Laparoscopic Management of Post-Cesarean Section Uterocutaneous Fistula

Abstract

A uterocutaneous fistula is a rare clinical presentation that occurs following cesarean section or any other pelvic surgery. We describe a case of uterocutaneous fistula with successful surgical management. A 25-year woman was referred to our hospital with complaints of cyclical bleeding from lower segment cesarean section scar (LSCS scar). It was diagnosed as uterocutaneous fistula on ultrasonography and computed tomography. The fistula tract was excised. Histopathology report was suggestive of sinus tract due to tuberculous etiology. Patient was started on antituberculous treatment. Recovery was uneventful.

Prenatal Diagnosis of Osteogenesis Imperfecta Type III


Assessment of the Cardiac Function in Intrauterine Growth-Restricted Fetuses and Appropriate for Gestational Age Fetuses

Abstract

Aim

Aim of the study is to evaluate the myocardial performance index in intrauterine growth restricted fetuses and compare this index with appropriate for gestational age fetuses.

Materials & Methods

A prospective study was conducted in S.M.S Medical College Jaipur, involving 72 singleton fetuses ≥ 28 weeks of gestation divided into two groups: 36 intrauterine growth restricted fetuses (IUGR) and 36 appropriate for gestational age fetuses (AGA). Myocardial performance index was obtained by fetal echocardiography.

Results

The mean myocardial performance index in the IUGR fetuses and AGA fetuses was statistically significant and that was 0.62 ± 0.02 and 0.45 ± 0.01, respectively; (p value: < 0.0001). These findings suggest that IUGR induces primary cardiac changes, which could explain the increased predisposition to cardiovascular disease in adult life. This study concluded that Fetal echocardiographic parameters (MPI) identify a high risk group within the IUGR fetuses, which could be targeted for early screening of blood pressure and other cardiovascular risk factors, as well as for promoting a healthy diet and physical exercise.

Pilimiction: A Rare Presentation of Ovarian Dermoid


Ventricular Tachycardia in a Fetus: Benign Course of a Malignant Arrhythmia

Abstract

Background

Fetal arrhythmias constitute 10 to 20% of the total referrals to fetal cardiology unit. Ventricular tachycardia (VT) is a rare form of fetal tachyarrhythmia.

Materials and methods

This report describes the clinical presentation, diagnostic features, and successful management of VT in a fetus at 32 weeks of gestation. Transplacental therapy with sotalol resulted in the termination of tachyarrhythmia in 48 h, followed by good postnatal outcome.

Conclusion

Fetal m-mode showing ventricular rate higher than atrial rate with atrio-ventricular dissociation is suggestive of VT. Early diagnosis and institution of transplacental therapy prior to development of hydrops seem to carry a good prognosis even in malignant fetal arrhythmias like VT.

A Comparative Study of Non-descent Vaginal Hysterectomy and Laparoscopic Hysterectomy

Abstract

Objective

To compare intra- and post-op complications between non-descent vaginal hysterectomy and laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.

Methods

A prospective comparative study of 80 hysterectomies was done over a period of January 2017–Dec 2017, with 40 cases each in one group of non-descent vaginal hysterectomy (NDVH) and other group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra-operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups.

Results

The most common age in both groups was 41–50 years. Fibroid uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 40 min while it was 120 min in TLH group, and the mean blood loss in NDVH group was 50 ml, while it was 120 ml in TLH group. P < 0.001 when intraoperative blood loss and operative time were compared between both groups. There were no conversions to laparotomy in NDVH group, while there were three conversions to laparotomy in TLH group. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.

Conclusions

Non-descent vaginal hysterectomy has advantage over laparoscopic hysterectomy as scarless surgery with fewer complications.

Posterior Reversible Encephalopathy Syndrome (PRES): Evolving the Mystery of Eclampsia!

Abstract

Background

With the availability of neuroimaging, it is possible to know the exact underlying CNS pathology in eclampsia, and thus, the therapy can be targeted at the same. The present study was undertaken to find out the neurological changes in cases of eclampsia and to find the incidence of PRES in association with eclampsia and to study the role of Inj. Mannitol in cases of eclampsia with PRES who do not respond to Inj. MgSO₄ alone.

