Prenatal Ultrasound Diagnosis of Vasa Previa With Careful Intraoperative Management: A Case Report

Vasa previa is a rare but potentially life-threatening condition to the fetus. Timely antenatal diagnosis and delivery by cesarean section (CS) can lead to a favorable outcome. Here, we report a case of recurrent pregnancy loss (G3A2) with vasa previa, which was diagnosed prenatally by ultrasound. She was admitted at her 31st week with bleeding per vaginum (PV) provisionally diagnosed as antepartum hemorrhage (APH) and managed conservatively as placenta previa. Follow-up ultrasonography (USG) revealed vasa previa at 33 weeks. The fetus was delivered by lower segment cesarean section (LSCS) after careful separation of the membranes and avoiding damage to the vessels as there was velamentous insertion of cord with the lower margin of the placenta in the lower segment. The baby was cared for in the neonatal intensive care unit due to prematurity and discharged after six days. This case report highlights the importance of prenatal ultrasound in diagnosing vasa previa and planning an elective cesarean section with caution intraoperatively for the safe delivery of the baby.

External validation of prediction models for vaginal delivery after the trial of labour among women with previous one caesarean section - A cohort study

OBJECTIVE

To externally validate three predictive models (the Grobman model (2007), the Zhang model (2020), and the Grobman model (2021)) for identifying women with increased chances of a successful trial of labour after caesarean section (TOLAC).

METHODS

This retrospective observational cohort study was conducted in a tertiary teaching hospital from 2018 to 2021. Individual probabilities were calculated for women with previous one caesarean section who underwent TOLAC at term, using the predicted probabilities from the logistic regression models. The primary outcome of this study was vaginal delivery following attempted TOLAC. The predictive ability of the models was assessed using the area under the receiver operative characteristics curves (AUC) and a calibration graph.

RESULTS

Of 1515 eligible women who underwent TOLAC, we found an overall rate of successful TOLAC of 60.3 %. No significant difference was noticed in adverse scar outcome and neonatal morbidity while comparing successful and failed TOLAC. The discriminative ability of Grobman-2007 and Grobman-2021 and the Zhang model were fair to poor with the AUC of 0.54(95 % CI 0.51-0.57), 0.62(95 % CI 0.59-0.65) and 0.66(95 % CI 0.63-0.69) respectively. The agreement between the observed rates of TOLAC success and the predicted probabilities for all three models was poor.

CONCLUSION

The performance of all three models predicting success after TOLAC was poor in the study population. A population-specific model may be needed, with the addition of factors influencing the labour, such as the methods of induction, which may aid in predicting the outcome.

Evaluating the Frequency and Characteristics of Unexpected Ovarian Malignancy in Postmenopausal Women Who Have Undergone Laparoscopic Surgery for Adnexal Masses - A Review of Five Years

Aim The aim of this study was to estimate the frequent existence of unexpected ovarian malignant lesions after laparoscopic surgery for an apparent benign adnexal mass and assess its clinical and ultrasound characteristics in postmenopausal women. Methods We re-examined the hospital records of 96 cases of postmenopausal women who underwent laparoscopic surgery for benign adnexal mass over five years. The age of the patient, parity, ultrasound findings, tumor markers level, intraoperative findings, and histopathological report were collected. Pearson's Chi-squared test and Fisher's exact test were used for statistical analysis, and a p-value of <0.05 was accepted as statistically significant. Results Of a total of 96, benign adnexal mass was in 93 (96.83%), an unexpected ovarian malignancy was observed in two (2.08%) cases, and one (1.04%) had a borderline ovarian tumor. Tumor marker CA-125 was done for all those cases of adnexal mass in postmenopausal women, and not a single case was found to have above 35 IU/ml, defined as the cut-off value for CA-125. Statistically significant differences were observed between the benign and malignant groups in relation to symptoms (p<0.05), ultrasound score (p=0.001), and bilaterality (p=0.013) of the tumor mass. Conclusion In postmenopausal women, the critical concern for laparoscopic surgery of benign adnexal mass is unexpected malignancy. So it is essential to select patients carefully for laparoscopic surgery. If a benign-looking adnexal mass turned out to be malignant on the histopathological report, we should try to post the patient for subsequent staging laparotomy as soon as possible.

A Successful Obstetric Outcome in a Woman With Familial Hypokalemic Periodic Paralysis: Challenges in Management

Hypokalemic periodic paralysis during pregnancy is a rare disease condition that presents during pregnancy. It manifests with acute muscular weakness associated with low potassium levels. We report a case of an antenatal woman presenting with leaking per vagina and weakness of four limbs at 33 weeks of gestation. She had similar episodes in the past but defaulted on taking oral potassium. On physical examination, she had hyporeflexia and flaccid paralysis of all limbs without sensory involvement. A neurology consultation was sought and diagnosed to have flaccid quadriparesis. Her investigations showed low serum potassium along with electrocardiography (ECG) changes. With potassium correction, her weakness improved within four days of initiating treatment. A week later, she had a spontaneous labour onset and delivered a healthy male baby. The peripartum period was uneventful. A timely diagnosis and management, avoiding precipitating factors, and preventing future attacks should be the primary goal of management.

Endometrial carcinoma in asymptomatic post-menopausal women with a thickened endometrium and its influencing factors - A cross-sectional study

Background:

A thickened endometrium upon trans-vaginal ultrasound in asymptomatic post-menopausal women always poses a clinical dilemma.

Objectives:

To investigate the frequency of endometrial malignancies by histopathological examination and identify the associated factors influencing the thickened endometrium in asymptomatic post-menopausal women.

Methods:

In trans-vaginal ultrasonography, we enrolled 72 asymptomatic post-menopausal women with a thickened endometrium (>5 mm). Dilatation and curettage were performed for all cases, and the specimen was sent for histopathological examination. According to the data distribution, all the continuous variables were stated as mean ± standard deviation/median (inter-quartile range), categorical variables were expressed in frequency, and percentage will be compared using the Chi-square test/Fisher exact test.

Results:

In our study, most of the women were multipara. The age of post-menopausal women ranged from 46 to 68 years, and the mean duration of menopause was 8.10. The most common histological findings were benign in 72.22% of the cases. We identified pre-malignant and malignant lesions of the endometrium in 18.05% and 9.72% of the cases, respectively. To predict the condition of the lesion, we noticed no definite cut-off value of endometrial thickness to indicate the state of the lesion. We observed that none of the patient’s characteristics showed a significant difference with a thickened endometrium.

Conclusion:

We observed an increased frequency of endometrial pathology irrespective of the presence or absence of risk factors. The result of this study is justified enough for the need of further evaluation of a thickened endometrium in asymptomatic post-menopausal women.

Diagnostic and management challenges of intraventricular neurocysticercosis presenting in the third trimester of pregnancy: A case report

The diagnosis of neurocysticercosis in pregnancy is challenging, even in endemic areas, as other neurological conditions with similar manifestations are common. Obstetricians and physicians may be reluctant to do neuroimaging in pregnancy and often the availability is limited in endemic areas. Management of neurocysticercosis depends on the symptomatology. In those presenting with features of increased intracranial pressure early treatment is necessary, taking into consideration the gestational age and the maternal condition at presentation. Presence of intraventricular cysts causing obstructive hydrocephalus necessitates their removal due to the risk of intracranial hypertension which could be life-threatening, particularly peripartum. We report a case of a woman with intraventricular neurocysticercosis, who presented in the third trimester, and described the management dilemmas that were encountered. The differential diagnoses and other aspects of the medical and surgical management of neurocysticercosis in pregnancy are also discussed.

Group Antenatal Care: A Paradigm Shift to Explore for Positive Impacts in Resource-poor Settings

The delivery of high-quality antenatal care is a perennial global concern for improving maternal and neonatal outcomes. Antenatal care is currently provided mainly on a one-to-one basis, but growing evidence has emerged to support the effectiveness of group antenatal care. Providing care in a small group gives expectant mothers the opportunity to have discussions with their peers about certain issues and concerns that are unique to them and to form a support system that will improve the quality and utilization of antenatal care services. The aim of this article is to promote group antenatal care as a means to increase utilization of healthcare.

Gynecological problems among adolescent girls in a tertiary care centre of South Andaman district

Background Gynecological problems of adolescents occupy a special space in the spectrum of gynecological disorders because they are often different from the conditions that affect adult women. The objective of study was to determine the different gynecological problems in adolescent girls attending outpatient departments. Methods Adolescent girls of age 10-19 years were included in this study. Various gynecological problems were evaluated by detailed history taking and thorough clinical examination. Investigations like haemogram, coagulation profile, hormonal assays and ultrasonography were done wherever indicated. Descriptive analysis was done and results are expressed in terms of percentage. Results A total of 824 (8.33%) adolescent girls attended the gynecology outdoor patient department (GOPD) during the study period. Menstrual disorders (67.11%) were the commonest complaint, followed by vaginal discharge (18.68%) and UTI (9.8%). Menstrual disorders varied from irregular menstruation (55.15%), dysmenorrhea (30.74%) and amenorrhea (14.10%). Dysfunctional uterine bleeding was the commonest cause of menstrual irregularity followed by polycystic ovarian disease (PCOD). Teenage pregnancy (0.84%) and ovarian tumor (0.60%) was found in a few cases. Conclusion Adolescent girls' gynecological problems should be evaluated thoroughly and managed accordingly. Adolescent health education needs to increase awareness and give further attention to gynecological problems.