Mariam Mathew

Acute massive fetomaternal hemorrhage: case reports and review of the literature

Massive fetomaternal hemorrhage occurs in approximately one in 1000 deliveries. For the majority the cause is unexplained. The warning sign is decreased fetal movements associated with abnormal cardiotocographic findings, such as decreased variability and a sinusoidal pattern, especially in a low risk pregnancy. We report two cases of acute massive fetomaternal hemorrhage in women with low risk pregnancies who presented with decreased fetal movements. The cardiotocograph showed reduced beat-to-beat variability in one case and a sinusoidal pattern in the other case. Both patients were delivered by emergency cesarean section and the newborns were profoundly anemic. One baby died 12h after birth whereas the other newborn had a good outcome.

Saline infusion sonohysterography – an effective tool for evaluation of the endometrial cavity in women with abnormal uterine bleeding

We evaluated the diagnostic accuracy of saline infusion sonohysterography (SISH) over transvaginal sonography (TVS) for the detection of intrauterine abnormalities using hysteroscopy as the gold standard in a retrospective study of 70 women mostly presenting with abnormal uterine bleeding. TVS was normal in 32 women, while in the others polyps or fibroids projecting into the cavity (n = 19) or a thick endometrium (n = 19) were suspected. On performing SISH the uterine cavity was found to be normal in 29 women, while 35 had suspected polyps/fibroids and 6 had other abnormalities. Hysteroscopy proved to be normal in 28 women, 35 had polyps/fibroids and 7 had other abnormalities. The sensitivity, specificity, positive and negative predictive values for TVS were 72.4%, 100%, 100% and 74%, respectively, while for SISH the corresponding figures were 91.4%, 92.6%, 89.3% and 94.1%. SISH is a simple, minimally invasive and cost‐effective investigative tool enhancing the diagnostic accuracy of TVS and can be an effective screening test prior to hysteroscopy.

Three consecutive ipsilateral tubal pregnancies.

Ectopic pregnancy (EP) is an unwelcome event in any patient and especially in communities where a high premium is placed on child bearing. If a woman with a previous ectopic gets pregnant, the risk of a recurrent EP is increased four-fold w1x. We report a case of three consecutive ectopic pregnancies in the same fallopian tube, in a 25-yearold Omani woman. Though there are case reports on three recurrent ectopic pregnancies, this seems to be the first case reported in the ipsilateral fallopian tube to the best of our knowledge in the English literature. The patient was a gravida-5 para-2, at 8 weeks of amenorrhoea admitted with mild painless vaginal bleeding for 1 week. Her first and second pregnancies were uneventful. Third pregnancy was a left ampullary ectopic-unruptured-partial salpingectomy carried out in August 2000, leaving behind the isthmus of the tube. Her fourth pregnancy—4 months after the third was a ruptured tubal stump pregnancy—underwent left salpingectomy in December 2000.

Ruptured Rudimentary Horn Pregnancy Diagnosed by Preoperative Magnetic Resonance Imaging Resulting in Fetal Salvage

Pregnancy in a rudimentary horn is very rare. The rupture of the horn during pregnancy is an obstetric emergency which can be life-threatening for both the mother and fetus. Preoperative diagnosis of such pregnancies can be challenging and they are usually diagnosed intraoperatively. We report a unique case of a 31-year-old multiparous woman who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in January 2013 at 32 gestational weeks with abdominal pain. Ultrasonography was inconclusive. A rudimentary horn pregnancy was subsequently diagnosed via magnetic resonance imaging (MRI). An emergency laparotomy revealed haemoperitoneum and a ruptured rudimentary horn pregnancy. A live baby with an Apgar score of 2 at one minute and 7 at five minutes was delivered. The rudimentary horn with the placenta in situ was excised and a left salpingo-oophorectomy was performed. The postoperative period was uneventful. The authors recommend MRI as an excellent diagnostic modality to confirm rudimentary horn pregnancies and to expedite appropriate management.

