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Dear Friends,
Greetings from Organizing Committee of Happy Gynecon 2021!
It is our great pleasure to invite you to the second part of 17th State Conference of Association of Obstetrics and Gynaecology of Chhattisgarh, 18th Septemeber 2021.
The Late Prof. Dr. Shobha Sharma Gold Medals for best paper and poster will be presented live online during the second half of this conference.
We invite papers and posters on the theme of the conference which will be judged by national judges online. Please visit this page to submit abstracts.
So gear up for an academic extravaganza. Update yourself, get ICOG credit points, and increase your eligibility for ICOG Fellowship by presenting papers and posters. Here is to being a Happy Gynecologist!
Welcome All!
Thanks & Regards
| Dr. Asha Jain | Dr. Tabassum Dalla |
| President Raipur Obstetrics and Gynecology Society | Secretary Raipur Obstetrics and Gynecology Society |
Background
Pregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.
Methods
This prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.
Results
Prevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.
Conclusion
Prevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.
BACKGROUND: Pelvic masses following hysterectomy are common findings in gynecological oncology centers. Incomplete preoperative evaluation, inadequate surgery (subtotal hysterectomy/only hysterectomy without salpingo-oophorectomy in postmenopausal women), and delay in histopathological diagnosis are few reasons for missing out on malignant etiologies. The diagnostic dilemma exists because of unknown primary malignancy. This study aims to highlight the various pathologies that present as pelvic masses after hysterectomy and their management based on histopathological examination and immuno-histochemical (IHC) markers.
MATERIALS AND METHODS: This was a retrospective analysis of all women who presented in 1 year duration to the gynecologic oncology department with a history of hysterectomy done outside for with pelvic mass. The data of these women were critically analyzed in regard to their demographic profile, preoperative and postoperative characteristics, histopathological and IHC markers of pelvic mass, management of the disease, and their outcome.
RESULTS: The total number of patients eligible for the study was 17. The median time to presentation after hysterectomy was 5 years (range: 1–20 years). The origin was female genital tract in 16 women and urothelial in 1 patient. Management options of these patients were concurrent chemoradiation/palliative radiotherapy/palliative chemotherapy/palliative care. The overall survival of these patients was dismal.
CONCLUSION: Before proceeding with hysterectomy, thorough evaluation should be done for all patients with even minimal symptoms. Early identification of malignant disease and management by a multidisciplinary team can greatly affect the overall prognosis of the patient
ABSTRACT
TITLE OF THE THESIS- SERUM AND SALIVARY URIC ACID LEVEL ESTIMATION AND ITS CORRELATION IN PREECLAMPSIA
BY-DR.SANGEETA PRADHAN
GUIDE-DR. PUSPAWATI THAKUR
The study was conducted in department of obstetrics and gynaecology,AIIMS RAIPUR from JUNE 2020 TO APRIL 2021.100 Antenatal women attending Obstetrics and Gynecology Antenatal OPD or admitted in Antenatal ward from 20-40 weeks of gestation fulfilling inclusion criteria (Inclusion criteria-Diagnostic Criteria for preeclampsia and severe preeclampsia As per Hypertension in pregnancy: diagnosis and management Nice guideline June 2019) and exclusion criteria were taken for study and divided into 2 groups.
Group I – It includes 50 Pregnant patients between 20 weeks – 4Oweeks of gestation diagnosed cases as preeclamps attending the Obstetrics and Gynaecology Outpatient department or admitted in Ante natal ward AIIMS, Raipur fulfilling inclusion and exclusion criteria.
GroupII –It includes 50 pregnant women between 20-40 weeks of gestation with normotensive pregnancy attending Obstetrics and Gynecology Antenatal OPD or admitted in Antenatal ward fulfilling inclusion and exclusion criteria.
The salivary sample and serum was sent to biochemistry labrotory and the findings were noted. There was linear correlation found between the salivary sample and serum uric sample values thus coming to the conclusion that elevated level of salivary uric acid precede the onset of preeclampsia, pregnancy-induced hypertension. uric acid may prove to be early biomarker of hypertensive complications of pregnancy .Serum uric acid can be used where routinely renal function tests cannot be done in low resource countries and developing countries like India.
Abstract
Objective: To study the correlation of point of care clotting test (POCCT) of whole blood with lab fibrinogen level in women having primary major postpartum haemorrhage (PPH) to generate evidence regarding its potential in rationalizing transfusion of blood components for supplementing fibrinogen.
Methods: Total 68 cases included 40 primary major PPH, 20 without PPH and 8 samples of FFP. POCCT was performed in PPH and non PPH group and at the same time a sample for lab fibrinogen was sent. The values were correlated using Pearson’s correlation coefficient (r). Depending upon the lab fibrinogen values, POCCT in PPH group was divided into 3 subgroups of <7, 7-11 and >11 minutes as subgroup 1,2 and 3 respectively.
Results: women of PPH group (n=40) had a mean fibrinogen level of 346.15± 143.37 mg% with a significant negative correlation with POCCT (r = - 0.69, p <.00001). Mean fibrinogen level of non PPH group and FFP samples was 602.1±169.72 and 286.75 ± 103.42 mg% respectively. PPH subgroups 1,2 and 3 had mean fibrinogen of 452.2±141.8, 332.58±138.51 and 158.71±145 mg% respectively. These values may potentially guide FFP transfusions.
Conclusion: POCCT is easy, costs nothing and has potential role in rationalizing FFP transfusion in Low to middle income countries.
To compare the effect of oral mifepristone with misoprostol and misoprostol alone in cervical ripening and labor in mid trimester abortion.this was randomised control analysis and prospective study in dheeraj hospital in 2019 which included 160 anc cases with gestational age > 12 weeks and <20 weeks with specific indications for abortion out of which 80 were induced with vaginal misoprostol and oral mifepristone and 80 alone with vaginal misoprostol.patients with combination therapy delivered early with lesser induction-abortion time however. side effects were same as with vaginal misoprostol alone.
TITLE:
Maternal Morbidity in Grade Three Abruptio Placenta in a Tertiary Care Centre
ABSTRACT:
Objective: To understand the impact of grade three abruptio placenta on maternal health and propose various methods to minimise it.
