A case report of heterotopic pregnancy

Heterotopic pregnancy is the presence of both intrauterine and extrauterine (ectopic) implantation as described by Reece in 1983 and is extremely rare. It accounts for 1 per 30000, in natural cycles and 9 per 10000, in assisted reproduction cycles. The aim of this report is to introduce this case as it poses a challenge to diagnosis due to its complex clinical and laboratory findings. A primigravida aged 30 at 6 weeks period of gestation, reported with minimal bleeding per vaginum. On performing a physical examination her vitals were stable and no significant findings were noted except for an enlarged uterus corresponding to 6 weeks with posterior forniceal fullness. Her beta-hCG was 23765 IU/ml and ultrasound showed a live intrauterine gestation with left adnexal mass- likely ectopic gestational sac. Laparoscopy showed a left tubal pregnancy and salpingectomy was done. The postoperative period was uneventful and she was discharged with a single live intrauterine gestation of 6-7 weeks. She carried on with her pregnancy and delivered a healthy baby at term. The diagnosis is possible only in cases when there is a high index of suspicion by the treating clinician. The adnexa must be inspected carefully in the confirmatory ultrasound. The early timely diagnosis gives a good maternal outcome and hence crucial in the management.

Peripartum Management of Patient with Long QT3 after Successful ICD Device Discharge Resulting in Device Failure: A Case Report

Background Long QT3 syndrome (LQT3) is a gain of function mutation of the SCN5A gene that is inherited in an autosomal dominant fashion. LQT3 results in an increase in arrhythmic events during rest, sleep, and bradycardia by extending the QT interval and inducing Torsades de pointes and sudden cardiac death. Attempting to block the sodium channel with Class I anti-arrhythmics or blocking adrenergic tone with beta blockers especially in women, have shown to be beneficial. There have been few large-scale studies on treating patients with LQT3 due to its lethality and underreported number of cases. Specifically, the safety and efficacy of pharmacologic treatment in pregnant LQT3 patients is unknown. Case summary This case demonstrates the safe use of Mexiletine and Propranolol in a third trimester pregnant LQT3 patient after a presumed ventricular arrhythmia and device-lead electrical short from therapy rendered her Implantable Cardioverter Defibrillator (ICD) inoperable in a VVI mode. With appropriate medications, the patient was safely monitored through the remainder of her pregnancy and safely delivered at 36 weeks of pregnancy a healthy baby girl. The daughter, heterozygous for LQT3, showed no evidence of intrauterine growth restriction or other side effects from the medications. Discussion There are many variants of the SCN5A gene mutations that can lead to different phenotypes and not all mutations are responsive to the same medications. In this case, Mexiletine and Propranolol, both of which have only recently shown to benefit certain variants or LQT3 respectively, were safely started during the third trimester of pregnancy without harming the fetus.

Success: It’s not a sorcery

Success breeds success. People want to be involved with things that are successful, that are moving forward. Once a success, always a success with a little effort, luck, determination, support, good habits, hard work and character. Rules of success are clear, then how to be successful celebrities, self-made men, and women. They are successful because, they skillfully leveraged ambition, determination, talent, knowledge, and hard work. The secrets of success are transferable; they can be used by anyone. Success is not a sorcery. How the Chamberlains, the 17th century midwives, magically delivered one healthy baby after another at a time when mothers and babies often died during childbirth. The secret of their success was “the forceps, the obstetrical tool” that the Chamberlains invented. They have skillfully kept their secret under wraps, literally working under sheets that they hid their hands. Further they used an intelligent act of transporting that forceps tool in a massive and mystical gold Box to obscure their secret. Spiritual success or success in relationships; career success, or celebrity. General hope is that you will use it for inspiration and light guidance; perhaps like forceps in the delivery room, this tool will make the process, a little easier. This article would be discussing all these facets associated with success, which means often not taking the path of least resistance but opening yourself to new challenges that enable you to grow, develop mentally, spiritually, and professionally. Keywords: success, leveraging, knowledge, hard work, talent, tips, techniques, magic, sorcery, ambition, personality, spiritual success, career success.

Case Report: severe hemoperitoneum due to spontaneous rupture of uterine vessels during the second trimester of pregnancy

Spontaneous rupture of uterine vessels during pregnancy is a life-threatening condition though, it has a rare occurrence. This case report discusses about a 32-year-old lady at 16 weeks of gestation presented with spontaneous rupture of uterine artery and she was managed with emergency laparotomy with suturing of ruptured artery. She had delivered a healthy baby after 37 weeks of gestation by a caesarean section due to pregnancy induced hypertension at 36 weeks of gestation.

Pemantauan Pertumbuhan Bayi Melalui Pelatihan Pijat Bayi Sehat Bagi Kelompok Ibu Di Kabupaten Karawang

