Can I Be Pregnant? – Diagnostic Challenges in Ruptured Chronic Ectopic Pregnancy

Ectopic pregnancy is an obstetric emergency which accounts for 4% of all pregnancy-related deaths. All women of child bearing age with abdominal pain or vaginal bleeding presenting to the Emergency Department should be evaluated for ectopic pregnancy. However, there have been many reported cases of diagnostic challenges of ectopic pregnancy. One rare variant of ectopic pregnancy that can be easily overlooked is chronic ectopic pregnancy. We present this case of a 39-yearold female, who presented with acute abdomen and free fluid in her abdomen. Urine pregnancy test indicated she was not pregnant. However, intraoperative findings confirmed left tubular pregnancy. We would like to highlight three major diagnostic challenges we faced in this case i.e.; (i) women of child bearing age with abdominal pain should always be evaluated for ectopic pregnancy; (ii) diagnosis of ectopic pregnancy should not be dismissed even though the pregnancy test is negative; and (iii) the role of computed tomography (CT) scan in acute abdomen of unclear aetiology. As a rule, all haemodynamically unstable acute abdomen should be sent to the operation theatre. Haemodynamically stable patients should be carefully evaluated to facilitate surgical management.

Awareness of Pregnant Women Registered with Federal Medical Centre, Makurdi on the Risk Factors of Obstetric Emergencies

Obstetric emergencies are the leading cause of maternal and child mortality worldwide. According to WHO, about 15% of all pregnant women will develop obstetric emergencies that will require special skills to manage. A Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion whereas most other developed countries have a risk of 1 in 4900. With figures so high, there is need for prompt response to arrest the problem. A good knowledge/awareness of pregnant women on the predisposing risk factors for occurrence of obstetric emergencies better equips them with appropriate steps to take in preventing the occurrence of such. In this study, the awareness of pregnant women on the risk factors of obstetric emergencies was assessed. Just about 37% of the women knew the concept of obstetric emergencies but when asked the specific types, a good number were aware of all the types. The most popular type was postpartum hemorrhage with 43.5% knowledge. The risk factors most recognized included poor antenatal care, age, infection, drugs and alcohol. 96% of the population however did not think they were at risk of developing any obstetric emergency.

GENITOURINARY MYIASIS CAUSED BY MUSCA DOMESTICA: REGARDING A SINGULAR

A 27-year-old woman from and resident in ourika(Marrakesh region – Morocco) with a history of anemia under iron treatment, without a history of surgery, has G1 P1. Presented to the Mohamed VI University Hospital on day 21 post partum of a vaginal birth at home, the evolution was marked by the appearance of urinary incontinence treated in the emergency room by placing a catheter urinary on day 6 post partum then send to her home for the COVID 19 context, then the patient consulted again at the gyneco-obstetric emergency room for deterioration of the general condition in a picture of hemodynamic shock. On physical examination, the patient was hemodynamically unstable with blood pressure figures of 70/40 mmhg, heart rate at 50 bpm, temperature at 35 ° and mucosal skin pallor.Examination of the vaginal cavity showed the presence of numerous whitish-looking maggots, a sample was taken by the biology team that collected the maggots for the purpose of a parasitological study to identify the parasite responsible.

Nifedipine or Labetalol: Hypertension Management during Pregnancy

Introduction: Hypertension complicates 10% of pregnancies causing significant morbidity and mortality worldwide. It is considered severe hypertension if Systolic >160 and Diastolic >110 lasting more than 15 minutes. It is an Obstetric emergency and needs prompt appropriate treatment. Methods: A quasi-experimental study was conducted at Tehsil Headquarter Hospital. One hundred fifty patients were included in the study divided into two groups: Nifedipine group (n:75) getting oral Nifedipine and Labetalol group (n:75) getting IV Labetalol. Results: This study shows that goal therapeutic blood pressure was reached earlier in patients receiving oral Nifedipine 28.2 ± 11.7minutes as compared with those receiving intravenous Labetalol 48.4 +- 23.5minutes. Fewer doses were required for the nifedipine group in contrast to the IV labetalol group Failure of treatment was higher among the IV labetalol group. Conclusion: Oral nifedipine is as productive and safe as compared to Iv labetalol and is more convenient in Low resource settings.

