Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.

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A two-year retrospective study of infants with Erb-Duchenne's palsy at a tertiary centre in Rajasthan, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180197 ◽

2018 ◽

Vol 7 (2) ◽

pp. 700

Author(s):

Rakesh Appasaheb Hasabe ◽

Dnyaneshwar S. Diwane ◽

Sushant S. Chandawar

Keyword(s):

Brachial Plexus Injury ◽

Single Mother ◽

Shoulder Dystocia ◽

Fetal Macrosomia ◽

Live Births ◽

Tertiary Centre ◽

Vaginal Deliveries ◽

History Of ◽

The Mean ◽

Care History

Background: Brachial plexus injury (BPI) has prevalence of between 0.5 and 4.4/1000 live births. It is commonly believed to be attributed to extensive lateral traction during difficult neck delivery. This paper aims to look at one aspect of birth injuries, Erb-Duchenne palsy, its incidence and contributing factors.Methods: All infants sustaining Erb-Duchenne palsy during birth were identified at Department of OBGY, NIMS Hospital, Jaipur. The notes of the infants and mothers were reviewed. Special attention was given to the known risk factors for birth trauma such as ethnicity, parity, antenatal care, history of diabetes etc.Results: During the two-year period 2013 to 2015, there were 6 infants diagnosed with Erb-Duchenne palsy, giving an incidence of 0.79 in 1000 live births. Out of six, four were primigravidae. All pregnancies were singleton, cephalic/vertex undergoing vaginal deliveries; none required forceps or ventouse deliveries. The mean infant birthweight was 4.378 kg with a median value of 4.48 kg (range 3.51-4.78). Four infants were classified as macrosomic i.e. birthweights greater than 4 kg, four infants had birthweights of 4 kg to 5 kg; none weighed over 5 kg. Three of the deliveries were documented as difficult shoulder delivery/shoulder dystocia. Five of the infants had APGAR scores that were less than seven.Conclusions: This study suggested that Erb-Duchenne palsy is strongly associated with fetal macrosomia and shoulder dystocia. Diabetes was not significant in causing macrosomia as only single mother was found diabetic. Fetal macrosomia contributed to shoulder dystocia in the majority of cases.

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Obstetric Characteristics and Management of Patients with Postpartum Psychosis in a Tertiary Hospital Setting

Obstetrics and Gynecology International ◽

10.1155/2015/386409 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

C. E. Shehu ◽

M. A. Yunusa

Keyword(s):

Hospital Setting ◽

Tertiary Hospital ◽

Medical Emergency ◽

Postpartum Psychosis ◽

Puerperal Psychosis ◽

Tertiary Centre ◽

Vaginal Deliveries ◽

Factor Evaluation ◽

The Mean ◽

Underlying Disorder

Background. Postpartum psychosis is the most severe and uncommon form of postnatal affective illness. It constitutes a medical emergency. Acute management emphasizes hospitalization to ensure safety, antipsychotic medication adherence, and treatment of the underlying disorder.Objective. The aim of the study was to determine the obstetric characteristics and management of patients with postpartum psychosis in a tertiary centre in North-Western Nigeria.Methodology. This was a 10-year retrospective study. Records of the patients diagnosed with postpartum psychosis from January 1st, 2002, to December 31st, 2011, were retrieved and relevant data extracted and analyzed using the SPSS for Windows version 16.0.Results. There were 29 cases of postpartum psychosis giving an incidence of 1.1 per 1000 deliveries. The mean age of the patients was 20.6 ± 4 years. Twelve (55%) were primiparae, 16 (72.7%) were unbooked, and 13 (59%) delivered at home. All had vaginal deliveries at term. There were 12 (52.2%) live births, and 11 (47.8%) perinatal deaths and the fetal sex ratio was equal. The most common presentation was talking irrationally.Conclusion. There is need for risk factor evaluation for puerperal psychosis during the antenatal period especially in primigravidae and more advocacies to encourage women to book for antenatal care in our environment.

