International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Challenges in cyto-diagnosis: a report of 2 interesting cases of pseudomyxoma peritonei
Get PDFDiffuse intra-abdominal gelatinous or mucinous ascites is commonly known as pseudomyxoma peritonei (PMP). It is a clinical entity rather than a histological diagnosis and usually results from peritoneal dissemination of mucus producing neoplasms most frequently from the appendix and rarely other GIT tumours. Since ascites may be the first symptom, cytologists may face diagnostic challenges in mucinous ascites. We present two cases of mucinous ascites in elderly females, in which thick, sticky, gelatinous fluid was received for cytological examination. After correlation of cytological examination findings with clinical and radiological features, diagnosis of disseminated peritoneal adenomucinosis was made which was later confirmed by fluid cell block with IHC studies
Isolated sixth cranial nerve palsy as the first manifestation of pre-eclampsia with twin pregnancy-case report and review of literature
Get PDFSixth cranial nerve palsy can occur either during or after gestation, and is often associated with hypertensive disorders of pregnancy. We report a case of a 39-year-old hypertensive primigravida with a twin pregnancy, who suddenly developed double vision in her second trimester. She was diagnosed to have isolated sixth cranial nerve palsy in her left eye. Her anterior and posterior segment examination, as well neurological imaging, were found to be entirely within normal limits. She was subsequently admitted with severe pre-eclampsia and haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and managed conservatively. The prognosis is usually favorable in such cases, with the palsy resolving as the blood pressure normalizes after delivery. This case demonstrates isolated abducens nerve palsy as the first sign of pre-eclampsia at 30 weeks of gestation
Chronic pelvic pain: a comprehensive review on its physical and mental effects
Get PDFChronic pelvic pain (CPP) is a multifaceted and often debilitating condition that affects a significant portion of the female population wherein there is persistent acyclic pain in the pelvic region continuing for a long period of time. It has multifactorial etiology which may encompass gynecological, urological, gastrointestinal, musculoskeletal, and neurological components. This comprehensive review highlights the physical and psychological effects of CPP and briefly summarizes the various treatment modalities for CPP
Intrapartum vulvovaginal haematoma causing obstructed labour: an obstetricians nightmare
Get PDFVulval hematoma during pregnancy is a rare event. Typically, they arise as a result of postpartum trauma. Rarely do hematomas of this type develop spontaneously during labour without any obvious underlying cause for the same. Prompt recognition and timely drainage of the hematoma helps to prevent any untoward complication and leads to speedy recovery
Immunohistochemistry-guided management of colon-like CUP in a 20-year-old female: a case report
Get PDFCancer of unknown primary site (CUP) is characterized by metastatic disease without an identifiable primary tumor, even after extensive evaluation. It accounts for approximately 2% of all cancers and is most commonly diagnosed in older adults, with the highest incidence in patients aged 60-75 years. Diagnosis involves clinical, pathological, and imaging evaluations, including PET and immunohistochemical (IHC) staining, to determine tumor lineage and guide treatment. We present a case of a 20-year-old female with a right inguinal mass. Initial evaluation revealed metastatic adenocarcinoma with no primary tumor identified. The patient’s history included a prior breast fibroadenoma excision, and comprehensive diagnostic work-up, including PET scan, was unremarkable. Immunohistochemistry results were consistent with colon-like CUP, and the patient underwent excision of the inguinal node followed by adjuvant chemotherapy with the FOLFOX regimen. CUP treatment and prognosis vary by tumor subtype, with colon-like CUP typically managed using colorectal cancer-specific therapies. This case underscores the importance of IHC in guiding treatment for CUP and highlights the role of site-specific therapy in improving patient outcomes. Further studies are needed to validate treatment strategies in younger patients with CUP.
Serum calcium level as a predictor for pregnancy induced hypertension
Get PDFBackground: Pregnancy induced hypertension is responsible for causing complications among 7-10% of antenatal females. Intracellular calcium concentrations have been involved in the pathogenesis of pregnancy induced hypertension. To assess estimate serum calcium and assess its the predictive value in development of pregnancy-induced hypertension in 12 to 20 weeks of antenatal women and correlate levels of serum Calcium in pregnancy induced hypertension
Methods: A prospective study was conducted in a tertiary care hospital among 400 pregnant females with 12 to 20 weeks of gestation. Blood pressure was measured using sphygmomanometer A detailed family and medical history was taken. Serum calcium levels were measured by the O- cresol phthalein complexone (OCPC) method.
Results: Among 400, majority of normotensive patients i.e., 184 had serum calcium levels<9 mg/dl and 91 had between 9-10 mg/dl. 121 patients with pregnancy induced hypertension had serum calcium<9 mg/dl and 4 patients had between 9-10 mg/dl. Among Maternal complications all the 7 patients with eclampsia and 03 with abruption had serum calcium levels<9mg/dl. 70 patients of pre-eclampsia had serum calcium<9 mg/dl and only 04 had between 9-10 mg/dl. Severe pre-eclampsia was seen in 32 patients with serum calcium<9 mg/dl and 01 with 9-10 mg/dl of serum calcium. Fetal complications in form of iugr was seen in 40 pts with serum calcium<9 mg/dl. 4 patients have still birth had s calcium<9 mg/dl. Results were found to be statistically significant(p<0.05).