ABSTRAK Pertumbuhan pada masa bayi dan balita dapat mengalami gangguan yang dapat menyebabkan berbagai macam kendala pada periode kehidupan selanjutnya. Hasil penelitian memaparkan bahwa permasalahan balita pendek (stunting), kurus (wasting) dan obesitas masih menjadi permasalahan gizi secara nasional, sehingga diperlukan upaya deteksi dini. Beberapa hasil penelitian menyebutkan bahwa tumbuh kembang bayi balita dapat lebih optimal bila dilakukan stimulasi. Upaya stimulasi dapat dilakukan dengan beberapa tindakan diantaranya dengan memberikan permainan edukatif, pemijatan dan SPA yang dapat mengoptimalkan pertumbuhan bayi. Studi pendahuluan di wilayah desa Telagasari didapatkan data bahwa terdapat 2,2 % balita mengalami stunting dan balita dengan gizi kurang. Tujuan pengabdian masyarakat ini untuk memberikan pengetahuan tentang pertumbuhan bayi dan keterampilan pijat bayi sehat pada ibu-ibu yang memiliki bayi sebagai upaya preventif gangguang pertumbuhan bayi. Metode ceramah tanya jawab digunakan dalam pemaparan pengetahuan, sedangkan pelatihan pijat bayi sehat menggunakan metode demonstrasi. Kegiatan pengabdian dilaksanakan pada bulan maret sampai desember 2020, dengan jumlah responden 30 peserta ibu yang memiliki bayi usia ≤ 6 bulan. Melalui kegiatan pengabdian ini peningkatan pengetahuan ibu tentang pijat bayi sehat hingga pengetahuan seluruh responden dalam kategori baik, pengalaman serta keterampilan ibu melakukan pijat pada bayi menjadi 100 % serta peningkatan pertumbuhan bayi rata-rata sebesar 607 gram. Diharapkan kegiatan pengabdian ini dapat dikembangkan di beberapa desa lainnya di Kabupaten Karawang. Kata kunci : Bayi, pertumbuhan, pijat, sehat ABSTRACT Growth during infancy and toddlerhood can experience some issues that can cause various kinds of obstacles in the next life period. Studies show that problems of stunting, wasting and obesity are still national nutritional problems. Therefore, early detection efforts are needed. Results from several research show that the growth and development of infants under five can be more optimal when stimulated. Stimulation can be done with several actions including providing educational games, massage, and SPA that can optimize baby growth. A preliminary study in the Talagasari village shows that 2,2 % of toddlers were stunted and under five with malnutrition issues. The aim of this community service is for knowledge sharing on infant growth and healthy baby massage skills for mothers who have babies as an effort to prevent baby growth disorders. A question and answer session was done during the knowledge sharing, while massage training for babies was used as a demonstration. Community service activities were carried out from March to December 2020, with respondent number of 30 mothers who had babies aged ≤ 6 months. . Through this service activity increase the knowledge of all respondents in the good category, the experience, and skill of mothers in doing massages on babies to be 100 % and increase in the growth of babies by an average of 607 grams. It is hoped that this service activity can be developed in several other villages in the Karawang regency. Keywords: Baby, growth, health, massage

Successful External Cephalic Version in Early Labour: A Case Report and Literature Review

Presentation: A 35 year old woman, gravida 7 para 7, all vaginal deliveries, presented with labour pains at 39 weeks’ gestation with intact membranes. Cardiotocograph (CTG) was reassuring. Diagnosis: Breech presentation was confirmed by an ultrasound. Treatment: The patient was offered options of External Cephalic Version (ECV) versus (vs) Lower Segment Caesarean Section (LSCS). She opted for ECV which was successful, followed by controlled artificial rupture of membranes. She delivered a healthy baby girl vaginally and was discharged home on day 1 postpartum. Conclusion: Although intrapartum ECV is not recommended routinely, there is a place for its judicious use in selective cases. The prerequisites include an experienced obstetrician, reassuring CTG, previous vaginal delivery, no obstetric indication for performing LSCS, adequate amniotic fluid volume with intact membranes, early labour, and informed maternal consent. We recommend keeping theatre on standby while performing ECV in case an obstetric complication arises.

First-generation somatostatin ligand receptor treatment in a pregnant patient with a neuroendocrine tumor with liver metastases

Summary This rare case describes the course of a pregnancy in a patient with a disseminated small intestinal neuroendocrine tumor. The patient received treatment with first-generation somatostatin ligand receptor (SLR) every 4 weeks and had stable disease for several years before her pregnancy. First-generation SLR treatment was initially paused after detection of the pregnancy. During pregnancy, the patient experienced moderate gastro-intestinal discomfort and fatigue, which was considered predominantly pregnancy related. However, since symptoms could be linked to the patient’s cancer, treatment was resumed after the first trimester. Chromogranin-A measurements remained stable throughout pregnancy and was paralleled by the absence of diarrhea and only minor flushing. She gave birth by elective caesarean section in week 37 to a healthy baby. Subsequent follow up imaging immediately after and 10 months postpartum showed no disease progression. The safety profile of SLR treatment during pregnancy in the context of disseminated neuroendocrine tumors (NET) is discussed. Learning points Neuroendocrine neoplasms (NEN) are rare cancers often occurring in the gastro-intestinal tract or lungs. Many patients with NEN live for several years with disseminated disease. SLR treatment has been given to pregnant patients before; often patients with acromegaly. Pregnancies are reported uneventful. This patient completed an uneventful pregnancy while receiving SLR treatment for disseminated neuroendocrine disease and gave birth to a healthy baby. More research regarding long term effects and safety signals of SLR treatment during pregnancy are much needed.

Successful pregnancy after ovulation induction with human chorionic gonadotropin in a woman with selective luteinising hormone deficiency

Selective LH deficiency has been described in several men, but only in two women who presented normal pubertal development but secondary amenorrhoea due to anovulation. Despite its rarity, this condition represents a valuable model for studying the processes regulated by FSH or LH during late folliculogenesis and ovulation in humans. A woman previously diagnosed with selective LH deficiency due to a homozygous germline splice site mutation in LHB (IVS2 + 1G→C mutation) was submitted to an individualised ovarian induction protocol, first with recombinant LH and then with highly purified urinary hCG. Ovarian follicle growth and ovulation were achieved, and a healthy baby was born after an uneventful term pregnancy. The treatment described herein demonstrates that the clinical actions of exogenous LH or hCG in inducing late-stage follicular development in women with deficient LH production or performance might be interchangeable or inevitable, once FSH-dependent early follicular growth is assured.