Posterior reversible encephalopathy syndrome (PRES) refers to a clinico-radiological entity with characteristic features on neuroimaging and rapid onset of nonspecific symptoms including headache, seizure, altered consciousness and visual disturbance. It is a neurotoxic state in response to the acute changes in blood pressure leading to vasogenic oedema. It is often but not always associated with hypertension. However, control blood pressure is one of the mainstays of management in such cases. Nitroglycerine (NTG) is a potent vasodilator and is one of the drugs for treatment of hypertensive emergencies. It is found to worsen the cerebral oedema in PRES which is considered due to failure of cerebral blood pressure autoregulation. Here, we report two such cases where patients with PRES deteriorated with NTG infusion. However, the neurological condition of the patients improved drastically the next day. NTG could have further enhanced vasodilation, thus aggravating developing PRES, after autoregulation was lost because of high blood pressure.

Objective – Here we are presenting a case of Primi with Rupture of sinus of Valsalva Aneurysm (RSOVA) who had an uneventful delivery under careful monitoring of Obstetrician, Anesthesiologist and Cardiologist.

Case Report - RSOVA is a rare congenital cardiac abnormality. Only a few such cases have been reported in the medical literature. Most patients required caesarean section (LSCS) to avoid complications. Our patient was diagnosed as a case of VSD earlier. On referral to our centre, she was diagnosed to have rupture of right coronary sinus of Valsalva aneurysm into right ventricle and right ventricular outflow tract with moderate valvular pulmonary stenosis by 2D Echo. She was advised elective LSCS at a tertiary care centre. However, she landed in labour at an advanced stage in our hospital and delivered vaginally with a good materno-fetal outcome.

Conclusion - With early diagnosis, timely intervention and prompt management by the medical team; good maternofetal outcome can be achieved in such high-risk cases. Keywords: Rupture of sinus of Valsalva, pregnancy, echo cardiography, good materno-fetal outcome.

Vesico ovarian fistula is a rare complication following tubo-ovarian abscess. We report a case of vesico-ovarian fistula in women with stage IV endometriosis. Patient presented with abdominal pain, fever and cloudy urine and imaging showed presence of adnexal mass and cystoscopy revealed presence of fistulous tract in bladder communicating with the adnexal mass. She was managed successfully with ovarian cystectomy and excision of fistula and repair. Diagnosis and management of vesico-ovarian fistula is a challenge especially in the setting of advanced endometriosis.

Endometrial stromal sarcoma is an uncommon malignancy of uterine corpus with incidence less than 1% (1). ESS is usually managed with hysterectomy along with bilateral salphingo oophorectomy. Stage I Low grade ESS is usually managed by surgery alone. For stage II, III and IV disease adjuvant treatment is either radiotherapy or hormone treatment or aromatase inhibitors (Fluvestrant). Here we are reporting a rare case of ESS recurrence after 8 years of primary treatment.

Patients of Von Willebrand disease are prone to high amounts of bleeding throughout their life. The chances of bleeding in such patients in the antenatal period is 10 times more as compared with normal women. The risk of bleeding is also comparatively high during parturition and also in the post-partum period. Therefore, healthcare providers should be vigilant for complications that they arise to such patients in the antenatal period, during delivery and in the post-partum period. we managed one such case of Von Willebrand disease in pregnancy with factor transfusion and vigilant monitoring and had a successful delivery with healthy baby.

Lymphoma of ovary is very rare. Involvement of ovary by lymphoma is usually secondary to disseminated systemic disease. Primary involvement of ovary by lymphoma is rare and is seen in only 1.5% of all ovarian neoplasms. Hereby we report a youngest case of ovarian lymphoma from India in 11year old girl presenting with abdominal mass and pain. Ovarian tumor was diagnosed on computed tomography and oophorectomy was done through laparotomy. Diagnosis of ovarian lymphoma was made on histopathology and immunohistochemistry. The primary ovarian lymphomas are rare and possess significant diagnostic challenge when occur due to nonspecific radiological features and diagnosis can only be made after histopathological and immunohistochemical examination of the tumor.

Ichthyosis uteri is an exceedingly rare condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium. It is a benign lesion and its association with benign and malignant conditions has been reported in the literature (Bewtra, Xie, Hunter, Jurgensen (Arch Pathol Lab Med 29:e124–e125, 2005)). Originally described as an endometrial response to iatrogenically introduced caustic substances, similar changes have since been described in association with a variety of inflammatory conditions of the endometrium. It is concluded that a squamous cell carcinoma of the cervix extended proximally into the endometrium (Bagga, Jaswal, Datta, Mahajan (Indian J Pathol Microbiol 51:267–268, 2008)). The possibility of significant cervical pathology should be considered when plaques of squamous epithelium with low-grade dysplastic changes are identified in an endometrial biopsy or curettage.

Delayed postpartum haemorrhage caused by partial or complete dehiscence of uterine scar is extremely rare. A case, hereby, is presented of delayed severe postpartum haemorrhage presenting as late as 44 days following LSCS. Patients with delayed postpartum haemorrhage should evaluated for uterine scar dehiscence. If missed, the consequences can be catastrophic with prolonged severe maternal morbidity.