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Histopathological examination of tissues following a surgical uterine evacuation in the first trimester bleeding: clinical relevance

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i3.32059 ◽

2020 ◽

Vol 10 (3) ◽

pp. 91-94

Author(s):

Bandana Khanal ◽

Basant Sharma ◽

Renuka Tamrakar ◽

Prekshya Singh

Keyword(s):

Clinical Relevance ◽

Histopathological Examination ◽

First Trimester ◽

Gestational Trophoblastic Disease ◽

Complete Mole ◽

Products Of Conception ◽

Partial Mole ◽

History Of

Background: There is no general consensus about the role of routine HPE of the obtained tissue at the time of uterine evacuation. However, it is understood clinically that it is of utmost importance to prove the presence of intrauterine gestation and to exclude gestational trophoblastic disease in the form of partial or complete mole. This study aimed to assess the role of histopathology in cases of first trimester miscarriages and to determine clinical relevance of histopathological examination following surgical evacuation. Methods: This was a retrospective study of collected data over 12 months (January 2018- December 2018) in an agency for reproductive health setup with predefined inclusion criteria. We included 60 consecutive patients attended with history of first trimester bleeding. Patient’s record and the histopathological examination report of products of conception following uterine evacuation were observed. The data was analyzed descriptive statistics including percentage, stander deviation, mean, and range in Microsoft Excel software. Results: Missed abortion was the most common type and constituted 55% of the studied group. The histopathological reports confirmed the pregnancy in all patients and revealed partial mole in 6(10%) patients and complete mole in 2(3.33%) patients. Conclusions: Histopathological examination of products of conception detects under diagnosed molar pregnancies that necessitates special follow up and is a key step to do further management.

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Esophageal eosinophilia in pediatric patients with cerebral palsy

Einstein (São Paulo) ◽

10.1590/s1679-45082015ao3266 ◽

2015 ◽

Vol 13 (2) ◽

pp. 232-237 ◽

Cited By ~ 2

Author(s):

Ana Carolina Ramos de Nápolis ◽

Flavia Araujo Alves ◽

Erica Rodrigues Mariano de Almeida Rezende ◽

Gesmar Rodrigues Silva Segundo

Keyword(s):

Cerebral Palsy ◽

Eosinophilic Esophagitis ◽

Pediatric Patients ◽

Pediatric Population ◽

Gastrointestinal Diseases ◽

High Power Field ◽

Cross Sectional ◽

Tertiary Centre ◽

Tertiary Center ◽

The Mean

ABSTRACT Objective: To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. Methods: Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. Results: Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. Conclusion: The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases.

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GESTATIONAL TROPHOBLASTIC DISEASES;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.02.1999 ◽

2012 ◽

Vol 19 (02) ◽

pp. 159-161

Author(s):

SYED MEHMOOD HASSAN ◽

SHOAIB NAYYER I HASHM ◽

BUSHRA AYAZ ◽

Faisal Rashid Lodhi ◽

Kanwal Sohail

Keyword(s):

Hydatidiform Mole ◽

Age Groups ◽

Gestational Trophoblastic Disease ◽

Trophoblastic Disease ◽

Complete Mole ◽

Trophoblastic Diseases ◽

Partial Mole ◽

Gestational Trophoblastic Diseases ◽

Data Source ◽

Naval Hospital

Objective: The study was carried out to evaluate the frequency and types of gestational. Trophoblastic diseases (GTD) inendometrial curettings received for histopathology examination. Data Source: Pathology Department, Shifa Naval Hospital Karachi. Design ofStudy: It was a Retrospective Descriptive Observational study. Setting: Department of Pathology, Pakistan Naval Ship; Shifa Naval HospitalKarachi. Period: From 2009 till 2010. Material & Methods: A total of 170 cases of endometrial curettage were examined. All specimensreceived with a diagnosis of product of conceptions (POC) or with the clinical suspicion of a gestational trophoblastic disease were included.Results: It was observed that partial mole identified in 57.1 % cases followed by complete mole 21.4%, choriocarcinoma 14.2% and placentalsite Trophoblastic disease 7.1% cases. Nearly half of the cases were diagnosed as having a gestational trophoblastic disease; these were fromthe age groups of 26-30 years followed by 21-25 years. Conclusions: Hydatidiform mole is the commonest gestational trophoblastic disease.Most complete moles are detected clinically but partial moles are misdiagnosed as abortions therefore all cases of abortions should be sent forhistopathological examinations.

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Clinical Usefulness of Immunohistochemical Staining of p57kip2for the Differential Diagnosis of Complete Mole

BioMed Research International ◽

10.1155/2015/905648 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Shigeru Sasaki ◽

Yasushi Sasaki ◽

Toshiaki Kunimura ◽

Akihiko Sekizawa ◽

Yoshihiro Kojima ◽

...

