Aparna Krishnamurthy

Abstract

Ovarian torsion is one of the common gynaecologic surgical emergencies. Ovarian stimulation in infertility treatment has become a major risk factor for ovarian torsion. The diagnosis of the condition is challenging in early pregnancy and timely diagnosis can prevent morbidity of both mother and foetus. We present a case of 28 years old primi gravida known case of polycystic ovarian syndrome (PCOS) conceived after ovulation induction, at 7 weeks period of gestation with right ovarian torsion. Laparoscopic untwisting of the ovarian pedicle and debulking of multiple follicular ovarian cysts bilaterally was done. Patient withstood the surgery well and the pregnancy continued uneventfully. The patient progressed to deliver a healthy male baby at 40 completed weeks of gestation.   Keywords: Ovarian torsion, Pregnancy, Laparoscopy, Untwisted.

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Abstract

Introduction: Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture. Materials and Methods : Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used. Results: The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one. Conclusion: The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity.   Keywords: Asymptomatic bacteriuria, Trimester, Pyelonephritis, Morbidity, Sepsis, Microscopy.

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