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Ruptured Ovarian Ectopic Pregnancy- A Rare & Real Life Threatening Case

Ruptured Ovarian Ectopic Pregnancy- A Rare & Real Life Threatening Case

-A 24 year old woman, resident of Kamothe (Panvel)- Sector 11, came to OPD for consultation for Abortion tablets, 

-She had a living female child of 2.5 years of age by normal delivery. ( G-2,P-1,L-1)

-She had missed her menses and her UPT- Urine Pregnancy Test was positive.

-She has been complaining of on & off menstrual like lower abdomen cramps, which on some moments were severe.

-But she did not start with menses.

-On examination- her lower abdomen was slightly distended.

– Pulse rate was 92/min and BP- 100/70 mm Hg

– As a routine test and precaution before giving abortion pills , Trans-Vaginal ultra sound was performed.

-The findings suggested intra-abdominal free fluid amounting to 700-800 ml

-There was G-Sac ( Gestational sac ) like structure near left ovary which was surrounded by a mass of tissue , which seemed to be attached to left ovary.

-Diagnosis of Ovarian ruptured ectopic pregnancy was suspected as there was a breach in the outer lining of ovary too and adnexal mass was lying just close to that, along with echogenic mass lesion in the ovary (Trophoblastic Tissue).

– She was immediately posted for Laparoscopy by Dr Santosh Jaybhaye , Om Sai Hospital, Kamothe.

– On putting the scope, the first finding that we noted was Haemoperitoneum ( Blood in peritoneal cavity)

– Upon suctioning and cleaning it up, it was then possible to locate ruptured Left ovarian ruptured ectopic pregnancy.

– Mass lesion was resected ( surgically cut ) and Haemostasis ( There is no longer bleeding ) was achieved.

– She required one unit of packed cells blood transfusion intra-operatively and her recovery post operatively was uneventful.

-Following routine safety protocols, timely intervention and availability of blood products saved the life of the woman

-You Can watch the video too by clicking on the following link-

 

 

 

 

Menopausal Transition-Take Care, Don’t Pause

20.12.18

Hello friends,

As this topic ‘Menopausal Transition’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone, we are starting an article series.The introductory article will give you a glimpse about how will we go about it.

Let’s start

-The   menopausal transition is a progressive endocrinological continuum that takes reproductive aged women from regular cyclic and predictable menses that are characteristic of ovulatory cycles to a final menstrual period associated with ovarian senescence.

-The term menopause refers to a point in time that follows one year after the   cessation of menstruation.

– The post menopause describes those years following this point. The average age of women experiencing their final menstrual period is 51-52 years.

–  The hormonal changes begin to happen a few years earlier to cessation of menses and extend to one year after that. These years are referred to as menopausal transition.

– We will discuss the changes that happen during this period that will include: –

– Physiological changes- under this head we will discuss hormonal changes that occur in hypothalamus, pituitary, ovary and adrenal glands.

– Endometrium is the lining of the uterus, that sheds with menses.  We will discuss menstrual disturbance patterns and fertility potential during menopausal transition

-The woman experiences thermoregulatory changes or vasomotor symptoms   such as hot flushes. We will discuss what causes it and its treatment part.

– Female hormones – Especially estrogen is very essential for maintaining strength of bones. When estrogen levels fall with menopause, skeletal disorders like osteopenia and osteoporosis may set in.

-We will discuss pathophysiology, diagnosis, prevention and treatment of these disorders.

– Menopausal transition and hormonal changes associated with it for changes in other systems too like, cardiovascular system, weight gain and fat distribution, skin changes, breasts changes, sleep disorder, psychosocial changes and sexual dysfunction.

-Along with this we will also discuss physical examination and lab testing for these disorders.

-So, friends you do get an idea of what all things we will cover under this topic ‘Menopausal Transition’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Pre-Cancerous Lesions of the Lower Genital Tract of Women

20.12.18

Hello friends,

As this topic ‘Preinvasive/Pre-Cancerous Lesions of the Lower Genital Tract of Women’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Pre-invasive lesions of the genital tract also is referred to as intraepithelial neoplasia which essentially means that the pathology or lesions are diagnosed by biopsy and histologic evaluation.