Keyword(s):

Stromal Cells ◽

Immunohistochemical Staining ◽

Dna Analysis ◽

Single Agent ◽

Positive Staining ◽

Nuclear Staining ◽

Complete Mole ◽

Partial Mole ◽

Hydropic Abortion

Objective. Can polymer-based immunohistochemical staining ofp57kip2replace DNA analysis as an inexpensive means of differentiating complete mole from partial mole or hydropic abortion?Methods and Materials. Original paraffin-embedded tissue blocks from 14 equivocal cases were turned over to our laboratory and examined by immunohistochemical staining ofp57kip2.Results. Four of the 14 cases showed clearly negative nuclear staining in cytotrophoblasts and villous stromal cells: these results were fully concordant with the control staining. The remaining 10 cases showed apparently positive staining in cytotrophoblasts and villous stromal cells. Without DNA analysis we are able to clearly differentiate the 4 cases of complete mole among the 14 equivocal cases. During follow-up, secondary low-risk gestational trophoblastic neoplasia (GTN) developed in 1 of the 4 cases of complete mole: the GTN was treated by single-agent chemotherapy. No subsequent changes were observed during follow-up in the other cases.Conclusion. Polymer-based immunohistochemical staining ofp57kip2(paternally imprinted gene, expressed from maternal allele) is a very effective method that can be used to differentiate androgenetic complete mole from partial mole and hydropic abortion. We might be able to avoid the cost of DNA analysis.

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Incidental diagnosis of sad fetus syndrome in triplets

BMJ Case Reports ◽

10.1136/bcr-2020-238977 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238977

Author(s):

Keerthana Rajasekaran ◽

Vatsla Dadhwal ◽

Mohamed Jassim

Keyword(s):

Normal Karyotype ◽

Normal Growth ◽

Gestational Trophoblastic Disease ◽

Donor Oocyte ◽

Complete Mole ◽

Beta Human Chorionic Gonadotropin ◽

Partial Mole ◽

Β Hcg ◽

Female Baby

An unusual presentation of gestational trophoblastic disease is twin molar pregnancy, rarest in triplets with differentials being partial/complete mole, placental mesenchymal dysplasia (PMD), placental cysts or chorioangioma each with different complications. Counselling to continue pregnancy depends on diagnosis. A 37-year-old G2P1L1, donor oocyte In vitro fertlisation (IVF) twin pregnancy was referred at 24 weeks with cystic areas in placenta. Probability of twin partial mole or PMD was assessed. The scan of fetuses showed normal growth, no structural anomalies. Biochemical markers showed high maternal beta human chorionic gonadotropin (β-hCG). Amniocentesis of molar fetus revealed normal karyotype. Likely diagnosis made as twin partial mole. The patient delivered by caesarean section at 28+2 weeks due to preterm labour. Twins, a male and a female baby, were delivered with three placentas, two normal and the third with molar changes and no fetal parts. Diagnosis was revised as triplet with partial mole, which was confirmed on histopathology. Serial monitoring of β-hCG became undetectable by eighth week. The male baby died on day 4. The mother and the female baby were discharged.

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63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.222 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Lau ◽

Z Arshad ◽

A Aslam ◽

A Thahir ◽

M Krkovic

Keyword(s):

Economic Impact ◽

Treatment Protocol ◽

Case Series ◽

Consecutive Series ◽

Financial Loss ◽

Patient Demographics ◽

Tertiary Centre ◽

The Mean ◽

Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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Prognostic value of the cardiorespiratory optimal point during submaximal exercise testing

European Heart Journal ◽

10.1093/ehjci/ehaa946.0957 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.P Dias Ferreira Reis ◽

A Goncalves ◽

P Bras ◽

V Ferreira ◽

J Viegas ◽

...

Keyword(s):

