Incidence of early pregnancy complications, management protocols and its outcome in patients at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India

Background: Early Pregnancy Complications can cause significant morbidity and mortality. Pregnant women an present with h/o amenorrhea, abdominal pain, vaginal bleeding or incidental scan finding of missed abortion, ectopic pregnancy and vesicular mole, features of hypermesis gravidorum like fatigue, nausea, vomiting, dryness and diminished urine output. The objective of present study was to analyze the incidence of various early pregnancy complications, assess the protocols for diagnosing these complications and their management.Methods: Present study was conducted at the Department of Obstetrics and Gynecology, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. All the women with first trimester pregnancy with different complications were included in this study while those women with uneventful first trimester were excluded. The inducted women were registered on pre-designed proforma. Studied variables including demographic details, gestational period, type of complications, risk factors, treatment and outcome.Results: Out of 740 total admissions 439 abortions of which incomplete abortion was 262, missed abortions were 132, threatened abortion 42 and 3 cases of septic abortion, ectopic pregnancy 154, molar pregnancy33, hyperemesis 31. There were about 63 cases of non-pregnancy related complication reported during early pregnancy like 31 with UTI, 9 with renal colic, 2 cases of appendicitis, four cases of asymptomatic cholelithiasis, 2 cases of hepatitis, 5 cases of ovarian cyst complicating pregnancy, 2 cases of ovarian torsion. Their mean age was 30.8+6.8 years.Conclusions: Study was successful in creating a confidence among trainees when following the recommended protocols as well as delivering clinical benefits to the hospital, patients and staff. Early gynecological consultation and bedside ultrasound scanning within the emergency department were key requirements for any emergency concerns.

An unusual presentation of choriocarcinoma

Choriocarcinoma is the most malignant growth arising from the uterine body. Incidence of choriocarcinoma following vesicular mole is 29-83%. Diagnosis of choriocarcinoma is by histopathology only. In the present case 22year old woman with history of vesicular mole evacuation 8 months back suddenly landed in shock. During her irregular follow up, misleading ultrasonographic findings and clinical features delayed the diagnosis of advanced choriocarcinoma till it perforated through the uterus and patient landed in shock due to massive hemoperitoneum.We report this case because of its unusual presentation which led to diagnostic dilemma and mismanagement.

Clinical study of vesicular mole

Background: Vesicular mole is an abnormal condition where there is partly degeneration and partly hyperplastic changes in the young chorionic villi. The purpose of this study is clinical presentation of molar pregnancy, serum β-hCG regression curve and further management.Methods: This was a prospective study undertaken in the Department of Obstetrics and Gynaecology at the tertiary care center for the study period from October 2007 to May 2009 approved by ethical committee.Results: Incidence of vascular mole was 2.5 per 1000 deliveries. 46.15% women were in the age group 20-24 years, 33.33% in the age group 25-29 years and 20.51% were in the teenage group. 58.97% women were between gravidity 2-4.Conclusions: There was a significant association of serum β-hCG >1,00,000 mlU/ml with theca lutein cysts >6 cm. 11.76% women with complete mole had elevated TFT while not a single woman with partial mole had elevated TFTs.