Hyperreactio luteinalis following frozen embryo transfer managed by fetal reduction.

We report a rare case of hyperreactio luteinalis (HL) which developed in association with triplet pregnancy in a 27-year-old woman who underwent assisted reproductive technology treatment for primary infertility. She had undergone frozen embryo transfer 2 months after ovarian retrieval. She presented in the first trimester with abdominal pain and distension associated with ovarian enlargement and did not respond to conservative management. Fetal reduction was done from triplets to twins which resulted in good symptomatic relief for the patient. Fetal reduction may be an effective approach in such situations when conservative strategies fail in HL.

Comparison of Polymerase Chain Reaction (PCR), Microbiological and Histopathological Observations in the Diagnosis of Endometrial Tuberculosis.

BACKGROUND: Female genital tuberculosis often faces diagnostic challenges due to the asymptomatic nature of the disease. Our study aims at comparing the microbiological and histopathological results with PCR in diagnosing genital tuberculosis in endometrial curettage specimens. METHODS: Around 139 patients with diverse gynaecological complaints were recruited for the study, and endometrial curettage specimens were collected. The specimens were subjected to microbiological culture and staining, histopathological examination and PCR to look for the presence of M. tuberculosis. Statistical analyses of the PCR results include calculating sensitivity, specificity, positive and negative prediction values and positive and negative likelihood ratios. RESULTS: PCR yielded a detection rate of 41.7% (58/139) when compared to the microbiology (2.15%) and histopathology results (1.43%). PCR with hsp65 and cfp10, in combination, detected 20% of the cases. Statistical analyses were suggestive that PCR with hsp65 showed a higher sensitivity and specificity of 50% and 92.59% respectively. CONCLUSION: The results obtained in this study suggest that for a definitive diagnosis, combinations of the results from various diagnostics techniques can only be considered.

Cesarean Myomectomy: An Experience from a Tertiary Care Teaching Hospital.

BACKGROUND: Recent literature supports the removal of myomas during cesarean section, which traditionally was considered a relative contraindication, given a higher complication rate. This study is to share our experience of cesarean myomectomy in the last decade. METHODS: This study is a retrospective review of our prospectively maintained database, from January 2008 to December 2017, at a tertiary care level teaching institution. All patients who underwent myomectomy during cesarean section were included. There were no exclusions. RESULTS: A total of twenty patients underwent myoma removal along with the cesarean operation during this period with a mean age of 30 years. Majority of patients were nulliparous (70%). Common comorbidities were diabetes mellitus (40%) and hypothyroidism (20%). Mean size of myomas were 5.33 cm (± 2.08), and the number varied from one to three. The most common location was the posterior surface of the uterus with the commonest variety being subserous. Most patients were discharged on the fifth postoperative day. CONCLUSION: This study demonstrates that cesarean myomectomy to be a safe and feasible procedure in experienced hands. It offers the advantage of avoiding a second surgery in selected patients.

Child birth, pregnancy and pelvic floor dysfunction.

INTRODUCTION: To determine the prevalence of incontinence and its relation to various factors like age, parity, mode of delivery and birth weight. METHODS: After informed consent, a questionnaire was filled by a trained interviewer. RESULTS: The prevalence of incontinence was 18.6%. Incontinence was reported in 12.5% of primis as compared to 26.4% in multis. The incidence of incontinence rose as age advanced. Sixteen percent developed incontinence following LSCS whenever 19.8% developed incontinence after normal delivery. CONCLUSION: Pelvic floor dysfunction occurs commonly following childbirth, with increasing parity urinary incontinence particularly stress incontinence was more common. No significant reduction in incidence of incontinence following LSCS was noted in this study.

Pseudoaneurysm of uterine artery: a rare cause of secondary postpartum hemorrhage.

OBJECTIVES: Secondary PPH has received little attention. In more than half of cases the etiology is not made out. Vascular abnormalities like pseudoaneurysm and AV malformation are rare but detectable and easily treatable. METHODS: This is an analysis of five women presenting with severe secondary PPH after the 3rd to 6th week of postpartum. All women were post LSCS with no identifiable cause and referred for further management. They were diagnosed to have pseudoaneurysm by angiography and uterine artery embolisation was done. RESULTS: Five women were analysed. Four of them had a pseudoaneurysm and were embolised one woman was hemodynamically unstable and hence taken up for hysterectomy. CONCLUSION: Pseudoaneurysm is an important vascular abnormality especially following LSCS. Uterine artery embolisation is safe and reliable alternative technique and prevents a hysterectomy.

Maternal and fetal outcome of dengue fever in pregnancy.

BACKGROUND & OBJECTIVES: As adult dengue fever increases it also affects women with pregnancy. Dengue fever is mainly treated conservatively. However, complications like pre - eclampsia, pre- term labour, increased risk of caesarean section and fetal transmission have been noted. During dengue epidemic in our region we noted many women with dengue fever and observed certain different problems. METHODS: A retrospective analysis of all pregnant women admitted in obstetric ward with dengue fever over a period of 18 months was done. RESULTS: The striking feature observed was the presence of severe thrombocytopenia in 78.57% of the study population. In addition, coexistence of other vector borne diseases was also noted. CONCLUSION: Most cases only require conservative treatment. Only women who went into labour required platelet transfusion. Outcome seemed to correlate with gestational age of occurrence of dengue fever.