Indian Journal of Obstetrics and Gynecology

Keywords: Genital Tract fistulae; Septic Abortion; Maternal Mortality; Faecal Fistula; Uterine Perforation; Traumatic Uterine Perforation. 

Key message: Aypical Eclampsia Diagnosis and Management is a Challenge to the Obstetrician. 

Background: Struma  ovarii  is a specialized  monodermal  teratoma, constituting 1-4% of benign ovarian teratoma. Composed  predominantly  of mature thyroid tissue of more than 50%.Based on histological features it can be classified into benign and malignant.The overall incidence of dermoid cyst is 20-25%. Case: A 28 year old multipara (G3P2L2) reported to VIMS labour  room complex in active phase of labour at term gestation with hand prolapse with previous history of full term normal deliveries. Conclusion: Struma  ovarii  is a rare  tumor of ovary. Diagnosis  is made by histopathological findings.The optimal treatment for benign  tumor   is surgical resection  i.e. either simple cystectomy or unilateral oophorectomy.Malignant cases need adjuvant treatment. Recurrence is uncommon. 

 Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time .It can be life threatening condition and can be missed easily when the diagnosis being overlooked. Nowadays heterotopic gestation although common with assisted reproductive techniques for subfertility treatment, a high index of suspicion can help in timely diagnosis and appropriate intervention. Heterotopic pregnancy can pose a diagnostic dilemma because an early transvaginal ultrasound may not diagnose an exutero gestation in all cases 1,2 The diagnostic role of serum beta-HCG level in heterotopic pregnancy is debatable. Therefore, if the beta-HCG levels are higher for the period of gestation with an intrauterine pregnancy ,one can look for a co-existant tubal pregnancy. Sometimes there are no conclusive adnexal findings and the diagnosis of ectopic pregnancy may be based on other ultrasound features such as haemoperitoneum ,haematosalphinx and free fluid in peritoneum or pouch of  douglas. We report a case of  heterotopic pregnancy in a 23  year old woman presented with  haemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation of 7 weeks ,diagnosed on  transvaginal ultrasound.  

Keywords : Heterotopic pregnancy,spontaneous conception, adnexal mass,  haemoperitoneum. 

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Keywords: Obstetric Rehabilitation; Gynecological Rehabilitation; Pelvic Floor Muscle Training; Exercise Therapy; Stress Incontinence. 

Aim of the study: To determine the need to change the present glucose challenge threshold value in screening for gestational diabetes mellitus (GDM) among women in Dakshina Kannada and neighboring areas. Study Design: Retrospective and Cross Sectional study. Materials & Methods: 997 patients were analysed in the retrospective study having a GCT done between 24 – 28 weeks from October 2009 to October 2010 and complications of GDM observed in them. A mean GCT was identified above which complications (maternal and fetal/neonatal) were noted. Following this, in the cross sectional study done between November 2010 to September 2011, 209 patients were identified as having a GCT above that determined by the retrospective study. They were subjected to a 100g glucose threshold test to diagnose GDM (using Carpenter Couston values). Sensitivity, specificity, positive and negative predictive value was calculated for each GCT threshold value. Results: The mean GCT at which complications of GDM were observed in the retrospective study was 123.56 (maternal complications) and 124.15 (fetal/ neonatal complications). In the Cross Sectional Study, therefore, 124 mg/dl was taken as the cut off above which women were subjected to a 100g oral GTT. The ROC curve identified a value of 143mg/dl showing a sensitivity of 83.3% and specificity of 72.3%. A value of 135mg/dl, however showed a high sensitivity (91%) which is required in a high prevalence area. This value had a moderate specificity (52%). Conclusion: A high prevalence area like ours requires a GCT threshold with a high sensitivity which in our study was observed at a threshold value of 135mg/dl. 

Objectives: This study is directed towards use of ultrasonography to assess the changes in urinary tract that occur because of uterine prolapse. Ultrasonography is a safe, easily available and efficient method of assessing urinary tract. Methodology: 80 women diagnosed as Pelvic Organ Prolapse (POP) were subjected to urine examination, renal function tests and ultrasonography. Results: Incidence of UTI is high(27.5%) in uterovaginal prolapse patients. On studying these 80  cases by USG  6.25% had evidence of obstructive uropathy. 

 The present study was conducted with the aim to assess the safety and efficacy of misoprostol alone and misoprostol with simultaneous mifepristone for second trimester termination of pregnancy. Material & Methods: The study was conducted on 160 cases, divided in two groups of 80 cases each. In the study group 200 mg mifepristone and 200 mg misoprostol given together on admission followed by misoprostol every 3 hrs upto a maximum of 8 doses or until the abortion occurs, whichever occurs early. In the control group only misoprostol was given in the same dose regime. If abortion did not occur within this duration it was considered failure of method. The results were analysed. Results: The success rate in first regimen was 98%. Mean induction abortion interval was significantly shorter in the study group, 8.62 ± 1.96 h as compared to 14.5 ± 3.01 h in the control group. The mean dose of the misoprostol required was significantly less in study group. The side effects like nausea,vomiting,fever,abdominal cramps,diarrhoea were observed more in control group (30%) in comparison to study group (12.1%). Conclusion: Mifepristone with simultaneous misoprostol is better than misoprostol alone and there is no need to wait for 24 hr after mifepristone for administration of misoprostol.

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