International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A missed diagnosis of ovarian torsion in a patient with multiple degenerating uterine fibroids: a case report
Get PDFThe presentation of ovarian torsion can be dramatic with most patients presenting with acute or severe nonspecific lower abdominal and pelvic pain, either intermittent or continuous, with nausea and vomiting. The diverse clinical presentation is one major reason the diagnosis of ovarian torsion is frequently missed. The incidence of ovarian torsion ranges from 3-10% and ovarian cyst accidents constitutes about 3-5% of gynaecological emergencies. The aim was to document a case of acute abdomen suspected to be acute red degeneration of fibroids and/or acute appendicitis with incidental finding of ovarian cyst accident with consequent loss of the ovary. Our patient is a 35-year-old lady who presented with lower abdominal swelling, right sided abdominal pain and vomiting, suspected to be acute appendicitis and/or red degeneration of uterine fibroids but subsequently had exploratory laparotomy with right salpingo-oophorectomy due to right ovarian torsion, alongside myomectomy and appendectomy. Ovarian torsion is a preventable incident if early diagnosis and intervention is made. There is therefore need to consider ovarian torsion as a differential diagnosis of acute abdomen in young females to avoid loss of ovary and its function
Letter to editor in response to: lepromatous leprosy in primigravida with early onset pre-eclampsia in third trimester: a rare case report
Get PDFWe read with great interest the case report on lepromatous leprosy in a primigravida with early-onset pre-eclampsia in the third trimester. The authors have brought attention to a rare and interesting clinical scenario. However, certain aspects of the case report need some clarification
Synchronous presentation of renal cell carcinoma and cervical cancer: a rare oncological challenge
Get PDFCervical cancer is the fourth most common cancer among women globally, with a high incidence and mortality, particularly in developing countries. Renal cell carcinoma (RCC), though less common, comprises 2% of global cancer diagnoses. The synchronous occurrence of RCC and cervical cancer is extremely rare, with less than 5% of cervical cancer cases presenting with another primary malignancy. We report a case of a 47-year-old multiparous woman diagnosed with FIGO stage IIIB cervical cancer, who, during staging and evaluation, was incidentally found to have a synchronous renal cell carcinoma. During the course, imaging revealed a mass in the right kidney, confirmed to be RCC via biopsy. A multidisciplinary tumor board recommended surgical management for the RCC, and the patient underwent a right radical nephrectomy, which confirmed clear cell RCC. Postoperatively, the patient resumed treatment for cervical cancer with concurrent chemoradiation. This case highlights the importance of comprehensive diagnostic imaging in patients with pelvic malignancies to detect any coexisting primary tumors. Early identification and treatment of synchronous malignancies are critical for optimizing patient outcomes, and this case contributes valuable insight into the rare co-occurrence of RCC and cervical cancer
Successful pregnancy outcome in a woman with malignant bilateral ovarian germ cell tumor
Get PDFMalignant ovarian germ cell tumors (MOGCT) are rare, accounting for 5% of all ovarian malignancies. In the first two decades of life, almost 70% of ovarian tumors are germ cell tumors and of these one-third are malignant. Bilateral involvement in MOGCT is very rare. This case presented a unique challenge of fertility-sparing surgery in the case of MOGCT. Although fertility-sparing surgery is recommended even in advanced stages if fertility is desired, the bilaterality of disease precluded the option in the index case. Neoadjuvant chemotherapy has been attempted in patients with malignant ovarian germ cell tumors with extensive intra-abdominal disease. Current chemotherapy for GCT has more than 80% chances of menstruation, more than 70% pregnancy rates with no increase in risk of teratogenicity, and less than 10% risk of premature ovarian failure. In our case not only the patient had a successful debulking surgery post NACT without any signs of recurrence, but also had a spontaneous conception with a successful pregnancy outcome with no complications pertaining to prior treatment given
A rare encounter with juvenile granulosa cell tumor: diagnosis, management, and outcome
Get PDFJuvenile granulosa cell tumor (JGCT) is a rare ovarian sex cord-stromal tumor, accounting for less than 5% of all granulosa cell tumors and primarily affecting prepubescent girls and young women. Due to its rarity, clinical presentation, optimal management, and long-term outcomes remain areas of ongoing investigation. We report the case of a 19-year-old nulliparous female who presented with intermittent lower abdominal pain and bloating for eight months, with no menstrual irregularities or signs of virilization. Clinical examination revealed a firm, 20-week-sized pelvic mass, and imaging studies suggested a large multiseptated right abdominopelvic mass. Patient underwent fertility-sparing staging laparotomy, and histopathology confirmed JGCT with micro metastasis in the omentum (pT3aN0). Immunohistochemistry showed positivity for inhibin, PR, calretinin, and WT1. The patient underwent four cycles of adjuvant paclitaxel and carboplatin chemotherapy and has remained in remission for one year and under three-monthly surveillance. This case highlights the importance of early recognition, comprehensive surgical staging, and appropriate adjuvant therapy in managing JGCT. Given its potential for aggressive behavior and recurrence, long-term follow-up is essential. This report underscores the need for individualized treatment approaches in rare ovarian malignancies.
Misoprostol versus combined regimen of mifepristone and misoprostol in termination of second trimester pregnancy
Get PDFThe present prospective study was conducted over 12 months at Dr. Mansukh Bhai K. Shah medical college and Sushilaben M. Shah multi-specialty hospital, Ahmedabad, serving predominantly lower socioeconomic groups. The objective was to assess the safety and efficacy of misoprostol alone versus a combined regimen of mifepristone and misoprostol in second-trimester pregnancy termination. A total of 18 patients were enrolled and divided into two groups. Group A received 200 mg oral mifepristone, followed 24 hours later by 200 mcg misoprostol administered vaginally every 4 hours up to a maximum of 4 doses or until expulsion occurred. Group B received only 200 mcg vaginal misoprostol every 4 hours, up to 4 doses. Success was defined as complete expulsion of the fetus and placenta without the need for surgical intervention. In group A, the success rate was 100%, and none of the patient’s required dilatation and evacuation (D and E). In contrast, group B had a success rate of 80%, with 2 patients (20%) requiring D and E. There were no failures in either group, defined as failure to abort within 72 hours of the last dose. The induction-abortion interval was shorter in the mifepristone-primed group. The study concludes that pre-treatment with mifepristone significantly improves the efficacy of second-trimester pregnancy termination with misoprostol, reduces the need for Surgical intervention, and shortens the induction-to-abortion interval. The combined regimen of mifepristone and misoprostol is thus more effective and safer than misoprostol alone
Prediction of preterm labor using ultrasound measurement of cervical length at 11 to 14 weeks and 18 to 20 weeks
Get PDFBackground: Preterm birth (PTB) is the most important problems that pose dilemmas for both the obstetrician and neonatologist, as it is the leading cause of perinatal morbidity and mortality around the world. Routine cervical length screening during early pregnancy can predict PTB. Objectives were to predict the PTB with the use of ultrasonographic cervical length measurement at 11-14 weeks and 18-20 weeks of gestation.
Methods: This prospective observational study was conducted from 1st March 2024 till 31st March 2024 at department of obstetrics and gynaecology pacific institute of medical science Udaipur. Total 100 cases selected which are routinely advised for ultrasound during antenatal checkup at 11-14 weeks and 18-20 weeks. In this study all the analysis was performed using 10.0 version of statistical software SPSS.
Results: In this study most women (49.0%) belonged to the age group of 26-30 years. 78.0% of women had term births and 22.0% of women had PTBs. It was observed that 12 women had cervical length <25 mm at 18-20 weeks and 83% of them had PTBs while 16.6% had term birth.
