Painful catamenial vulvar lesions misleading gynecologist

Endometriosis usually presents as cyclical pain in the pelvis but may also present as painful cutaneous lesions. Many diseases may mimic hidradenitis suppurativa (HS) since HS, a chronic inflammatory painful skin disease, is a clinical diagnosis. A 32-year-old woman presented with painful lumps on her vulva and groin accompanied with bloody discharge during menstruation. She was followed up with preliminary diagnosis of endometriosis. Previous excision without definitive diagnosis resulted in temporary relief. She was prescribed oral contraceptive pills that alleviated her symptoms but quitted due to headache. Surgical excision was performed for definitive diagnosis and therapeutic relief. Pathology report revealed HS. She was prescribed oral doxycycline. She responded well to the therapy and has symptom-free for the last 2 years. She delivered one healthy girl via cesarian section 2 years after the treatment. Endometriosis and HS should be included in the differential diagnosis when women present with menstrual painful lesions around external genitalia for diagnosis and treatment.

Role of Certified Registered Anesthetists (CRAs) in the Prevention and Management of Supine Hypotension during Cesarian Delivery under Spinal Anesthesia at the Tamale Teaching Hospital (TTH), Ghana

Background: Supine hypotensive syndrome is a pathophysiologic state in a parturient after 20 weeks’ gestation when put in the supine position during cesarian section under spinal anesthesia. Spinal anesthesia produces rapid, effective, reliable and safe anesthesia making it the preferred technique for cesarian section. Maternal hypotension is a known common side effect of spinal anesthesia and is generally managed pharmacologically and/or non Pharmacologically. The aim of this study was to assess the management of supine hypotension during cesarean section under spinal anesthesia among CRAs at Tamale Teaching Hospital (TTH). Methods: A cross-sectional study with both quantitative and descriptive approaches were employed. Thirty-eight (38) CRAs were conveniently sampled and a structured self-administered questionnaire was used for data collection after pretesting for validity and reliability. Data was analyzed with Stata I/C. Results: Non-Pharmacological interventions: 19(50%) of CRAs placed parturient in the supine position n after spinal anesthesia with head up, 15 (39.5%) in Supine position alone, 4 (10.5%), used lateral position alone. Pharmacological interventions (Use of Intravenous fluids): Lactated Ringers solution 6(15.8%), Normal saline solution 24(63.2%), Crystalloid and colloid combination 8(21%). Vasopressor of choice: Ephephrine alone 36(94.8%), Phenylephrine alone 1 (2.6%), Multiple agents 1 (2.6%). Preferred intervention: non-Pharmacological 21(55.3%), Pharmacological 17(44.7%). Determinants of choice of intervention: Severity of hypotension 29(76.3%), availability of intervention 7(18.5%), diagnosis of the patient 1(2.6%), frequency of hypotension 1(2.6%). Conclusions: Most CRAs placed parturient in the supine position with head up as a non-pharmacological approach to managing supine hypotension after spinal anesthesia. Normal saline solution and ephedrine were widely used as pharmacological agents. Majority of the CRAs preferred using the non-pharmacological techniques as compared with the pharmacological approaches and their choice of intervention was significantly influenced by the severity of the intervention.

THE INFLUENCE OF OSTEOPATHIC CORRECTION OF PELVIS DYSFUNCTIONS IN WOMEN IN LABOR WITH PRETERM AMNIORRHEA IN CASE OF FULL-TERM PREGNANCYON THE LABOR COURSE AND RESULT

The eff ectiveness of applying osteopathic methods to patients with amniorrhea in case of full-term pregnancy was evaluated. 40 pregnant women with singleton full-term pregnancy without severe somatic and obstetric pathologies, with preterm amniorrheaunder the absence of regular labor activity were included into the study. The main group (n = 20) included women who underwent treatmentwith osteopathic methods. In the control group (n = 20) the labor was managed in accordance with the labor management protocol in case of amniorrhea. The osteopathic examination, which was performed in the course of the study, showed that all patients had biomechanical disorders at the pelvis level. The women in labor, who underwent osteopathic correction, started to deliver on their own in a greater percentage of cases as compared with the control group; there was a signifi cant decrease of frequency of labor anomalies and the total number of complications in labor and, as a consequence, a signifi cant decrease of obstetric aids and frequency of the emergency deliveryby cesarian section. A decrease in the frequency of episiotomy was noted. A decrease in the duration of the rupture-to-delivery interval was also noted.

Comparison of analgesic efficacy of transversus abdominis plane block with local wound infiltration using 0.25% levobupivacaine for post cesarean analgesia: A randomized controlled trial

The key component of Enhanced recovery after cesarian section (ERAC) is to improve maternal and child outcome and enhance recovery by dint of effective non opioid based pain control. We aim to compare the efficacy of Transverse abdominis plane (TAP) block with local wound infiltration for postoperative analgesia in cesarian section (CS).Eighty-two patients undergoing caesarean section under spinal anaesthesia were randomized to undergo local wound infiltration(Group I) (n=41) versus landmark guided bilateral TAP plane block (Group T) with 20ml of 0.25% levobupivacaine postoperatively Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS). Requirement of analgesia, patient satisfaction, time for the first and second rescue analgesia, and the incidence of side effects was also noted. The median VAS was more in the group I compared to group II and was statistically significant (p=0.0032). The mean time to first rescue analgesia was prolonged in group I (4.060 ± 0.682 hrs) compared to group T (3.302 ± 0.519 hrs)(P< 0.001). The mean total analgesic requirement in 24 hours was reduced in group T (89.63 ± 41.82) as compared to group I (137.2 ± 33.13) (P<0.001. Group (T) compared to group I patient had a higher mean patient satisfaction score (1.487 ± 0.589) (2.097 ± 0.430) respectably (P < 0.001).TAP block provides better quality of analgesia and can be safely incorporated as a part of multi-model analgesic regimen postoperative pain over local infiltration in cesarian section.