Gestational and Pregestational Diabetes Mellitus in Omani Women: Comparison of obstetric and perinatal outcomes

OBJECTIVES The aim of this study was to assess the prevalence of gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM) among pregnant women in Oman and compare their obstetric and perinatal outcomes. METHODS This retrospective study assessed the obstetric and perinatal outcomes of pregnant Omani women with GDM or PGDM who delivered at the Sultan Qaboos University Hospital in Muscat, Oman, between January 2009 and December 2010. RESULTS There were a total of 5,811 deliveries during the study period. Of the 5,811 women who gave birth, 639 women were found to have diabetes mellitus (11.0%). A total of 581 of the diabetic women had GDM (90.9%) and only 58 (9.1%) had PGDM. Women with PGDM had a significantly higher incidence of pre-eclampsia (P = 0.022), preterm deliveries (P <0.001) and Caesarean sections (P <0.001). Neonatal complications, such as respiratory distress syndrome (RDS), neonatal hypoglycaemia, neonatal jaundice and subsequent admission to a neonatal intensive care unit (NICU) were significantly higher for neonates born to mothers with PGDM compared to those born to mothers with GDM (P <0.001). The corrected perinatal mortality rates for women with PGDM and GDM were 34.5 and 13.7 per 1,000 live births, respectively. CONCLUSION In this Omani cohort, women with PGDM were at higher risk of developing obstetric and perinatal complications such as pre-eclampsia, preterm delivery and Caesarean delivery compared to women with GDM. In addition, neonates who had mothers with PGDM had higher rates of RDS, neonatal hypoglycaemia, neonatal jaundice and admission to the NICU.

Idiopathic intracranial hypertension presenting as postpartum headache

Postpartum headache is described as headache and neck or shoulder pain during the first 6 weeks after delivery. Common causes of headache in the puerperium are migraine headache and tension headache; other causes include pre-eclampsia/eclampsia, post-dural puncture headache, cortical vein thrombosis, subarachnoid hemorrhage, posterior reversible leukoencephalopathy syndrome, brain tumor, cerebral ischemia, meningitis, and so forth. Idiopathic intracranial hypertension (IIH) is a rare cause of postpartum headache. It is usually associated with papilledema, headache, and elevated intracranial pressure without any focal neurologic abnormality in an otherwise healthy person. It is more commonly seen in obese women of reproductive age group, but rare during pregnancy and postpartum. We present a case of IIH who presented to us 18 days after cesarean section with severe headache and was successfully managed.

Twin Pregnancy with a Complete Hydatidiform Mole and a Coexisting Live Fetus Rare entity

A hydatidiform mole with a coexisting live fetus is a rare occurrence and the optimal management for this condition is not yet known. We report the case of a 32-year-old woman (gravida 3, para 2) who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in March 2012 at 13 gestational weeks with abdominal pain and vaginal bleeding. An ultrasound examination revealed a hydatidiform mole pregnancy coexisting with a live fetus. After extensive counselling, the patient and her husband opted for a conservative management approach. Unfortunately, a hysterotomy had to be performed at 17 gestational weeks due to severe haemorrhage. The postoperative period was uneventful and histopathology results confirmed one complete mole with a coexisting fetus and normal placenta. The patients serum β-human chorionic gonadotropin level remained normal for 18 months following her surgery.

Misdiagnosed cervical pregnancy following a pregnancy with cotyledonoid leiomyoma

regression of metastatic lesions in situations where estrogen levels fall significantly [2]. Hormonal management can be accomplished surgically by bilateral oophorectomy and the medical management includes the use of GnRH analogues, selective estrogen receptor modulators (e.g. tamoxifene, raloxifene) and aromatase inhibitors [1,2]. Recent evidence favours a combination of GnRH analogues with raloxifene to arrest the progression of myomas, without any bone or endometrial adverse effects [4]. In patients with intrapulmonary lesions, a median survival of 94 months has been reported after excision of the lesions [5]. To conclude, BML is a rare entity that usually affects women with history of uterine fibroids. The lungs are the most common site of metastatic involvement and hence BML should be a differential in any patient with multiple pulmonary nodules and a history of uterine leiomyomatosis.

Asymptomatic Ovarian Mucinous Cystadenoma with a Solid Mural Leiomyoma: Case report and brief review

Mucinous neoplasms of the ovary may have associated benign or malignant mural nodules. A leiomyomatous mural nodule is a rare, benign lesion associated with mucinous tumors of the ovary. We report a case of a mural leiomyomatous nodule arising in a benign mucinous cystadenoma in a 29-year-old woman who presented with a large heterogenous abdominal mass. After pre-operative evaluation, exploratory laparotomy was performed upon suspicion of ovarian malignancy. A pathological examination confirmed the benign nature of the mural nodule.

Multiple Enteric Duplication Cysts in a Twin Fetus : Diagnosis and management

Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully.