Unruptured ectopic pregnancy with alive fetus

A woman aged 41, referred with spotting, abdominal and cervical motion tenderness and adnexal mass. βHCG was positive and ultrasonography confirmed tubal pregnancy with an alive fetus. Pathology showed intact dilated fallopian tube with a fetus of 10 weeks.Advanced tubal pregnancy is uncommon and never lead to alive fetus.

PELVIC INFLAMMATORY DISEASE (PID): A CROSS SECTIONAL PROSPECTIVE STUDY AT A TERTIARY CARE CENTRE

Introduction : Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Objective: to find out the clinical profile of PID in a tertiary care centre. Methods: This was a cross sectional, descriptive study conducted at the Department of Obstetrics and Gynaecology, during period from January to December2016. Total 200 patients complaining of lower abdominal pain, vaginal discharge & having adnexal as well as cervical motion tenderness on bimanual examination between the age group of 18 -45 years were randomly selected for study. Parameters like age, parity, socio-economic status, age of marriage, sexual behavior, Presenting complaints and use of contraceptive were recorded. Results: Most common age group was 20-24 years (29.5%). Maximum number of cases was seen in parity between 2-5 (58%). PID was commonest amongst illiterate women (36%). Maximum number of cases was seen in women from lower socioeconomic class (74%). Out of 200 cases, 79% patients were married, 14 % were remarried. Presenting complaints were pain in abdomen (93.5%), per vaginal discharge (66%), fever (51%). Abdominal tenderness was seen in 95 % of cases. Palpable mass was present in 11 % of cases. Forniceal & cervical motion tenderness were the commonest Per Vaginal examination findings seen in 89% & 84% cases respectively. Conclusion: Incidence of PID was higher in age group between 20-29 years, multipara, women from lower socioeconomic class & illiterate women. Pain in lower abdomen, per vaginal discharge & fever were the commonest complaints. Most of the patients on examination had forniceal & cervical motion tenderness.

Per-vaginal Findings among the Women with Pelvic Inflammatory Diseases at a Tertiary Care Hospital in Dhaka City

Background: Pelvic inflammatory disease (PID) is a major health problem for adult female. Women presented with pelvic inflammatory diseases give different per-vaginal findings. So we designed this study to assess the per-vaginal findings among the women presented with pelvic inflammatory diseases.Objective: The purpose of the present study was to measure the pervaginal findings among the women with PID.Materials and Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College & Hospital, Dhaka during January to June 2007. Women in the age group of 15−45 years presented with lower abdominal pain, tenderness, per-vaginal discharge and cervical motion tenderness were included in this study. After taking verbal consent from the patients, a pre-designed data collection sheet was filled in after per-vaginal examination.Results: The study was done on 50 cases, of which 20% patients had 1st degree perineal tear, 6% had utero-vaginal prolapse and 24% had foul-smelling vaginal discharge. Majority (90%) patients had healthy vagina. Ninety percent patients had anteverted uterus; and uterus was mobile in 60% cases. Cervical motion tenderness was present in 44% cases, tenderness of fornix was found in 34% cases and thickening of fornix was found in 22%.Conclusion: In this study first degree perineal tear, foul smelling vaginal discharge and cervical motion tenderness are the commonest findings among the women presented with pelvic inflammatory diseases.J Enam Med Col 2018; 8(2): 90-93

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a generalised term that describes infection of the upper genital tract in women. It is commonly caused by the sexually transmitted infections Chlamydia Trachomatis and Neisseria Gonorrhoea. Clinical features of PID include pelvic pain, deep dyspareunia, cervical motion tenderness and adnexal tenderness. Complications include infertility, ectopic pregnancy and chronic pelvic pain. Therefore, it is important for GPs to have a high index of suspicion when women present with symptoms of PID and to initiate antibiotic treatment before vaginal swab results are known.

Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis but definitive diagnosis is made only during surgery. A 20-year-old woman with previous 2 abortions presented with acute abdomen. She had no history of amenorrhoea but there was history of two episodes of bleeding in the last month at an interval of 14 days, each episode lasting for two-three days. The last episode of bleeding was 10 days back. Her urine pregnancy test was done and it was positive. There was marked abdominal tenderness with guarding and rigidity. Per vaginal examination revealed marked tenderness in the right fornix and cervical motion tenderness, uterus size could not be assessed due to tenderness. It was diagnosed as a case of ruptured ectopic pregnancy. Since she was haemodynamically unstable, emergency laparotomy was done. She had a right sided broad ligament ectopic pregnancy which had ruptured. The tissue was completely removed and haemostatic sutures were taken. High index of clinical suspicion, early diagnosis and prompt surgery is the key to management.

Endometrioid Carcinoma and Ectopic Pregnancy Coexisting in an Ovarian Endometrioma

ABSTRACT A 28 years old female presented to our OPD with the complaints of inability to conceive for the last 13 years and a lump in abdomen for the past month. Perspeculum examination revealed a healthy cervix and vagina and a per-vaginum examination revealed a uterus that was normal in size but a lump was palpable in the right adnexa. There was no cervical motion tenderness. Routine investigations were normal. Ultrasonography showed a complex right-sided adnexal mass of 165 by 78 mm with heterogenous echotexture. Tumor markers were within normal range except serum β-hCG, which was raised. Urine pregnancy test was positive. CT scan reported a welldefined large solid-cystic moderately enhancing pelvic mass with internal septations, seemingly arising from right adnexa. The patient was taken up for a staging laparotomy. Peroperatively, the picture was suggestive of a chronic ectopic pregnancy. Histopathological analysis from the lesion showed an ovarian endometrioid carcinoma and ectopic pregnancy coexisting in the endometrioma complete surgical staging was done, followed by chemotherapy. The patient has responded well to the treatment.