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.

Spontaneous heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.

Seroprevalence of rubella in pregnant women

Background: Rubella is a droplet infection characterized by self-limiting illness. However infection during pregnancy may result in miscarriage, congenital birth defects leading to long term morbidity. The aim of the study was to estimate the seroprevalence of rubella immunity in pregnant women.Methods: Antenatal patients, irrespective of period of gestation, fulfilling the inclusion criteria were tested for rubella IgG antibodies.Results: A total of 258 pregnant women were included in the study. The estimated seroprevalence of immunity against Rubella infection was 70.5% (n=182) whereas 29.5% (n=76) were seronegative and thus susceptible to rubella infection. The distribution of seroprevalence of rubella immunity based on age group and gravidity were also evaluated.Conclusions: The results reveal high level of rubella sero positivity, which indicates continued transmission of rubella infection in the community.

Hyperemesis Gravidarum and Hyperthyroidism

Hyperemesis gravidarum might require hospitalisation in patients, and upto two-thirds of women with hyperemesis gravidarum have transient hyperthyroidism. We undertook a study of pregnant women admitted with no known cause of vomiting. These patients were subjected to tests for TSH, Total T4, and Total T3 hormones to establish hyperthyroidism, and the values of these tests were serially monitored. We studied pregnancy outcomes such as period of gestation, and weight at birth, Apgar score at three and five minutes, and maternal TSH values at birth. The Total T4, Total T3, and TSH levels had normalised by gestational age of 14-16 weeks, and TSH at birth was found to be normal. Birth weight showed only a small deviation. The results suggest that asymptomatic patients with TSH value indicating hyperthyroidism in the first trimester need no further revaluation. Key words: Hyperemesis gravidarum, pregnancy, hyperthyroidism.

EVALUATION OF FETAL THIGH CIRCUMFERENCE AS AN ADDITIONAL MARKER FOR FOETAL BIOMETRY

Objective: Accurate determination of gestational age is the sine qua non of optimal management and hence prognostication of all pregnancies.A meticulous biometry ensures timely interventions resulting in favorable maternal and fetal outcomes. Traditionally, the parameters of Biparietal diameter (BPD), Femur length (FL), Head circumference (HC), and Abdominal circumference (AC) have been utilized for routine fetal biometry. The present study aims to assess the utility of Fetal Thigh Circumference (ThC) as an additional marker for fetal biometry. Methods: The present retrospective, observational, and cross-sectional study was done in the Departments of Radiodiagnosis and Obstetrics and Gynaecology in an ethically and socio-economically diverse group of pregnant females. All pregnant females with singleton pregnancies between 22 and 40 weeks of gestation and fulfilling the inclusion and exclusion criteria were subjected to ultrasound examination. Subsequently analysis was done for the data collected. Results: There were a total of 287 participants in present study group with mean age of 23±3.4 years. The strength of agreement almost perfect (>0.99) between the mean observed ThC to ThC values by Deter et al. taken as standard. There was a highly significant positive correlation between gestational period and standard biometry parameters and ThC. ThC model for prediction will be better than standard biometry parameters of BPD, HC and AC but not as good as FL model according to the regression analysis of the present study. Conclusions: There is concordance of fetal ThC as an accurate predictor of period of gestation only after FL. It can be combined with standard biometry parameters to give a better estimation of period of gestation.

ANAESTHETIC MANAGEMENT IN CAESAREAN SECTION IN A PARTURIENT WITH KYPHOSCOLIOSIS : A CASE REPORT

Alterations in maternal physiology and pathological changes in kyphoscoliosis results in anaesthetic complications for caesarean section with potential risk for both mother and fetus. Safe and skilled anaesthetic management to minimize risk to mother and fetus is required. We report a case of 25-year-old female, with G2P1L1, with 28 weeks of period of gestation, with history of previous caesarean section, with pre-eclampsia, with kyphoscoliosis in labour with contracted pelvis, managed by general anaesthesia for caesarean section.

Do Anomalous Stillbirths Have Risk To Be Delivered Preterm? A Cross-Sectional Study Conducted in Kandy, Sri Lanka

Stillbirths is one of major health issues in Sri Lankan context. This study aimed to explore the distribution of externally identifiable congenital anomalies according to their sex and the period of gestation and to estimate risk of stillbirth with or without congenital anomalies to be born pre-term or term. Sample size was 246. Due to extreme prematurity and maceration, 05 fetuses were excluded. Of 241 stillbirths, 36 (14.9%) had congenital anomalies and majority were females (n=23, 9.5%). The mean period of gestation was 31 weeks (SD=5.3). 12.5% with congenital anomalies were pre-term. 95% confidence interval (0.261-1.170) of risk estimate revealed that there is no statistically significant association between fetal sex and having congenital anomalies. Risk to be preterm stillbirth for the fetuses with congenital anomalies was 2.447 times (OR = 2.447) greater than the non-anomulous. Females were at high risk to acquire congenital anomalies. Congenital anomalies caused preterm stillbirths.

A retrospective study on causes of unsafe abortions in referred patients, at a tertiary care centre in western Uttar Pradesh

Background: Unsafe abortions occur when pregnancy is terminated by unqualified person or in an environment that do not conform to minimal medical standards or both. The aim of this study was to analyse the causes in referred patients of unsafe abortions, methods used and complications with which patients were admitted.Methods: A retrospective observational study conducted in the department of Obstetrics and Gynaecology, SIMS Hapur Uttar Pradesh, India from 1stJune 2019 to 29thFebruary 2020. Data was collected from previous hospital records. Total 150 women aged between 18-40 years, admitted with complications of unsafe abortions and who had taken advice for termination outside our institute, were included. The demographic profile, detailed history, first contact person for abortion advice, abortion service provider, method of termination and prior ultrasound were noted. Exclusion criteria was period of gestation more than 20 weeks and spontaneous abortions.Results: The study showed 92% contacted unqualified person, out of which 22.5%were uncertified doctors, 30.4% ANM’s, 16.7% Nurses, 12.3% consulted quacks and 10.9% Chemists. Among the abortion service providers 23.6% were uncertified doctors, 45.7% Chemists, 15% Nurses, 5.7% Quacks, 3.6% ANM’s and 6.4% had taken self-medication. Prior ultrasound was done in 28% cases. Method of termination was medical in 78.7% and surgical in 21.3% cases. Period of gestation was <8 weeks in 69.3%, 8-12 weeks in 27.3%, 12-16 weeks in 2%. 37.3% had parity 2 and 55.3% were Hindus.Conclusions: Despite availability of safe abortion services, unsafe abortion practices are still prevalent. Approved MTP centres, skilled and certified abortion providers must be easily accessible to women even in rural areas to safeguard their health.

A RARE ISOLATION OF BURKHOLDERIA CENOCEPACIA FROM HIGH VAGINAL SWAB IN A POST NATAL WOMAN

We report a case of a vaginal infection caused by a strain of Burkholderia cenocepacia. The strain was isolated from vaginal swab specimens from a 27 Year old female, house wife G2 A1 at 34 weeks+5 days period of gestation with hypothyroidism, oligohydramnios, early onset IUGR with Doppler changes. Treatment with inj metronidazole and inj.ceftazidime annihilated B. cenocepacia infection and vaginal symptoms.