PCOS in relation to BMI in women attending the PCOS clinic in a tertiary hospital in eastern India. Methodology This hospital-based cross-sectional study was carried out in the gynecology outpatient department of a tertiary care center. The study population included all the women in the age group between 15 and 45 years diagnosed as having PCOS using the Rotterdam definition. The various physical, clinical, and biochemical parameters were measured in the study population and compared among the obese and lean PCOS patients. Results and discussion A total of 143 women were included in the study. The mean age of the study population was 26.8 years. Among these, the underweight and normal weight patients were categorized as lean PCOS patients, 35 in number (24.5%), and overweight and obese patients were categorized as obese PCOS patients, 108 in number (75.5%). All the physical parameter measures like age (mean = 28.05, SD = 5.722), height (mean = 153.384, SD = 6.679), weight (mean = 68.182, SD = 11.501), waist circumference (mean = 95.135, SD = 10.291), hip circumference (mean = 101.47, SD = 9.320), waist-to-hip ratio (mean = 0.940, SD = 0.0831), and neck circumference (mean = 34.85, SD = 2.445) were significantly higher in the obese group as compared to the lean group. Menstrual irregularity was significantly more common in the obese PCOS patients as compared to the lean PCOS group (p = 0.02). There was a significant difference (p < 0.05) between the obese and lean PCOS patients when the biochemical parameters like fasting insulin, fasting glucose, and homeostatic model assessment of insulin resistance (HOMA-IR) were compared. There is a strong link between obesity, insulin resistance, and PCOS. Obesity can exacerbate insulin resistance, a common feature of PCOS, leading to increased levels of insulin and androgens. Conclusion The demographic distribution of PCOS in relation to BMI is essential for tailoring interventions and treatments.

Breastfeeding and Environmental Consciousness: A Narrative Review of Environmental Implications and Potential Contributions to Reduce Waste and Energy Consumption.

Breastfeeding is a natural and essential process that not only confers numerous health benefits to infants and mothers but also plays an important role in environmental sustainability. This narrative review explores the environmental implications of breastfeeding in comparison to formula feeding and examines the potential contributions of breastfeeding to reduce waste, energy consumption, and carbon footprint. By exploring the existing literature and research findings, this review sheds light on how breastfeeding aligns with environmental conservation efforts and reinforces the importance of promoting breastfeeding practices for a more sustainable and environment-friendly future.

Neurofibromatosis-Noonan Syndrome With Primary Amenorrhoea: A Case Report.

Neurofibromatosis-Noonan syndrome is a rare RASopathy syndrome. It occurs due to the mutation in the NF1 gene and the patients present with the phenotypic features of both Neurofibromatosis and Noonan syndrome. Here a case of an early adolescent girl is described who presented with the chief complaint of primary amenorrhoea and on evaluation was diagnosed to be a patient of Neurofibromatosis-Noonan syndrome. The index case was short-statured with a short and broad neck. Physical examination revealed a pointed pinna, hypertelorism, telecanthus, characteristic facies, and multiple freckles all over the body. She also had numerous atypical café-au-lait spots. Whole genome sequencing revealed Neurofibromatosis-Noonan syndrome which was likely a pathogenic variant causative of the typical phenotype present with a mutation in the neurofibromin gene (NF1) on chromosome 17q11. We discuss here the management and follow-up of the case.

Persistent Right Umbilical Vein in Association With Single Umbilical Artery: A Case Report and Review of Literature.

Persistent right umbilical vein (PRUV) and single umbilical artery (SUA) are developmental malformations of the vascular system. In isolation, these are not rare, but the presence of these two malformations together is not very common. When they are present together, there are increased chances of associated congenital anomalies, especially anomalies of the vascular system. So, when these two coexist, a detailed examination of all other organ systems, especially the cardiovascular system, should be conducted. The accurate evaluation of such vascular malformations during fetal life is needed to provide adequate antenatal counseling, the timing of delivery, and appropriate post-natal care. We report a case of a primigravida who was diagnosed with PRUV and SUA in the fifth month of gestation. In this article, we discuss this case's management with a literature review. The anomaly scan done at around 21 weeks revealed a two-vesseled umbilical cord with an SUA and PRUV. Apart from this, there were no other structural anomalies. The patient had preterm delivery at 35 weeks 5 days gestation period and delivered a 2.6 kg male baby.