ESTIMATION OF THE EFFECTIVENESS OF ASSOCIATED ANESTHESIA BASED ON EPIDURAL BLOCKADE IN CESARIAN SECTION IN PATIENTS WITH «EVIDENT» MITRAL STENOSIS

aim. To assess the efficacy and safety of general associated balanced anesthesia based on epidural block during cesarean section in patients with “severe” mitral stenosis.Material and methods. The results of clinical observations, and a complex of clinical, functional and biochemical studies during cesarian section of 26 women aged 18-30 years, with a gestation period of 32-34 weeks had been studied. All patients had «severe» MS (according to A.N. Okorokov, s classifications). Depending on the method of anesthesia all patients were divided into two equal groups Patients of group I (n=13) were operated under conditions of associated balanced anesthesia (CBA) on the basis of epidural blockade (EB) patients of group II (n=13) were operated under conditions of one of the most common variants of multicomponent anesthesia (MCA). The operations were performed in a planned method, their durations made 35-60 minutes. The duration of anesthesia were 50-110 minutesResults. Significant advantages of CBA on the basis of EB became apparent: minimal expense of narcotic preparations and muscular relaxants: rapid rehabilitation of reflex muscular activity, making it possible to carry out extubations of trachea in earlier term: opportunity of using epidural catheter in postoperative period in order to receive prolonged postoperative analgesia. Conclusion. CBA on the basis of EB provides reliable antinociceptive protections of the body from surgical aggression, ensures a smooth course of anesthesia and early postoperative period and therefore has an obvious advantage over the traditional version of GMCA with AVL.K

COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State

A 40-year-old pregnant woman at 28 weeks of gestation was diagnosed with severe acute respiratory failure syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). She had severe hypoxemia despite the use of mechanical ventilation and muscle relaxant infusion. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used, and she had a cesarian section while on ECMO support. She developed disseminated intravascular coagulation (DIC) with overt bleeding. This was managed by a multidisciplinary team (MDT) and a change of the ECMO circuit resulted in a dramatic improvement of her coagulation profile. Both the mother and the baby were discharged and went home in good condition.

Uterine torsion of term pregnant uterus due to anterior fibroid

We present a case of uterine torsion caused by a large 7.0x8.0 cm subserosal myoma in a gravid uterus. This is an uncommon disorder where the prospective diagnosis is difficult thus raises challenges in management.Uterine torsion in gravid uterus is found to carry a substantial degree of risk of perinatal mortality. Leiomyoma is found to be a potential risk factor in these cases. Therefore the diagnosis must not be delayed to prevent complications. Though there are no imaging criteria, CT or MRI can produce a preoperative diagnosis. Uterine torsion can be asymptomatic and in most cases is an accidental finding during cesarian section. Thereby many times cesarian section yields the most certain diagnosis. Posterior low transverse incision is an accessible and effective approach in uterine torsion cases. High degree of suspicion along with swift management is essential factors contributing to favorable outcome.

Successful management of perimortem cesarian section with two types of pelvic packing; a case report

Perimortem cesarean is rare and one of the worst possible scenarios in obstetrics. Multidisciplinary approach and speed are extremely important. Pelvic packing in massive postpartum hemorrhages is a method which obstetricians do not commonly use. The patient who had cardiac arrest during travail was successfully managed with a peripartum hysterectomy and two different types of pelvic packing after perimortem cesarean. The mother and baby were healthily discharged. Fetal and maternal survival after perimortem cesarean is quite low. The most important factor determining survival is speed. Pelvic packing is effective in postpartum unstoppable bleeding.

Prognosis and effectiveness of antibacterial treatment of endometritis after cesarian section with isolating drug-resistent ESKAPE pathohens

Purpose. The purpose of this study was to determine the frequency of isolation of drug-resistant ESKAPE pathogens isolation in endometritis after cesarean section; to assess the prognosis of the disease and the effectiveness of initial empirical antimicrobial therapy for isolating multiresistant pathogens. Methods. A retrospective analysis of all the cases of endometritis after cesarean section in St. Petersburg was performed. The study period: September 2008 September 2019. Results. 68 (26.7%) out of 255 cases of endometritis after cesarean section were caused by pathogens of the rESKAPE group. In puerperas with endometritis caused by rESKAPE pathogens, the following are more often observed: clinical failures in prescribing initial empirical antimicrobial therapy compared with endometritis of another etiology (p = 0.0012); severe course of infectious process with the risk of its generalization and hysterectomy (p 0.05). Conclusions. Endometritis after abdominal delivery caused by rESKAPE pathogens is associated with an unfavorable prognosis of the disease and a high risk of ineffective antimicrobial therapy.