Abstract

Uterine torsion, when seen in a non-gravid uterus, is quite extremely rare condition (less than 50 cases reported). Further, only few such cases in postmenopausal age group have been reported as the present one. This 57-year-old lady presented as acute abdomen. CT scan confirmed a large fibroid with calcifications arising from the uterine body and stretched round ligament lying beneath the peritoneum and twisted dense uterine vessels in the pedicle. Gross and histological examination showed gangrenous change (haemorrhagic infarct) in uterus, adjacent part of leiomyoma and right ovary. Torsion of the vessels at the pedicle caused irreversible ischaemic damage of the uterus, led to rapid clinical deterioration. Thus, it is urged that surgical removal of the huge subserosal fibroids or ovarian cysts should be done in the perimenopausal or postmenopausal women in view of the possibility of the torsion of uterus with or without adnexa. 

Abstract

Russell boy cervicitis is a rare form of cervicits characterised by the accumulation of intracytoplasmic eosinophilic inclusion bodies in the plasma cells. Extensive literature search revealed previous four reported cases of Russell body cervicitis. Here, we report a case of Russell body cervicitis in a 44-year-old female who presented with recurrent endocervical polyps.

Abstract

Multiple myeloma is a B-cell neoplastic disorder and represents 1% of all cancers and 13% of hematological malignancies. It is predominantly a disease of elderly, and less than 3% of all cases are below the age of 40 years. We present the case of a 29-year-old lady with multiple myeloma who had spontaneous conception during maintenance therapy and subsequently a successful pregnancy outcome. She gave birth to a healthy female infant through normal vaginal delivery and subsequently could remain off therapy for 5 years. Since the patient had a history of abortions and stillbirth, it was a precious pregnancy and we could successfully salvage both the mother and the baby. Young female patients of myeloma who are in remission can be encouraged to start a family during their reproductive years with the support of a comprehensive care team of hema-tologists/oncologists and obstetricians.

Abstract

Cloacal anomalies are rare anorectal malformations usually affecting girl child. It needs surgical correction in childhood and may have significant bearing on the reproductive outcome in later life. We are presenting a case report of such a case posing obstetric challenge and complications.

Abstract

Congenital diaphragmatic hernias are usually detected during fetal life or soon after birth, though there are several reports of this condition being diagnosed later in life. When it manifests first in pregnancy, the diagnosis can be extremely challenging and delayed, resulting in poor maternal and perinatal outcomes. We report one such case, who presented with acute symptoms late in pregnancy, and the cascade of misleading events before the correct diagnosis was made and treatment could be instituted.

Abstract

Pseudoaneurysm of uterine artery is rare and can present as abnormal uterine bleeding or as postpartum hemorrhage. Uterine artery embolization (UAE) is used for management for pseudoaneurysm but not preferred in women wanting future fertility as it might cause ovarian failure and pregnancy complications. Here we present two cases where women with uterine artery pseudoaneurysm who presented with abnormal uterine bleeding and were managed with UAE and subsequently conceived and delivered without any complication. Successful pregnancies after UAE for fibroid have been reported but not after pseudoaneurysm treatment.

Placental chorioangioma has been noted to be the most common benign tumour of the placenta, being diagnosed as an incidental finding. Conversely however, large sized tumours (> 4cm) have adverse fetal (polyhydraminos, fetal cardiomegaly, hydrops fetalis, intrauterine growth restriction) and maternal (gestational hypertension, antepartum haemorrhage, pre eclampsia) outcomes, requiring close monitoring and follow up. We present a case report of a 26 year old, primigravida, 31 weeks + 5 days of gestation, referred to the Department of Obstetrics and Gynaecology, SRIHER for an early delivery. Placental chorioangioma being a rare case in the field of obstetrics; there is a lack of management guidelines / treatment protocols. Our case is one wherein timely interventions and prompt institutional delivery led to a successful feto-maternal outcome. Ultrasonography with doppler remains the gold standard for diagnosis. Invasive techniques – embolizaton and fetal transfusion - used to prolong gestation, despite minimal experience with the same, have proven to have a successful outcome.

Abstract

Vulvar necrosis is a rare complication after lower limb fractures and hip surgeries either due to direct damage to internal pudendal artery or post-surgery ischemic necrosis due to use of a perineal post. We present a series of 3 cases post-orthopedic surgeries with vulvar necrosis. All three patients presented to us after history of orthopedic surgeries which used a perineal post intraoperatively. They developed vulvar edema and blackish discoloration 6–8 h after the orthopedic procedure and referred for further management. Traction post-related vulvar necrosis can have major psychological and functional consequences; hence, formulating measures for prevention and promptly diagnosing the condition and ensuring early management to maintain the functionality of vulva is of utmost importance.

Abbreviations
NSAIDs Non-steroidal anti-inflammatory drugs
EUSOL  Edinburgh University solution of lime

Introduction : Ursodeoxycholic acid (UDCA) is the mainstay of treatment in intrahepatic cholestasis of pregnancy (ICP), which improves pruritus and normalizes bile acids in most cases. A case with severe ICP, not controlled on UDCA alone, and managed successfully by adding rifampicin is being reported.

Case report : A 28-year-old women was diagnosed as a case of early onset severe ICP with elevated bilirubin at 17+6 weeks. As patient did not respond to UDCA therapy, oral rifampicin was added which reduced bilirubin. Patient went into spontaneous preterm labour at 31+6 weeks and delivered a baby with 9/9 Apgar score. Conclusion: Adding Rifampicin to UDCA enhances bile acid excretion and is an option for severe refractory ICP.

