Indian Journal of Obstetrics and Gynecology

Background: Thyroid dysfunction is due to Failure in compatibility with physiologic changes during pregnancy which leads to adverse maternal and foetal outcomes.There is an increased risk of complications like abortion, preterm delivery, pre-eclampsia, anemia, placental abruption, Post-partum haemorrhage in pregnant women with thyroid disorders. Foetal complications include intrauterine growth restriction, preterm babies, still birth and neonatal deaths. Thyroid dysfunction has its effects on both maternal and foetal outcomes.2 Aim & Objective: To assess the incidence of thyroid disorders in pregnancy and to interpret the maternal and foetal outcome. Methodology: The Prospective study was conducted for a period of two years in Obstetrics & Gynaecology department of Bharati Vidyapeeth University, Pune. The methodology were explained to women and valid informed written consent was recorded. The ethical clearance was obtained from ethical review committee of the tertiary centre.The patients with thyroid dysfunction on treatment/without treatment were followed up till delivery/abortion. The maternal and fetal outcome were studied. Results: Out of 498 pregnant women 33 (6.6%) had hypothyroidism and 3(0.6%)had hypothyroidism and 462(92.8%) were Euthyroid group. In all the three group majority of the babies were not requiring admission in NICU. In hypothyroid group, 39.39% had complication. In hyperthyroidism group, 66.67% had any complications. In Euthyroid group, 30.74% had complication. Complication rate was comparatively higher in hypothyroidism and hyperthyroidism group compared to Euthyroid group. There was no case of placental abruption in my study. Conclusion: Due to impact that the maternal thyroid disorders has on pregnancy outcomes, Prompt identification of thyroid disorders and timely initiation of treatment is essential.

Bleeding in first trimester of pregnancy poses a risk to embryo. It can be a natural symptom of implantation, sign of spontaneous abortion, or of pathologic condition like ectopic pregnancy/gestational trophoblastic illness.4 Aim: To assess the etiology and outcome of first trimester bleeding. Objectives: (1) To study the etiology for first trimester bleeding. (2) To study the incidence of various etiological factors. Settings and design: This is the prospective observational study carried out in a tertiary health care centre over 2 years from October 2019 to october 2021. Materials and methods: This study was conducted on women with complaints of vaginal bleeding in first trimester of pregnancy. The methodology were explained to the women and valid informed written consent was recorded. The ethical clearance was obtained from ethical review committee of the tertiary care centre. After taking a detailed history and physical examination, the patient will undergo a urine pregnancy test, on confirmation she will be sent for a TVS scan depending upon the USG report further management and follow-up will be decided. Conclusion: Bleeding in first trimester doesn’t necessarily lead to miscarriage, but causes anxiety to the patient. Women and obstetricians should consider the outcome of continued pregnancies after the first trimester bleeding when planning antenatal care and clinical interventions. We need more researches on this to improve our better understanding and knowledge so that we can better plan the continued pregnancy as well as council the patient in better way.

Sarcomas are connective tissue cancers and Rhabdomyosarcomas are cancers originating from the skeletal muscle cells of the body. A 23 year old female unmarried, nulligravida presented in our emergency with the complaint of bleeding per vagina on and off since last 4 months. The lesion measured 9.2 (cc) x8.7 (cs)x7.8 (ap) cm. The lesion displaced the uterus superiorly distended the vaginal canal compressed the urinary bladder and urethra anteriorly but with no evidence of infiltration into the pelvic side wall and with maintained fat plane. Rest all pelvic organs as well as abdominal organs were within normal limit. The HPE report on microscopic examination of the tissue showed features suggestive of malignant spindle cell neoplasm. Immunohistochemistry was done and IHC report showed: Positive for Desmin, Myogenin predominantly cytoplasmic positive. Correlating the morphologic and IHC markers the report came to be Embryonal Rhabdomyosarcoma (Botryoid Rhabdomyosarcoma). As soon as the final diagnosis was made patient was referred to Department of Oncology and chemotherapy with Cyclophosphamide was started. She has been on regular follow up since then and is keeping well. The presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor.

Introduction: Acute fatty liver of pregnancy (AFLP), a rare but recognized obstetric and medical emergency, is a catastrophic illness for both the mother and unborn offspring. It develops rapidly in the last trimester of pregnancy and contributes to significant maternal and perinatal mortality. Its demands early diagnosis, immediate delivery of fetus, systematic approach for anticipating complications and dealing with them. Aim and Objective: To enlighten the varied presentations of this rare entity which help in early diagnosis, prompt delivery and highlighting the importance of supportive care to reduce maternal morbidity and mortality. Materials and Methods: The authors report an observational case series of patients who developed AFLP and were managed in critical care in a period of 3 months. Results: A total of three cases of AFLP were diagnosed in a period of 3 months. Nausea, vomiting and anorexia were the most common symptoms. Jaundice was seen in all. Anticipation of the complications like postpartum haemorrhage, DIC, hepatorenal syndrome and sepsis and providing prophylactic treatment in that view can reduce the morbidity and in-hospital days for the patient. Conclusions: AFLP has significant perioperative mortality and morbidity secondary to renal dysfunction, coagulopathy and massive transfusion related complications. Clinical outcome can be improved by early diagnosis, urgent delivery of fetus and supportive care from multidisciplinary team.

Tuberculosis continues to be a major health issue even now in a country like India due to its large population belonging to lower socioeconomic class. Tuberculous spondylodiscitis/Pott’s disease in pregnancy leading to paraplegia is uncommon and is a diagnostic and therapeutic challenge. According to World Health Organisation (WHO), TB is the third leading cause of death worldwide in women of reproductive age group. 21% of global burden of TB in pregnant women is in India. We report a case of a 28 year old, G3A2, at 29 weeks +3 days who presented with progressive bilateral upper limb and lower limb weakness and urinary incontinence. She was evaluated and was diagnosed to have Nurick Grade IV cervical compressive myelopathy with upper motor neuron (UMN) bladder due to tuberculous spondylodiscitis of C4 and C5 vertebrae. She underwent Elective lower segment caesarean section (LSCS) followed by 2 level C4-C5 corpectomy with expandable cage fusion and posterior stabilisation and fusion. Antitubercular regimen for 4 months was started thereafter. With a multidisciplinary approach, there was a good maternal and neonatal outcome. TB in pregnancy mandates early suspicion, diagnosis and treatment for timely intervention to prevent sequential complications to the mother and baby. So in high risk population clinicians should have a high index of suspicion of TB. We here aim to update the knowledge in early diagnosis and management of a rare case of Pott’s disease in the antenatal period which may help clinicians in their practice. Key message: Neurological manifestations in antenatal women especially in high risk groups for TB should prompt clinicians to consider a diagnosis of tuberculosis. Early initiation of anti-tuberculous drugs and if required adjunct surgery provides excellent maternal and neonatal outcome.