Conclusion: Hypocalcaemia may have a role in causing pregnancy induced hypertension. Thus, intake of calcium supplements helps to reduce its incidence of PIH
Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in postmenopausal women with bleeding
Get PDFBackground: Postmenopausal bleeding is defined as blood loss occurring at least 12 months after menopause. Aims and objectives were to assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with postmenopausal bleeding.
Methods: It was a prospective study that took place at Government Medical College and Rajindra Hospital Patiala. from June 2018 to May 2019. The study was carried out in 60 patients presenting with postmenopausal bleeding to the OPD of department of obstetrics and gynecology, Government Medical College and Rajindra Hospital, Patiala. Patients with post-menopausal bleeding were included in the study. The endometrial thickness (ET) was measured on TVS. Hysteroscopy was done. Findings were recorded as atrophic endometrium, endometrial hyperplasia, endometrial polyp, fibroid, and endometrial carcinoma (obvious intrauterine growth with necrotic tissue). Endometrial biopsies were taken in all patients. Histopathological examination was done and was considered as the final diagnosis. Data collected was analysed using Microsoft Excel Office software 2019 version 19.11 and Epi info (CDC Atlanta) version 7.2.3.1.
Results: The best diagnostic accuracy for TVS was obtained at endometrial thickness of 4 mm.
Conclusions: TVS is useful for detecting endometrial pathology with a cut-off value for ET of 4 mm having a high sensitivity. Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions
A case report of ruptured corpus luteal cyst with congenital bleeding disorder
Get PDFWomen of reproductive age with Von Willebrand disease (VWD) are at increased risk of haemorrhagic ovarian cysts due to excessive bleeding into the corpus luteum during ovulation. The rupture of these cysts can lead to life-threatening hematoperitoneum and other complications such as pelvic adhesions, fallopian tube blockages, and ovarian damage, which may impair fertility. Early diagnosis and management of VWD are critical to mitigating these risks. A 20-year-old unmarried woman presented to the emergency department with acute abdominal pain and vomiting. She was hemodynamically unstable and in shock, with severe pallor, abdominal distension, and guarding. Laboratory tests revealed a hemoglobin level of 3.9 g/dl. Imaging suggested a ruptured corpus luteal cyst with gross haemoperitoneum, and a negative urine pregnancy test ruled out ectopic pregnancy. Emergency laparotomy revealed a ruptured 4x2 cm corpus luteal cyst and approximately 2000 cc of haemoperitoneum, which was drained. Postoperatively, the patient experienced recurrent bleeding from the wound site, requiring multiple blood transfusions, resuturing, and a second exploratory laparotomy to drain a 500 cc subcutaneous hematoma. Further investigations confirmed a diagnosis of VWD. The patient was managed with transfusions of blood products and factor VIII and eventually discharged in stable condition. This case underscores the diagnostic and therapeutic challenges of managing VWD in reproductive-aged women with acute gynecological emergencies. Severe haemoperitoneum, recurrent bleeding, and impaired wound healing necessitate a high index of suspicion for bleeding disorders in similar presentations. Multidisciplinary care involving gynecologists, hematologists, and critical care specialists is essential for optimal outcomes
A rare case of cribriform hymen with pregnancy
Get PDFThe genital tract anomalies in females have a major impact on their sexual and menstrual life. Cribriform hymen is a rare condition in which the hymen membrane contains multiple perforations. This condition occurs in 1% of the females and requires management if there is any interference in the menstrual flow or sexual function. Here in this case report we present a 21-year-old pregnant woman with cribriform hymen. The patient had a history of hematocolpos at the early menstrual age and has done needle drainage occasionally during the menstrual cycles. Thus, to prevent further complications lower segment caesarean section (LSCS) was done to deliver the baby. Hymenectomy was also done simultaneously after LSCS to improve the quality of life of the patient during the menstrual cycle. The patient was discharged after the procedure under stable conditions
Uterine multiple leiomyoma: a case report
Get PDFUterine leiomyomas are benign growth arising from smooth muscle cells of uterine myometrium and it the most common neoplasms of the uterus. Multiple myomas are common and usually cause diagnostic and therapeutic problems due to their size, clinical features, and degeneration. Their diagnosis is usually not missed due to wide spread use of ultrasound in gynecological department. In this article, we present a multiple myoma case in a 39 years old woman who presented with heavy menstrual bleeding, prolonged menstrual cycle, anemia, and dysmenorrhea for six months. Physical and radiological examination revealed the presence of multiple masses arising from the uterus. Myomectomy was done for the same (multiple fibroids enucleated). Histological examination confirmed the same. The patient's postoperative period was uneventful and she was discharged after 4 days and followed up after 2 months