Deep Takkar

Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy

In this report we describe 32 pregnancies complicated by hyperthyroidism cared for over a 7-year period at AIIMS, New Delhi. In 6 cases hyperthyroidism was diagnosed during pregnancy; others were diagnosed before conception and were on antithyroid therapy during pregnancy. For control of thyrotoxicosis thiourea derivatives, carbimazole (CMZ) and propylthiouracil (PTU), were both used. The dosage of antithyroid drugs could be decreased or stopped in the third trimester in only 28% cases, while 50% cases did not require any change in the dosage during gestation and 21% required an increase in dosage with advancing gestation to control thyrotoxicosis. Maternal and fetal complications included preterm labour (25%), PIH (22%), thyroid crisis (9%) and intrauterine growth retardation (13%). Thyroid status of neonates was found abnormal in 9% cases, including 1 case (3%) of neonatal thyrotoxicosis with goitre and 2 (6%) cases of neonatal hypothyroidism. One maternal death occurred due to thyroid storm. No case of stillbirth or perinatal death occurred in the present study. In our experience of 32 cases maternal and fetal complications are reported with increased frequency, requiring close surveillance of thyroid status to maintain euthyroidism and intensive fetal monitoring during pregnancy to achieve good maternal and perinatal outcome.

Pregnancy in a Patient of Glanzmann's Thrombasthenia with Antiplatelet Antibodies

Glanzmanns thrombasthenia is an autosomal recessive, inherited platelet function disorder. There is an absence of glycoprotein (GP) IIb/IIIa on the platelet membrane which causes reduced platelet aggregation with a defective platelet haemostatic plug formation. The management of bleeding episodes in these patients with platelet transfusions may result in alloimmunization and make the successive transfusions less effective. Pregnancy and delivery is rare in these patients and is associated with a high risk of severe haemorrhage. We describe a primigravida with Glanzmanns thrombasthenia and alloimmunization who developed secondary postpartum haemorrhage and was successfully treated with oral prednisolone.

Hydatiform mole with coexisting live fetus in dichorionic twin gestation

A case of dichorionic twin pregnancy was diagnosed in a 29-year-old, on routine ultrasound at 12 weeks. Subsequent ultrasounds for persistent vaginal bleeding at 16 weeks revealed molar placenta with viable fetus in both gestational sacs. The patient declined any invasive prenatal testing to confirm the karyotype of the fetus. The pregnancy was managed expectantly until 21 weeks, when she had a spontaneous abortion of twin fetuses and separate placentae with attached molar tissue. A final karyotype on cord blood samples confirmed 46XY and 46XX for both fetuses. Histopathology of molar tissue reported complete mole, with diploid chromosomal pattern on subsequent DNA flow cytometry. The clinical, ultrasound and chromosomal examination suggest that there has been a quadruplet pregnancy where two embryos developed into normal fetuses and other two degenerated to complete moles.

Gravid Uterus in an Incisional Hernia

A case of gravid uterus in an incisional hernia is reported. The pregnancy was further complicated by intrauterine growth restriction, oligohydramnios and pregnancy induced hypertension. The management of the case is discussed.

Laparoscopic gonadectomy in male pseudohermaphrodites

OBJECTIVE To study patients of male pseudohermaphroditism and establish the laparoscopic approach for gonadectomy in these cases. STUDY DESIGN Seven phenotypic females with XY karyotype were evaluated through a diagnostic protocol which included clinical, cytogenetic, hormonal, endoscopic and histologic evaluation. The gonads were then removed by laparoscopic surgery. RESULTS The seven patients included three patients of pure gonadal dysgenesis, two patients of testicular feminization and one patient each of mixed gonadal dysgenesis and dysgenetic male pseudohermaphroditism. Two of the seven patients (28.57%) had gonadal neoplasias on histopathology-one dysgerminoma and one occult seminoma. In all of these patients, removal of the gonads was accomplished laparoscopically. No complications occurred during any of the surgeries. CONCLUSION Due to the reduced morbidity, shorter hospital stay and safety, laparoscopic gonadectomy can be considered the treatment of choice for the removal of gonads in male pseudohermaphrodites in the hands of experienced laparoscopic surgeons.

Incarcerated pregnant uterus in an incisional hernia

This paper reports a case of incarcerated pregnant uterus in an incisional hernia which required operative reduction. A 20-year-old gravida 2 with previous lower segment cesarean section and early neonatal death was booked at 19 weeks of gestation for antenatal care at a hospital. However at 28 weeks of gestation the patient complained of severe abdominal pain. Upon examination the uterus was found incarcerated inside the incisional hernia. She was admitted for an emergency laparotomy for operative reduction of the incarcerated uterus. The ulcerated and redundant skin was removed the hernia ring excised and the uterus returned into the abdominal cavity. Such an obstetric situation is rare but serious. Its management protocol would largely depend upon the period of gestation. During the second trimester when the risk of incarceration inside the hernia is maximal conservative management by rest by use of abdominal binders and by avoiding undue straining is preferred. However when the hernia is so large that despite conservative management the uterus remains inside the hernia sac and is at increased risk of incarceration herniorrhaphy is considered during pregnancy. In the late second or third trimester herniorrhaphy is postponed until after the delivery.

Unexplained absence of both fallopian tubes with ovary in the omentum

A rare case of unexplained absence of both fallopian tubes and ovaries from their normal position, resulting infertility is presented. On careful search an ectopic ovary containing dermoid cyst was found in the omentum. Possible mechanism and clinical significance of such a rare occurrence is discussed.

Sexual trauma—an unusual cause of a vesicovaginal fistula

A 20-year-old nullipara presented with a post-coital vesicovaginal fistula in the trigone of the bladder. She had normal genital development and no other cause was found. The fistula was repaired by vaginal route.

Immunosuppressive effect of pregnancy on autoimmune hepatitis: a case report and review of literature

We report a case of autoimmune hepatitis with suppressed disease activity during pregnancy and relapse in puerperium. This is only the second report of such pregnancy-induced remission.

Indomethacin Therapy in the Treatment of Polyhydramnios Due to Placental Chorioangioma

A 26‐year‐old primigravida presented with acute polyhydramnios at 30 weeks gestation. Ultrasonography revealed a large placental chorioangioma with severe hydramnios. No anomalies were detected in the fetus. Preterm labor started with respiratory distress and indomethacin, 25 mg was given every 6 hours. The patient showed a good response with improvement of the hydramnios and respiratory symptoms. A normal infant with no neonatal complications was delivered 3 weeks later.