Effectiveness of Obstetric Emergency Workshop in Medical Students in Newcastle University Malaysia

Global practices in health sectors envisioned maternal mortality as an indicator of the health standard of the nation. World Health Organization rests its goal on ‘Eight Millennium Development’ over the globe by means of MDG 5 is to improve the maternal health. The aim of the study is to upgrade teaching and learning method to optimise acquisition of knowledge in undergraduate students to meet the effectiveness of obstetric emergencies. We evaluated changes in knowledge using a single best answers questionnaire. The study 115 stage-5 students from 2019-2020 academic years were selected, and they were divided into 5 small groups with monthly rotation to attend the workshop. There are 23-24 students in each rotation. The assessment of knowledge of obstetrics emergencies carried out by using the SBA test before and after the workshop conducted by means of teaching and learning method.

Ectopic Pregnancy - A 1 Year Clinical Study in King George Hospital, Visakhapatnam

BACKGROUND Ruptured ectopic is a life threatening obstetric emergency. Obstetrician must have a high index of suspicion for ectopic pregnancy and should be aware of importance of early diagnosis and early intervention. The present study was undertaken to evaluate the incidence, clinical presentation, risk factors, treatment and morbidity associated with ectopic pregnancy. METHODS Retrospective analysis of ectopic pregnancy was done in King George Hospital, Visakhapatnam from January 2020 to December 2020 in the department of OBG. The following parameters: Age, risk factors, clinical presentation, site of ectopic, diagnostic methods, mode of treatment were noted. RESULTS A total of 63 cases were reported during this time frame. It is a tertiary care centre getting referrals from nearby districts and other hospitals. Incidence of ectopic pregnancy in the present study is 0.89 %. 41.26 % of patients belonged to age group between 26 to 30 years. Out of 63 cases 49.20 % were multigravida. 28 % of the cases were associated with previous H/O abortions and 23 % of the cases were associated with PID and in 17.4 % of the cases there was no predisposing factors. 96.82 % the patients presented with pain abdomen. Shock in 34.92 % of the cases. Ampulla is the most common site of ectopic. In 76 % of the cases there was hemoperitoneum > 500 ml. Salpingectomy was done in 79.3 % cases. 84 % of cases required blood transfusion > 1 unit. There was no mortality. CONCLUSIONS Ectopic pregnancy is one of the obstetric emergency with significant morbidity and mortality. PID and post abortal sepsis are one of the important risk factors for ectopic pregnancy. As many patients may not have recognizable risk factors, a high index of suspicion is critical for early diagnosis. Early USG diagnosis of ectopic pregnancies reduces mortality and enables us to offer the patient conservative medical and surgical treatment. KEYWORDS Ectopic Pregnancy, TVS, Ampulla, Salpingectomy

Trends in obstetric emergency department attendance the first months of the coronavirus pandemic

Many medical disciplines reported a decline in patient attendance during the coronavirus pandemic. Our paper examines the effects that the coronavirus pandemic had on obstetric Emergency Department (ED) attendances in a tertiary maternity centre in the Republic of Ireland. A retrospective cross-sectional analysis was performed on administrative data regarding the number of obstetric patients attending the ED from January to July in 2019 and 2020. These numbers were compared to the number of reported coronavirus cases in Ireland as released in official government publications. A paired sample t-test was carried out to see if there was a significant difference in attendance in the obstetric ED in 2020 compared to in 2019. When COVID-19 cases peaked at 17,377 in April 2020, ED attendance showed their largest decline of 27%. The cumulative decline in ED attendances from January to July in 2019 to 2020 was 13%. However, this decline was not found to be statistically significant. In contrast to other disciplines, the COVID-19 pandemic did not cause a decrease in obstetric ED attendance.