Acute spinal hematoma during pregnancy: A case report.

Background: Spontaneous spinal subdural-epidural hematoma during pregnancy is rare. Case Description: A 29-year-old gravida II patient experienced the onset of vomiting, headache, and progressive paraparesis. The initial non-contrast brain computed tomography and coagulation profiles were negative. The next day, the spine magnetic resonance imaging (MRI) revealed a C7-T4 epidural hematoma; contrast studies revealed no accompanying vascular lesions. On day 3, she underwent a cesarean delivery followed by a C3-T1 laminectomy. Her sensory and sphincteric function returned on postoperative day 2, but at 6 postoperative months, she continued to exhibit a 3/5 paraparesis. Conclusion: Pregnant patients with acute paraparesis should undergo STAT MRI screening of the spine to look for epidural/subdural hematomas.

Rubella immunity among pregnant women and the burden of congenital rubella syndrome (CRS) in India, 2022.

BACKGROUND: India aims to eliminate rubella and congenital rubella syndrome (CRS) by 2023. We conducted serosurveys among pregnant women to monitor the trend of rubella immunity and estimate the CRS burden in India following a nationwide measles and rubella vaccination campaign. METHODS: We surveyed pregnant women at 13 sentinel sites across India from Aug to Oct 2022 to estimate seroprevalence of rubella IgG antibodies. Using age-specific seroprevalence data from serosurveys conducted during 2017/2019 (prior to and during the vaccination campaign) and 2022 surveys (after the vaccination campaign), we developed force of infection (FOI) models and estimated incidence and burden of CRS. RESULTS: In 2022, rubella seroprevalence was 85.2% (95% CI: 84.0, 86.2). Among 10 sites which participated in both rounds of serosurveys, the seroprevalence was not different between the two periods (pooled prevalence during 2017/2019: 83.5%, 95% CI: 82.1, 84.8; prevalence during 2022: 85.1%, 95% CI: 83.8, 86.3). The estimated annual incidence of CRS during 2017/2019 in India was 218.3 (95% CI: 209.7, 226.5) per 100, 000 livebirths, resulting in 47,120 (95% CI: 45,260, 48,875) cases of CRS every year. After measles-rubella (MR) vaccination campaign, the estimated incidence of CRS declined to 5.3 (95% CI: 0, 21.2) per 100,000 livebirths, resulting in 1141 (95% CI: 0, 4,569) cases of CRS during the post MR-vaccination campaign period. CONCLUSION: The incidence of CRS in India has substantially decreased following the nationwide MR vaccination campaign. About 15% of women in childbearing age in India lack immunity to rubella and hence susceptible to rubella infection. Since there are no routine rubella vaccination opportunities for this age group under the national immunization program, it is imperative to maintain high rates of rubella vaccination among children to prevent rubella virus exposure among women of childbearing age susceptible for rubella.

BF3·Et2O-assisted synthesis of sulfinylated spiro[5.5]trienones from biaryl ynones.

Sulfinyls are valuable structural moieties used for developing synthetically new pharmaceuticals and agrochemicals. Herein, we disclose a straightforward synthesis of sulfinylated spiro[5.5]trienones proceeding via an unprecedented BF3·Et2O-promoted spirocyclization of biaryl ynones. The availability of relatively inexpensive BF3·Et2O to carry out transformations on a bulk scale along with its further application towards the synthesis of dibenzocyclohepten-5-ones delivers a unique opportunity to deploy it in various synthetic directions.

Recurrent Postpartum Hemorrhage: A Case of Uterine Artery Pseudoaneurysm Probably Induced by Anticoagulants.

Pseudoaneurysm formation often occurs when there is inadequate sealing at an arterial puncture site. We present the case of a 27-year-old primigravida with rheumatic heart disease and a history of mitral valve replacement on anticoagulants who experienced recurrent episodes of postpartum hemorrhage (PPH). Despite conservative management and adjustments to anticoagulant therapy, the bleeding persisted. Further investigations revealed a small pseudoaneurysm originating from the left uterine artery. Bilateral uterine artery embolization (UAE) using polyvinyl alcohol particles was successfully performed. The patient's condition improved, and she was discharged on a carefully regulated medication regimen. This case highlights the importance of considering rare causes of PPH in high-risk patients, such as uterine artery pseudoaneurysm. Anticoagulants could be a potential contributor of its spontaneous rupture. Prompt diagnosis and appropriate intervention, such as UAE, can effectively manage PPH and prevent adverse outcomes.

