ORIGINAL RESEARCH ARTICLE | March 5, 2021
A 5-year Study on Ectopic Pregnancy in North India
Dr. Jayati Nath, Dr. Akshara Mishra, Dr. Vaishali Verma, Dr. Somya Gupta
Page no 49-54
Ectopic Pregnancy, a life jeopardizing emergency, can land in disaster, if the diagnosis is missed. Any woman in the reproductive age group presenting with vaginal bleeding and abdominal pain- the first suspicion should be ectopic. This was a hospital based retrospective cohort study of 5 years in Haryana, North India (3 Tertiary Care Centres)- to evaluate the incidence, patient profile, high risk factors, clinical presentation, diagnostic methods, treatment, outcome and complications of the same. Statistical analysis was done by MS Excel spread sheet using SPSS software 19.0 version. A total of 175 cases of ectopic pregnancy were diagnosed during the study period (Incidence of 1.521%).Majority of the patients were in age group 21 to 30 years 101/175(57.71%) with nulliparous being 60/175(34.28%).Most important risk factors found were past history of miscarriage, pelvic surgery, tubal surgery and tubal ligation.75 % patients presented with the classical triad of lower abdominal pain, amenorrhoea, and bleeding per vaginum. Clinical diagnosis was possible in 85.71% while 11.4% patients were ultrasonographically diagnosed. 96.7 % were tubal ectopic gestations. Conservative expectant management was done in 2 patients, medical methotrexate therapy was given in 26 out of which 6 required surgery for failed therapy & 84 % were surgically managed. 54 % required blood transfusion and there were no deaths. We conclude that identifying common risk factors and being ectopic minded will help clinicians in diagnosing and managing ectopic pregnancy at the earliest to reduce morbidity and mortality associated with the condition.
CASE REPORT | March 13, 2021
Management of Pregnancy on Sickle Cell Disease: A Case Report
Mohamed Adnane Rhaidouni, Sofia Jayi, Mohamed Adnane Berdai, Ghizlane Berrady, Fatima Zohra Fdili Alaoui, Alpha Boubacar Conte, Hikmat Chaara, Moulay Abdelilah Melhouf
Page no 55-57
SS homozygotic sickle cell disease combines chronic hemolytic anemia with vaso-occlusive and infectious complications. The association between Sickle cell disease and pregnancy is a maternal and fetal high-risk situation. Case description: A 27-year-old woman carrying a pregnancy on a sickle cell field with a history of miscarriage and hospitalization in critical care department for post-abortion septic shock. Her pregnancy was followed in our department in collaboration with internists, under aspegic, acfol and tardyferon and during the pregnancy, she received three blood transfusions and a caesarean section was planned at 39 weeks of gestation. She gave birth to a newborn weighing 3600g in good condition. The post-partum was marked by a fortuitous discovery of IVC thrombosis. Conclusion: Sickle cell disease and pregnancy is a high-risk situation as we illustrate in our case. In addition to the absence of complications during pregnancy, post-partum also remains a period of risk even without obvious clinical manifestation
ORIGINAL RESEARCH ARTICLE | March 21, 2021
Socio-Environmental Co-Factors Associated with Cervical Cancer in Bangladesh
Md. Monirul Hassan, Dr. Taslima Nigar
Page no 58-62
Introduction: Cervical cancer is one of the major NCDs around the world and is the second leading malignancy in terms of mortality and incident cases in Bangladesh. The high mortality rate was associated with a lack of awareness regarding cervical cancer. The study was conducted to find out the relations between the incidence levels of cervical cancer, and social and environmental co-factors. The aim of the study was to figure out the socio-environmental factors of cervical cancer patients in Bangladesh and measure their effects on the incidence numbers. Methods: This was a cross-sectional study conducted over 4 months with a sample size of 100. The study was conducted with only female subjects in Dhaka city, among the patients coming to the Genealogical Department of the NICRH. Result: The majority of the patients were above the age of 40 and only 20% of the patients were under the age of 40. 69% of cancer patients had no education. 31% had some level of education. 88% of the cancer patients were housewives. 2% were involved in agriculture and 10% were in other occupations. Over half had a monthly income of less than 10,000 BDT. Almost 3/4th of the patients got married before the age of 17. The study subjects had a higher-than-average number of children, with 57% of them having 3-5 children, 27% of patients had less than 3 children and 16% of them had more than 5 children. The majority of the patients were admitted with advanced stages of cancer. Only 2% had been admitted with stage I disease. Conclusion: The study showed a surprising lack of knowledge of cervical cancer and the socio-environmental factors that play a part in it. Awareness was positively related to education level.
ORIGINAL RESEARCH ARTICLE | March 23, 2021
Fetal Outcome of Preeclamptic Mother in a Tertiary Care Level Hospital
Dr. Begum Shaira Sharifa, Dr. Taslima Begum, Dr. Shamsun Nahar, Dr. Gazi Golam Mostofa, Dr. Shazia Afrine Eva, H. M. Hasan Imam
Page no 63-66
Background: Hypertension is the most common diagnostic sign of preeclampsia, although some women present with convulsions, abdominal pain or general malaise. Preeclampsia occurs in 5 to 7 percent of all pregnancies. Although its pathogenesis is incompletely understood, it is a major cause of maternal and neonatal morbidity and mortality. Objectives: The aim of the study was to evaluate the fetal outcome in preeclamptic mothers in a tertiary Hospital. Methodology: The Study was conducted in the department of obstetrics and gynecology of Sylhet MAG Osmani Medical College Hospital. Sylhet, Bangladesh to find out the common indications of fetal outcome of preeclamptic mother. 120 cases were randomly selected for the study whose common indication of fetal outcome of preeclamptic mother. Clinical examination and evaluation were done from July 2006 to June 2007. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Comparison of mean (±SD) age (24.30±4.03 and 24.654.41 years) and height (61.43±1.80 and 61.92±1.52 ern) did not show any significant difference. However, comparison of mean (±SD) weight (71.20+4.38 and 69.27±2.86 kg), blood pressure (systolic: 154.83±9.48 and 112.33±11.10; diastolic: 102.58±9.94 and 71.33±6.23 mmHg), gestational age (36.12±2.45 and 38.42± 1.03 weeks) and gravidity (1.45±1.13 and 1.10±0.30) showed significant differences between case and control groups. Conclusions: To avoid and/or reduce fetal and neonatal morbidity and mortality among preeclamptic women, careful examination and investigations are required for early detection and thus to reduce. Maternal and fetal morbidity and mortality.
CASE REPORT | March 30, 2021
Woman with Partial Androgen Insensitivity Syndrome and Bilateral Sertoli Cell Tumor: A Rare Case Report
Dr. Tandra Ghosh, Dr. Shakeela Ishrat, Prof Jasmine Banu, Prof Md Ruhul Amin, Dr. Nighat Sultana, Dr. Sadia Afrin Munmun, Dr. Mumtahena Amir, Dr. Abhijit Roy
Page no 67-71
Partial Androgen Insensitivity Syndrome (PAIS), a 46XY disorder of sexual differentiation where there is partial loss of function of androgen receptors (AR). The spectrum of clinical presentation can vary in adult from phenotypic female with mild virilization to under virilized male with or without genital ambiguity. Case description: A 25 years old woman presents with primary amenorrhea, ambiguous genitalia and features of mild virilization like hirsutism and voice change. After admission in Reproductive Endocrinology and Infertility Department of Bangabandhu Sheikh Mujib Medical University, she underwent genitoplasty, vestibuloplasty and bilateral gonadectomy. Histopathology of the atrophic testes revealed Sertoli cell tumor. Conclusion: Partial Androgen Insensitivity Syndrome (PAIS) is presented clinically as ambiguous genitalia, as predominant female to male phenotype with varying degree of virilization. Multidisciplinary approach of management aims at appropriate sex assignment, reconstructive surgery, gonadectomy to prevent tumor genesis and hormone replacement therapy.
CASE REPORT | March 30, 2021
Woman with Unclassified Mullerian Anomaly, Polycystic Ovary Syndrome and Infertility: A Case Report
Dr. Shakeela Ishrat, Dr Farhana Parveen, Dr. Muhammad Jasim Uddin, Dr. Sabiha Sultana, Dr. Mehnaz Mushtary Shume, Dr. Serazoom Munira, Dr. Sheikh Farhana Huda
Page no 72-75
Mullerian anomalies cannot always be defined in one or the other class, as described by the American Society of Reproductive Medicine. One such unclassified anomaly incidentally found in a infertile women with polycystic ovary syndrome, was difficult to diagnose with existing imaging modalities. The final diagnosis was not made until after the surgeries including diagnostic laparoscopy and hysteroscopy.
ORIGINAL RESEARCH ARTICLE | March 30, 2021
Demographic and Clinical Features of Patients with Subfertility
Dr. Polly Ahmed, Dr. T.A Chowdhury, Dr. Kaniz Mahmud
Page no 76-81
Aim and Background of the study: Subfertility is an intricate health problem which is rising dramatically. Patient’s demographic factors along with pelvic pathology significantly important for uprising trend. The aim of this study was to evaluate the demographic and clinical characteristics of patients with infertility specially identifying the ovulatory disturbance, tubal factors, pelvic adhesion and endometriosis by Laparoscopy. Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh from May, 2007 to October 2007. The sample size was 100.Result: In this study, among 100 patients 68% had primary and 32% had secondary infertility. 55.9% were within 20 to 30 years age group and 44.1% above 30 years age in primary subfertility. 21.9% were within 20 to 30 years age group and 78.1% above 30 years age group in case secondary subfertility. 58% patients were house wife. 42% of patients were service holder they were teacher and other professional personnel. In this study majority (77%) of patients are from upper-middle class and middle class family. Out of all patients of primary infertility 58.8% had regular, 44.2% had irregular cycle 30% had scanty, 20% had menorrhagia and 29.4% had dysmenorrhea. Within secondary infertility
group 87.5% had regular, 12.5% had irregular cycle 25% had scanty, 21.4% had menorrhagia and 75% had dysmenorrhea. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4%right & 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right & 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases. In this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder. In this study, Pouch of Douglas was normal in 77% cases, 7% had endometriotic deposits 16% had adhesion and obliteration of Pouch of Douglas. In this study 74% of patient had normal size of uterus, 3% had uterus smaller than normal size and 23% had bulky uterus. 83% patient had freely mobile uterus and rest had restricted mobility. Conclusion: From analyzing the findings, we recommend that awareness developing program about the factors affecting infertility should be taken. Laparoscopy is more convenient, conclusive & more precise for diagnosing the cause of subfertility. Early diagnosis and treatment should be encouraged among couple.