Adrenal disorders in pregnancy, labour and postpartum - an overview.

Adrenal disorders may manifest during pregnancy for the first time, or present from before pregnancy as either undiagnosed or diagnosed and treated. They may present as hormonal hypofunction or hyperfunction, or with mass effects or other non-endocrine effects. Adrenal disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyper-aldosteronism and adreno-cortical carcinoma are rare in pregnancy. Pregnancy presents special problems in the evaluation of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axis as these undergoe major changes during pregnancy. Diagnosis is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. A timely diagnosis and treatment is critical as these disorders can cause maternal and foetal morbidity and mortality. A high index of suspicion must be maintained as they can go unrecognised and untreated. An early diagnosis and treatment often improves outcomes. The aim of this article is to review the patho-physiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.

Controversies related to vitamin D deficiency effect on the maternal and feto-placental unit - an update.

Vitamin D deficiency (Vit D deficiency) is a global health concern and a common occurrence especially among pregnant women. It has been suggested that Vit D deficiency has implications on both the mother and the foetus. Vitamin D deficiency is the most under-diagnosed nutritional deficiency in the world, affecting the majority of individuals, irrespective of their geography, gender, age or race. Vitamin D deficiency is also linked with several diseases (autoimmune diseases, cancer, cardiovascular, dementia and musculoskeletal diseases). Therefore, appropriate supplementation is required in a deficient population. A diagnosis can be missed as symptoms associated with pregnancy are also seen in vitamin D-deficient women. A timely diagnosis and treatment can be beneficial as these disorders can cause maternal and foetal morbidity. Vitamin D status during pregnancy has been associated with maternal and foetal morbidity, but reported findings are inconsistent.

A rare case of de novo gigantic ovarian abscess within an endometrioma.

We are reporting a rare case of de novo ovarian abscess in an endometrioma. Ovarian abscess within an endometrioma is a rare gynecological problem, but de novo abscess in the endometrioma is even rarer. Most of the ovarian abscesses develop in the endometriomas following interventions, e.g., aspiration, pelvic surgery, and oocyte retrieval. We are presenting a case of a spontaneous giant abscess in a large ovarian cyst in a nulliparous woman who presented with acute abdomen. Patient was treated in a district general hospital with multidisciplinary approach. Thirteen liters of the pus were drained. She has had a sub total (supra cervical) hysterectomy and bilateral salpingo-oophorectomy (BSO) performed. Histology of the abscess wall confirmed endometriotic nature of the cyst. Patient made an uneventful recovery and was discharged home on the 14th postoperative day. This case highlights that endometrioma and its complication can present as a surgical emergency and should be dealt as one.

Value of routine transvaginal ultrasound scan in women requesting early termination of pregnancy.

This was a retrospective study of 140 women attending a termination clinic from 1 April 2002 to 31 March 2003. All women had a transvaginal ultrasound scan. Of 140 women, 56 women benefited from the scan; 26.7% had non-viable pregnancy, 35.71% did not remember their LMP, 12.5% had discrepancy between the scan and LMP. Incidental findings were noted in 24.6% of which two had a twin gestation, nine had ovarian cysts, one had an ectopic pregnancy, one had a hydatidiform mole, one conceived with an IUCD and one had a bicornuate uterus with pregnancy in one horn. Two of the nine women with ovarian cysts needed a laparotomy. This study concludes that routine transvaginal scan (TVS) scan is an essential investigation for proper assessment of all women requesting termination of pregnancy. TVS is a safe and effective procedure which provides useful information regarding gestational age, viability of pregnancy and uncertain dates. In cases of the ectopic pregnancy and the hydatidiform mole transvaginal ultrasound helped us in appropriate management from the outset and minimised complications.

Endometrial ablation--long-term complications.

Endometrial ablation is the alternative of hysterectomy performed to treat dysfunctional uterine bleeding in premenopausal women. Although early complications are significantly documented, little is known about their late complications. The aim of the study was to evaluate long-term complications of endometrial ablation. We audited two hundred and ten patients (mean age of 43) to assess the effectiveness of alternative of hysterectomy (endometrial ablation) in long term. This article presents four patients who presented with acute abdominal pain a few years after successful endometrial balloon ablation.