Association Between Early Pregnancy Body Mass Index and Gestational Weight Gain in Relation to Neonatal Birth Weight.

INTRODUCTION: Maternal early pregnancy body mass index (BMI) and gestational weight gain (GWG) strongly correlate with pregnancy outcomes. Gestational hypertension and diabetes have been associated with overweight and obesity in pregnancy. A low pre-pregnancy BMI has been associated with low birth weight and preterm birth. METHOD: This observational study was carried out from November 2018 to July 2020 in a tertiary care hospital in South India with a sample size of 100. Pregnant women with uncomplicated singleton pregnancies booked for regular antenatal care by 10 weeks of gestation were included in the study. During the participants' antenatal check-ups, detailed history and examinations were made. The weight of the participants was recorded at every antenatal check-up. Information about the gestational age at delivery and the birth weight of the neonates were collected following delivery. RESULTS:  The mean age of women was 25.83 + 2.74 years. Of women who delivered low birth weight neonates (<2.5 kg), 86% had GWG below the Institute of Medicine (IOM) recommendation. A total of 57% of women with normal early pregnancy BMI and 67% of obese women had GWG within the IOM recommendation. Early pregnancy BMI had a positive correlation with neonatal birth weight (r (98) = 0.779, p = 0.001). Of the underweight pregnant women, 72% gave birth to small for gestational age (SGA) babies, and 97% percent of normal early pregnancy BMI women delivered neonates with normal weight for gestational age. A total of 33% of overweight and 50% of obese women had large for gestational age (LGA) babies. CONCLUSION: Results from this study suggest that maternal early pregnancy BMI is more strongly associated with neonatal birth weight than GWG. Therefore, early pregnancy BMI may be an important focus for counseling during pregnancy.

Labial Fusion Recurrence in a Prepubertal Girl: A Case Report and Review of Literature.

Labial fusion is the fusion of labia minora or majora and results in partial or complete fusion of the vaginal orifice. The condition is commonly seen in prepubertal girls and post-menopausal women, but it can sometimes be seen in reproductive age group women also. We present here a case of a three-year-old girl who presented with recurrence of labial fusion and dysuria. The patient had a similar labial fusion three months before, which was treated with manual separation followed by estrogen cream application. The recurrence of labial fusion was managed conservatively. This case report highlights the possibility of recurrence of labial fusion in prepubertal girls till they attain puberty, as well as its conservative management.

Fertility-Preserving Surgery of Borderline Serous Ovarian Tumors: A Case Report.

Borderline ovarian tumors (BOTs) are tumors with low malignant potential and have an excellent prognosis. They are distinct by an epidemiological shift toward younger women. Fertility-sparing surgery is considered the gold standard in young patients presenting with BOTs. Spontaneous conception has been reported after conservative surgery with no enhanced risk of mortality or morbidity from disease progression during pregnancy. The prognosis of BOTs is very good; however, a small proportion of these tumors may recur and show malignant transformation. Timely follow-up of the patients is required for timely detection of any recurrence. We are presenting here a case of a 23-year-old woman diagnosed with BOT. The patient was nulliparous and hence was the appropriate candidate for fertility-sparing surgery. She underwent unilateral salpingo-oophorectomy and is now on regular follow-up.

Cervical Dysgenesis: A Rare Mullerian Duct Anomaly.

Cervical agenesis or dysgenesis is a rare congenital anomaly. The patients usually present with primary amenorrhoea, primary infertility, and cyclical abdominal pain or with a history of prior surgeries like hymenectomy, vaginoplasty, or adhesiolysis for endometriosis along with well developed secondary sexual characters. We present a case of 15 years old girl with cervical dysgenesis and proximal vaginal agenesis, who presented with severe cyclical abdominal pain. She was managed with cervicovaginal canalization by coring and drilling technique done by vaginal approach with simultaneous laparoscopic guidance. Being a rare type of developmental anomaly of the female genital tract, no standard treatment for type-2 cervical dysgenesis has been established. The patient was followed up for 18 months during which she reported to be having regular menstruation.