Abstract

Background We report a case of afibrinogenemia in a lady, which was detected for the first time during her pregnancy.CaseA 24-year-old G4A3 was referred as a case of vaginal bleeding, after a cervical cerclage at 14 weeks of gestation. Elastometry targeted correction of coagulopathy was done initially, and targeted cryoprecipitate transfusion was done to maintain her gestation. She underwent induced vaginal delivery at 34 weeks of gestation. Fourteen days postpartum, the mother and child were discharged home well.

Conclusion Coagulation factor deficiency should be considered as a rare cause for RPL. Serum fibrinogen level of 50–100 mg/dl during pregnancy seems to be a safe and adequate target to maintain in pregnant patients with afibrinogenemia.

Background Uterovesical abscess, or bladder flap hematoma, refers to an infected collection in the space formed between the lower uterine segment and bladder during lower segment cesarean section. It presents as pain, fever, and anemia in the puerperal period, and can be diagnosed as a pelvic collection on ultrasound or magnetic resonance imaging. Laparotomy and drainage has traditionally been used for large abscesses, contributing to perinatal morbidity.

Conclusion Minimally invasive surgery extrapolated to the obstetric ward, can reduce maternal and neonatal morbidity.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome associated with a number of conditions including preeclampsia, eclampsia. We report three cases of PRES in eclamptic women and describe the management of these patients. All three women improved after multidisciplinary team management. PRES should be considered in women with severe form of eclampsia associated with coma or other neurological features.

Myomatous erythrocytosis syndrome (MES) is a condition where uterine myoma is associated with erythrocytosis. It is a rare condition which is even rarer in pregnancy. This is no report of MES in pregnancy in India. Our case is 31 years old G3P1L1A1 with previous 2 myomectomies who presented at 32 weeks with cellulitis of right lower limb and severe pre-eclampsia. She was already diagnosed to have uterine myomas in the 1st trimester sonogram. On routine investigations she was found to have erythrocytosis. Her erythropoietin levels were also elevated, and repeated sonograms showed progressive increase in the size of myoma. She was managed preoperatively with venesection and hydration. Later she was taken up for classical Cesarean section and myomectomy with tubal sterilization at 36 weeks. Postoperatively her haemoglobin and haematocrit dropped. Her erythropoietin levels also showed a marked downward trend. Histopathology of myomectomy specimen reported as leiomyoma. Erythropoietin and its receptor could not be demonstrated in the surgical specimen for the want of investigation felicities.

Endometrial Stromal Sarcoma is an uncommon gynaecological tumour. Extrauterine Endometrial Stromal Sarcoma (EESS), the extra uterine variant of its relatively more common counterpart is even rarer with only few case reports documented. We report a case of a 40-year woman with a diagnostically challenging bilateral adnexal tumours and synchronous invasive ductal breast carcinoma (IDC). The pathology specimen confirmed the diagnosis of EESS in the absence of florid endometriosis and synchronous hormone positive infiltrating duct cancer in the breast. Patient was started on adjuvant endocrine therapy and is disease free at 2 years. To the best of our knowledge, this is the first documentation of synchronous presentation of IDC and EESS, highlighting the possible role of hyper-estrogenemia as an etiological factor

Background Primary amenorrhea secondary to the uterine injury caused by a blunt trauma to the pelvis, in childhood is a rare problem. To the best of our knowledge this is the first case reported.

Methods We report a rare case of primary amenorrhea in a 17 year old girl and how systematic approach helped us to come to a diagnosis and treat the patient successfully. Results: Detailed history, biochemical testing, imaging, karyotype and diagnostic laparoscopy, revealed normal uterus which was seen separately from the cervix with the uterine transection seen at the lower uterine segment. Both the ovaries and tubes were normal with retrograde bleeding seen in the pouch of Douglas. Surgical correction was successful by laparoscopic anastomosis of uterus with the cervix resulting in her normal periods.

Conclusion We are presenting an unusual case of successfully treated uterine injury with uterine and cervical anastomosis. Uterine injury caused due to a road traffic accident at 2 years of age was missed and it presented as primary amenorrhea at the age of 16 years. Postoperatively she started menstruating regularly. Stepwise evaluation of a primary amenorrhea case leads to early diagnosis and early correction of the problem which helps in retaining the future fertility

We present a case of 46-year old female with hyperandrogenism due to leydig cell tumour of 30 left ovary which was masqueraded by adrenal incidentaloma. She was referred to 31 Endocrinology department for virilization work up. Her biochemical evaluation revealed 32 serum testosterone level of 418 ng/dl with normal adrenocortical hormones. In view of 33 normal transvaginal ultrasonography and computed tomography of abdomen and pelvis 34 showing right adrenal mass, she was subjected to laparoscopic right-adrenalectomy. But her 35 testosterone levels remained elevated after surgery. This mandated laparoscopic exploration 36 of ovaries, which ended in bilateral oophorectomy. Histopathological examination of left 37 ovary revealed a leydig cell tumour. Three-month post-surgery, her hirsutism regressed to a 38 large extent and shaving frequency reduced to once in two months. Thus, tumoural range 39 hyperandrogenism with normal adrenocortical hormones mandates evaluation for an ovarian 40 cause even in background of an adrenal mass.