Paapa Dasari

Abstract

A 29-year-old second gravida, previous abortion with twins, was induced at 32 weeks because of severe pre-eclampsia. Emergency caesarean section was needed for the second of twins, at which time she had an atonic postpartum haemorrhage. Bilateral uterine vessel ligation followed by B-Lynch suture was undertaken due to failure of medical measures. Post-operatively she had a stormy course with high spiking temperature and distension of abdomen and on imaging suspected foreign body in the uterus or uterine necrosis. At laparotomy, there was 6 liters of foul-smelling peritoneal fluid, and there was a deep groove on the uterus with impending perforation and partial necrosis of the uterus. After removing the suture, the perfusion slowly resumed, and hysterectomy was deferred. After five months, she expelled a necrotic tissue of the uterine cast. After six months, she resumed menstruation, and after three years, she had an intrauterine pregnancy, and presently, at five years, she has regular menstruation.   Keywords: Emergency caesarean section, PPH, Uterine vessel ligation, B­Lynch suture, Uterine necrosis, Re-laparotomy.

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Abstract

Menarche, the beginning of menstrual function occurs as a result of complex interaction between the hypothalamus, pituitary and ovarian hormones and is an important event in any girl’s life as it signifies the beginning of fertility. Rarely some diseases like migraine, epilepsy, inherited bleeding disorders can manifest at menarche and cause significant anxiety to the parents and the adolescent girl. A 13-year-old girl presented with convulsions following 8 days of excessive bleeding at the time of menarche. She had altered sensorium, severe anaemia with Respiratory alkalosis and needed ICU Care. She needed multiple transfusions of blood and blood products. She showed features of sepsis on haemogram at admission later manifested respiratory findings. Her bleeding per vaginum did not respond to antifibrinolytics and progesterones and stopped only after evacuation of contents on day 5 under GA. No organism could be isolated and she recovered on Day 6 of higher broad spectrum antibiotics. Her parents were counselled to watch for occurrence of seizures in later life as this catastrophe may signify onset of epilepsy in later life.   Keywords: Menarche, Seizures, Puberty menorrhagia.

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Abstract

A 30-year-old primigravida who conceived following ICSI (Intra Cytoplasmic Sperm Injection) was admitted at 34 weeks of pregnancy with singleton fetus in breech presentation with Gestational diabetes and Gestational hypertension. To start with Quintuplets were diagnosed and she underwent fetal reduction of 3 foetuses at 14 weeks of pregnancy. Follow up USG revealed only one live fetus after one week. At LSCS (Lower Segment Caesarean Section) performed at 37 weeks, the placenta was found to be adherent and was manually removed. There was profuse bleeding after removal of placenta which was not controlled with uterine massage and uterotonics. Placental examination showed 3 fetus payraeceae. Intrauterine examination revealed an adherent fetus which was removed following which the haemorrhage stopped. In pregnancies following fetal reduction, postpartum haemorrhage can result due to retained fetus papyraceus and hence it is essential to make sure all papyraceae were removed. Keywords: Quintuplets, Foetal Reduction, Foetus Papyraceous, PPH.

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Abstract

A 29-year-old young third gravida with history of previous 2 caesarean sections who was referred as partial mole at 9 weeks of pregnancy was evaluated and diagnosed to have missed abortion. Clinically her general condition was good, uterus was 14 weeks size and she underwent suction evacuation. Torrential haemorrhage occurred after removal of some products of conception and a bag like structure was felt in the lower pole of uterus on passage of curette. Onsite USG evaluation suspected scar pregnancy and she underwent immediate laparotomy and bilateral internal iliac artery ligation because of haemorrhagic shock. At laparotomy left lateral wall mass of size 2x3 cm was found which was communicating to the uterus suggestive of Isthmocele. Excision and repair was carried out and she recovered well due to timely blood transfusion. This finding of isthmocele was missed on routine ultrasound evaluation prior to management plan mainly because of its location. Keywords: Previous caesarean section, Isthamocele, Suction evacuation, Maternal near miss.

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