Heart Failure ◽

Primary Endpoint ◽

Statistical Significance ◽

Peak Level ◽

Submaximal Exercise ◽

Peak Oxygen Consumption ◽

Optimal Point ◽

Reduced Ejection Fraction ◽

Tertiary Center ◽

The Mean

Abstract Background Peak oxygen consumption (pVO2) is a key parameter in assessing the prognosis of heart failure with reduced ejection fraction (HFrEF) patients (pts). However, it is a less reliable parameter when the cardiopulmonary exercise test (CPET) is not maximal. It is crucial to identify the submaximal exercise variables with the best prognostic power (PP), in order to improve the management of pts that cannot attain a maximal CPET. Purpose The aim of this study was to evaluate and compare the PP of several exercise parameters in submaximal CPET for risk stratification in pts with HFrEF. Methods Prospective evaluation of adult pts with HFrEF submitted to CPET in a tertiary center. A submaximal CPET was defined by a respiratory exchange ratio (RER) ≤1.10. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation. Several CPET parameters were analyzed as potential predictors of the combined endpoint and their PP (area under the curve - AUC) was compared to that of pVO2, using the Hanley and McNeil test. Results CPET was performed in 487 HF pts, of which 317 (66%) performed a submaximal CPET. Pts averaged 57±12 years of age, 77% were male, 45.7% had ischemic cardiomyopathy, with a mean LVEF of 30.4±7.6%, a mean heart failure survival score of 8.6±1.1. The mean pVO2 was 17.1±5.5 ml/kg/min and the mean RER 1.01±0.08. During a mean follow-up (FU) time of 11±1 months, 18 pts (6%) met the primary endpoint. Cardiorespiratory optimal point (OP - VE/VO2) had the highest AUC value (0.915, p=0.001), followed by the partial pressure of end-tidal CO2 at the anaerobic threshold - PETCO2L (0.814, p<0.001). pVO2 presented an AUC of 0.730 (p=0.001). OP≥31 and PETCO2L ≤37mmHg had a sensitivity of 100 and 76.9% and a specificity of 71.1 and 67%, respectively, for the primary outcome. OP presented a significantly higher PP than pVO2 (p=0.048), whether PETCO2L didn't achieve any statistical significance (p=0.164). Pts with anOP≥31 presented a significantly lower survival free of HT during FU (log rank p=0.002). Conclusion OP had the highest PP for HF events of all parameters analyzed for a submaximal CPET. This parameter can help stratify the HF pts physiologically unable to reach a peak level of exercise. Funding Acknowledgement Type of funding source: None

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Comparison of Efficacy of Refrigerated Oxytocin with Oxytocin Kept at Room Temperature for the Prevention of Post-Partum Haemorrhage in Vaginal Deliveries in a Tertiary Care Setting

Open Access Journal of Gynecology ◽

10.23880/oajg-16000207 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Pandey U

Keyword(s):

Blood Loss ◽

Low Income ◽

Room Temperature ◽

Postpartum Haemorrhage ◽

Past History ◽

Post Partum ◽

Cold Chain ◽

Vaginal Deliveries ◽

History Of ◽

The Mean

Introduction: Postpartum haemorrhage is one of the leading causes of maternal death worldwide and it accounts for nearly one-quarter of all maternal deaths and almost half of all postpartum deaths in low-income countries. Primary postpartum haemorrhage (PPH) is the most common form of major obstetric haemorrhage. Materials and Methods: The study protocol was comprised of Consent, Measurement of Pre-delivery Hemoglobin, Administration of the Intervention, Measurement of postpartum blood loss and Measurement of Post-delivery (24-48 hours) Hemoglobin. Blood loss was measured using a calibrated drape. The drape was placed beneath the parturient buttocks and secured around her abdomen with ties. Blood loss was monitored for a minimum of one hour and was continued in the second hour in case of persistent bleeding. The drape with the collected blood was weighed on a scale. The weight of the drape and the container in which it is placed was deducted from the total recorded weight in order to obtain the weight of the blood collected in the drape. Blood loss weight in grams was converted to milliliters by dividing the figure in grams by 1.06 (blood density in grams per milliliter). Results: The cross tabulations were used to study the demographic, obstetrical and medical factors in women with obstetrical haemorrhage. Table 1 shows the selected sociodemographic characteristics of the study population. The mean age of cases and controls are 26.333.559 and 26.853.873 respectively. On comparison, they are statistically insignificant. (p=0.324). The educational, occupational and socioeconomic status was comparable between cases and controls (p >0.05). Table 2 shows Antenatal, intra-partum and post-partum data in cases and controls. Discussion & Conclusion: It is a study done in North India comparing the Oxytocin kept at room temperature with failure of maintenance of cold chain during transport and storage and the refrigerated Oxytocin. It is the common understanding and general training that Oxytocin must be stored in the refrigerator, failing which its efficacy reduces i.e. it, will not be effective in controlling PPH. During the study we compared the mean blood loss and change in hemoglobin levels in cases and control and despite the fact that major risk factor for PPH for example past history of PPH, past history of D&C, prolonged third stage labour duration, manual removal of placenta were comparable in both cases and controls, still the mean blood loss and change in hemoglobin values was more in cases than controls. This could be attributed to usage of market oxytocin which had failed cold chain maintenance resulted in less effective oxytocin in prevention of PPH, Hence causing more blood loss and drop in hemoglobin values. This shows the need of room temperature stable uterotonic drug in LMIC’s like ours. Recently room temperature stable carbetocin shows the potential as an effective uterotonic drug for the prevention of PPH. However according to various studies carbetocin cannot be used for induction or augmentation of labour so it cannot replace oxytocin fully, rather it acts as a part of collective PPH reduction strategy.

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