Classic congenital adrenal hyperplasia: a delayed presentation

Congenital adrenal hyperplasia [CAH] is a rare congenital disorder, which in cases of female genotype may result in virilization. Specific enzyme deficiencies in adrenocorticoid hormones biosynthetic pathway lead to excess androgen production causing virilization. Classic type presents early in infant life as salt losing or simple virilizing type, whereas non classic form presents late at puberty or in adult life. Depending on the type of classic CAH, type of adrenocorticoid deficiency, extent of virilization and genotype, surgical corrective procedures, glucocorticoid and mineralocorticoid replacement therapy are the mainstay of management. We present here a case of classic congenital adrenal hyperplasia of simple virilizing type, which presented later in childhood

Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae

To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage [APH]. Cross-sectional, analytical study. Gynaecology Unit II, Civil Hospital, Karachi, from August 2007 to July 2009. Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of pregnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing >/= 500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level < 0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 [p < 0.01]. Near-miss cases were also significantly higher in abruptio placentae, 22.27% verus 11.18% [p < 0.01]. Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae [p < 0.05]. Abruptio placentae carry significantly higher perinatal mortality and near-miss morbidity than placenta previa