Indian Journal of Obstetrics and Gynecology

Hemoperitoneum in pregnancy especially in second and third trimester is a dangerous complication which can be life threatening. It can be due to obstetrical or non obstetrical causes which is difficult to diagnose clinically pre operatively. Obstetrical causes includes placenta percreta perforating the uterus and scar rupture. Placenta accreta spectrum(PAS) should be highly suspected in placenta previa cases with history of Prior caesarean deliveries, prior uterine surgeries or curettage even if USG findings are not suggestive of it. Early diagnosis, well preparedness and multidisciplinary approach can help in reducing maternal and fetal morbility and mortality in such cases.

Introduction: Spinal schwannomas during pregnancy are exceedingly rare, with most cases occurring as pregnancy-related spinal tumors (PRST). These tumors can appear or become symptomatic within a year of pregnancy. Few reports exist of third-trimester diagnoses, and their management presents unique challenges, including balancing maternal-fetal safety during diagnosis and intervention. Case Presentation: We present the case of a 35-year-old woman at 36 weeks of gestation (G2P1L1) who developed acute bilateral lower limb weakness, rapidly progressing to involve the upper limbs. Neurological examination revealed absent reflexes and sensory loss below T12. MRI without contrast identified an intradural extramedullary lesion, likely a schwannoma, at the C5-D1 level compressing the spinal cord. An emergent lower segment cesarean section (LSCS) was performed, followed by successful tumour resection via C4-D1 laminotomy. Histopathology confirmed ancient schwannoma. Postoperative recovery was gradual, with significant neurological improvement after three months. Discussion: The diagnosis of spinal tumours during pregnancy is often delayed due to symptom overlap with common pregnancy-related conditions. Surgical timing remains a contentious issue, but the literature supports intervention under general anaesthesia as safe during pregnancy when neurological symptoms are rapidly progressing. Our case demonstrates the successful use of a multidisciplinary approach involving obstetricians, anaesthetists, neurosurgeons, and neonatologists to manage maternal and fetal outcomes. Conclusion: Spinal schwannomas in pregnancy, though rare, require early diagnosis and a multidisciplinary treatment approach to optimise maternal and fetal outcomes. Timely surgical intervention can lead to favourable neurological recovery and safe delivery.

A 60-year-old, postmenopausal woman presented with lower abdominal heaviness in to our OPD. On subsequent examination 7x8cm firm mass was felt through left fornix. CA-125 was found to be 447U/ml, and her CECT was suggestive of 7.7X5.3X6.9CM solid cystic left adnexal mass. Patient underwent Primary cytoreductive surgery. Intraoperatively Left adnexal mass was present measuring 10x8cm, multiple calcified stony hard irregular shaped deposits were present in omentum and paracolic region. Final histopathology report was suggestive of high grade serous ovarian carcinoma pT3cpN0 and calcified deposits were reported as mature cartilaginous tissue. Patient subsequently received 6 cycles of adjuvant chemotherapy. Currently patient is doing well.

Granulosa cell tumors (GCTs) are uncommon ovarian neoplasms that account for 2% 5% of ovarian malignancies. GCTs are of two types; one is the adult type seen among peri menopausal women and another is juvenile type seen among prepubertal girls and in women aged less than 30 years of age. Adult granulosa cell tumors are more commoner than juvenile type. We present a case of GCTs of the ovary in post-menopausal women who presented to us with post-menopausal bleeding. On further evaluation, a solid mass is noted in the right ovary. Endometrial biopsy revealed disordered proliferative endometrium. She underwent staging laparotomy, and Intraoperatively, the right ovary is replaced with a 10x8 cm solid mass and capsular breech is noted. Histopathology of the specimen revealed a Granulosa cell tumor, stage IC2. Postoperatively, she received adjuvant chemotherapy with Carboplatin and Paclitaxel for 6 cycles and she is under follow-up.

Background: Conservative methods for the management of placenta accreta spectrum disorders includes all the methods which aims to reduce the morbidity associated with peripartum hysterectomy, intraoperative complications, blood loss during surgery and mainly to preserve future fertility. These methods are to be practiced as much as possible in appropriate cases after weighing risks and benefits. Objective: To report two cases of placenta accreta which were managed by uterine artery embolization followed by caesarean section in a hybrid operation theatre in our tertiary care centre. Cases: This is a case series of two cases of pregnant women who were diagnosed to be having placenta accreta spectrum disorder. Here, we describe the steps and outcomes of the above-mentioned method. Conclusion: Uterine artery embolization prior to caesarean section in selected cases of placenta accreta spectrum disorders is a feasible and advantageous procedure. It decreases the operating time, intraoperative blood loss and complications, and ICU stay. Larger studies may be needed to confirm the advantages.

Background: Artificial intelligence (AI) for cervical cancer screening and diagnosis offers promising advantages over traditional methods like Pap smear and visual inspection. AI based medical diagnostic applications provide improved accuracy by analysing data with precision, potentially reducing errors compared to subjective human interpretation. This technology automates the screening process, enhancing efficiency and decreasing the time needed for analysis and result delivery. Aim: To Screen cervical carcinoma using smart scope AI. Objectives: To compare the diagnostic accuracy of Smart scope AI, pap smear and HPE when available and categorise the patients using the images taken by smart scope and to compare the reports of smart scope with Pap smear. Materials and Methods: All subjects underwent Pap smear with smart scope imaging and HPE when indicated. Statistical analysis: The data were analysed using SPSS (Statistical Package for the Social Sciences) version 20.0 software. As applicable for qualitative data, tests like the chi-square test were used for comparison of variables used in the study. Results: The impression of Pap smear was abnormal only in 4 (3.25%), smart scope was abnormal in 86 (69.9%), Out of 4 histopathology that were done, all reported with abnormal findings. Conclusion: According to our study pap smear is a better screening tool to detect cervical cancer compared to smart scope.

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Total 74 postmenopausal osteopenic women confirmed by DEXA with T score <-1.5 were recruited. Group 1 (n=37), received 70 mg oral alendronate and calcium 500mg and VitD 200 IU, Group 2 (n=37) received calcium and VitD in same doses. Therapy was given for 6 months and followup DEXA was done at 6 months. Out of 102 postmenopausal cases 74 were found eligible (71% showing low T score, 30% had osteoporosis and 41% had osteopenia). They presented at median 7 years after menopuase at mean age of 46.7 years. In lumber spine, T score, Z score and BMD (gm/cm2) improved from -2.4±1.4, -1,8 0.9, 0.751 to -2.2± 1.1, -1.4± 0.9, 0.815 (p=0.001); at hip joint 1.5±0.89, 0.8±1.5, 0.734 to -1.3±1.0, -0.9±0.8, 0.762 (p=0.01) respectively in group 1 wheras in group 2, in lumbar spine, -2.2± 0.85, -1.3± 0.72, 0.808 to-2.1± 0.89, -1.3±1.40, .818, (p>0.05) at hip joint -1.5±0.74, 0.8±0.71, .767 to -1.4±0.67, -1.1±1.50,.764 (p=0.07). There was improvement in BMD by 8.5% in spine and 3.8%in hip in group 1 and 1.2% in spine and no effect in hip in group 2. Hence weekly alendronate is effective and safe. Screening by DEXA in postmenopausal women should be started at 55 years of age in Indian senario.