Navigating the Complexities: A Rare Case of Intrahepatic Cholestasis of Pregnancy With Placenta Previa Manifesting With Seizures.

Intrahepatic cholestasis of pregnancy (ICP) is a prevalent and reversible liver disorder that occurs during pregnancy. It is primarily characterized by itching, especially on the palms and soles, and elevated levels of transaminases and bile acids. Some patients may also exhibit hyperbilirubinemia. This condition generally has a good maternal prognosis. The patient, in this case, presented with severe itching, elevated liver enzymes and bile acids, and an ultrasound indicated placenta previa. Uniquely, she experienced an episode of seizure and high blood pressure following surgery. This case report underscores the need for vigilant monitoring of patients with ICP, not only during pregnancy due to the risk of adverse perinatal outcomes but also for antenatal and postpartum complications.

The Correlation of Hysteroscopy and Histopathology in Evaluating Abnormal Uterine Bleeding: Observations From a Tertiary Care Center.

BACKGROUND: Abnormal uterine bleeding (AUB) is an important clinical entity, and its subtype, heavy menstrual bleeding (HMB), affects 14%-25% of women of reproductive age, potentially impairing their physical, emotional, social, and material quality of life. However, in addition to prior studies that supported the efficacy of hysteroscopy in identifying AUB, this study determined the overall pattern of abnormalities in AUB and correlated the diagnosis through hysteroscopy and histopathology. Additionally, a comparison of ultrasonography was done in this study. This study helps healthcare providers provide timely diagnosis and, thereby, timely interventions in treating different causes of AUB. METHODOLOGY: This hospital-based prospective observational study was conducted at a tertiary care center, including women aged 20-60 admitted with complaints of AUB between September 2022 and June 2024. Participants were selected based on their willingness to participate in the study. A statistical analysis was performed using relevant descriptive statistics and plotting the frequency and percentage. Cohen's kappa was applied to ascertain significant associations and patterns within the dataset.  Results: The study included 47 women who were admitted to the hospital for diagnostic hysteroscopy. A majority of clinical symptoms presented as menorrhagia (17, 36.2%). The hemoglobin (g/dL) ranged from 5.9 to 14.7. Overall, on hysteroscopy, 37 (78.7%) women had a normal uterus. On hysteroscopy, 36 (76.6%) participants showed a normal cervical canal and cervix. In terms of histopathology, a majority of the study population (21, 44.7%) had proliferative endometrium. In terms of the correlation between hysteroscopy and histopathology, the two methods agreed in 83% of cases and disagreed in 17% of cases. CONCLUSION: This study confirms that hysteroscopy is a crucial tool for assessing patients with AUB, particularly those with a thick endometrium, across all age groups. It does not replace other diagnostic methods; instead, it enhances them. Hysteroscopic-guided biopsy along with histopathology is now widely regarded as the most reliable method and new gold standard for assessing cases of AUB.

A Rare Case of Severe Preeclampsia and HELLP (Hemolysis, Increased Liver Enzymes, Low Platelets) Syndrome With Complex Clinical Presentation.

Severe preeclampsia is a disorder of pregnancy, characterized by increased blood pressure (>140/90 mmHg) and proteinuria (≥ 300 mg/24 hours) at later than 20 weeks of gestation. Particularly in underdeveloped nations, severe preeclampsia and eclampsia have a significant negative impact on the health of expectant mothers, fetuses, and newborns. The HELLP (hemolysis, increased liver enzymes, low platelets) syndrome is thought to be a subset of preeclampsia, a group of hypertensive disorders of pregnancy that also includes eclampsia. Compared to preeclampsia alone, maternal and fetal problems are more severe in HELLP. There can be a diagnostic dilemma that arises when attempting to differentiate HELLP from its numerous imitators to determine the appropriate course of treatment. Here, we present a rare case of a pregnant woman presenting with preeclampsia complicated by manifestations and investigations suggestive of HELLP syndrome with acute kidney injury (AKI), retinal detachment, and symptoms of DIC (disseminated intravascular coagulation), which can be grievous to the mother as well as the fetus.

The Prevalence of Domestic Verbal Abuse in Pregnant Women in a Semi-urban Area.

Introduction Domestic violence (DV) in the form of verbal abuse is very common among women, especially pregnant women, posing as a serious public health issue that could lead to complications in pregnancy and threaten maternal and fetal outcomes. Studies have determined that domestic verbal abuse (DVA) in pregnancy was more common in women less than 25 years of age as well as in those with low education levels. This study determined the overall prevalence of verbal abuse in pregnant women, in a semi-urban population and is unique in that the verbal abuse in pregnant women with a previous girl child was also determined. This study helps healthcare providers identify the potential causes of DVA in pregnancy and provide timely interventions in the form of counseling for pregnant women and families. Objective This observational study was carried out to assess the prevalence of DVA among pregnant women, to determine the trimester of occurrence of DVA among pregnant women, and to explore the associations of DVA with age, employment status, parity gestational age, and birth weight.  Materials and methods This was a six-month hospital-based observational study conducted at Dr D. Y. Patil Medical College's in-patient department (IPD) of Obstetrics and Gynecology in Pimpri, Pune. Consent was obtained from 200 pregnant women who received admission for delivery and provided a validated modified copy of a DV assessment screening questionnaire. A statistical analysis was performed using GraphPad Prism 10. A Chi-square test was employed wherever required, and a p-value of less than 0.05 was considered significant. Results The study included 200 pregnant women, who were admitted to the hospital for delivery. The prevalence of DV in the form of verbal abuse was noted to be 74 out of 200 (37%). The working status of the woman showed an influence on DVA. There was also a significant increase in verbal abuse (68%) among the age group between 18 and 23 years. The previous delivery of a female child also had a significant impact on DVA, which turned out to be more prevalent, particularly if two female children were born previously (80%). The study also noted higher rates of preterm deliveries in pregnant women with DVA being 57%. Conclusion The study demonstrates that women, even in modern times, experience DVA during pregnancy, especially among the younger age group. It has also been found that it is more common among women who are financially dependent due to maternal unemployment. As a result, there is a need to routinely screen pregnant women for DVA to avoid potentially detrimental pregnancy outcomes and to prevent ongoing abuse.

A Case Report of Uterine Torsion: An Obstetric Emergency During Pregnancy.

Uterine torsion is an exceedingly rare obstetric emergency representing pelvic organ torsion, characterized by the uterus rotating more than 45 degrees around the longitudinal axis. This torsion predominantly occurs at the junction of the cervix and uterine corpus. Albeit the infrequent prevalence, this condition can arise in any reproductive group. Oligohydramnios is defined as an amniotic fluid volume of 2 cm or less in the single deepest vertical pocket. During pregnancy, uterine torsion is known to be associated with severe maternal and perinatal consequences encompassing placental abruption, maternal mortality, and intrauterine fetal demise. Here, we present a specific case of a woman who experienced uterine torsion during pregnancy, leading to complications such as uteroplacental and fetoplacental insufficiency, severe fetal growth restriction, and persistent oligohydramnios throughout the pregnancy.