Background

Ergot derivatives are commonly used for the treatment of postpartum as well as postabortal hemorrhage. Peripheral Gangrene is a rare acute complication of administration of ergometrine and its analogue in patients with postpartum or postabortal hemorrahge

Case report

We report a case of 25 years multipara with undiagnosed primary antiphospholipid antibody syndrome, develops fingertip gangrene after the use of Inj Methergine to manage postabortal hemorrage.

Conclusion

Methergine use always needs a word of caution, before its use we have to rule out all the contraindications and assess high risk patients who have high chances of complications.

Labetalol is a commonly used first-line drug for the treatment of gestational hypertension (GHT). It has rarely been associated with Raynaud’s phenomenon of the nipple (RPN). Herein, we report a case of labetalol-associated RPN, the first from India. A 30-year-old woman, gravida 1, para 0, with no significant medical history and regular antenatal check-up was diagnosed with GHT at 34 weeks of gestation. She was initiated on tablet Labetalol 100 mg twice daily. Around 1-hour after the first dose, she complained of severe burning sensation with severe tenderness at nipple-areola area, lasting 2-3 hours. She experienced similar symptoms, within 45 minutes of second dose and immediately contacted her Obstetrician. Subsequently, tablet Labetalol was withdrawn and tablet Nifedipine 20 mg twice daily was initiated, following which she did not experience any adverse events and pregnancy remained uneventfully till delivery at full-term. Spontaneous resolution of nipple-related adverse event, absence of similar event following initiation and continuation of Nifedipine, and review of literature allowed us to reach the diagnosis of labetalol-associated RPN. Through this case, we intend to report a rarely documented adverse event associated with Labetalol use in pregnancy. Moreover, Obstetricians should be made aware of Labetalol-associated RPN. When prescribing Labetalol in pregnancy, patient should be counselled regarding any nipple-related discomfort and encouraged to report on an urgent basis.

Case report of a 50 year old lady presenting with leiomyosarcoma after hysterectomy. This is a case of leiomyosarcoma occurring after a hysterectomy done for benign fibroids occurring after 3 years of the surgery. The rarity of this case is due to rare diagnosis of uterine smooth muscle tumour of uncertain malignant potential (STUMP) in patients and incidence of leiomyosarcoma in these cases.

A 59-year-old post-menopausal female presented with complaints of per vaginal spotting for 3 months. Histopathological examination of contents of dilation and curettage revealed endometrial carcinoma (FIGO stage I), along with benign endocervical polyps. MRI also showed presence of left-sided structure indicative of ectopic pelvic kidney. The patient underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy and bilateral ilio-obturator lymph node dissection. Dissection was started along the left pelvic plane. The left pelvic kidney was seen, and left ureter was located and confirmed below the uterus. The patient withstood the procedure well. Anomalies of pelvic anatomy, such as a malpresentation of the kidney and ureter, may prove as surgical challenges while performing open and laparoscopic surgery. However, in depth preoperative imaging, meticulous intraoperative dissection and proper identification of surrounding structures reduces the risk of such complications.

Tumor lysis syndrome is an oncologic emergency, usually occurs in hematologic malignancies and remains very rare in gynecological malignancies. We present a case of a young unmarried girl who presented with a large abdominopelvic mass with acute kidney injury and characteristic biochemical abnormalities of tumor lysis syndrome.

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors, originating primarily from interstitial cells of Cajal of the gastrointestinal tract wall with the majority of them KIT (CD117)-positive. Due to their non-specific clinical presentation, they may present a diagnostic dilemma in women with abdominopelvic mass. The current manuscript presents an unusual case of GIST originating from the omentum, which was preoperatively presumptively diagnosed as an adnexal mass during routine gynecological and radiological evaluation. Also, it highlights the importance of the multidisciplinary coordinated approach for the optimal care of such patients.

