A rare case of morbidly adherent placenta in a young Primigravida with RH negative pregnancy managed with peripartum subtotal hysterectomy.

INTRODUCTION AND IMPORTANCE: Postpartum hemorrhage (PPH) can be defined as excessive bleeding (>500 ml) from the genital tract after the delivery of baby upto 6 weeks. PPH accounts for major cause of maternal mortality rate. Prevention and early intervention can prevent this complication of delivery. However condition like placenta accreta leads to retention of placenta and makes PPH inevitable. CASE SUMMARY: We present the case of massive postpartum hemorrhage secondary to Placenta accreta in young primigravida with RH negative pregnancy. Clinical findings and investigations were not significant during her admission. She delivered the baby via vaginal route but placenta was not expelled till 30 min. Due to failed manual removal of placenta patient was shifted to OT.Manual vacuum aspiration was done in OT setting and chunks of placenta along with blood clots were obtained.Uterine balloon tamponade was inserted. Due to persistent PV bleeding subtotal hysterectomy was carried out in line for placenta accreta. DISCUSSION: Placenta accreta being one of the life threatening obstetric condition, it should be diagnosed as early as possible and need prompt management so as to prevent maternal mortality. Due to increasing number of cesarean delivery the cases of placenta accreta has been rising but rarely in some cases can it present in young primigravida with Rh negative pregnancy. CONCLUSION: In the cases of morbidly adherent placenta it is necessary for obstetrician to early identify such conditions and timely intervene to save the mother's life. Moreover Rh negative could be a hidden risk factor.

Premenstrual Syndrome among Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Introduction: Premenstrual syndrome is the premenstrual disorder with wide range of prevalence world-wide leading to higher rates of work absences, higher medical expenses, and lower health-related quality of life. The aim of this study was to find out the prevalence of premenstrual syndrome among medical students of a medical college. Methods: A descriptive cross sectional study was conducted in a medical college among medical students using self-reported questionnaires based on American College of Obstetricians and Gynaecologists criteria for premenstrual syndrome, and 12-Item Short Form Health Survey for quality of life, from 1 January 2022 to 31 March 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 207807955). Convenience sampling was used among students who met the inclusion criteria. Point estimate and 95% Confidence Interval were calculated. Results: Among 113 patients, premenstrual syndrome according was seen in 83 (73.45%) (82.93-83.06, 95% Confidence Interval) out of which, 56 (67.46%) showed mild premenstrual syndrome, and 27 (32.53%) had moderate premenstrual syndrome. The most commonly reported affective symptoms of premenstrual syndrome was irritability 82 (98.79%), while the somatic symptoms was abdominal bloating 63 (75.90%). Conclusions: The prevalence of premenstrual syndrome among medical students was similar to in the other studies done in similar settings. Keywords: premenstrual syndrome; prevalence; quality of life.

Sexual Intercourse during Pregnancy among Postpartum Women Admitted to the Department of Obstetrics in a Tertiary Care Centre.

Introduction: Pregnancy is a time when women's bodies and minds go through a lot of changes. Sexuality is an important part of a woman's health and well-being, and it often changes during pregnancy. Most women admit that their libido changes in some way during pregnancy. However, the sexuality of a pregnant woman is very individual and influenced by a variety of different factors. This is a very important topic that is often taboo, especially in a male-dominated society, and it needs to be explored more. The aim of this study was to find out the prevalence of sexual intercourse among postpartum women admitted to the Department of Obstetrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among postpartum women admitted to a tertiary care centre after taking ethical approval from the Institutional Review Committee. The study was carried out from 1 January 2021 to 30 December 2021. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 97 pregnant women admitted to the Department of Obstetrics, the prevalence of sexual intercourse was 36 (37.11%) (27.50-46.72, 95% Confidence Interval). A total of 34 (94.44%) were sexually active in the first trimester while 13 (36.11%) and 4 (11.11%) were sexually active in the second trimester and third trimester respectively. Conclusions: The prevalence of sexual intercourse during pregnancy was lower than other studies done in similar settings. Keywords: pregnancy; sexual behaviour; sexual intercourse; sexuality.

Persistent gestational trophoblastic disease following ovarian molar pregnancy: A case report of a rare entity with review of the literature.

Ovarian molar pregnancy, though a very rare entity, behaves like any other molar pregnancy. After surgical management, close follow-up with ß-hCG surveillance is invariable to detect progression to persistent gestational trophoblastic disease.

Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Abnormal uterine bleeding is a common gynecological presentation, accounting for at least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty, anovulatory cycles, and abnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. METHODS: A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College. Convenient sampling was done. Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. RESULTS: Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid,and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding wasmenorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7(8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism. CONCLUSIONS: Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was the most common pattern of abnormal uterine bleeding.