Methods: This is a retrospective observational study conducted in the department of obstetrics and gynaecology in KAMSRC, Hyderabad, Telangana, over a period of three years from 2017 to 2019. The main outcomes measured were risk factors, complications and outcome.
Results: The incidence of abruptio placenta in our centre is 0.7%. The total number of cases of grade 3 abruption were 18, out of which 14 patients had gestational hypertension or pre-eclampsia, 1 had eclampsia, 1 had trauma, 1 multiple pregnancy, and 1 polyhydramnios. 13 had intrauterine death, 2 were stillborn and one neonatal death, 2 live births admitted to NICU. The complication rate is 88% in these patients. The most common complications are postpartum anemia, postpartum hemorrhage, acute kidney injury, puerperal pyrexia, thrombocytopenia, and coagulopathy respectively.
Conclusion: Grade 3 abruption is associated with high perinatal mortality and maternal morbidity, so early diagnosis and active management to prevent complications is needed. Also prevention of anemia and early detection of gestational hypertension and pre eclampsia can reduce maternal morbidity and fetal death in utero.
• Background: Abortion service as medical health care facility is the essential service a women needs. Despite well-developed medical service centers in our country and the legalization of abortion, the incidence of illegal and unsafe abortion has not come down. It still contributes around 10% of maternal mortality. This study was carried out to analyse the complications following self-medication of abortion pills and to suggest measures to prevent such practice.
• Methods: This was a prospective observational study conducted in 125 women who came with history of self intake of abortion pills and presented to our hospital from January 2020 to December 2020.
• Results: In present study Majority of subjects who took self abortion pills were between 21-25 years (36%). And most of them had completed their higher secondary education 61.6 Nearly half of study subject (49.6%) who present to obstetrics and gynecology department with history of 2-3 months of amennorhea. Incomplete abortion was present in 62 (49.6%) of patients. Instrumental evacuation was required in 30 (24%) patients. 23 (18.4%) patients were severely anaemic. Transfusion of blood was required in 38 (30.4%) of patients.
• Conclusions: Medical abortion is effective and safe when carried out under medical supervision. Unsupervised use of medical abortion pills was associated with many complications like incomplete abortion, severe anaemia ,rupture ectopic and ruptured uterus. So, over the counter sale of medical abortion pill should be restricted.
• Keywords: Abortion pills, Medical abortion, Self-medication
BACKGROUND:
Acute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Pregnancy often results in a delay in diagnosis because the early symptoms are non-specific. Nonspecific symptoms such as fatigue, weakness, dyspnoea, and pallor and certain laboratory abnormalities are easily attributed to the physiological changes occurring during pregnancy such as anaemia of pregnancy, leucocytosis, or gestational thrombocytopenia. Recurrent infections and bleeding can reflect bone marrow failure.
CASE:
A 31yr old multigravida, was referred to our institute with ?coagulopathy with HELLP syndrome APH? Abruption at 38 weeks Gestational age (by dates). She presented with complaints of pedal oedema, ecchymosis all over body and decreased urine output since 10 days, following which she had urinary tract infection for which she was treated. She later presented with complaint of bleeding per vagina. On evaluation, her coagulation profile was deranged, raised serum LDH, low platelet count, peripheral smear showing more than 70% blast like cells and was having proteinuria. She was transfused with blood products following which she was found to be in labour and has delivered a term female baby by VBAC. Mother had PPH after delivery, which was managed with massive transfusion protocol and bleeding was controlled. But, she has collapsed suddenly nearly 4 hours after delivery preceding a spike in her blood pressure. She also had hematuria and gum bleeding. All resuscitative measures tried but the patient succumbed to death.
CONCLUSION:
This is probably a case of acute AML type 3, based on her peripheral blood smear showing evidence of anaemia, thrombocytopenia and more than 70% blast like cells, presenting like HELLP syndrome. Death in this case is due to intracranial haemorrhage caused by DIC in leukemia. Early diagnosis and appropriate intervention could have prevented such circumstances.
Deficiency of Vitamin D or 25(OH) cholecalciferol, is severe health problem all over the world. Vitamin D is important for calcium and bone metabolism and also protect against various autoimmune disorders, cardiovascular diseases, chronic infections, cancers and even infertility. It also plays important role in pregnacy. During pregnancy, fetus acquire their vitamin D from their mother and also for first few months of life after delivery, particularly in breast fed infants. Deficiency of Vitamin D in infants can lead to rickets, respiratory infections, allergic diseases, heart failure. Aims and objective: To investigate the prevalence of vitamin D deficiency in postpartum period and to study its relation with the sociodemographic characteristics of the patients. Material And Methods: It wa cross sectional observational study conducted over a period of one year. Sociodemographic characters and serum concentrations of vitamin D in form of 25(OH)D were compared. Results: Total 550 patients were enrolled. Mean age of patients were 26.5 years, around 58% patients were from periurban area, maximum patients were primiparous. Around 90% patients did not have any sun exposure on regular basis. Around 59% enrolled patients were either unbooked or had only one antenatal visit. The mean plasma concentrations of 25(OH)D in postpartum patients was 27.6ng/mL. No association was found between sociodemographic factors studied and vitamin D concentration. Conclusion: This study showed the higher prevalence of deficiency of vitamin D in postpartum patients of India despite having abundant sunlight and identifies the need of supplementation of vitamin D in pregnancy and postpartum and this supplementation has to be followed routinely in hospital in obstetric management protocol
INTRODUCTION: Placenta accreta refers to the range of pathologic adherence of the placenta and it includes- placenta increta, percreta, and accreta. The most favoured hypothesis is a defect in the endo-myometrial interface leading to a failure of normal decidualisation in the area of the uterine scar. It is a life threatening condition with significantly high maternal morbidity and mortality. The risk factors are history of accreta in a previous pregnancy, previous caesarean delivery and other uterine surgery, repeated endometrial curettage. This risk rises as the number of prior caesarean sections increases. It is associated with substantial morbidity, with the majority of women requiring blood transfusion, unanticipated surgery, and admission to the ICU.
MATERIALS &. METHODS: Retrospective observational study conducted over a period of 2 years in IMS & SUM Hospital, Bhubaneswar.
I hereby present a case series of 9 women with morbidly adherent placenta with comparison of their risk factors, clinical outcome.
