Transcatheter Artery Embolization for Postoperative Haemorrhage after Arterio-Venous Malformation - Safer Option.

SUMMARY INTRODUCTION: Hemorrhage is one of the commonest and dreaded complications especially with pelvic surgeries. Gestational trophoblastic neoplasias (GTN) are notorious for their propensity to bleed torrentially and metastasis to vital organs. GTN is associated with an arterio-venous malformation (AVM) about 10-15% of the time, which can lead to bleeding after surgery or after complete remission. After the failure of conventional management with chemotherapy or surgery one is compelled to take another modality of management. One of such methods is the use of transcatheter artery embolization in cases of GTN or post-hysterectomy cases of GTN. Transcatheter arteryembolization (TAE) was effective in controlling bleeding due to arterio-venous malformation in 96% of cases. CASE: 46 years P2L2A5 (para 2, living issue 2, abortion 5) post-hysterectomy patient presented with bleeding from the vagina after surgery. Twice she underwent vaginal vault repair after hysterectomy but failed. Ultrasonography (USG) showed arterio-venous malformation (AVM); angiography revealed massive extravasation from (left internal iliac artery and abnormal vascularity from the right internal iliac. She was taken up for bilateral internal iliac arteries embolization but again had a heavy bout of bleeding after one week. CT scan confirmed a residual lesion and she underwent a repeat embolization after which the bleeding stopped. Serum BHCG was advised during workup and it was 1997 IU/ml. A diagnosis of GTN was confirmed. The patient was discharged after two cycles of chemotherapy with advice to review for the third one on an outpatient department basis. CONCLUSION: We concluded that TAE is an effective and safer alternative to surgery in postoperative bleeding from AV malformation in the case of GTN. It can be repeated and should be made to more liberal use in emergency settings.

The Concepts and Consequences of Early Ovarian Ageing: A Caveat to Women's Health.

Apparent rise in the incidence of infertility in females and the trend shifting towards delayed child bearing brought up the concept of ovarian ageing. Women in their early thirties show poor ovarian reserve which is an entity named as early ovarian ageing. Early ovarian ageing is mostly genetically determined, but acquired modifiable factors like smoking, or ovarian surgery have some roles. Infertility and subfertility are the only clinical recognizable sequelae in the early ovarian ageing. The worrisome fact is that the outcome of assisted reproductive techniques is also not that much encouraging. Even if ovarian priming with DHEA has raised hope in the assisted reproductive techniques for these patients, but more randomized trials are needed to support this. Screening of these women with antimullerian hormone, antral follicle count and genetic analysis may be useful for recommendation at appropriate biological time regarding conception or fertility preservation.

Spontaneous pregnancy in primary amenorrhea; a case report.

INTRODUCTION: Primary ovarian failure (POF) is a syndrome composed of amenorrhea, estrogen deficiency and Follicular Stimulating Hormone (FSH) of menopausal ranges in young women. In this article, we report a case of primary amenorrhea that presented with full term pregnancy. CASE PRESENTATION: A 29-year old woman with a history of primary amenorrhea attended hospital with full term pregnancy. She had experienced a few episodes of withdrawal bleeding on hormonal treatment initially and she had conceived spontaneously. Subsequently, she had uneventful pregnancy and caesarean delivery on maternal request. CONCLUSION: This case was presented to emphasize the real chances of spontaneous conceptions due to intermittent and unpredictable ovarian function in patients with POI. Nevertheless, egg donation is still considered the best option for infertility in such women.

Ectopic molar pregnancy: a rare entity.

INTRODUCTION: Ectopic molar pregnancy is a rare occurrence and consequently not often considered as a diagnostic possibility. In this article, an attempt was made to stress on the need for histopathological examination and follow up of every case of ectopic pregnancy. This was substantiated with the help of a case report. CASE PRESENTATION: A 30-year-old gravida 4, para 3, pregnant woman with a 7-week history of amenorrhea attended hospital with abdominal pain. Per vaginal examination revealed a tender left adnexal mass measuring 4x4 cm and on ultrasonography there was a live fetus corresponding to a 7-week and 6 days gestation with free fluid in the pelvic cavity. Laparotomy, revealed a ruptured left tubal ectopic pregnancy and histopathological examination was suggestive of a molar pregnancy. CONCLUSION: Although rare, molar changes can occur at any site of an ectopic pregnancy. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis.