Abha Govind

Intramural ectopic pregnancy: a case and review of the literature.

An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management.

Myasthenia gravis and pregnancy

Summary Myasthenia gravis (MG) is a chronic autoimmune disorder of neuromuscular transmission characterized by varying degrees of weakness and easy fatigability of the skeletal muscles. Precipitants of myasthenic symptoms or crises include physical and emotional stress, systemic illness, infections, hypo or hyperthyroidism, pregnancy, any type of surgery with general anaesthesia as well as corticosteroids. The authors report two cases of MG in pregnancy and discuss briefly the various aspects of the disease course and management in pregnancy. As MG occurs predominantly in women of reproductive years, it is important that obstetricians are aware of this condition and its management in pregnancy.

Obstructive nephropathy and chronic kidney disease secondary to uterine leiomyomas.

We present three cases of chronic kidney disease secondary to large fibroid uterus. The difficulties experienced in their clinical management and a review of literature is outlined.

Fetal demise despite normalisation of serum potassium in Gitelman syndrome Case report and literature review

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Pregnancy with known syndrome of inappropriate antidiuretic hormone

Syndrome of inappropriate antidiuretic hormone (SIADH) is rarely encountered in pregnancy. We report a case of severe hyponatraemia with idiopathic SIADH. A total of 18 cases of hyponatraemia in pregnancy have been reported; seven fit the criteria of SIADH. Unlike our case, none were diagnosed before pregnancy. Of the cases, 13 were associated with pre-eclampsia. Our patient developed intrauterine growth restriction (IUGR) but did not develop pre-eclampsia.

Maternal serum analytes as markers of adverse obstetric outcome

Screening for Down syndrome is available in the first or second trimester. In the absence of aneuploidy and structural anomalies, abnormal maternal serum levels of first and second trimester markers are associated with adverse obstetric outcome. As the number of markers increases and their value becomes more extreme the likelihood of adverse obstetric outcome increases. Although many of the associations between maternal serum markers for adverse maternity outcome are statistically significant, the positive predictive value for individual outcomes are too low for them to be clinically useful as screening tests. Potential management strategies for care of women with abnormal serum markers are yet to be established. Pregnancies complicated by pre‐eclampsia, fetal growth restriction, pre‐term delivery, fetal demise and spontaneous miscarriage have been associated with abnormal deviations in either one or several components of these markers.

HIV in pregnancy: a case of Pneumocystis (carinii) jiroveci pneumonia

This review highlights the rising prevalence of HIV in pregnancy both in the developed and developing world. It focuses on the challenges of diagnosis and management of Pneumocystis (carinii) jiroveci pneumonia in an HIV-positive pregnant woman. Public health efforts need to continue addressing testing at the earliest opportunity, the psychosocial issues which impact negatively on the care of HIV-positive individuals and ways to reduce stigmatisation associated with this viral illness.

The “catheter bag” sign revisited: a simple way detecting bladder trauma during operative laparoscopic procedures

Early detection and repair of bladder perforation reduce postoperative morbidity. We describe two cases of bladder perforation sustained during complicated laparoscopic adhesiolysis and discuss a previously reported simple method of detecting bladder trauma during operative laparoscopy.

Emergency department ultrasound diagnosis of spontaneous iliopsoas haemorrhage in a patient on warfarin

A 87-year-old man presented to the emergency department (ED) with right-sided abdominal and thigh pain which had been present for the last 3 days and was getting worse. He had been diagnosed with a deep venous thrombosis of the left common femoral and superficial veins 10 days previously and had been discharged on a loading dose of warfarin and low-molecular weight heparin (dalteparin) injections. Despite his international normalised ratio being only 2.4, an ED ultrasound showed an unusual mass in the right iliac fossa, partly cystic and partly solid. A CT scan was performed which showed the lesion was a haematoma in the right iliopsoas muscle mass.

Beware of add on procedures: A cautionary tale of regret following sterilisation

This report discusses the issues involved with jointly performing elective and emergency procedures following a case report of a 41-year-old woman who regretted a sterilization procedure that was paired with laparoscopy. It concludes that careful thought should be given before routinely adding on elective procedures to emergency ones but may be appropriate with good patient selection and appropriate counseling supported by detailed documentation.