Anshuja Singla

Transabdominal amnioinfusion in preterm premature rupture of membranes.

To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM).

Vaginal Total Hysterectomy in Benign Indications: Hysterectomy Techniques with Bipolar Diathermy System

Hysterectomy for benign gynecological disease is one of the most commonly performed gynecological procedures. Vaginal route appears to be superior with benefits of shorter stay, few complications and low cost, though the major drawback is the limited space for surgical access. Electro-surgical Bipolar Vessel Sealing (EBVS) technique is an alternative method to conventional suturing and stapling techniques. This system enables large caliber vessels to be secured safely and effectively. Some of the major advantages of EBVS are less operative hemorrhage with decreased operative time and an easy access especially in morbidly obese women. Also, there is a decrease in postoperative pain and micturition symptoms.

Anatomic Considerations in RPL

Anatomic defects, both congenital and acquired of the uterus and the cervix, have been implicated in the etiology of recurrent pregnancy loss (RPL). The exact contribution of each of these factors is still largely unknown.

Massive Maternal Haemorrhage: A Rare Case of Ruptured Uterine Varix

Abstract Haemoperitoneum anytime during pregnancy is a rare but catastrophic event. With advancement in antenatal and intrapartum care, the maternal survival has improved manyfold. Management involves immediate resuscitation with volume correction followed by surgery, mostly laparotomy. This case is of a booked primigravida, with otherwise uneventful pregnancy, who suffered a massive haemoperitoneum. On laparotomy, the only cause found was a small uterine varix on the posterior uterine surface. The patient survived after multiple transfusions, but it led to a fresh stillborn baby. Immediate action is the only answer to improving maternal and foetal survival.

Colposcopic Examination in Pregnancy

Cervical intrepithelial neoplasia (CIN) is the most common preinvasive lesion seen in women during pregnancy. It is found in 0.19 %–0.53 % of pregnant women, but cervical carcinoma is rare. Physiological and anatomical changes in cervix which are associated with pregnancy make cytological and colposcopic assessment difficult during this period.The main role of colposcopy during pregnancy is to rule out invasive disease and to defer treatment until postpartum. The regression rates of CIN during pregnancy are low and so postpartum evaluation is essential in women having intraepithelial leions of the cervix in the antepartum period.

Evaluation of sonographic endometrial patterns and endometrial thickness as predictors of ectopic pregnancy

To evaluate whether endometrial patterns and thickness could be used for the prediction of ectopic pregnancy (EP).

A ten year audit of maternal mortality: Millennium development still a distant goal

Objective: To assess various causes of maternal mortality over a ten year period Design: Retrospective audit of hospital case records Setting: Tertiary care hospital Population: Pregnant women who expired in the premises of GTB Hospital. Materials and Methods: A retrospective audit of case records of maternal deaths was conducted for a ten year period (January 2005 to December 2014). Results: There were a total of 647 maternal deaths out of 1,16,641 live births. Sixty-eight percent (n = 445) of women were aged 21-30 years, while 10.5% (n = 68) were <20 years of age. The most common direct causes of maternal mortality were preeclampsia/eclampsia in 24.4% (n = 158), obstetric hemorrhage in 19.1% (n = 124) and puerperal sepsis in 14.5% (n = 94). With regards to indirect causes, anemia accounted for 15.3% (n = 99) mortality. There was only 1 (0.1%) mortality because of HIV/AIDS. Other notable causes of maternal mortality were infective hepatitis in 7.1% (n = 46). Tuberculosis, that is a disease of tropical countries, accounted for 3.0% (n = 20) of the total deaths. Conclusion: High maternal mortality in GTB hospital can be due to it being a tertiary hospital with referrals from all neighbouring states. Accessible antenatal care can help prevent these maternal deaths. Female education can be of immense help in dealing with the problem and improving the utilization of public health facilities.

Laparoscopic excision of bladder peritoneal endometriosis

Figure 1. Endometriotic spots on the bladder peritoneum. A 24-year-old woman presented with progressively increasing dysmenorrhea for the last 2 years. She had multiple prior consultations for abdominal pain and fullness. Her menstrual cycle was normal in amount and duration. She was not sexually active and had no urinary or bowel complaints. At the age of 13 years, she underwent a laparotomy for intestinal obstruction. Two years ago she was evaluated for the same complaints, when a 4.5-cm chocolate cyst was seen but no treatment was given. General and abdominal examination was normal. Relevant blood and imaging studies were done. Ultrasound showed a right ovarian endometrioma of 7 cm. Laparoscopic enucleation was planned. On laparoscopy, excision of right ovarian endometrioma was done. There was anterior cul de sac peritoneal endometriosis that was excised (Figure 1) and cauterized (Figure 2). Posterior cul de sac peritoneal endometriosis was also cauterized (Figure 3). The bladder defect was repairedwith 3-0 Vicryl. Cystoscopywas done to check bladder integrity and ureteric reflux. She was discharged in a satisfactory condition and is on regular follow-up. Her abdominal pain and dysmenorrhea have markedly reduced. Endometriosis is a common gynecological problem affecting ovaries, fallopian tubes, uterosacral ligaments, pouch of Douglas, and rectum. Urinary tract endometriosis affects 0.3e12% of all women with endometriosis, with the bladder being involved in 80% of cases.1 In women with deep infiltrating endometriosis, involvement of the urinary tract can be found in up to 52% of cases. Bladder endometriosis is rare and seen in only 1e2% of cases. One-third patients are usually

Paraneoplastic Cerebellar Degeneration—A Rare Presentation of Ovarian Malignancy

Paraneoplastic cerebellar degeneration (PCD), a type of paraneoplastic syndrome (PNS), is a heterogeneous group of neurologic disorders caused by non-metastatic immune response to a primary malignancy, commonly lung, breast, and ovarian cancers, and lymphomas. There are less than 100 cases reported worldwide, and only one Indian case has been reported till date [1]. It typically occurs in middle-aged to older patients. PNS may precede the diagnosis of cancer in 50–80 % of cases [2], with estimates ranging from 1 in 10,000 to 1 in 100. We present a case report of a 61-year-old female with PCD associated with ovarian carcinoma.

Pregnancy with Pemphigoid Gestationis: A Rare Entity

Pemphigoid Gestationis (PG) is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies with earlier onset and a more severe course. Direct Immunofluorescence (DIF) staining is confirmatory on skin biopsy specimen. A 24-year-old female presented at 6 months period of gestation with increased blood pressure records. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs. Termination of pregnancy was done due to high BP. Patient delivered a fresh still birth weighing 750 gm. No postpartum flare ups were seen and she was discharged on prednisolone in a satisfactory condition.