Postpartum hemorrhage is a long-running and frequent cause of maternal death in most developing countries and is associated with uterine atony. Nowadays, balloon tamponade has gained popularity due to its advantages. It is a technically simple, safely applied, time saver, and easily removed in a low-risk method and also needs less expertise and no special equipment. Despite all advantages, the Bakri balloon is very expensive in less developed countries and not available everywhere, especially in limited resource settings. Such disadvantages prompted us to perform an innovative, cost-effective, and practical method relying on low-resource equipment and named it “Glove Balloon.” A 26-year-old woman presented in her third pregnancy underwent an elective cesarean section. Following the surgeon’s mention of low segment atony, the patient returned to the operating room quickly. The bleeding continued despite the administration of uterotonic drugs, and because of active bleeding, the decision was made to apply a glove balloon. After gently inserting the glove balloon into the uterus, 500 ccs of saline was inflated into the balloon, and the bleeding stopped shortly afterward. The patient was discharged on the third postoperative day and remained well after. We believe that junior obstetricians and midwives should consider all options, even new strategies, to stop hemorrhages before considering invasive surgical procedures. The “Glove Balloon” is an innovative, practical uterine tamponade balloon that can make the difference between life and death in treating postpartum hemorrhage cases and should be considered a life-saver tool in all settings.

Nearly 25% cases of pyrexia of unknown origin (PUO) may be associated with malignancies but this fever can be attributed to a multitude of causes. In contrast, neoplastic fever by definition is a diagnosis of exclusion and a rarely reported presenting symptom of cancer. We share our experience of yolk sac tumour in an 18 year old unmarried girl who presented with high grade fever as the chief complaint. No cause could be found for her fever even after extensive workup and she failed to respond to empirical antibiotics. Response to oral Naproxen (Naproxen test) suggested the diagnosis of neoplastic fever in this patient. The patient was taken up for staging laparotomy after resolution of fever and unilateral salpingoophorectomy and omectectomy was done. The patient stayed afebrile following appropriate surgical management which further corroborated our diagnosis of neoplastic fever. This unsual presentation should be further studied and considered early on incases of malignancies to avoid delay in diagnosis and management.

Introduction Ovarian carcinosarcoma constitutes 1-4% of all ovarian cancers. The more common site of sarcoma in the pelvis is the uterus. In this paper, we are reporting a case of ovarian carcinosarcoma along with a brief literature review on this aggressive disease. Our case was initially operated at non- oncology centre and referred to us after incomplete surgery.

Case details A 44 year old non- hypertensive and non- diabetic nulliparous female presented to outpatient department with history of sub-total hysterectomy and right oophorectomy done for ovarian tumour at peripheral hospital one month back. Histopathological examination showed malignant spindle neoplasm. Immuno-histo-chemistry was suggestive of ovarian carcinosarcoma/ mixed mullerian tumour with stromal overgrowth. The patient underwent completion surgery and with completion of cytoreduction (CC) score of zero. Final histopathological examination revealed it to be a stage IIIC disease with intra-abdominal metastasis. The patient completed platinum based adjuvant chemotherapy within stipulated time. However, the disease progressed within one month of completion of chemotherapy and the patient is currently recieving second line agent.

Conclusion Given that carcinosarcoma are rare, prospective datas are lacking and case reports, series and observational studies contribute to the understanding of natural course of the disease. This case report stresses upon the need to widen our vision for the rare histologies and their timely diagnosis and appropriate management. This case also affirms the aggressive behaviour of the disease as cited in the previous literature.

An intrauterine contraceptive device is a temporary method of contraception accepted widely all over the world. Although it is safe, complications may occur likewise with any other foreign body. Uterine perforation and extra-uterine migration are rare but serious complications. Here, we describe a case of spontaneous fracture and transmigration of the intrauterine contraceptive device (CU-T 380 A) in the urinary bladder resulting in vesical stone formation.

Body dysmorphic disorder (BDD) was first described centuries ago but it is still unknown to many clinicians. Although onset of body dysmorphic disorder occurs in adolescent age but BDD has received very little attention in adolescent psychiatry literature. Here we are discussing a case report of 14 year girl suffering from belief of splitting of her clitoris. She would watch it in mirror multiple times and feel disgust due her malformed genital part. She would often become very distressed and force her family member for genital surgery. She was taken to gynaecologist. She was referred and treated successfully with use of SSRI and cognitive behaviour therapy.