Risk Factors and Clinical Outcomes Associated With Acute Respiratory Distress Syndrome in Pregnant and Non-pregnant Women Diagnosed With COVID-19: A Comparative Analysis.

OBJECTIVE: We aim to compare risk factors and clinical outcomes of acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19) in pregnant versus non-pregnant women of reproductive age. MATERIALS AND METHODS: This retrospective study included all women (18-45 years) with ARDS and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted during the study period from May 2020 to July 2021. Pregnant women were considered as case and non-pregnant women as control. Primary outcomes included ventilatory support, the need for high-flow nasal oxygenation (HFNO), severe ARDS, and death. Secondary outcomes included intensive care unit (ICU) admission, length of hospital stay, and requirement of oxygen at discharge. RESULTS: We included 59 women diagnosed with ARDS and confirmed SARS-CoV-2 infection, of them 12 were pregnant and 47 were non-pregnant. The non-pregnant women were significantly older than pregnant women (28.7±5 versus 35.5±8.2, p=0.008). Presenting symptoms were comparable among the groups. Diabetes was significantly higher in the non-pregnant group (8.3% versus 31.9%, p<0.02). Pregnant women had a significantly higher range of D-dimer (5.8±7.2 versus 1.8±1.9, p<0.01) and interleukin-6 (IL-6) (212.0±300.8 versus 49.7±57.7, p<0.011) and lower platelet count (129.4±120.1 versus 197.6±92.9, p<0.05) compared to non-pregnant women. Pregnant women were more likely to experience primary outcomes including the need for HFNO (33% versus 8.5%, odds ratio (OR): 5.3, p<0.02) and death (50% versus 31.9%, OR: 2.1, p<0.04) compared to non-pregnant women. CONCLUSION: Pregnant women with severe COVID-19 and ARDS were at an increased risk for experiencing ICU admission, intubation, and mechanical ventilation compared to age-matched non-pregnant women, although comorbidities such as diabetes were higher among the non-pregnant cohort. These findings suggest that pregnancy itself is a potential risk factor for complications and morbidities among women with severe COVID-19.

Successful Management of Cervical Ectopic Pregnancy: A Multidisciplinary Approach Utilising Uterine Artery Embolisation and Hysteroscopic Resection.

Cervical ectopic pregnancy (CEP) is a rare and challenging condition that requires prompt management to prevent complications. We present a case of a 27-year-old woman with a history of prior uterine surgeries who presented with vaginal spotting. Ultrasonography revealed an empty uterine cavity and a growing gestational sac with a viable foetus in the cervical canal. Despite methotrexate therapy, her beta-human chorionic gonadotropin hCG levels continued to rise, necessitating an alternative treatment approach. Bilateral uterine artery embolisation (UAE) was performed to reduce the risk of haemorrhage before hysteroscopic resection of the pregnancy. The combined approach of UAE and hysteroscopic resection successfully managed the CEP, leading to a favourable outcome. This case highlights the importance of early detection, tailored interventions and multidisciplinary collaboration in the management of CEP. UAE, in conjunction with hysteroscopic resection, offers a promising treatment option for CEP, minimising complications and preserving reproductive health.

Hidradenoma papilliferum at vaginal vault - A rare cause of vault growth.

ABSTRACT: Hidradenoma papilliferum (HP) is a rare benign tumor of the apocrine gland and is commonly seen at the anogenital region. A 32-year-old post-hysterectomy woman presented with excessive vaginal discharge and itching. Small polypoidal mass was noted at vault. Excision of the lesion was done, and histopathology confirmed HP. The patient is symptom free following excision. This case report highlights the presence of pluripotent cells in the vagina and their differentiation into any cell lineage.

The Appropriate Criteria in Patients Selection for Myomectomy in the Era of Minimally Invasive Surgery: A Case Report.

Background: Myoma is the most common benign monoclonal neoplasm of the uterus with increased frequency during reproductive years of women. Case Presentation: A twenty two year old female presented with abdomen lump, dysmenorrhoea, and heavy menstrual bleeding. Multiple myomas were diagnosed based on clinical and radiological findings. Abdominal myomectomy was performed and 75 myomas were enucleated followed by reconstruction of uterus. The second case was a 28 year old married woman presented with heavy menstrual bleeding and dysmenorrhoea. Ultrasound reported single posterior wall myoma of 8×6.3×5.8 cm in size. Laparoscopic myomectomy was performed. At follow-up visit, both cases were completely free of any symptoms. Conclusion: Myomectomy is a feasible and safe option and a uterine preserving surgery even in the presence of multiple myomas. Setting appropriate criteria in selecting patients for abdominal myomectomy rather than MIS is essential to avoid conversion and associated morbidity.

