The outbreak of COVID-19 has become a globally concerning pandemic having affected more than 5 million people worldwide. The disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious. Only limited literature exists on the evaluation and management of pregnant women with suspected or confirmed COVID-19. In this short commentary, we inform the readers of the potential role of chest CT in symptomatic COVID-19 pregnant women and the related limitations.
Keywords COVID-19 • Coronavirus • Chest CT • Pregnancy • Severe acute respiratory syndrome coronavirus-2 • SARSCoV- 2
Informed consent process has become a challenging issue before surgery for any emergency obstetric care during this COVID pandemic. There is an increased risk of morbidity if there is a need of intensive care unit postoperatively and a risk of high mortality if patient has symptoms of COVID-19. Admission to intensive care unit adds on to the financial burden to the patient. Also, there is an increased risk of perinatal anxiety and depression during the COVID pandemic. When an asymptomatic carrier develops symptoms of COVID after delivery or caesarean section, the morbidity increases. So we have designed an informed consent form for patients undergoing emergency obstetric surgeries incorporating some points specific for COVID-19.
Keywords COVID-19 • Pandemic • Informed consent
Background/purpose of study In view of restrictions on patients because of COVID-19 pandemic, face-to-face consultations are difficult. This short commentary tells us about the feasibility of telemedicine in this scenario in obstetrics and gynaecology.
Methods The database from our teleconsultation application (Apollo 247 and Askapollo) was analysed to assess feasibility of telemedicine and to design a triage pathway to reduce hospital visits for non-emergency situations and also to identify emergency cases without delay during this lockdown phase. Existing guidelines by Ministry of Health and Family Welfare (MOHFW), Government of India, were accessed.
Results This was a single-doctor experience of 375 consultations done over 65 days. We also designed a triage pathway for obstetrics and gynaecology cases, and we discussed general practice for obstetricians and gynaecologists with its utility and limitations.
Conclusion Telemedicine has provided us the opportunity to manage women health problems and pregnancy concerns during this pandemic of COVID-19, except a few instances where face-to-face consultation or hospital visit is must. If we implement the triage pathway, we can minimize the risk of exposure for both patients and healthcare teams during COVID-19 pandemic.
Keywords Telemedicine • Obstetrics and gynaecology • Pandemic • Lockdown
Baliyan et al. (in J Obstet Gynecol https ://doi.org/10.1007/s1322 4-019-01220 -8, 2019) in their study evaluated the sensitivity and specificity of MCV and MCH for the screening of the beta thalassemia trait in late pregnancy. However, they failed to rule out iron deficiency, which is a confounding factor for low MCV and MCH; as a result, they observed low specificity. Authors recommend ruling out iron deficiency prior to screening for beta thalassemia and preferably in the first trimester of pregnancy so that antenatal diagnosis can be performed in high-risk subjects if necessary.
Keywords Red cell indices · Beta thalassemia · Pregnancy
Progesterone supplementation is a routine practice after intrauterine insemination and IVF-ET procedures. Progesterone is indicated in patients of PCOS and cervical incompetence. It also helps in prevention of recurrent unexplained miscarriages. Effect of a high dose of progesterone supplementation in causing earlier onset of Intrahepatic cholestasis of pregnancy (ICP) merits further focussed investigation.
Background: Fetal arrhythmias constitute 10 to 20% of the total referrals to fetal cardiology unit. Ventricular tachycardia (VT) is a rare form of fetal tachyarrhythmia.
Materials and methods: This report describes the clinical presentation, diagnostic features, and successful management of VT in a fetus at 32 weeks of gestation. Transplacental therapy with sotalol resulted in the termination of tachyarrhythmia in 48 h, followed by good postnatal outcome.
Conclusion: Fetal m-mode showing ventricular rate higher than atrial rate with atrio-ventricular dissociation is suggestive of VT. Early diagnosis and institution of transplacental therapy prior to development of hydrops seem to carry a good prognosis even in malignant fetal arrhythmias like VT.
Fetal tachyarrhythmia, Ventricular tachycardia, Prenatal diagnosis, Transplacental therapyBorn in 1883 in Kyme, Greece, George Papanicolaou obtained his medical degree in 1904 from the University of Athens and doctorate in Zoology in 1910 from the University of Munich. He migrated to the USA in 1913 and worked as an assistant at the Department of Anatomy in the Cornell Medical College. There, Papanicolaou examined vaginal smears under his microscope, charted the cyclic ovarian and uterine changes every day and harvested the oocytes at the appropriate time. He published his research on the cytologic patterns in guinea pigs in the American Journal of Anatomy in 1917. Eventually, he began taking similar scrapings from women and noticing malignant cells in smears taken from women with cancer. In 1928, his presentation on the topic at the Race Betterment Conference in Battle Creek, Michigan, was greeted with skepticism as researchers felt that a biopsy and tissue examination was the only way to detect the disease. In 1939, he collaborated on a clinical study with Herbert F. Traut, MD, a gynecologic pathologist at Cornell, to validate the diagnostic potential of the vaginal smear and published their landmark paper in 1943 titled ‘‘Diagnosis of uterine cancer by the vaginal smear.’’ In 1954, Papanicolaou published the ‘‘Atlas of Exfoliative Cytology.’’
