We report a case of late pregnancy following in vitro fertilization, complicated by severe early preeclampsia in a 45-year-old primigravida. The treatment was conservative for two weeks and then the pregnancy was terminated by caesarean section in view of the worsening of the clinical and biological parameters. The maternal prognosis was favorable. As for the perinatal prognosis, it resulted in prematurity, intrauterine growth retardation and neonatal respiratory distress requiring transfer to neonatal intensive care. Thus, when a couple wishes to have recourse to IVF or ICSI for a late pregnancy, health professionals must inform them of the probable increases in the risks for the woman but also for the child.
ORIGINAL RESEARCH ARTICLE | Sept. 20, 2022
Effect of Misoprostol in Third Trimester of Pregnancy- A Multi-Center Study in Bangladesh
Dr. Tahmina Begum, Dr. Ferdousi Begum, Dr. Meherunnessa, Dr. Nazrul Islam
Background: Misoprostol is an analogue of prostaglandin (PGE1) and the first registered PGN used for the treatment of peptic ulcer disease. Misoprostol should not be used in pregnant women but it can be used in termination of intrauterine fetal death (IUFD). It has been used for the induction of abortion in the first and second trimester of pregnancy. Misoprostol has already been proved to be effective and efficient for second trimester since 1987. There is insufficient information available from clinical trials to support their use to induce labor in third trimester of pregnancy. Aim of the study: The aim of this study was to describe the effect of misoprostol in third trimester of pregnancy. Methods: This retrospective study was carried out in two large hospitals in Dhaka city, which is the capital of a South Asian country, Bangladesh. The record of the studied subject was taken from the Department of Obstetrics and Gynecology of Alpha Hospital and the maternity ward of Beta Hospital from June 2018 to August 2019. The actual names of the two hospitals are pseudonym for privacy. A detailed history of each patient was taken and physical and obstetric examination were done. In total 52 patients were investigated and data were analyzed by SPSS version 23.0. Results: In this study, the primi gravida response time was found as the highest. On an average 20.34 hours was needed for the primi gravida category. In single, 2 and multi-parity cases the average pain response times were found as 16.3125, 10.3375 and 14 hours respectively. In Primi, 2nd, 3rd and 5th gravida cases the average delivery times were found 13.0714, 12.5938, 9.0769 and 3 hours respectively. Against single, two and three doses of misoprostol, the average pain response times were found 7.6875, 11.5375 and 19.25 hours respectively. Conclusion: In this study, it had been found that, most of the patient of IUFD was ‘primigravid’ (30.8%) of total respondents having complication with medical and endocrinal disease. Pre- eclampsia is more common in prim gravid than multi. There is history of thyroid dysfunction. In some cases, now a day, GDM is the cause behind IUFD.
ORIGINAL RESEARCH ARTICLE | Sept. 28, 2022
Observing the Maternal Complications and Fetal Morbidity and Mortality of Preterm Birth
Dr. Khadiza Begum, Dr. Umme Rehnuma Tarannum, Dr. Priyanka Waddedar, Dr. Sulekha Bhattacharjee
Introduction: Preterm labor is one of the clinical events that can change a normal pregnancy into a high-risk one for both the mother and the fetus. Preterm labors are thought to be caused by a combination of factors, including decidual bleeding and uterine deformation. Aim of the Study: The aim of the study was to observe the maternal complications of preterm birth. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Chittagong Medical College Hospital, Bangladesh. The study duration was 6 months, from January to June of 2015. Purposive sampling method was used to select a total of 100 women from those admitted at the study hospital for deliveries according to inclusion and exclusion criteria. Result: Most of the patients were from the third decade of life. Majority (61.0%) patients had multi para. Majority (39.0%) patients were gestational age 34 weeks. More than half (53.0%) had infection, among which urinary tract infection were the most common. Neonatal death was 61%, and most common cause of neonatal death was septicemia, followed by respiratory distress syndrome. Conclusion: Most of the patients were in 3rd decade of life, and did not receive regular antenatal check-up. Infection and pre-eclampsia were the most common maternal complications, while respiratory distress syndrome was the most common perinatal morbidity. Septicemia and respiratory distress syndrome were the most common cause of perinatal death.
ORIGINAL RESEARCH ARTICLE | Sept. 30, 2022
Unilateral and Bilateral Involvement of Ovarian Tumors According to Histopathological Types
Introduction: Ovarian neoplasm is produced by the rapid growth and division of cells within the ovary. Under normal circumstances, ovarian cells reproduced to maintain tissue health. When growth control is lost and cellular division is too much and too fast, a cellular mass or tumor is formed. Ovarian neoplasm is the one of major gynecological malignancies & is a frequent site for primary & metastatic tumors. Due to its complex structure, primary ovarian neoplasm manifests a wide spectrum of clinical, morphological & histological features. Ovarian neoplasm has become increasingly important, not only because of a large variety of neoplastic entities but also because they have gradually increased the mortality rate due to genital cancer. The study aimed to find out the unilateral and bilateral involvement of ovarian tumors according to histopathological types. Methods: This cross-sectional study was carried out among forty-five patients who were admitted to the department of gynecology at Shaheed Suhrawardy Medical College & Hospital with features of ovarian neoplasm from February 2013 to February 2014. Result: A total of 45 cases were studied in this present study. Patients were of age group 2nd to 7th decade with ovarian tumors. Among 45 cases majority had benign tumors (82.3%), followed by malignant tumors (15.5%). A case of borderline tumor (2.2%) was also found. Benign tumors were the commonest in the 3rd decade. The highest frequency of malignant tumors was in the 4th to 6th decade. Germ cell tumors were found at a young age and sex cord-stromal tumor was found in the 5th decade. Most of the benign tumors (67.56%) were cystic, the rest 27.03%, and 5.42% of cases were partly cystic and partly solid respectively. Among benign tumors, two of the mature teratomas were solid. About 42.86% of malignant tumors were solid, 42.86% were partly cystic partly solid and only 14.28% cases were cystic. Among the malignant tumors, serous cystadenocarcinoma was solid in 3 out of 4 cases and the rest of the malignant tumors of different histology were partly cystic and partly solid. Borderline Brenner tumor was solid in morphology. Most of the benign cases were unilateral 78.38% and the rest 21.62% were bilateral. Among the benign cases, serous cystadenoma showed the highest percentage covering 45.95% followed by mucinous cystadenoma at 18.92%. The borderline tumor showed unilateral distribution. Among malignant cases 57.14% were bilateral and 42.86% were unilateral. Conclusion: This study concludes that benign ovarian tumors are more common from the 3rd decade & malignant tumors occur in the 4th to 6th decade. This study also showed that most of the benign tumors were cystic. Malignant ovarian tumors had an equal percentage of being solid entirely and partly cystic partly solid. Most benign cases were unilateral and malignant cases were mostly bilateral.
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