Risk of vertical transmission of SARS CoV-2 infection to neonates born to covid positive mothers: A pilot study from a tertiary care hospital of North India.

OBJECTIVES: To assess the risk of neonatal SARS-CoV-2 infection born to the women with confirmed SARS-CoV-2 infection. MATERIALS AND METHODS: This prospective study was conducted at single tertiary hospital from September 2020 and May 2021. 50 pregnant women with confirmed SARS-CoV-2 infection and 50 neonates were included for analysis. We performed comprehensive testing of all biological samples for vertical transmission including the cord blood immunoglobulin. RESULTS: We detected SARS-CoV-2 in one fetal membrane and one amniotic fluid sample. We also demonstrated presence of anti-SARS-CoV-2 IgM antibodies in cord blood of 3 neonates. Though none of the samples of vaginal secretion, breast milk and nasopharyngeal swab from neonates were tested positive for covid infection via RT-PCR. We demonstrated presence of anti-SARS-CoV-2 IgG antibodies in the cord blood which had shown positive correlation with increasing disease to delivery interval and disease severity. CONCLUSION: Vertical transmission of SARS-CoV-2 is possible. As virus was not detected in cervicovaginal secretions and breast milk so vertical transmission through this mechanism seems unlikely. Presence of IgG in cord blood is suggestive of passive immunity acquired from mother. This finding has greater clinical implication as large number of expecting mothers are being vaccinated.

Sexual and Psychosocial Outcome After Neovaginoplasty Using Interceed in Females with Mayer-Rokitansky-Küster-Hauser Syndrome: A Case-Control Study.

There is a paucity of research on psychosexual outcomes after neo-vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. We compared anatomical and psychosexual outcomes between women with MRKH syndrome who had undergone vaginoplasty and age-matched, sexually active, childless women. Outcomes were assessed using the female sexual function index (FSFI), World Health Organization Disability Assessment Schedule (WHODAS 2.0), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) tools. Although mean vaginal length was shorter in women with MRKH syndrome than controls (8.6 ± 1.8 cm vs 9.3 ± 2.6 cm), FSFI scores were comparable in both groups (27.8 ± 1.4 vs. 27.3 ± 4.1). Women with MRKH syndrome reported fewer depressive symptoms, and WHODAS 2.0 scores were comparable in both groups (8.9 ± 2.4 vs. 7.8 ± 6.7). Therefore, psychosexual outcomes for women who had undergone neo-vaginoplasty for MRKH syndrome were not different from those of the general population.

Arteriovenous Malformation Complicating Cesarean Scar Pregnancy: A Rare Case of Vaginal Bleeding Managed Successfully by Uterine Artery Embolization.

Objective: Arteriovenous malformation (AVM) can occur in cesarean scar ectopic pregnancy. The presence of retained product of conception can pose a diagnostic dilemma and clinical presentation could be similar. Case report : A 27 year old female presented with continuous vaginal bleeding for two and half months following dilatation and evacuation (D&E) done for cesarean scar pregnancy (CSP) of 10 weeks 4days period of gestation. Sonography with color Doppler revealed dilated tortuous vessels around the mass in lower uterine segment suggesting CSP with AVM. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization achieved complete devascularisation as confirmed on post intervention angiogram. Patient became symptom free since then. Conclusion: Uterine artery embolization is an effective mode of treatment of AVM complicating CSP if future fertility is desired.

Safety and efficacy of two repeated cycles of ulipristal acetate in the management of symptomatic uterine fibroid among Indian women.

