Neelam Banerjee

Pregnancy associated aplastic anemia: maternal and fetal outcome.

Aim:  To study the maternal and fetal outcome in cases of aplastic anemia associated with pregnancy.

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 removal of translocated retroperitoneal IUD.

IUDs represent a safe and effective method of contraception and are widely used in various countries. This article reports the case of a 42-year-old female patient who had undergone a laparoscopic removal of translocated retroperitoneal IUD. Local examination demonstrated a complete perineal tear which occurred during her last childbirth and for which she had not sought any treatment. Pelvic examination revealed a normal-sized uterus and her rectal examination was also normal except for a complete perineal tear. On ultrasonography the IUD was not seen in the uterine cavity or buried in the myometrium. Plain X-ray of the abdomen revealed the IUD lying just above the right ureter and pelvic vessels and it was successfully removed laparoscopically. This case demonstrates that laparoscopic removal of a misplaced IUD from this difficult site is safe and effective. It also highlights the need to inspect the abdominal walls and retroperitoneum carefully when a translocated IUD is not found in the pelvic or abdominal cavity.

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.

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.

Aplastic anaemia during pregnancy: variable clinical course and outcome

Aplastic anaemia occurring during pregnancy is a rare event and is associated with high maternal and fetal morbidity and mortality. Prognosis is poorer when aplastic anaemia develops during pregnancy and many such patients have an unsuccessful pregnancy outcome. We report two cases of aplastic anaemia associated with pregnancy. Both the patients had very different antenatal course and outcome. Their etiopathogenesis and management is discussed.

Retrieval of lost Copper-T from the rectum

A case of lost Copper-T lying partly in the rectal lumen and its removal through the rectal route is described. This case emphasises the importance of rectal examination in the case of lost intra-uterine contraceptive device (IUCD) and highlights the possibility of safe retrieval of an IUCD through the rectal route even when it is partly embedded in the rectal wall.

Inversion of uterus during cesarean section

Acute inversion of the uterus is a rare complication during cesarean section. We describe one such case in which diagnosis was made immediately and reversion was performed within few minutes. A high index of suspicion and prompt management can prevent further complications.

Pregnancy following tubal sterilization: an 11-year survey.

This paper reports the findings of an 11-year survey which examined post-sterilization pregnancy among women who underwent sterilization at the All India Institute of Medical Sciences from March 1986 to March 1997. Out of the 6639 patients who were followed up for a minimum of 2 years 25 came back with post-sterilization pregnancy. All these patients underwent repeat laparoscopic tubal sterilization (LTS) with Falope ring and minilaparotomy tubal sterilization (MTS) using Pomeroys technique. Of the 25 post-sterilization pregnancies 21 (84%) were intrauterine pregnancies and 4 (16%) were ectopic pregnancies. LTS failure due to misidentification of tubes recanalization and fistula formation occurred in 19 patients while MTS failure caused by recanalization and fistula formation occurred in 6 patients. The rate of method failure following LTS ranges from 0.09% to 0.6 % while the failure rate following minilaparotomy sterilization varies from 0.4% to 0.7%. The findings suggest that there is no 100% effective method of sterilization.

Balanced X; 22 translocation in a patient with premature ovarian failure.

A case of balanced X; autosome translocation 46, X, t (X; 22) (q 24; q 13) in a 25-year-old female with secondary amenorrhea and premature ovarian failure (POF) is described. The relationship between balanced X; autosome translocation [t (X; A)] and varied phenotypic expression observed in these women is discussed. This case highlights the importance of early recognition of these women in order to give them the best chance of conception in their oligohypomenorrhic phase before complete loss of gonadal function.