Accessory and cavitated uterine mass is rare developmental Mullerian anomaly. There is a non-communicating uterus-like mass that occurs contiguously along wall of uterus often underdiagnosed and needs expertise to identify. To raise awareness, provide information about this pathology and emphasize role of coronal 3D ultrasound in its diagnosis. A 28-year-old married female presented with dysmenorrhea and chronic pelvic pain. On ultrasound, a homogeneously isoechoic mass was noted in right lateral wall of uterus with central echogenicity. On 3D reconstruction, the main uterine cavity was normal and both cornu were visualized without any recognized Mullerian anomaly. No communication with the main endometrial cavity seen. On laparoscopy, mass was located under right round ligament insertion. Sectioning revealed chocolate colored fluid. ACUM is non-communicating uterus-like mass. It resembles uterus both macroscopically and microscopically. It represents a cavitated mass lined by endometrial glands and stroma surrounded by irregular smooth muscle cells. Criterias for diagnosing ACUM are (1) accessory cavitated mass located under round ligament; (2) normal uterus, fallopian tubes, and ovaries (3) surgical case with excised mass and pathological examination; (4) accessory cavity lined by endometrium with glands and stroma; (5) chocolate-brown fluid contents. On ultrasound, they appear solid isoechoic masses with central cystic areas separate from ovaries. 3D reconstruction can be used to rule out Mullerian anomaly. ACUM is a rare surgically treatable cause of dysmenorrhea, often underdiagnosed due to lack of knowledge about entity. 3D ultrasound can be highly accurate in making the diagnosis.

NMDA encephalitis is a rare but potentially fatal condition triggered by dermoid cysts of the ovary. We present a case of a young lady with behavioural changes that progressed to abnormal movements and coma. Evaluation revealed anti-NMDA antibodies and a teratoma in the ovary. She underwent tumor removal and immunotherapy, with subsequent recovery. The case highlights the need for awareness among the patients and gynaecologists of this unique entity.

Pigmentation on hysteroscopy is a rare finding. The authors describe a case where hysteroscopy revealed hemosiderin pigmentation on fundal endometrium. Hemosiderin pigmentation is a marker of a number of uterine afflictions including Adenomyosis and endometritis among others.

Intractable seizures during pregnancy necessitate an extensive workup to ascertain the cause for convulsions. We report a case of idiopathic intractable seizures in pregnancy and discuss the challenges faced in her management. A 27-year-old normotensive G2P1L1 presented at 29 weeks with intractable seizures. No definite cause was found despite a detailed work-up. She was started on anticonvulsants, doses were escalated, and stepped up to four anticonvulsants with no response. A diagnosis of atypical eclampsia was made. She was started on magnesium sulphate and labour was induced. Even after delivery, she continued to have 3- 4 episodes of convulsions per day postnatally. She finally responded to pulse therapy of methylprednisolone after continuing to have seizures daily for 21 days. Such a presentation of intractable seizures unresponsive to four antiepileptics and of unknown etiology that finally responded to high dose steroid therapy has not been reported in the literature.

Vulvar hematoma during pregnancy is a rare event. Usually they develop due to trauma post delivery. Rarely such hematomas appear spontaneously intrapartum without any underlying cause. A 25 year old primigravida at 34 weeks with twin pregnancy was found to have developed spontaneously a vulvar hematoma intrapartum. Prompt recognition and timely drainage of the hematoma prevented any untoward complication and led to quick recovery.

We report a case of a 25-year-old female who presented with primary infertility with AMH value of 9 ng/ml, and ultrasound image suggesting the possibility of three ovaries seen in two different planes and no polycystic pattern in any ovary. Diagnostic laparoscopy performed in this patient revealed two ovaries on the left side, placed in normal anatomical position. Both having their individual ovarian ligaments connecting both the ovaries separately with the cornual end of the uterus on the left side. However, only the lateral one of the two ovaries on the left was attached to the lateral pelvic wall with infundibulopelvic ligament. The adnexa on the right side was normal. Biopsy confirmed this accessory tissue as an ovary. The “third ovary” in our case is a functional ovary. This explains the rise of AMH value. The ovary responded to ovulation induction, and follicles were retrieved thereafter which later showed fertilization. Hence, confirming their functionality. The occurrence of third ovary has been established in the literature. However, none of the definitions supports our finding, that is, the presence of third functional ovary attached with ovarian ligament and no infundibulopelvic ligament. Hence, we name this unique occurrence as “Superfluous Ovary”.

Fraser syndrome is a rare disorder with autosomal recessive inheritance having a wide spectrum of phenotypic appearances. A fourteen-year-old female presented to us with a chief complaint of acute retention of urine without any cyclical abdominal pain with syndromic appearance. She had partial vaginal agenesis which was treated by successful reconstructive surgery by lotus petal flap technique followed by recanalisation. Objective of this report is to highlight the rare disease of Fraser syndrome along with successful rare surgical management.

Background Nearly 90% of all the hormone-producing ovarian tumours are sex cord-stromal tumours (SCSTs). The Ovarian fibroma is a hormonally inactive variant of SCST. It is composed of spindle, oval, round cells producing collagen and accounts for approximately 4% of all ovarian neoplasms. Amongst the other SCSTs, Inhibin B is an important tumour marker. It is a heterodimeric glycoprotein hormone that is secreted primarily by the granulosa cells of the developing follicles. High levels of Inhibin-B can hamper follicular recruitment, leading to amenorrhea in a reproductive age woman.

Finding In this case report, we describe a rare case of a reproductive age female presenting with secondary amenorrhea, having an Ovarian Fibroma, producing massive amounts of Inhibin B. .

Significance Although some pathological variants of ovarian fibromas like cyst-adeno-fibroma and ovarian fibro-thecoma are known to secrete inhibin B, benign /pure ovarian fibromas rarely do so.