INTRODUCTION: To evaluate the safety and efficacy along with the impact on uterine and fibroid vascular indices of 2 repeat 12-week courses of ulipristal acetate (UPA) among Indian women. MATERIAL AND METHODS: Ninety-four premenopausal women aged 18-45 years with at least 1 symptomatic fibroid of size ranging from 1 cm to 10 cm were included in the study. All participants received 2 courses of 5 mg of UPA orally for 12 weeks starting from the 5th day of their menstrual cycle with a 2-menstrual-cycle break in between. The efficacy was measured in terms of time to amenorrhoea, percentage of women who achieved amenorrhoea for the last 35 consecutive days, reduction in uterine and fibroid volume, as well as its vascularity at the end of the first and second treatment cycle. RESULTS: Eighty-six women completed the first treatment cycle whereas only 65 women completed the second treatment course. Seventy-nine per cent of women achieved amenorrhoea for 35 consecutive days during the first treatment cycle. Median time to amenorrhoea was 7 days and 5 days during the first and second treatment cycle, respectively. Percentage reduction of the mean fibroid volume was 32% and 52% after the first and second treatment cycle, respectively. We observed an increase in fibroid vascular indices (pulsatility index and resistive index) suggesting reduction in fibroid vascularity. Serum oestradiol remained at mid-follicular phase. No serious drug emergent side effect was noted. CONCLUSIONS: Two interrupted repeat course of 5mg UPA is well tolerated efficient and safe in symptomatic fibroid among Indian women.

Rate of premalignant and malignant endometrial lesion in "low-risk" premenopausal women with abnormal uterine bleeding undergoing endometrial biopsy.

OBJECTIVE: To determine the incidence of endometrial hyperplasia and endometrial cancer (EH/EC) in low-risk premenopausal women with abnormal uterine bleeding (AUB) undergoing endometrial biopsy and to build a predictive model that includes clinical variables for predicting EH/EC in these women. METHODS: This retrospective study was conducted between January 2015 and March 2020. All premenopausal women aged <55 years with AUB who underwent endometrial sampling during a specified time period were included. Data regarding baseline characteristics, sonographic findings, and histological reports were collected from patient record sheets. RESULTS: During the specified time period, 1,089 premenopausal women underwent endometrial biopsy for AUB. Complete data analysis was done for 1,084 women. Of the endometrial samples, 95.3% revealed benign pathology, whereas 4.7% of the samples had major endometrial pathology EH/EC. On step-wise logistic regression analysis, intermenstrual bleeding (IMB) (OR, 3.15), body mass index (BMI) >25 kg/m2 (odds ratio [OR], 4.4705), age >40 years (OR, 1.14), endometrial thickness (ET) >13 mm (OR, 2.59), and hypothyroidism (OR, 1.35) were significantly associated with EH/ EC. Considering the pretest probability for an EH/EC of 4.7%, this prediction model with a likelihood ratio of 14.2% demonstrated a post-test probability of 41% in the presence of the above-mentioned variables. CONCLUSION: The risk of EH/EC was lower in low-risk premenopausal women with AUB. However, premenopausal women with IMB aged >40 years, hypothyroidism, BMI >25 kg/m2, and thickened endometrium (ET >13 mm) are at high risk of EH/EC; therefore, endometrial biopsy should be considered early in their management plan.

Adenomyotic cyst mimicking a congenital Müllerian anomaly: Diagnosis and treatment with laparoscopy.

A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder.

Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy.

OBJECTIVE: Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH). METHODS: This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention. RESULTS: There was a significant difference in the duration of analgesia among the groups (P » .00). It was significantly longer in group Q (mean » 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean » 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean » 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P » .001) and the cumulative analgesic consumption (P » .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block. CONCLUSION: It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect.

Huge broad ligament leiomyoma with cystic degeneration: A diagnostic and surgical challenge.

Broad ligament is the common extrauterine site for fibroid. We present a case of huge broad ligament fibroid with cystic degeneration. Patient presented with abdominal swelling and mild pain abdomen. On abdominal examination, a large tense cystic mass of 34 weeks gravid uterus size arising from pelvis was noted. Cervix was pulled up and all fornices were full with mass on pelvic examination. Ultrasound suggested adnexal mass as ovaries were not seen. Contrast-enhanced computed tomography abdomen too reported adnexal mass likely of ovarian origin. On laparotomy, 6 L of straw color fluid drained from the mass which was seen arising from left broad ligament, bilateral ovaries were separate from the mass and appeared healthy. Enucleation of mass was done to ease the hysterectomy and careful evaluation of ureteric course was done throughout the surgery to avoid its injury. Total hysterectomy with bilateral salpingo-opherectomy and pelvic lymphadenectomy was performed. This case is being reported for its rare incidence, diagnostic dilemma and surgical challenge.