– These lesions include squamous epithelium or superficial surfaces of cervix, vagina, vulva, perineum and anus.

-In this series we will talk about the grading of these lesions and their terminology.

-In brief we will discuss pathology of external genitalia and vagina.

– However, we will discuss in detail the pathology involving cervix.

– I would like to mention that the formation and dynamics of cervix is such that squamo-columnar junction plays a big part in its pathology.

– This junction undergoes changes depending upon age, hormonal status and many other factors which we will discuss.

– Transformation zone which is the origin point of cervical cancer usually lies near to squamo-columnar junction. We will discuss relation between them.

-Human papilloma virus also known as HPV is the causative factor of cervical cancer.

-About HPV we will discuss its life cycle, types of virus, HPV transmission, outcome, natural history, diagnosis, treatment and prevention of HPV infection.

-While discussing cervical intraepithelial neoplasia we will talk about it incidence, natural history and risk factors.

-For its diagnosis cervical cytology also popularly known as Pap’s smear, HPV testing and colposcopy is used. We will discuss the guidelines and various procedures involved.

-Biopsy means microscopic evaluation of a piece of cervix. We will discuss its procedure.

-In management of cervical intraepithelial neoplasia, we will discuss ablative and excisional methods along with post treatment surveillance.

-For lesion involving vagina, vulva and anus we will discuss their pathophysiology, risk factors, diagnosis, treatment and prognosis.

-So, friends you do get an idea of what all things we will cover under this topic ‘Preinvasive/Precancerous Lesions of The Lower Genital Tract of Women’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Pelvic Mass in Women: Let’s Bring Clarity

20.12.18

Hello friends,

As this topic ‘Pelvic Mass in Women’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone, we are starting an article series.

The introductory article will give you a glimpse of how will we go about it. Let’s start:

– Pelvic masses are a common finding.

– In this series, we are going to talk about gynaecological reasons for these masses, their symptoms, evaluation and treatment.

– The pathology of pelvic masses differs with each age group namely- pre-pubertal girls, adolescents, reproductive-aged women and post-menopausal women.

– We will have a discussion age group vies about concerned pathologies.

– In the discussion of uterine causes, we will discuss leiomyoma or commonly known as fibroid.

We will discuss is the pathology, hormone effects, risk factors, classification, symptoms, management options- which include drug therapy and many modalities of surgery like myomectomy and hysterectomy and their routes like hysteroscopy, laparoscopy and laparotomy.

– We will talk about adenomyosis- its pathogenesis, risk factors, symptoms, diagnosis and management.

– We are going to discuss masses arising from the ovary.

An ovarian mass is a vast group. Our discussion will be mainly on ovarian cystic masses and functional ovarian cysts.

– In this, we will discuss its pathogenesis, risk factors, symptoms, diagnosis and management.

– In tubal pathology, we will have a discussion on hydrosalpinx.

– In the next update of the article of this series, we will take one of the above-listed topics and bring more clarity on that

– Keep a watch on this article itself as a dated update will arrive soon.

Techniques Used for Imaging in Gynaecology

20.12.18

Hello friends,

We are starting a new series of write ups that will give information & knowledge about a major Gynaecology related topic,the first of which being

-Techniques used for imaging in gynaecology 

-The first modality is sonography

-We will discuss about the routes of sonography that are trans- abdominal and trans- vaginal

– Doppler Technology which is study of blood flow through blood vessels in pelvic organs

-We will tell you about the normal sonographic findings of female reproductive tract organs and normal condition of endometrium and evaluation of pelvic floor

-We will discuss clinical applications of sonography in determining pathological condition of uterus like fibroids and adenomyosis,endometrial abnormalities

-Pathological conditions of ovaries that include tumors and torsion

– Pelvic inflammatory disease -Benefits of 3D sonography

-We will discuss HSG or hysterosalpingography as fallopian tube’s patency test in infertility cases 

-Discussion on CT scan will include

-Normal pelvic anatomy

-Importance of CT scan after gynaec surgery and gynaec malignancy

-Discussion on MRI will include 

-Normal findings on MRI

-Uterine abnormalities like fibroids and adenomyosis

-Congenital anomalies of genital tract

-Adnexal masses

-Gynecologic malignancies of cervix, endometrium and ovaries

– so friends, you do get an idea of what all things we will discuss

-In next article update of this series we will take one of the above listed topics and have a discussion on that

