Indian Journal of Obstetrics and Gynecology

Fetal Supraventricular tachycardia (SVT), though rare, is the most commonly encountered clinically significant tachycardia in the fetus. When  SVT is  sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction.  Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction [1]. Digoxin has been successfully used to treat fetal SVT, when therapy with digoxin fails alternative therapies may be used with equivocal results [2]. There is no clear consensus regarding the best drug-treatment regimens for fetal SVT. Digoxin has been recommended as first-line therapy in cases of SVT with cardiac failure, but recent evidence suggests that the transplacental passage may be impaired in the presence of hydrops [3]. Other agents such as flecainide and sotalol have been tried as first-line agents but with adverse events [4].

We here describe a case of fetal supraventricular tachycardia without hydrops diagnosed antenatally at 29 weeks of gestationand managed with oral digoxin.

Fetal Supraventricular tachycardia (SVT), though rare, is the most commonly encountered clinically significant tachycardia in the fetus. When  SVT is  sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction.  Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction [1]. Digoxin has been successfully used to treat fetal SVT, when therapy with digoxin fails alternative therapies may be used with equivocal results [2]. There is no clear consensus regarding the best drug-treatment regimens for fetal SVT. Digoxin has been recommended as first-line therapy in cases of SVT with cardiac failure, but recent evidence suggests that the transplacental passage may be impaired in the presence of hydrops [3]. Other agents such as flecainide and sotalol have been tried as first-line agents but with adverse events [4].

 We here describe a case of fetal supraventricular tachycardia without hydrops diagnosed antenatally at 29 weeks of gestationand managed with oral digoxin.

Pseudomyxomaperitonei is a rare gynaecological condition characterised by mucinous ascites. It has been described as the presence of gelatinous ascites and implants that involve the peritoneal surfaces  and omentum. Though essentially associated with mucinous cystadenomas of the appendix and the ovaries , the proliferative nature and gross mucinous ascites associated with PMP demand the need for an optimal debulking surgery. Newer modalities of treatment for PMP are still being studied, intra peritoneal chemotherapy has been found to be the most useful after debulking surgery, to prevent recurrence.

Keywords: Pseudomyxoma Peritonei; Jelly Belly; Mucinous Ovarian Tumours.

Gastroschisis is type of an abdominal wall defects, can be diagnosed in antenatal period with the help of an ultrasonic scan. However, routine ultrasonic scanning of all gravida is not possible due to lack of adequate facilities in some health centers in developing countries. Hence, a number of patients with fetal, abdominal wall defects are diagnosed only after the delivery In developing countries, especially in India it is not uncommon to see the patients presenting with gut loops lying in vagina or outside vagina in cases of abortions being managed by unskilled persons. If one sees intestines coming out in the vagina, the first possibility which is thought is of either the uterine perforation or rupture uterus. We report a rare case in which gastrochisis was confused with uterine rupture, due to presence of intestines in the vagina of the mother.

Keywords: Gastroschisis; Bowel Loops; Uterine Perforation.

Rupture uterus is a dreaded obstetric complication. It is a very rare event in an unscarred uterus of a primigravida. We present a case of rupture uterus in a primigravida diagnosed late in puerperium. She was managed conservatively without the need of any laparotomy. Such case is yet not reported in literature. Primigravidas are not immune to rupture uterus and many a times it can be treated without any surgical intervention.

Keywords:  Rupture Uterus; Primigravida; Puerperium.

Pregnancy in a rudimentary horn of uterus is a form of ectopic pregnancy. Clinical manifestations will depend upon the development of rudimentary horn. Viable pregnancy in non-communicating rudimentary horn is very rare, as more than  80% cases of rudimentary horn pregnancy present in second trimester with rupture of the horn and is life threatening. Early diagnosis of rudimentary pregnancy is  required to avoid such complication. Sometimes, even modern ultrasonography scan cannot confirm the diagnosis of rudimentary horn pregnancy.  We report a case of successful pregnancy outcome at 34 weeks in a non communicating rudimentary horn.

Keywords: Pregnancy; Ultrasonography; Rudimentary Horn.

Condyloma accuminata (CA) is the overgrowth of epithelial tissue of the anogenital area which occurs due to the infection by human papilloma virus (HPV). Giant condyloma acuminata also called as Buschke-Löwenstein tumour (BLT) is a slow growing cauliflower-like tumour, locally aggressive and destructive, with possible malignant transformation. It is a disease transmitted by sexual intercourse and affects both women and men. We are reporting an interesting  case of giant condyloma accuminata in a multiparous, 70 year old lady, who presented with one year history of rapidly growing vulval mass, associated with malodorus vaginal discharge, pruritus, pain and difficulty in walking. The tumor measured 10cm x 8cm and was successfully excised with lotus petal skin grafting.

Keywords: Condyloma Accuminata; Human Papilloma Virus; Lotus Petal Skin Grafting.

Thyroid diseases affect upto 5% of all pregnancies. The  repercussions  of maternal thyroid dysfunction during pregnancy causes numerous maternal and fetal adverse outcomes just like the Pandora’s box. Adequate treatment of these situations is thought to reduce the risks. Hypothyroidism is commonly treated with levothyroxine, with advancing pregnancy the levothyroxine requirement also increases. Hyperthyroidism is often treated with antithyroid drugs in pregnancy. However they are not completely safe to use during pregnancy but benefits of treatment with these drugs is found to outweigh the minor risks of side-effects. The treatment goal for hypothyroidism and hyperthyroidism is to achieve euthyroidism quickly and maintain it throughout pregnancy. Autoimmune thyroiditis and isolated maternal hyper-thyroxemia do not currently warrant treatment during pregnancy, unless hypothyroidism ensues. Treatment of thyroid nodules and differentiated thyroid cancer can generally be safely postponed until after delivery.