Conclusions: Ultrasound measurement of cervical length in early pregnancy is a reliable and cost-effective method for screening of PTB. We observed that women with shorter cervix early on in pregnancy had a greater number of PTB s as compared to women with normal length of cervix
A comparative assessment of decision to delivery interval for emergency and urgent lower segment caesarean section following maternal and foetal outcomes
Get PDFBackground: Background: Timely decision-to-delivery interval (DDI) in lower segment caesarean section (LSCS) is critical for safeguarding maternal and foetal health. This study aimed to measure the DDI and assess its relationship with maternal and foetal outcomes.
Methods: A prospective observational study was conducted among 361 deliveries at a tertiary care hospital in Bhilai, Chhattisgarh. Pregnant women undergoing emergency (Category 1, n=283) and urgent (Category 2, n=78) LSCS were enrolled. Maternal and foetal outcomes were evaluated.
Results: A statistically significant difference was observed between mean DDI values in Category 1 and Category 2 (p<0.02). Maternal outcomes, including postpartum haemorrhage (PPH), post-operative fever, and blood transfusion, were significantly associated with increasing DDI (p<0.0001). A significant difference in neonatal intensive care unit (NICU) admission rates between the two categories was noted (p=0.03). APGAR score comparisons showed significant variations at different DDI intervals: 31–40 vs 51–60 min (p<0.0002), 41–50 min (p<0.00021) for 1-minute scores, and 21–30 min (p<0.028) for 5-minute scores.
Conclusions: While increased DDI correlated with certain adverse maternal and neonatal outcomes (NICU admission and low APGAR scores), no critical maternal or foetal mortality was attributed directly to prolonged DDI
Struma ovarii with serous cyst adenoma: a rare case report
Get PDFStruma ovarii is a rare ovarian teratoma of mono dermal variant constituting 1-4% of all benign teratoma. Any ovarian teratoma is called struma ovarii only when it consists of at least 50% thyroid tissue. Its coexistence is extremely uncommon with serous cystadenoma with only a handful of cases reported till date. Hereby we present a rare case of 36 years old women with hypothyroidism presented to our OPD with pain abdomen for past 3 months and ovarian mass. Clinicoradiologically possibility of an endometrioma was considered. Histopathological examination revealed coexisting double pathologies; of which struma ovarii was an incidental finding. This case is important, not only being rare, but it also highlights the importance of careful and extensive histopathological examination even in a seemingly simple cystic lesion of the ovary to avoid missing concomitant focal pathologies
Feto-maternal outcome in eclampsia at tertiary care hospital in an observational prospective study
Get PDFBackground: Eclampsia is a grave consequence of pre-eclampsia. It is defined as development of seizures in a woman with pre-eclampsia during pregnancy or puerperium that cannot be attributed to other causes. Pre-eclampsia complicated by generalized tonic clonic convulsions raises the risk to both mother and fetus. The current study is being done to analyse the cause, clinical course, it's management and feto-maternal outcome in patients of eclampsia.
Methods: prospective observational study at Gopinath maternity home, Obstetrics and Gynaecology department, Government Medical College, Bhavanagar including all antepartum, intrapartum and postpartum cases of eclampsia in 10-month period August 2023 to May 2024.
Results: The findings underscore the high prevalence of eclampsia among younger women, particularly primigravidae. The study also revealed that the majority of cases were managed as emergencies, reflecting the lack of adequate prenatal care and monitoring. These demographic and socioeconomic insights emphasize the urgent need for improved healthcare access and educational programs targeted at vulnerable groups to mitigate the risks associated with eclampsia.
Conclusions: The high incidence of eclampsia and its complications during this study indicate the need for early identification of risk factors and timely intervention to improve maternal and perinatal outcome. By giving mass awareness towards the importance of antenatal care, ensuring early detection of symptoms of pre-eclampsia in peripheral hospitals and providing adequate treatment, the incidence of eclampsia can be reduced effectively