All the diagnostic and imaging techniques are a great benefit in aiding  a clinician to arrive at a diagnosis timely.Opinion of an expert Radiologist means a lot. Some of these investigations like sonography/ ultrasound/ doppler sonography and MRI are free from radiation. Others like HSG and C T -Scan involve radiation .Some investigative techniques can be operated in OPD setting and others require a specialized set up

-So, friends you do get an idea of what all things we will cover under this topic ‘Preinvasive/Precancerous Lesions of The Lower Genital Tract of Women’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Gestational Trophoblastic Disease-a Strangely Abnormal Pregnancy

20.12.18

Hello friends,

As this topic ‘Gestational Trophoblastic Disease’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Gestational trophoblastic disease or GTD refers to a spectrum of interrelated but histologically distinct tumors originating from the placenta.

– These diseases are characterized by a reliable tumors marker beta HCG   and have varying tendencies towards local invasion and spread.

-Gestational trophoblastic neoplasia or GTN refers to the subset that develops malignant and cancerous sequelae.

-We will discuss incidence and risk factors of GTD.

– Hydatidiform mole or molar pregnancy is the subset which is benign or non- cancerous in nature.

-It is divided into two complete and partial hydatidiform mole. In this discussion we will see karyotype pattern, microscopic and macroscopic findings and clinical findings.

– Diagnosis of  mole is usually done by beta HCG estimation, trans- vaginal sonography and histopathology.

– Management requires suction evacuation of molar pregnancy and post molar surveillance by serial beta HCG level estimation. We will have a discussion on that.

-Gestational trophoblastic neoplasia include

-Invasive mole

-Gestational  choriocarcinoma

-Placenta like trophoblastic tumor and

-Epithelioid trophoblastic tumor

We will discuss criteria for diagnosis of GTN and their individual features.

– Most GTN cases are clinically diagnosed based on beta HCG levels.Tissue histology is also used.

-After diagnosis patients with GTN undergo thorough pre-treatment assessment including CT scan.

-Staging is done as per Gynaec society and WHO guidelines.

-This disease is divided into non-metastatic and metastatic disease.

– Treatment of GTN is either surgical or with chemotherapy.

-We will also discuss psychological consequences and subsequent pregnancy outcome of this disease.

-So, friends you do get an idea of what all things we will cover under this topic ‘Gestational Trophoblastic Disease’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Medical Investigations of Couple Seeking Fertility

20.12.18

Hello friends,

As this topic ‘Evaluation of Couple Seeking Fertility’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series. The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Infertility is defined as the inability to conceive after 1 year of unprotected intercourse of reasonable frequency.

– it can be subdivided into primary infertility, that is no prior pregnancies and secondary infertility referring to infertility following at least one prior conception.

– We will look into the definition of fecundability and population studies and its relation to age.

-We will discuss when should we consider investigations in a couple.

– We will have a discussion on etiology

– that is causative factors, both male and female leading to infertility.

– Medical History taking of both partners will be discussed that will include medical, surgical, medication and social aspects.

-Importance of physical examination will be explained.

-There are certain tests which determine specific causes of infertility like-

– Ovulation studies

-Tubal and pelvic factors

-Uterine abnormalities and

-Cervical factors

We will have a discussion on these factors

-We will have a separate discussion on normal and abnormal production of sperms and its evaluation.

-So, friends you do get an idea of what all things we will cover under this topic ‘Evaluation of Couple Seeking Fertility’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that -Keep a watch on this article itself as a dated update will arrive soon.

 

 

Cervical Cancer- a Leading Cause of Cancer in Women

18.12.18

Hello friends,

As this topic ‘Cervical Cancer‘ is a vast topic concerning women, we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Cervical cancer is the most common gynecologic cancer in the women.

– While discussing incidence we will see the age pattern of those women who get this cancer.

-Infection with Human Papilloma Virus also known as HPV is the major risk factor.

-Other risk factors being low socioeconomic status, cigarette smoking, reproductive behaviour and sexual activity.

