Indian Journal of Cardiovascular Disease in Women WINCARS, 2020
In the era of COVID-19, pregnant patients have genuine concerns regarding their own health and th... more In the era of COVID-19, pregnant patients have genuine concerns regarding their own health and the health of the unborn. It is difficult to provide standard protocols due to extremely limited data. The recommendations and guidelines are being frequently revised as we learn more about the disease.
Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal ph... more Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic term...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Acute respiratory distress syndrome (ARDS) is an uncommon condition encountered in pregnancy. The... more Acute respiratory distress syndrome (ARDS) is an uncommon condition encountered in pregnancy. The incidence of ARDS in pregnancy has been reported to be 1 in 6229 deliveries with mortality rates to range from 24% to 39% in pregnant patients. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. In critically ill patients where both cardiorespiratory support is required, Extracorporeal Membrane Oxygenation (ECMO) can be used to help maintain the vital functions. ECMO is a temporary cardio respiratory or respiratory support in critically ill patients who are unresponsive to conventional management. In present case a young female with post-partum ARDS was successfully managed with extra corporeal membrane oxygenation (ECMO).
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Arthrogryposis Multiplex Congenita is a syndrome or disorder that presents with multiple congenit... more Arthrogryposis Multiplex Congenita is a syndrome or disorder that presents with multiple congenital joint contractures at birth. It is X-linked recessive disorder, non-progressive and is of variable severity. Here is a case report with three consecutive pregnancies having fetus affected with Arthrogryposis Multiplex Congenita (AMC) diagnosed antenatally. Arthrogryposis Multiplex Congenita affects 1 in 3000 live births. During embryogenesis, joint development is normal. Motion is essential for the normal development of joints and surrounding structures. Fetal akinesia causes extra connective tissue to develop around the joint. This results in fixation of the joint and a further increase in the contracture. Earlier in pregnancy the contractures form, worse is the prognosis.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at... more Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at some stage of their lives. Medical management is the first line of therapy for menorrhagia (heavy menstrual bleeding: HMB). Progestins have been found to be very effective in the management of heavy menstrual bleeding especially during acute episodes, norethisterone acetate being widely used for the same. Ormeloxifene is a new drug with promising results in managing HMB. The study was undertaken to compare the efficacy, safety and acceptability of Ormeloxifene /Norethisterone acetate in the medical management of heavy menstrual bleeding.Methods: This was a retrospective study conducted from January 2016 till December 2018 in which 98 women of reproductive age group presented with abnormal uterine bleeding without any organic, systematic and iatrogenic causes. The patients were divided into 2 groups. Those wanting contraception along with control of HMB were assigned to Group O and given...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connect... more Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosi...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive sp... more Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Endometriosis is defined as the presence and proliferation of the endometrium outside... more Background: Endometriosis is defined as the presence and proliferation of the endometrium outside the uterine cavity affecting an estimated 89 million women of reproductive age worldwide. Endometriosis occurs in 5% to 10% of all women, often resulting in debilitating pain and infertility, endometriosis at the scar site known as Scar endometriosis has also been described following obstetrical and gynecological surgery. Scar endometriosis has a much rarer incidence with an illusive presentation and is often misdiagnosed and definitive treatment gets delayed. Objectives of this study was to review the demographic profile, clinical presentation, treatment modalities and outcome in patients with scar endometriosis.Methods: The retrospective study of patients with scar endometriosis managed at DMCH during January 2014 to December 2018 was done.Results: Eight patients of scar endometrosis were diagnosed and operated in our institution over a period of five years. All patients (six with pre...
International journal of applied & basic medical research, 2013
Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 preg... more Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts, and multiple organ dysfunction syndromes. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. AP is most often associated with gall stone disease or hypertriglyceridemia. We present 2 years of experience during which we had eight patients of AP. Of the eight patients, three underwent laparoscopic cholecystectomy and five were treated conservatively. One had multiple cysts in the abdomen which were drained. All the patients delivered at term. Prophylactic tocolysis was given for 48-72 h to only those patients who had laparoscopic cholecystectomy. All the patients recovered completely. There was no maternal or fetal mortality. Wh...
International journal of applied & basic medical research, 2014
Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleedin... more Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient. The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years. A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment m...
International Journal of Applied and Basic Medical Research, 2014
The objective of this study is to review the clinical profile and outcome in patients requiring t... more The objective of this study is to review the clinical profile and outcome in patients requiring the angiographic embolization in obstetrics. The retrospective data of patients requiring uterine artery embolization for control of obstetrical hemorrhage was studied during the period from August, 2005 to August, 2010. A total of 35 patients with obstetrical hemorrhage (seven post lower segment caesarean section, 13 post vaginal delivery, 13 postabortal, one with cervical pregnancy and one patient post laparotomy for abdominal pregnancy) underwent angiographic embolization for control of bleeding. In all patients, hemorrhage was successfully controlled; none required post procedure hysterectomy and one patient subsequently became pregnant with in a year. Our clinical experience suggests that embolization is superior first-line alternatives to surgery for control of obstetric hemorrhage including postpartum, post-cesarean and postabortal bleeding and prevents hysterectomy.
Indian Journal of Cardiovascular Disease in Women WINCARS, 2020
In the era of COVID-19, pregnant patients have genuine concerns regarding their own health and th... more In the era of COVID-19, pregnant patients have genuine concerns regarding their own health and the health of the unborn. It is difficult to provide standard protocols due to extremely limited data. The recommendations and guidelines are being frequently revised as we learn more about the disease.
Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal ph... more Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic term...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Acute respiratory distress syndrome (ARDS) is an uncommon condition encountered in pregnancy. The... more Acute respiratory distress syndrome (ARDS) is an uncommon condition encountered in pregnancy. The incidence of ARDS in pregnancy has been reported to be 1 in 6229 deliveries with mortality rates to range from 24% to 39% in pregnant patients. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. In critically ill patients where both cardiorespiratory support is required, Extracorporeal Membrane Oxygenation (ECMO) can be used to help maintain the vital functions. ECMO is a temporary cardio respiratory or respiratory support in critically ill patients who are unresponsive to conventional management. In present case a young female with post-partum ARDS was successfully managed with extra corporeal membrane oxygenation (ECMO).
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Arthrogryposis Multiplex Congenita is a syndrome or disorder that presents with multiple congenit... more Arthrogryposis Multiplex Congenita is a syndrome or disorder that presents with multiple congenital joint contractures at birth. It is X-linked recessive disorder, non-progressive and is of variable severity. Here is a case report with three consecutive pregnancies having fetus affected with Arthrogryposis Multiplex Congenita (AMC) diagnosed antenatally. Arthrogryposis Multiplex Congenita affects 1 in 3000 live births. During embryogenesis, joint development is normal. Motion is essential for the normal development of joints and surrounding structures. Fetal akinesia causes extra connective tissue to develop around the joint. This results in fixation of the joint and a further increase in the contracture. Earlier in pregnancy the contractures form, worse is the prognosis.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at... more Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at some stage of their lives. Medical management is the first line of therapy for menorrhagia (heavy menstrual bleeding: HMB). Progestins have been found to be very effective in the management of heavy menstrual bleeding especially during acute episodes, norethisterone acetate being widely used for the same. Ormeloxifene is a new drug with promising results in managing HMB. The study was undertaken to compare the efficacy, safety and acceptability of Ormeloxifene /Norethisterone acetate in the medical management of heavy menstrual bleeding.Methods: This was a retrospective study conducted from January 2016 till December 2018 in which 98 women of reproductive age group presented with abnormal uterine bleeding without any organic, systematic and iatrogenic causes. The patients were divided into 2 groups. Those wanting contraception along with control of HMB were assigned to Group O and given...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connect... more Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosi...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive sp... more Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Endometriosis is defined as the presence and proliferation of the endometrium outside... more Background: Endometriosis is defined as the presence and proliferation of the endometrium outside the uterine cavity affecting an estimated 89 million women of reproductive age worldwide. Endometriosis occurs in 5% to 10% of all women, often resulting in debilitating pain and infertility, endometriosis at the scar site known as Scar endometriosis has also been described following obstetrical and gynecological surgery. Scar endometriosis has a much rarer incidence with an illusive presentation and is often misdiagnosed and definitive treatment gets delayed. Objectives of this study was to review the demographic profile, clinical presentation, treatment modalities and outcome in patients with scar endometriosis.Methods: The retrospective study of patients with scar endometriosis managed at DMCH during January 2014 to December 2018 was done.Results: Eight patients of scar endometrosis were diagnosed and operated in our institution over a period of five years. All patients (six with pre...
International journal of applied & basic medical research, 2013
Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 preg... more Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts, and multiple organ dysfunction syndromes. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. AP is most often associated with gall stone disease or hypertriglyceridemia. We present 2 years of experience during which we had eight patients of AP. Of the eight patients, three underwent laparoscopic cholecystectomy and five were treated conservatively. One had multiple cysts in the abdomen which were drained. All the patients delivered at term. Prophylactic tocolysis was given for 48-72 h to only those patients who had laparoscopic cholecystectomy. All the patients recovered completely. There was no maternal or fetal mortality. Wh...
International journal of applied & basic medical research, 2014
Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleedin... more Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient. The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years. A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment m...
International Journal of Applied and Basic Medical Research, 2014
The objective of this study is to review the clinical profile and outcome in patients requiring t... more The objective of this study is to review the clinical profile and outcome in patients requiring the angiographic embolization in obstetrics. The retrospective data of patients requiring uterine artery embolization for control of obstetrical hemorrhage was studied during the period from August, 2005 to August, 2010. A total of 35 patients with obstetrical hemorrhage (seven post lower segment caesarean section, 13 post vaginal delivery, 13 postabortal, one with cervical pregnancy and one patient post laparotomy for abdominal pregnancy) underwent angiographic embolization for control of bleeding. In all patients, hemorrhage was successfully controlled; none required post procedure hysterectomy and one patient subsequently became pregnant with in a year. Our clinical experience suggests that embolization is superior first-line alternatives to surgery for control of obstetric hemorrhage including postpartum, post-cesarean and postabortal bleeding and prevents hysterectomy.
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