Bhaswati Ghosh

Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns.

Objective: To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in cord blood of term non‐asphyxiated newborns and to investigate variations in NRBC counts in perinatal asphyxia. Methods: A total of 75 cases were studied. Levels of NRBC per 100 WBC in umbilical venous blood were compared between 26 asphyxiated newborns (group I) and 49 non‐asphyxiated newborns (group II). Correlation with neonatal outcome was also evaluated. Results: The mean (±S.D.) NRBC per 100 WBC level in umbilical blood of newborns in group I was 16.5±6.4, range 3–25; whereas that in group II was 8.6±7.01, range 1–26. This difference was statistically significant (P<0.001). A statistically significant negative correlation existed between NRBC level and markers of acute intrapartum asphyxia, Apgar score and umbilical arterial pH (r=−0.50, P<0.001 and r=−0.48, P<0.001, respectively). Positive correlation was demonstrated with evidence of chronic antepartum asphyxia, presence of pregnancy induced hypertension and intrauterine growth restriction (r=2.66, P=0.02). A high NRBC count in umbilical blood correlated with poor early neonatal outcome. Conclusions: The level of NRBC per 100 WBC correlates both with acute as well as chronic antepartum asphyxia. Further, it can be used as a reliable index of early neonatal outcome.

Ectopic pregnancy following levonorgestrel emergency contraception: a case report.

Use of levonorgestrel as emergency contraception is a safe and effective measure to prevent unwanted pregnancy. However, ectopic gestation in case of failure is a known risk. Access to levonorgestrel without a prescription in many countries has made it impossible to estimate the exact incidence of this potential adverse event. Thus, spontaneous reporting of cases serves to alert physicians to this possibility. We present a case of ectopic pregnancy following use of levonorgestrel emergency contraception. To our knowledge, this is the first case report from India following introduction of levonorgestrel emergency contraception in 2001.

Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

To evaluate the efficacy and complications of uterine artery embolization (UAE) versus laparoscopic occlusion of uterine vessels (LOUV) in the management of symptomatic fibroids.

Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography

Objectives:

Comparison of Lignocaine Gel–Soaked Falope Rings vs Rectal Diclofenac Suppository for Pain Relief in Laparoscopic Sterilization

STUDY OBJECTIVE To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal diclofenac suppositories in patients undergoing interval laparoscopic sterilization under conscious sedation. DESIGN Prospective, randomized, controlled, single-blinded, clinical trial. SETTING Day-case center in a tertiary care hospital in India. PATIENTS Ninety-six women undergoing interval laparoscopic sterilization using Silastic bands (Yoon rings) randomly allocated by computer-generated random numbers into 3 groups. INTERVENTIONS All women received intravenous sedation with injection diazepam and pentazocine along with local infiltration lignocaine injected at the site of the incision meant for insertion of the single site laparocator. In group 1 (n = 32), the Silastic bands (Falope rings) were presoaked in 2% sterile lignocaine gel; in group 2 (n = 32), women received a 100-mg rectal diclofenac suppository while on the operating table; and women in group 3 received only conventional analgesic. Pain perception was assessed using an 11-point visual analog score just after the procedure while still on the table (zero minutes), at 30 minutes and 1 hour after the procedure, and at discharge. MEASUREMENTS AND MAIN RESULTS The women in all 3 groups were comparable insofar as age and parity. At zero minutes (while on the operating table), the pain score in all 3 groups was similar. However, the pain scores at 30 and 60 minutes, and at discharge were significantly lower in groups 1 and group 2 compared with group 3. However, 2 women (6.25%) in group 2 and 6 (18.75%) in group 3 required supplemental analgesia within 1 hour, and were administered a 500-mg oral dose of mefenamic acid. The need for further analgesia was significantly lower in groups 1 and 2 compared with group 3 (p = .02). Comparison of groups 1 and 3 revealed that in group 1, the pain scores were significantly lower at 30 minutes (p = .02), 1 hour (p = .005), and at discharge (p = .004). No patients in group 1 requested analgesia, whereas 6 women in group 3 asked for further analgesia within an hour postoperatively (p = .01). Similarly in groups 2 and 3, women who received diclofenac suppositories had significantly lower pain scores at the specified intervals (p = 0.02, 0.002, and 0.02, respectively). CONCLUSION Application of lignocaine gel to Falope rings and preoperative insertion of a rectal diclofenac suppository are simple and effective measures for pain control in the early postoperative period in patients undergoing day-case laparoscopic sterilization under conscious sedation. Either method could be incorporated into routine practice, depending on patient and physician choice.

