Massive Post-Partum Haemorrhage In A SARS-Cov-2 Positive Primi Gravid Patient: A Case Report.

A 20-year-old, primi gravid, south Asian woman, was referred from secondary care to Aga Khan University Hospital for further management of primary post-partum haemorrhage after a normal vaginal delivery, on July 12, 2021. She was otherwise healthy, with no known comorbidity. She tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during her admission, on account of universal Covid-19 testing policy. Initially, conservative measures were instituted to control bleeding, including bilateral internal iliac artery ligation, concluding with hysterectomy to stop the haemorrhage. Multiple units of blood products had to be transfused. Obstetrical haemorrhage being the menace in this case, the possibility of Covid-19 positive obstetrics patients being more susceptible to massive post-partum haemorrhage, requiring more radical life-saving procedures to be conducted earlier, was considered. In future, more observational studies will be needed to determine any association between Covid-19 infection and obstetric haemorrhage.

A different strategy for management of a case of adenoid cystic carcinoma of Bartholin gland.

Adenoid cystic carcinoma of the Bartholin gland is a rare vulval cancer. Available literature suggests an aggressive nature with protracted clinical symptoms and local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. This case demonstrates the role of neoadjuvant chemotherapy and interstitial brachytherapy with less radical surgery, in the treatment of adenoid cystic carcinoma of the Bartholin gland. A 63-year-old woman presented in the clinic four months after the removal of vulvar mass with histopathology report showing adenoid cystic carcinoma of the Bartholin gland with positive margins. Clinical examination and imaging showed local disease extension up to the levator ani and abutting anal margin. She was given four cycles of neoadjuvant chemotherapy followed by ipsilateral hemivulvectomy with inguino-femoral lymphadenectomy followed by 25 cycles of external beam radiation and three cycles of interstitial brachytherapy. The patient has been disease free for more than 30 months. The use of neoadjuvant chemotherapy in treatment of Bartholin carcinoma along with conser vative surgery and radiotherapy can be a good treatment strategy as it reduces the morbidity associated with radical surgery without recurrence to date.

Growing teratoma syndrome in ovarian germ cell tumours - a diagnostic challenge, two case reports.

Growing teratoma syndrome (GTS) is a rare complication of ovarian germ cell tumours and occurs in young age group. It is characterized by clinical or radiological increase in tumour size during or after chemotherapy, with normalization of tumour marker levels. Histopathological tissue growth post chemotherapy is a mature teratoma without any malignant component. Mainstay of treatment is surgical excision of the disease to prevent progression of tumour as mature teratomas are resistant to both chemotherapy and radiotherapy. Diagnosis is a challenge as disease recurrence or chemo-resistance can be difficult to distinguish. Benign nature of this disease entity is essential to avoid overzealous chemotherapy or radical surgery.

Spontaneous bilateral tubal pregnancy.

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described.

Primary hyperparathyrodism in pregnancy and review of literature.

hyperparathyroidism (PHPT) is rare condition during pregnancy; however, it can carry significant risks to both mother and foetus during and after the pregnancy. The definitive treatment is parathyroidectomy undertaken preferably in the second or early third trimester. A case of asymptomatic PHPT diagnosed and treated by parathyroidectomy in the third trimester is described.