-In pathophysiology we will discuss how and where tumour cells originate along with it spread to local and distant areas.

-Histology reveals that most common sub-types of cervical carcinoma are squamous cell carcinoma and adenocarcinoma.

– We will discuss these types in detail and also their prognosis comparison.- Diagnosis of cervical cancer is based on its symptoms, physical examination of patient, Pap’s smear, colposcopy and cervical biopsy.

-We will have a detailed discussion on each modality.

– Staging of Cancer helps in deciding the treatment options and prognosis. For cervical cancer staging is done clinically. In easy language we will explain the staging of cancer for everyone’s understanding.

-During evaluation of cervical cancer many tests are needed. They include  -Testing of blood for various parameters

– Radiologic investigations include chest X-ray, IVP, CT Scan MRI and PET scan

-Certain procedures like cystoscopy and proctoscopy may also be needed. We will have discussion on them too.

-We will have discussion on lymph node dissection and prognostic factors.- Procedures required for treatment of cervical cancer depend upon its clinical staging. it includes

– Cervical conization

-Simple or radical hysterectomy

-Trachelectomy

-Lymphadenectomy

-Chemoradiation and

-Palliative chemotherapy

-We will discuss surveillance of patient following surgery for radiotherapy.

– We will also discuss management of cervical cancer during pregnancy.

-So, friends you do get an idea of what all things we will cover under this topic ‘Cervical Cancer’

In next update of article of this series we will take one of the above listed  topics and bring more clarity on that-Keep a watch on this article itself as a dated update will arrive soon

Endometriosis-a Medical Dilemma in Women

18.12.18

Hello friends,

As this topic ‘Endometriosis-A Medical Dilemma’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Endometriosis is a common benign gynecologic disorder defined as the presence of endometrial glands and stroma outside of the normal location.

– The word endometrium means- inner lining of the uterus which gets shed every month during menstruation.

– Endometriosis gives rise to variety of symptoms in women of chiefly reproductive age group.

– In simple language we will explain the causes of endometriosis, its hormone dependence and role of the immune system.

– We will discuss   risk factors of endometriosis.

– We will discuss its classification system and anatomic sites where it is present.

– Patient may present with pain of various origins, infertility of various degrees and in advanced cases- intestinal and ureteral obstruction.

– In diagnosis of endometriosis, we will discuss physical examination, lab testing, role of sonography, CT scan, MRI, importance of diagnostic laparoscopy and histopathologic analysis.

– Treatment of endometriosis depends on many factors like severity of symptoms, location of endometriotic lesions and desire to conserve future fertility.

– Medical management of endometriosis requires giving non-steroidal anti-inflammatory drugs, hormones, GnRH agonists and GnRH antagonists.

– The route of surgical treatment can be either laparoscopy or laparotomy. it can include lesion removal and adhesiolysis, endometrioma resection and hysterectomy with bilateral salpingo-oophorectomy-

So, friends you do get an idea of what all things we will cover under this topic ‘Endometriosis’.

-In next update of article of this series we will take one of the above listed  topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon

Ectopic Pregnancy-a Devastating Outcome of Pregnancy

18.12.18

Hello friends,

As this topic ‘Ectopic Pregnancy’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-An ectopic or extra uterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity.

-We will discuss the factors that will help in explaining the increased incidence of ectopic pregnancy.

-There are consequences of ectopic pregnancy like tubal rupture and tubal damage which are associated with maternal morbidity and in rare cases with mortality too. We will have a discussion on that.

-We will discuss clinical symptoms and signs of ectopic pregnancy.

-Certain blood tests and sonography or ultrasound aid in arriving at a diagnosis. We will have discussion on these findings.

-Ectopic pregnancy can be managed either medically or surgically.

-There are certain criteria to be met during medical management, we will discuss that.

-Surgical treatment is either by laparotomy or laparoscopy.

-Surgery done is either salpingectomy or salpingostomy.

-So, friends you do get an idea of what all things we will cover under this topic ‘Ectopic Pregnancy’

-In next update of article of this series we will take one of the above listed  topics and bring more clarity on that-Keep a watch on this article itself as a dated update will arrive soon.