Keywords: Thyroid Dysfunction;  Hyperthyroidism; Autoimmune Thyroiditis; Thyroid Hormone- Binding Globulin (TBG).

Bioethics is  essential  dimensions  of  Obstetrics   practice. Modern era has witnessed  many  technological  advances like  Assisted Reproductive Techniques. Presence of Higher Order Multiples  is  higher with  ART.  Multiple  pregnancies are  associated with  many maternal and fetal risks. Ethical  issues in multiple pregnancy are multidimensional  having many aspects.These are related to fetal reduction and selective termination of pregnancy, congenital malformations  in multiple pregnancy, impact on parents and physicians perspective.  Multiple pregnancy has impact on  parents,community and health resources. Adequate support  is essential to tide over the situation.

Keywords: Ethics; Multiple Pregnancy; Fetal Reduction; Selective Termination of  Pregnancy; Congenital  Malformations.

Background: Hepatitis is the liver inflammation caused by A, B, C, D and/or E viruses. Hepatitis is a major health issue in India and the worldwide. The prevalence is increasing among pregnant women in proportion to the increase worldwide. Hepatitis in pregnant women leads to increased maternal and neonatal morbidity and mortality. This led to collection of data to formulate a better plan. Methods: An observational study was done was done at Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India from the month of January  to December 2014. Women who attended our outpatients department or delivered in our labour room and had Hepatitis were included in this study. Blood biochemistry and liver enzymes were done on all patients. Hepatitis markers were done as well. Results: The prevalence of hepatitis was 2.82% in our study population (irrespective of whether Hepatitis A, B, C or E). Hepatitis A was 28.8%, hepatitis B was 40.7%, hepatitis C was 18.6% and hepatitis E was 11.9% in our study population. Lower educational status women had higher incidence of hepatitis, illiterate group had 35.59% and high school educated had 42.37%. Low socioeconomic status (SES) had 52.4% and middle SES had 47.45% of hepatitis. There were 10.2% cases of abruption, 8.5% cases of DIC and 5.1% case of preeclampsia. Conclusions: This study highlights the overall prevalence of hepatitis in our catchment area. It also shows that the very basic facilities are still the missing like sanitation, education and income. We need to highlight and work on those areas. Blood and blood products needs to be screened to reduce hepatitis B and C. Pregnant mothers should be managed as high risk group to improve their outcome. Neonatal immunisation should be both active and passive even if government has to bear the cost.

Keywords: Hepatitis; Screening; Prevention; Screening. 

ECTOPIC PREGNANCY “ A GREAT DECEIVER “ may present with  varied symptoms  and signs []. BETA HCG and ULTRASONOGRAPHY has revolutionized the diagnosis of ectopic pregnancy  and this has drastically reduced maternal morbidity and mortality[2]. Still in rural, unaware   , malnourished and severely anemic population it poses diagnostic and management dilemma.  This is   retrospective study, carried out at  PIMS (Pacific Institute of Medical Sciences Umarda, Udaipur, Rajasthan)  in 2014 and 2015. Total 32 cases were analyzed. 26(81.25%) had pelvic infection either acute or chronic including sexually transmitted diseases and post abortal and previous tubercular infections. All patients had pain in the abdomen, 28(87.50%) had history of amenorrhea and 26(81.25%) had uterine bleeding.   USG in 28(87%) was suggestive of fluid/clots in peritoneum or tubo -ovarian Mass. However Urine Pregnancy Test/Beta HCG were positive in 25(78.13%). Salpingectomy was the most common surgery done in 31(98.67 %). There was no negative laparotomy in this study. There was no maternal mortality in this series.  Prevention of sexually transmitted diseases, pelvic infection, early diagnosis and prompt treatment helps in reducing mortality and morbidity.

Keywords: Ectopic Pregnancy; Sexually Transmitted Diseases In Ectopic Preg Ruptured Ectopic Prgnancy; Haemoperitoneum; Conservative Surgery For Tubal Pregnancy; Salpingostomy; Salpingectomy; Salpingo-Opherectomy.

Context: Gestational Diabetes Mellitus is associated with an increased risk of maternal and foetal complications. Early diagnosis and management of GDM improves maternal and perinatal outcome; thereby preventing the long term risks of future diabetes in both the mother and her offspring. Aims: Our study was undertaken to determine the prevalence of gestational diabetes mellitus and associated risk factors in a tertiary care centre in Karnataka. Settings and Design: This was a prospective study carried out in a tertiary care teaching institute in Karnataka. Material and Methods: Eight thirty nine fasting pregnant women with 24-28 weeks of gestation underwent WHO-75 gram OGTT. Proforma with information on demographic characteristics, age, BMI, gravidity, past obstetrical history, past history of gestational diabetes, family history of diabetes was collected. Statistical Analysis Used: Descriptive and inferential statistical analysis. Results: GDM was diagnosed in 53 women. Age >25 years, BMI >25 kg/m2, higher gravidity, family history of diabetes, past history of gestational diabetes, past history of intrauterine fetal demise and history of abortions were significantly associated with higher prevalence of GDM. Conclusion: Prevalence of GDM was 6.32% in our study. Appropriate interventions are required for control and risk factor modification.

Keywords: Age; BMI; Gravidity.

Key Message: Education regarding the diabetogenic potential of modifiable risk factors such as raised BMI is essential to prevent long term complications in both mother and offspring.