ABSTRACT
A cornual gestation is one of the most hazardous types of ectopic gestations, which accounts for 2 - 4% of all the ectopic pregnancies and it has a mortality rate which is 6 - 7 times higher than that of the ectopics in general. The diagnosis and the treatment of such a pregnancy is challenging and it constitutes an urgent medical situation. Because of the myometrial stretch ability, they tend to present relatively late, at 7 - 12 weeks of gestation. A significant maternal haemorrhage which can lead to hypovolaemia and shock, can rapidly result from a cornual rupture. We are reporting a case of 28 year old woman who presented to the emergency obstetrical room in a state of hypovolaemic shock. The diagnosis of a ruptured ectopic pregnancy was confirmed in view of the history of 10 weeks of amenorrhoea, with a positive urine pregnancy test. She was shifted for emergency exploratory laparotomy. Intraoperatively, we encountered a left lateral wall ruptured uterus with a 10 week old foetus in the peritoneal cavity, which suggested a left cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully.
ABSTRACT
In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.