Background: Thyroid disorders are one of the leading causes of abnormal uterine bleeding in women of all age groups and in India its prevalence in women is about 26%. Sequelae of thyroid disorders may vary from infrequent menstrual cycle, light menstrual bleeding to even a very severe life threatening heavy menstrual bleeding leading to anemia & shock. It occurs due to anovulation, endometrial hyperplasia and coagulation defects. Thyroid screening is important while investigating all cases of AUB.
Case: A 18year old girl was brought to Dr. BRAM hospital with very severe anemia (Hb: 1.1gm/dl) and grade IV hemorrhagic shock (BP 50/30mm of Hg) but surprisingly pulse rate was normal (80bpm). Her peripheries were cold and clammy. SpO2 -80% on room air, she had facial puffiness and grade III pitting edema over her hands and feet. Her TSH was very high >100µIU/ml and decreased (T4 - 0.678µg/dl, T3 - 0.359 µg/ml) suggestive of severe primary Hypothyroidism. USG was suggestive of bulky uterus with 14 mm endometrial thickness. Her shock was managed and tablet Norethisterone, Tranexamic acid, Levothyroxine and Iron supplements started.
Conclusion: Severe hypothyroidism can cause life threatening uterine bleeding. This case is of peculiar interest because of profound hypothyroidism associated with hemorrhagic shock. Early recognition and proper management is important to prevent hazardous complications.
Keynotes: AUB, HMB, Hypothyroidism, Shock
• Background: Nausea and vomiting is a common entity of pregnancy. 7 out of 10 women experience some level of NVP. Gastric cancer with pregnancy in one of a rarest cause of NVP complicating 0.026-0.1% of all pregnancy worldwide.
• Case: A 25 years primigravida presented to Dr.BRAM hospital with severe IUGR and severe vomiting, tolerating liquid diet only. She was thin built, brittle discolored rough hairs with cracked lips and angular cheilosis. She had tachycardia but BP was normal. All her routine investigations were within normal range except mildly elevated liver enzymes. She was investigated for her persistent vomiting with consultation from physician and surgeon. USG whole abdomen to rule out other causes of vomiting showed thickening of stomach wall. MRI – asymmetrical circumferential thickening of antropyloric region of stomach. Endoscopic biopsy-showed diffuse infiltrative adenocarcinoma (signet ring cell). Her nutritional deficiency was managed. She had preterm vaginal delivery; baby was handed over after 35days of birth. She received neoadjuvant chemotherapy followed by surgery and radiotherapy tolerating semisolid food well.
• Conclusion: Severe, persistent and nonresponsive NVP associated with weight loss should be investigated vigilantly and thoroughly. Apart from other causes one of rarest cause i.e., gastric carcinoma should not be missed. Diagnosis in early stage and management can have better prognosis and prolong the life expectancy.
• Keynotes: NVP, gastric carcinoma in pregnancy, Severe IUGR….
introducion: women with GDM are expected to have increased risk for development of gestational hypertension and pre eclampsia. GDM is associated with increased risk of maternal and fetal complications.
Aims and objectives: to study maternal and fetal outcome in patients with GDM.
Material and Methods: a retrospective cohort study was carried out in SMGS Hospital. A total of 278 patients were included in the study, 139 with GDM and 139 without GDM. Maternal and neonatal complications were studied.
Results: the women with GDM had higher BMI. 18% of the women had BOH, 31% had associated hypertension. 56% women with GDM had vaginal delivery as compared to 77% in women without GDM. Shoulder dystocia was reported in 2% women in GDM group, while no case was reported in another group. 18% of the neonate born to mother with GDM required NICU admission and 4 fetal deaths were reported, while no fetal death was reported in another group.
conclusion: Early screening for gestational diabetes mellitus especially in high risk patients should be done for a better maternal and neonatal outcome. Pregnant women with GDM should deliver at health facilities to properly manage any complications if occurs during delivery.
Abstract:
Objectives: The aims of the study were to generate information regarding causes and complications leading to maternal deaths in an urban tertiary care centre and to find if any of the causes are preventable. Material and Methods: The medical records of all maternal deaths occurring over a period of 4 years between January 2015 and December 2018 were reviewed. Results: Maternal Mortality Ratio ranged between 127 and 48 per 1, 00,000 births in the study. The causes of deaths were haemorrhage (29.47%), PIH (28.42%), anaemia (12.63%), sepsis (9.47%), thromboembolism (6.31%), hepatic causes (5.26%), blood reactions (3.15%), heart diseases (2.10%), CNS related (1.05%) and others (2.10%). Maximum deaths occurred in women between 21-30 years of age. Mortality was highest in post-natal mothers (70.52%). Conclusion: Overall maternal mortality due to direct obstetric causes was (73.68%), indirect obstetric causes (22.10%) and unrelated causes (4.2%).
Keywords: maternal mortality, direct obsteric death, indirect obstetric death, unrelated deaths.
Abstract:
Aim: Informed consent is an ethical and legal requirement and is practiced before all the surgical procedures. It consists of availing information to the patient in an understandable manner without coercion to allow the patient to make an informed decision about their healthcare. So, this study was aimed to assess the adequacy of informed consent in patients who underwent caesarean section at SMGS Hospital, Government Medical College, Jammu. Material and Methods: A cross-sectional study was done. The study population was the group of patients who underwent emergency or elective caesarean section at GMC, Jammu. A total of 230 patients were included in the study based on inclusion and exclusion criteria. The data were expressed as percentage of proportion. Results: 230 patients participated in the study. About 73.04% patients were in the age group of 21-30 years, only about 20.86% patients were above 30years of age. About 30.43% were educated upto middle standard and 23.04% patients were educated upto 12th standard. Majority of the patients (64.78%) belonged to rural areas and 35.21% belonged to urban areas. About 79.13% patients underwent emergency LSCS while 20.80% patients underwent elective caesarean section. About 96.95% patients knew the name of the procedure. 91.73% patients were informed about the indication of the surgery. 95.21% of the patients were aware about the benefits of surgery and about 93.41% of the patients were knowing risks of surgery. About 83.04% patients were informed about the procedure of the surgery. pregnancy options. Conclusion: The majority of the caesarean sections were performed due to some emergency indications. It was found that majority of the patients were well informed about the procedure and the related consequences.
My patient is Mrs.Bhamma bai,35yr/Female,residing at hinodiya nagar,Vidisha,belong to lower socioeconomic status
•Referred for continuous bleeding p/v from 4wks to PCMS, post abortion bleeding in spite of curettage.No histology of curetting,No h/o passing clots,breathlessness,tremors,excess of vomiting,Pregnancy test positive after admission
Family history/Personal history -Nil
Obs History–Married life-11 yrs,Non consanguisous marriage,second gravida,ABORTION 2
1-Spontaneous abortion at 2months with h/o suction evacuation done.5 yrs back,Male partner-oilgospermia
2-Present pregnancy-8 wks pregnancy,According to Record–IUI done with donor insemination,Check curettage were done twice at interval of 2wks for incomplete abortion confirmed by USG
On examination
Patient-sick,NoPallor,Afebrile,No goitre,
exophthalmoses,tremors
P/S examination-Blood stained discharge+
P/V examination-Uterus 6-8 weeks soft,fornices clear,cervical motion tenderness absent
Patient was investigated and check curettage was done
Under USG guidance all products were badly adherent and removed with curette
No bleeding in post operative period,After 1wk HPE of products was s/O choriocarcinoma-Atypical Syncytiotrophoblast and Cytotrophoblast,Extensive necrosis and hemorrherage,No chorionic villis
INVESTIGATIONS
HCG titer-51000 mIU/ml
CBC-Hb-11.3gm/dl,Wbc-5600,Plt-396
Blood grop-B POSITIVE
USG Pelvis-Large echogenic content 4 x 3.1 cm in cavity at fundus region with internal vascularity i/v/o ,H/o Dilation and Curettage is suggestive of retained product of conception
S.TSH-2μg
LFT-Bilirubin-0.24-0.17-0.41
S.ALP-64,SGOT/SGPT-32-23U/L
KFT-Blood Urea 24mg/dl
S.Creatinine-.081mg/dl
CT Scan-brain-No intracranial SOL
No focal vasogennic edema
No abnormal meningeal enhancement
CT Scan-chest abdomen and pelvis-Bulky uterus with large hetrogenously enhancing mass lesion 3.1X4cm in right side uterine myometrium with preserved parametrial flat planes – malignant neoplastic mass,It appears inseparable from endometrial cavity
Small hypodense nodular lesion in posterior segment of right upper lobe of lung –metastasis?
FINAL DIAGNOSIS CHORIOCARCINOMA WITH RETAINED TUMOUR MASS /PRODUCTS IN CAVITY? WITH SECONDARIES IN LUNGS(No live issue )
FOLLOW UP
Patient is on EMACO REGIMEN IS GIVEN FOR 2 WKS,Follow up for PERSISTENT GTN AND PERSISTENT BLEEDING
ABSTRACT:
BACKGROUND: Cardiac disease in pregnancy is considered to be an important cause of maternal morbidity and mortality. Cardiac disease complicates 1-3% of all pregnancies and considered leading cause of indirect maternal deaths. Cardiac disease in pregnancy is considered to be high risk and management of it in pregnancy is challenging.
AIM: To evaluate fetomaternal outcome in cardiac disease complicating pregnancy.
OBJECTIVES: To evaluate the fetal and maternal outcome in pregnancy with cardiac disease. To measure the prevalence of cardiac disease in pregnancy
MATERIALS & METHODS: A retrospective observational study of all women who delivered at a tertiary care Centre from 2002 to 2018 with heart disease complicating pregnancy were included in the study. Their details were collected from the case record and registers, their prevalence and outcomes were studied.
RESULTS: The prevalence of cardiac disease was found to be 0.66%. Most common heart disease in pregnancy was found to acquired heart disease (72%). Among them most common heart disease was found to be mitral stenosis (35%).Various fetal outcome, maternal complications were studied.
CONCLUSION: Cardiac disease is a high risk pregnancy and has major effect on morbidity and mortality in pregnancy. Hence adequate antenatal monitoring, involvement of multidisciplinary team and delivery in a tertiary care setup with ICU and Cardiac care facilities may improve the fetal and maternal outcomes in cardiac disease complicating pregnancy.
Background : Post COVID vaccination complications are new speculated health problems and its effects on reproductive system and on menstrual cycles are yet to be studied .
Changes in menstrual cycle has been speculated due to increased stress , changes in weight and sedentary lifestyle during COVID 19 pandemic and COVID 19 vaccination
Objective-
To observe and estimate alteration in various menstrual patterns in female medical and nursing students of PCMS & RC who have received COVID 19 vaccination .
Methodology
-An observational cross sectional study on medical and nursing student of PCMS & RC
-Through predesigned questionnaire students were assessed for the status of their vaccination and its effects on menstrual cycle.
Result :
After detailed questionnaire evaluation , it was observed that out of 243 participants approximately 40 % belongs to 21- 25 year of age ,most of them (90 % ) were vaccinated with COVISHIELD vaccine , and remaining with COVACCINE vaccine , 75 % had received 2 doses of vaccine , approximately 82 % of them had reaction after vaccination and 20 % of participants also suffered with COVID 19 infection , final observation was that 12.3 % had alteration in amount of menstrual flow per day , 12 % had changes in duration of menstrual cycle and 14 % had changes in frequency of menstrual cycle after covid 19 vaccination .
Conclusion :
Through the studied we have observed that significant number of students (approx. – 12 to 14 % ) had alteration in menstrual cycle after COVID 19 vaccination , however the study is limited due to small number of participants , so further prospective study need to be conducted at broader level .
EFFECT OF NUCHAL CORD
ENTANGLEMENT AT TERM ON
FETOMATERNAL OUTCOME
• Presented by-Dr. Mrigya Jain, Guided by-Dr. Jyoti
Jaiswal ,Dr. Abha Daharwal, Dr. Anand Jaiswal
• BACKGROUND- An entangled cord around neck
may prevent progression of fetal head towards
outlet, may be associated with non reassuring
heart rate pattern thus contributing to many
obstetrics and pediatrics complications.
• METHOD-women with term pregnancy who has
nuchal cord in fetus presenting for delivery to
obstetrics and gynaecology department of Dr.
CONCLUSION- Nuchal cord is a common finding and
in most cases there is no association between
mode of delivery and neonatal outcome, but type
of loop, number of loop can affect outcome and
in this condition cesarian section can improve
outcome.
KEY WORDS- nuchal cord, mode of delivery, APGAR score
Background –
PCOS is a complex condition with reproductive, endocrine and metabolic characteristics. For its diagnosis, Rotterdam Criteria is used : 2 of 3 criteria should be present-
• Oligomenorrhea/ Amenorrhea
• Biochemical or clinical signs of hyperandrogenism
• Polycystic ovaries with >20 follicles in ovary or ovarian volume >10cc
**Irisin** is a newly discovered peptide hormone , a cleavage product of fibronectin type III domain 5 (FNDC5) , which consists of 212 amino acid residues. During exercise, irisin is secreted by skeletal muscle where it converts white adipose tissue to brown adipose tissue and produces thermogenesis.
Aims & objectives-
- To determine Serum Irisin levels in cases with PCOS and healthy controls
-To compare Serum Irisin levels in cases with PCOS and healthy controls
Setting: Dr BRAMH, Raipur , OPD patients
Method- Total 90 patients, out of this 30 Obese PCOS patients, 30 non-obese PCOS patients and 30 healthy controls. Participants 2ml fasting blood sample was taken for estimation of Irisin ,by commercially available ELISA kit . Anthropometric measurements taken and hormonal profile also evaluated.
Results- In our study Polycystic ovary syndrome women showed different body compositions compared with controls(non- PCOS). Serum irisin level of PCOS did not show significant difference compared with controls.Irisin maybe raised in obese PCOS patients as compared to non obese PCOS.
AIM- Is there any association of mean follicular diameter at the time of ovulation trigger with conception rate after Intrauterine Insemination?
METHODOLOGY- This was a prospective observational study conducted in department of Obstetrics and Gynaecology, AIIMS, Raipur from October 2019 to March 2021. All women who were planned for IUI after Ovulation Induction (with Clomiphene Citrate or Letrozole) and those who fulfilled the inclusion and exclusion criteria were enrolled for the study. Partner with TMSC >5 million was included. The first cycle that was conducted was selected for the study. All patients were followed up from day 2 of cycle. As per the standard protocol of IUI, Ovulation induction (with Clomiphene Citrate or Letrozole), serial follicular monitoring were done. Later, ovulation trigger was given. The Mean Follicular Diameter (MFD) at the time of ovulation trigger was noted and participants were divided into 4 groups:
Group A: MFD ≤ 18 mm
Group B: MFD 18- 20 mm
Group C: MFD 20-22 mm
Group D: MFD >22 mm
IUI was performed after 36 hours of hCG injection. Luteal phase support for next 14 days were given from the day of IUI. Urine Pregnancy Test (UPT) was advised after missed periods and result were noted.
OBSERVATION- Of the 73 undergone IUI, 9 (12.3%) became pregnant successfully. The average of MFD among the study subjects who conceived after IUI was 19.43. Maximum conception was observed in group with MFD 18.1-20 mm (17.1%) followed by MFD 20.1-22 mm (15%), whereas all the IUI recipients in < 18 mm and >22 mm groups did not conceive.
CONCLUSION- There may be an inverted U-shaped relationship between the MFD among the outcomes of IUI. However, the optimal MFD can be recommended between 18-22 mm for ovulation trigger with hCG for successful pregnancy outcome.
INTRODUCTION: Subcorneal pustular dermatosis (SCPD) also known as SNEDDON-WILKINSON DISEASE, is a rare, chronic, relapsing, sterile pustular eruption of unknown etiology . SCPD is more common in females than in males (4:1). SCPD is benign, chronic disorders for which primary concerns are minimizing morbidity, improving quality of life and ruling out presence of associated internal disease. SCPD during pregnancy only few cases has reported .Herein, We report a Case of SPD that developed during pregnancy.
CASE REPORT: a 29 year 2nd gravida presented at 37 weeks of gestation with previous LSCS scar and mild lower abdominal pain and history of Skin lesion 1 month back. She was had similar complain a year back. Physical and Obstetrical examination revealed no other abnormal findings. Patient taken for LSCS,On third day post caesarean she again developed similar type of skin lesion . Starting from the abdomen, involved whole of the trunk in same day. Lesions were small multiple flaccid pustular which were initially vesicular, slight redness around it, associated with itching. Culture report from lesion shows no growth and HPE -neutrophilic infiltration beneath Subcorneal layer confirms diagnosis of SCPD. Case was discussed with Dermatologist, Patient was prescribed Tab Prednisolone 40 mg OD , tab Levocitrizine 10mg HS, Beclomethasone lotion for LA. She recovered and was discharged on 9th day. No relapses were noted in 2months.
CONCLUSION: Subcorneal pustular dermatosis should be differentiated from wide spectrum of disease that progress with pustular eruption, such as bacterial folliculitis , acne, localized pustular contact dermatitis, impetigo, pemphigus foliaceus, SSSS, and generalized pustular psoriasis .HPE is very important to make definitive diagnosis of SCPD to avoid maternal mortality because of secondary infection to pustules which leads to Septicimia and may lead to maternal mortality.
Background: Abnormal uterine bleeding (AUB) is defined as any bleeding pattern that differs in the regularity, frequency, duration and amount from a pattern observed during a normal menstrual cycle or menopause. Menstrual disorders pose a huge burden on gynecology OPD, accounting for approximately 10%- 30% of attendance. The thyroid gland plays an important role in the growth, development, metabolism and function of every organ in the body. Thyroid dysfunction is a cause of nonstructural AUB. Thyroid is closely linked with the process of ovarian maturation and endometrial hyperplasia. Females with thyroid gland abnormality have chances of reproductive abnormalities ranging from abnormal sexual development, menstrual irregularities, infertility and premature menopause.
Methods: This is an observational cross-sectional study performed at Pt J. N. M. Medical College and Dr. B.R.A.M. Hospital Raipur (C.G.) between 1st January 2020 to 31st December 2020. A total of 100 cases were included in the study.
Results: In the present study among 100 women, majority belongs to the age group more than 39 years (46%). 56% belong to class III socioeconomic status. 41% of women were multiparous. 22 cases of AUB were hypothyroid, 7 cases were hyperthyroid. The commonest pattern of bleeding was heavy menstrual bleeding (52%) followed by frequent menstrual bleeding( 20%). Among others 15% belong to infrequent menstrual bleeding, 9% belong to light menstrual bleeding and 4% have amenorrhea. Structural abnormality like leiomyoma of uterus seen in 37 out of 100 cases, 17 cases have adenomyosis, and 14 cases have ovulatory dysfunction which is a non-structural abnormality.
Conclusion: The study concludes that as there is a high incidence of thyroid disease in our area so thyroid profile study must be carried out in all cases of AUB. It reduces the need of unnecessary hormonal treatment and hysterectomy.
Keywords: Abnormal uterine bleeding, hypothyroid, hyperthyroid.
Category – Reproductive Medicine
A study on the impact of presence of Smooth endoplasmic reticulum aggregates (SERa) in oocyte on fertilisation rate after ICSI
Dr.Lakshmi Sujani CH, Dr. Sheila Balakrishnan
Background and Objective: The aim of stimulation during IVF/ICSI is multifollicular development. The response is assessed by the number of M2 oocytes. These Me oocytes can develop SERaggregates in them. The mechanism of occurrence and its impact is poorly understood.Present study is to know the impact of presence of SERa on fertilisation of sibling oocytes during ICSI
Materials and methods: A retrospective study conducted at a tertiary level infertility centre from January 2019 to March 2020. The SERa-positive cycles had at least one SERa oocyte in the oocyte cohort. The SERa-negative cycles had morphologically unaffected oocytes. A total of 151 SERa-positive and 30 SERa-negative cycles were analysed from 180 women. Stimulation data, embryological, clinical and neonatal data was collected.
Results: The incidence of SERa oocytes is 3.06% (n=52) out of total 1695 M2 oocytes from 181 cycles. There was no statistical difference for age, Body Mass Index, days of stimulation and ovarian reserve in terms of antral follicle count in between the two groups. There was no difference in fertilisation rate (p=0.74) in between the two groups. On follow up, no difference was observed in clinical pregnancy rate(p=0.19) . Howvere the live birth rate is 39.2% and 33% in SERa positive and negative groups respectively(p=0.05)
Conclusion: Clinical as well as stimulation parameters, embryological outcome were similar in both groups. The presence of SERa could affect the reproductive outcome in terms of livebirth rates in the sibling oocytes.
INTRODUCTION:Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries.WHO defines anemi in pregnancy as haemoglobin level below 11gm/dl.
OBJECTIVE:To analyze the maternal and neonatal outcome in anemia.
METHOD:This is a retrospective study conducted in the department of obstetrics and gynecology,GMC Hospital, Jammu over a period of one year. Pregnant women with Hb level below 11gm/dl in the third trimester were categorized anemic and those with Hb level above 11gm/dl as non anemic.280 patients wrre taken in each group. Data was reviewed and statistically analyzed.
RESULTS:Adverse maternal outcomes were compared between the two groups. In anemic group gestational hypertension (38.57%),APH(22.14%),PPH(35%),Blood transfusion (45%) were significantly more common as compared to non anemic group. Adverse neonatal outcomes such as low birth weight (40%),preterm labour (32%) and IUD(15.4%) were associated more with anemia.
CONCLUSION:It is important to identify women at risk and ensure that sufficient and timely care is provided at each level by health care providers. Routine screening and general awareness programs at community levels.
BACKGROUND: Sickle cell disease (SCD) refers to any of syndromes in which the sickle mutation is co-inherited with a mutation at the other beta globin allele that reduces or abolishes normal beta globin production.The major features are hemolytic anemia,vaso-occlusion, which can lead to acute and chronic pain and tissue ischemia or infarction.These pregnancies are at increased risk of obstetrical and fetal complications,medical complications of SCD are due,to metabolic demands, hypercoagulable state, and vascular stasis associated with pregnancy.
CASE REPORT:22Y old G2A1(MTP) with history of multiple blood transfusions (12-15) since the age of 12,on hydroxyurea pre-pregnancy,admitted in view of severe anaemia (Hb-5.7) with DCDA twin.Conception was spontaneous with 6 units blood transfusions in first trimester.7 units transfusion were done,but haemoglobin was declining.Extensive workup was done involving multidisciplinary team. She had fever episode . Dengue IgM+.4 UNITS of FFP transfusion due to deranged INR(6.9)..She was ANA+,DCT +,HPLC of SCD with Beta Thal trait.On USG ,hepatosplenomegaly with hemangioma and gammagandy body in spleen.Immune antibody profile showed minor blood group antibody.Ecosprin,Enoxaparin,vitcofol and methylprednisolone pulse therapy with antibiotic coverage and blood transfusion was done after complete crossmatch testing minor blood groups. Connective tissue disorder,APLA profile investigations negative. Her haemoglobin was stabilised (hb6-7).Readmitted at 28 weeks with joint pain.Haemoglobin 3.6 and pulmonary oedema, severe hypertension Dexamethasone,2 units of blood transfusion and 9 units of IVIG transfusion were done along with MgSo4.LSCS was done(30W) with 1 unit of intraop blood transfusion,Hypertension managed with medications and live male and female of 1.235 kg and 1.15 kg were born.Babies are stable in NICU.The patient is stable with post-op haemoglobin of 7.6g/dl and is on hydroxyurea.
CONCLUSION: Early identification of SCD women with twin pregnancy with vigilant surveillance, well-defined care plan and extensive collaboration with multidisciplinary team highlights the advantage of improved clinical outcomes in complicated cases.
Endometriosis is a disease of adolescents and reproductive-aged women characterized by endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility despite treatment with analgesics and cyclic oral contraceptive pills. Endometriosis affects 10–15% of all women of reproductive age and 70% of women with chronic pelvic pain. The lesions can be peritoneal lesions, superficial implants or cysts on the ovary, or deep infiltrating disease. Diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive and consistent biomarkers. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments are limited as endometriosis often recurs.
27 years, nulligravida, case of primary infertility came with complain abdominal distension and was anxious to conceive. Ultrasonography of abdomen done suggestive of ascites and bilateral ovarian tumour (right side- 4.2x2.9x3.3 cm, left side – 4.3x2.4x3.7 cm). tumour markers were done, CA 125 -1243. FNAC of ascitic fluid was showing atypical cells. Patient was planned for staging laparotomy. Intra operatively, approx. 1500 ml greenish haemorrhagic fluid was present. bilateral ovaries and fallopian tubes were adhered to posterior surface of uterus and sigmoid colon. Left oophorectomy with bilateral pelvic and paraaortic lymph node dissection done. All samples were sent for histopathology examination. Histopathology was suggestive of endometriotic lesions at all site. On the basis of histopathology report, patient was put on injection leuprolide. After 3 months, patient is symptomatically better and repeat CECT showed no residual mass or ascites. Patient is currently under follow up for infertility.
BACKGROUND: Fetal growth restriction (FGR) is associated with increased perinatal risks and mortality. Differentiation from SGA (small-for-gestational-age-babies) and managing them is challenging. A protocol is proposed by the Barcelona Center of Maternal-Fetal Medicine that classifies them and optimizes delivery timings. We conducted a RCT that tested the efficacy of the Barcelona protocol.
OBJECTIVE: To determine the perinatal outcome of FGR using Barcelona protocol and comparing it with conventional antenatal management.
METHODOLOGY: 30 women with single, live non-anomalous fetuses of more than 26weeks of gestation were randomized into two groups: 15women in Group-A(Barcelona protocol) and 15women in Group-B(conventional management). The perinatal outcomes were compared.
RESULTS: 3 Women in each group were SGA and 12 were stage-1 FGR. Mean age at delivery in SGA:40+1weeks in group-A, 38weeks in group-B. In Stage-1 FGR, it was 38+6weeks in group-A, 36+4weeks in group-B. Mode of delivery: SGA fetuses- all had vaginal-delivery in group-A while 1 had Caesarean-section in group-B. In FGR-fetuses, group-A:4 vaginal, 8 Caesarean-deliveries while Group-B:3 vaginal, 9 Caesarean-deliveries. Maternal complications:1 woman in group-A, 2 in group-B developed preeclampsia, 2 women in group-A, 4 in group-B developed Oligohydramnios. One baby in group-B required tactile-stimulation for resuscitation. Mean APGAR-scores at1-min, 5-min were 7.8, 8.6in group-A and 7.0, 7.9 in group-B respectively. Birth weight:<1500gm-2 in group-B;1500-2499:8 in Group-A, 10 in group-B;2500-2999:6 in group-A and 3 in Group-B;>3000gm:1 in group-A. 3 neonates in group-B had respiratory-distress at birth, 2 had hyperbilirubinemia, 1 septicemia. Follow-up at 7th-day of life showed- one neonate had septicemia in group-B.
Introduction:
Ebstein anomaly is a rare congenital heart disease. It’s a dysplastic abnormality of tricuspid valve where there is a downward displacement leading to tricuspid regurgitation and complete arterialisation of right ventricle. The aim of this paper is to address the maternal and perinatal outcomes of pregnancies with Ebstein anomaly in a tertiary centre.
Case Description:
We report three cases of pregnancies with incidentally diagnosed Ebstein anomaly who presented to us at term gestation. All were acyanotic, no clubbing, no tachycardia, rest of examination was unremarkable. Two pregnancies were complicated by fetal growth restriction. Pre-eclampsia was seen in two of them, well controlled on medication. ECG and ECHO depicted Right bundle branch block (RBBB), right axis deviation and moderate-severe tricuspid regurgitation, ASD, dilatation of right heart. One patient developed pulmonary oedema in the woman with preeclampsia, another case developed supraventricular tachycardia (SVT) during labour. Both the cases were medically managed with the help of multidisciplinary team. Labour was closely monitored under graded epidural analgesia. Two women delivered vaginally, one set into spontaneous labour and the other required induction for severe preeclampsia. One underwent emergency caesarean for obstetric indication.
Discussion:
Arrythmias are more common in pregnancy with Ebstein anomaly due to
worsening of tricuspid regurgitation and maternal hypoxia which occurrs as result of physiological changes in cardiovascular system. Two women developed pre- eclampsia which is commonly seen in cyanotic and chronic hypoxic state due to vascular endothelial damage. During labour epidural anaesthesia and euhydrayed status is are preferred to reduce maternal arrythmias and congestive cardiac failure due to right-to-left shunt.
Conclusion:
Pregnancy is well tolerated in women with Ebstein anomaly as in our series. Close monitoring of pregnancy by a multidisciplinary team optimizes the materno-fetal outcomes. Vaginal delivery is preferred and caesarean delivery is reserved for obstetric indications only.
BACKGROUND: Takayasu’s arteritis(TA), also known as Pulseless disease/ Aortoarteritis /“young female arteritis,” is a rare chronic inflammatory progressive large vessel vasculitis (LVV) of unknown etiology causing narrowing, occlusion, and aneurysms of systemic and pulmonary arteries, especially the aorta and its branches, afflicting women of childbearing age. During pregnancy, such patients warrant special attention. An interdisciplinary collaboration of obstetricians, cardiologists, and neonatologists is necessary to improve maternal and fetal prognosis.
CASE REPORT:A 33yrs old third gravida, conceived after ovulation induction, was admitted in the hospital as pregnancy with chronic hypertension and low lying placenta at 23 weeks gestation. She had history of one still birth at 7 months and one spontaneous abortion, for which she had no hospital visit.No past history. Her physical examination revealed a difference of 40 mm Hg in Systolic BP between the arms and was subjected for further evaluation. No hypertensive retinopathy changes on fundus examination. After discussing with nephrologist and physician, a probable diagnosis of Takayasu’s arteritis was mad and she was started on LMWH and aspirin. Immunological workup revealed P-ANCA and C-ANCA negative. APLA and ANA profile was negative. ECG and 2D ECHO were normal.USG KUB raised a suspicion of Renal artery stenosis and arterial Doppler of bilateral upper limbs and lower limbs raised a suspicion of possibility of arteritis due to biphasic spectral waveform in left upper limb and bilateral lower limbs. CT angiography done postoperatively, revealed near complete occluding thrombus in left subclavian artery and irregular circumferential plaques along the abdominal aorta resulting in diffuse segmental narrowing, more marked in the infrarenal segment s/o Midaortic syndrome secondary to burnt out granulomatous aorto-arteritis (Takayasu arteritis).She was started on prednisolone and atorvastatin in addition to aspirin and LMWH. She was discharged on POD - 10 with advice on regular follow-up and explaining the complications.
A rare case of vaginal sarcoma in pregnancy-A diagnostic dilemma
Dr. Divya Gupta, Dr. Avinashi Kujur,Dr.Minu Keshkar, Dr.Suma Velgin Ekka ,Dr.Archana Roy
ABSTRACT
INTRODUCTION- Vaginal sarcoma is an extremely rare diagnosis constituting 2-3% of malignant neoplasm in female genital tract1. The etiology is currently unknown and unrelated to pregnancy. DES exposure, HPV infection, family history, cervical cancer may be the cause in some women, still influence of pregnancy on initiation, promotion and development of sarcoma is unclear2.
CASE REPORT -A 20 year old primigravida with 31weeks pregnancy presented with lower abdominal pain and on & off urinary retention from 1 month, for which she was referred to DR.BRAMH Raipur. Her vitals were stable. P/S & P/V- A 10X10 cm firm mass with regular margin felt, extending posteriorly and occupying whole of vagina with copius pus discharge was present. She was operated in view of Pre-PROM after 3 days of admission and delivered a healthy male baby .Intraoperatively the mass was not found to be originating from uterus or cervix .
MRI finding- A 12.3x11x15.7 CC leiomyoma noted in abdominopelvic cavity with malignant transformation with metastasis noted in bone marrow of pelvis and bilateral femur.
Pathological finding : suggestive of sarcoma.
CONCLUSION-Pregnancy includes many hormonal, molecular, anatomic transformation in genital tract. Overlapping of these changes with cancerous changes makes diagnosis challenging. As sarcoma runs a fast course hence timely detection and management by multidisciplinary approach is important.
KEY WORDS- Pregnancy, sarcoma ,malignant
INTRODUCTION:
Osseous metaplasia of the endometrium results from the transformation of non osseous connective tissue into mature bone .Nearly 80 cases have been reported in the literature. In most cases ossification occurred after abortions. The most common presentation is infertility
CASE REORT:
A 31 years old female P0L0A2 married for 7 years presented with history of secondary infertility for 5 years .An ultrasound examination was done in which hyperechoic calcifications was reported inside the endometrial cavity .She was then posted for hysteroscopy.
Multiple coral white coloured bony tissues were removed which were embedded into the uterine cavity . The patient was kept in follow up and repeat ultrasound still showed calcification . so repeat hysteroscopy was performed in which endometrial cavity was filled with multiple flat bones and bones were removed as far as possible.
The bones were sent for histopathological examinations and the reports were suggestive of trabeculae of immature bones consistent with fetal bones.
A 3rd hysteroscopy was performed after 2 months which showed bones with sharp edges and thicker in consistency. So gentle hysteroscopy was performed as chances of injury was greater this time.
Inspite of 3 hysteroscopic sittings the bony tissues could not be removed completely . The hysteroscopy in this case failed to prove as a therapeutic measure unlike other cases that were reported .
CONCLUSION:
This case is different from other cases reported because of its aggressive nature and recurrence. Surrogagy is the best available option that can be suggested to the patient.
BACKGROUND-
The incidence of Dermoid ovarian cyst is 15-20% of all ovarian neoplasm, which is a common entity.
Mesenteric cyst is one of the very rare entities with incidence of 1 in 2,00,000 and Mesenteric Dermoid cyst are even rarer entity amongst all of the mesenteric cysts with incidence of 1:1,00,000.
Both mesenteric cyst & mesenteric dermoid cyst have good prognosis.
Here we report a rare abdominal tumor, which was initially diagnosed clinically as an ovarian dermoid cyst but operative and histology revealed mesenteric dermoid cyst.
Case: A 36-year multipara presented with abdomino-pelvic mass gradually increasing in size since 1 year with recent onset of abdominal pain..
Physical examination revealed abdominal mass upto 26cm*20cm size, globular, nontender, variegated surface, mobile, cystic to solid in consistency.
CECT abdomen & pelvis revealed a large well defined, abdomino-pelvic 14.42123.1 cm heterogeneous mass with areas of fat density and calcifications, suggestive of neoplastic mass ,likely teratoma.
Tumor markers : AFP, B-hCG and CA-125 all within normal limit.
Patient was managed surgically after necessary pre- operative investigations.
Laparotomy findings revealed a huge solid mesenteric mass (22cm*20cm) weighing 6.5kgs. Small bowel & both ovaries were adhered & was separated from mass by fine dissection. Postoperative period was uneventful.
Histopathological examination showed mature cartilage, osteoid formation, fibro-adipose connective tissue, focal lymphoid aggregates, congested blood vessels, focal mature neuronal component and no immature elements seen, confirming dermoid cyst.
KEYWORDS- Dermoid cyst, mesenteric cyst
BACKGROUND: Abdominal pregnancy is defined as pregnancy anywhere within peritoneal cavity exclusive of tubal, ovarian or broad ligament. It can be primary or secondary (more common). It represents 0.9-1.4% of all ectopic pregnancy with incidence of lithpedion being 1.5-1.8% of all extrauterine pregnancies.
CASE REPORT: Unbooked case of 28 year, P2L1D1, presented as a 3rd day postnatal case with vaginal delivery and second retained fetus in abdominal cavity. She had features of acute abdomen. She was pale with abdomen grossly distended with ascites. Ultrasonography suggested abdominal ectopic in left lumbar region. CT Angiography revealed calcified fetus with small calcified mass of 3*3 cm attached near cornu of uterus which might be placental tissue. After stabilizing the patient, laparotomy was planned with multidisciplinary team. Intra-op findings include stone baby (lithopedion) present in lower abdomen wrapped in omentum suggestive of calcified fetus of 26 weeks size and a small calcified mass attached to rudimentary anlagen on right side of uterus with no internal communication with uterus. She was discharged on 8th day of post op recovery in good condition.
CONCLUSION: Proper antenatal care and early diagnosis of ectopic/ heterotopic pregnancy is required for management as such cases which can present later with high incidence of maternal mortality and morbidity.
This was a special case of heterotopic pregnancy. Intrauterine pregnancy delivered vaginally while secondary abdominal pregnancy retained as lithopedion which is a very rare phenomenon. This occurred as the case was undiagnosed for a long time which resulted in calcification of dead fetus without autolysis. Maternal mortality can be reduced with multidisciplinary approach in management of such patients.