A Case of Colouterine Fistula Managed Laparoscopically

Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic management of a colouterine fistula caused by a foreign body in the uterus. Fistulas between the gastrointestinal tract and the female genital tract are usually found between the vagina and rectum as a result of complications of childbirth or iatrogenic trauma. Communication between the uterus and bowel is rarely reported. We report successful laparoscopic management of an unusual case of colouterine fistula caused by a foreign body in the uterus.

Recurrent ovarian haemorrhage in a girl with congenital factor X deficiency

Dear Editors, Corpus luteal cysts are functional and most tend to regress spontaneously. However, they are prone to rupture and ovarian haemorrhage from ruptured corpus luteum is a common cause of acute abdominal pain in young women. Clinical presentation varies from minimal abdominal pain to life-threatening shock secondary to massive intraperitoneal bleed. Serious and life-threatening bleeding has been reported in women on anticoagulants and bleeding disorders [1]. We report successful management of a young woman with rare congenital factor X (FX) deficiency who experienced recurrent episodes of ovarian haemorrhage. A 20-year-old unmarried girl, with history of recurrent episodes of joint pains and swelling, epistaxis, gum bleeds and petechiae since childhood, was diagnosed as a case of congenital FX deficiency at the All India Institute of Medical Sciences in 2003 [prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), FX levels <1% of normal and inhibitors to FX were negative]. There was no history of bleeding disorder in the family. She first presented to us in August 2005, with severe lower abdominal pain of 7 days duration. She was not sexually active, and her last menstrual period began 2 days before she presented to the hospital. There was history of menorrhagia and severe congestive dysmenorrhea since menarche. She had a similar episode of pain one year ago requiring admission. Old records showed an ultrasound report of free fluid in the peritoneal cavity and mixed echogenic mass in the right adnexa. She had been managed conservatively at that time, and packed RBC (red blood cells) and FFP (fresh frozen plasma) were transfused. At the time of admission with us, her vital signs were stable, she was pale (haemoglobin 7 g%), and on abdominal examination there was diffuse tenderness. Ultrasound examination of abdomen and pelvis revealed 7 · 8 cm mixed echogenic masses in both ovaries, with free fluid in the abdomen. The uterus was of normal size. Magnetic resonance imaging (MRI) done at the same time confirmed bilateral ovarian haematomas with haemoperitoneum. A diagnosis of corpus luteal cyst rupture with haemoperitoneum was made. The pain responded to analgesics and there was no deterioration in clinical condition or increase in size of haematomas. In consultation with haematologists, as there was no active bleeding, FFP was not transfused. The patient refused blood transfusion. She was discharged after five days with instructions to follow-up for regular ultrasound examination to look for resolution of the ovarian masses. She was also prescribed low-dose oral contraceptive pills. The patient however did not follow-up as advised but presented again in February 2007, after a gap of 18 months, with increasing pain in lower abdomen for the preceding two months. On examination, her vital signs were stable and she was mildly pale (haemoglobin 9.4 g%). Abdominal examination revealed an irregular, fixed, firm suprapubic mass arising from the pelvis, corresponding to 18 weeks gravid uterus. There was no clinical evidence of free fluid in the abdomen. Ultrasound revealed a large 15 · 19.6 cm heteroechoic mass in the pelvis, mainly in the right adnexa, and extending into the pouch of Douglas. Neither ovary could be visualized separately. There was no free fluid, and the uterus was normal. The patient had had ultrasounds done elsewhere every 3–4 months in the past 18 months, but failed to follow-up with us. These scans revealed persistent heteroechoic mass in right adnexa which was gradually increasing in size. A provisional Correspondence: Dr Vatsla Dadhwal, Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029, India. Tel.: +91 9811015979; fax: +91 26588663; e-mail: vatslad@hotmail.com