Methods

This is a referral hospital-based prospective study of 110 consecutive cases of eclampsia who were subjected to MRI/CT scan brain without contrast. All 110 women with eclampsia were treated with routine principles of management of eclampsia. Inj. MgSO₄was the drug of choice as anticonvulsant. Inj. Mannitol was added as antiedema agent in patients who did not respond to MgSO₄ alone.

Results

All patients of eclampsia showed PRES on neuroimaging. 40 (36.36%) patients received inj. Mannitol as they had either recurrent convulsions or extreme irritability or deep coma after multiple convulsions and did not recover consciousness after convulsions were controlled.

Conclusion

PRES is the core component of the pathogenesis of eclampsia, and the incidence is 100% in our study. Inj. MgSO₄ is the drug of choice, and addition of Inj. Mannitol in cases with recurrent convulsions, extreme irritability, visual symptoms and severe headache plays a dramatic role in control of convulsions and recovery of the patients.

Role of Chromohysteroscopy in Evaluation of Endometrial Pathology Using Methylene Blue Dye

Abstract

Background

Chromohysteroscopy is expected to help in diagnosing subtle endometrial pathologies which could be missed on conventional hysteroscopy and also help in targeting biopsy from endometrium.

Objective

To study staining pattern of endometrium in patients undergoing chromohysteroscopy and to evaluate and compare the histopathology of chromohysteroscopy-guided endometrial biopsy with conventional endometrial sampling.

Method

This was a cross-sectional study conducted during the period of 18 months in Department of Obstetrics and Gynaecology, ESI PGIMSR, New Delhi, India, from September 2016 to February 2018. Totally, 60 women with complaints of infertility, failed intrauterine insemination (IUI), recurrent spontaneous abortions (RSA), heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB) and postmenopausal bleeding (PMB) meeting inclusion criteria were evaluated and enrolled in the study. In patients with normal looking endometrium on hysteroscopy, methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained areas followed by blind endometrial sampling immediately. The results of chromohysteroscopy-guided biopsy from light- and dark-blue-stained areas and blind biopsy were compared.

Results

Mean age of the study group was 37 years, with mean BMI of 24 kg/m2. There were 24 cases of HMB, 9 of IMB, 7 of PMB, 15 of infertility, 2 of failed IUI and 3 with RSA. On chromohysteroscopy, 39(65%) cases showed light-stained endometrium (group I) and 21(35%) showed dark-stained endometrium (group II). Comparison was done between histopathology obtained through chromohysteroscopy and blind endometrial sampling. The diagnostic accuracy of chromohysteroscopy-guided endometrial biopsy in evaluation of endometrial pathology was 86.67% with sensitivity of 91.67%, specificity of 85.41%, PPV of 61.12% and NPV of 97.61% (P <0.001).

Conclusion

Chromohysteroscopy was able to detect endometrial pathology which was missed on conventional hysteroscopy and detected more cases of endometrial pathology than blind endometrial sampling.

Reference Centile Chart of Fetal Cerebroplacental Doppler from 24 to 40 Weeks Gestation in Indian Population

Abstract

Objective

Construction of reference centile chart of middle cerebral (MCA) and umbilical artery (UA) Doppler along with cerebroplacental ratio from 24 to 40 weeks gestation in Indian population.

Method

It was a cross-sectional observational study; antenatal women between 24 and 40 weeks gestation underwent the MCA and UA Doppler. The centile charts for MCA, UA and cerebroplacental ratio (CPR) were derived.

Results

Total 300 antenatal women were included; the MCA PI, RI, S/D ratio values showed a parabolic curve with the peak at 33–35 weeks; the umbilical artery Doppler and cerebroplacental ratio showed a linear decrease with increasing gestational age. The regression analysis showed a weak correlation between the Doppler parameters and the gestational age. The MOM values of all Doppler parameters, across the gestational age, were also derived.

Conclusion

The constructed MCA, UA and CPR charts along with their MOM values could be used as reference for the regional population.