Abdominal pregnancy-a case report

Abdominal pregnancy is a rare obstetric complication with high maternal mortality and even higher perinatal mortality, and it can be primary or secondary with the latter being the most common type. This is a case of abdominal pregnancy in gravida 2, para 0+1 women admitted to the hospital with h/o amenorrhoea for two and a half months, with the chief complaints of pain abdomen for one week which was severe that day for which she attended emergency. Ultrasonography revealed a single live intra uterine pregnancy with a solid retro gestational sac collection, with a CRL of 11W3D. She was initially managed conservatively. Surgical intervention became necessary on day 9th when with the rising fundal height and drop in Hb levels, under general anaesthesia.

Ruptured Cervicoisthmic Pregnancy with 20 Weeks Intrauterine Foetal Death Lying in Left Broad Ligament- A Case Report

Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3P2L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need of peripartum hysterectomy.

Urgent diagnostics of musculoskeletal injury: the value of ultrasonography

The article presents a review of literature on the value of ultrasonography in acute musculoskeletal injury diagnostics. The main objectives of emergency ultrasonography are outlined: detection of fractures, large hematomas, injuries of tendons, muscles and nerves, detection of foreign bodies of soft tissues, ultrasonic navigation of surgical manipulations and reposition of fractures. The ultrasound method is highly sensitive цand specific in the detection of long-bone fractures, muscles and tendons rupture, which can make an impact on therapeutic tactic and patient’s routing. Ultrasound diagnostics has become useful for pediatric patients due to its ease of use, mobility and non-ionizing qualities. Ultrasonography of acute musculoskeletal injury will probably be increasingly important for orthopedic surgeons and emergency physicians.

Diagnostic evaluation of causes of bleeding per vagina in pregnancy through ultrasonography

Background: Vaginal bleeding is a common obstetric situation ranging from an insignificant episode to life threatening emergency. Ultrasonography is playing an increasing role in the diagnostic process. The objective of present study was to evaluate the uses of ultrasound as new diagnostic aid for patients of bleeding PV in pregnancy.Methods: A hospital-based prospective study was conducted among 100 pregnant patients who have the problem of bleeding. A complete general physical and pelvic examination was done, and patients were then subjected to ultrasound examination. Epi info 7 software was used for statistical analysis. Chi- square test was used as the test of significance. P<0.05 is considered statistically significant.Results: Among these 100 cases, Incomplete abortion was the commonest cause of bleeding. This was observed in 15 cases (27%). There were 8 (20%) cases of complete abortion in the present study in the scan done on <20 weeks. Abruptio placenta was seen in 10 (25%) cases as the most common cause in the scan after 20 weeks.Conclusions: Ultrasound is a valuable tool in the differentiation of causes of first trimester vaginal bleeding. Ultrasound is helpful in the decision-making algorithm about the safe continuation of the pregnancy, timely intervention for abnormal pregnancy.

Lifesaving Sonography Protocols: A Pilot Course Involving Undergraduate Medical Students

Background: Ultrasonography protocols are easy to learn, frequently used in emergency medicine, and could be useful for inexperienced doctors. Inthis field, only a few protocols are needed to give an initial diagnosis and to start fast and proper treatment. Until now, only Focused Assessmentwith Sonography for Trauma (FAST) protocol training studies have been reported in the medical literature. Our point-of-care course, comprisedof extended FAST, lung scan and ocular scan trainings. The students’ curriculum usually does not include such ultrasonography courses, thus,we wanted to check its utility for the undergraduate medical students. Methods: Training lasted six days and consisted of two parts: 22 hoursof theoretical classes and 18 hours of practical activities, all trained and evaluated by six experienced medical doctors. Eighty-five electedstudents completed pre- and post-study questionnaires about emergency ultrasonography and passed the practical final exam. Results: Eighty-fiveparticipants of the course were present in the pre- and final test. Final test scores of theoretical and practical exams were significantly higherafter the training (58% vs. 87%; n=85; p<0.01). Answers for the questions related to FAST and EFAST (extended FAST) were correct irrespectiveof completion of the course. A question regarding the sonographic evaluation of body fluid incontinence was found to be the most difficult forstudents. After the course, 96.5% of participants were able to complete an EFAST scan at an adequate level of performance in under two minutes.Conclusion: Results show that medical students significantly extended their knowledge about point-of-care emergency medicine ultrasonographyand acquired practical skills during the course. Emergency medicine ultrasonography courses could be included into medical students’ curricula.