George Nicholas Papanicolaou was a pioneer in cytopathology and creator of the Papanicolaou test or Pap smear. This revolutionized the early detection of cervical cancer and led to a 70% reduction in cervical cancer deaths. Keywords Cervical cancer Screening Pap smear
Cervical cancer, Screening, Pap smearCaesarean section performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. A study was conducted to analyse the indications and maternal and neonatal prognosis of caesarean sections performed in the second stage of labour. Four percentage of caesarean sections were performed in the second stage of labour; 60% of these were referred cases. Most common indication was non-descent of head. Forty-three percentage of newborns were admitted in the neonatal intensive care unit. Hospital stay was prolonged which further increased the hospital burden. A proper judgement is required by the obstetrician to take decision for instrumental delivery or caesarean section. Early diagnosis and timely referral with a good infrastructure would help to decrease the maternal and neonatal morbidity.
Introduction: Congenital high airway obstruction syndrome (CHAOS) is a rare, usually lethal abnormality characterized by complete or near-complete intrinsic obstruction of the fetal airway. Laryngeal atresia is the most frequent cause, but other etiologies include laryngeal or tracheal webs, laryngeal cyst, subglottic stenosis or atresia, tracheal atresia and laryngeal or tracheal agenesis. When antenatal diagnosis of possible upper airway obstruction is made, specific type of obstruction is rarely determined making the term CHAOS introduced by Hedrick et al in 1994 more appropriate.
USG Characteristics: Sonographic findings in CHAOS are characteristic and are secondary to high airway obstruction. The lungs are symmetrically enlarged, echogenic and homogenous. The distended lungs have mass effect on the diaphragm, which appears flattened or inverted, and the heart is displaced anteriorly in the midline. The heart often appears dwarfed by the surrounding enlarged lungs.
Discussion: The primary abnormality is an intrinsic obstruction of the upper airway. Normal lung development involves a continuous efflux of fluid from the fetal lungs. Laryngeal atresia/CHAOS stops the efflux of this fluid, and this retained fluid distends the alveoli with fluid giving the lungs voluminous echogenic appearance and inverting the diaphragm. Isolated airway obstruction without hydrops has a relatively favorable prognosis. CHAOS with associated anomalies and with early presentation of hydrops is an ominous sign with a high rate of fetal demise and a poor survival rate even with the ex utero intrapartum treatment (EXIT) procedure.
Laryngeal atresia, Antenatal, SonographyAntagonist cycles have an inherent issue of lack of flexibility. As a result where batching of cycles is desired, it is not the preferred protocol in ART cycles. There is also the limitation of ovarian response in antagonist cycle due to the size heterogenesities of antral follicles at the start of stimulation. Among the different options available, use of estrogen in the luteal phase of the preceding cycle has definitely shown benefits with regard to better control of cycle as well as synchronization of follicles available for stimulation. The article gives a detailed analysis of the different options available for timing the egg collection in antagonist cycles, the advantages and drawbacks, and the method of use of estrogen. Whereas in the majority of the trials where estrogen pretreatment was used, the goal of scheduling of egg collection was definitely achieved, increased duration and dose of gonadotropin stimulation were required. There was definite advantage of higher oocyte yield in these cycles. The possibility of premature LH rise later during stimulation and subsequent poor implantation in these cycles has to be further evaluated. Nevertheless, batching of patient friendly antagonist cycles can be effectively possible by use of precycle estrogen treatment.
Antagonist cycle, Precycle estrogen, SynchronizationBackground Endometriosis is an enigma. Extrapelvic endometriosis is even more challenging, as theories of origin are difficult to explain. Very few cases of skeletal endometriosis have been reported in the literature.
Method We managed a case of 39-year-old nulliparous woman, who presented to the department of plastic surgery with complaints of a painful nodule measuring about 2 cm, in left upper arm since past 8 years. She had history of myomectomy 8 years back, while she was undergoing treatment for primary infertility. Differential diagnosis of extrapelvic endometriosis was made based on clinical history of cyclical pain and swelling, and she was referred to gynecology for hormonal treatment. MRI and FNAC were inconclusive. She underwent excision biopsy of the lesion.
Result Histopathology confirmed intramuscular endometriosis of left deltoid with positive margins. Postoperatively, she was started on dienogest 2 mg once daily and LNG IUS was inserted. Both were withdrawn a year later, due to side effects. It has been more than 6 months since removal of LNG IUS, and currently she is asymptomatic.
Conclusion To the best of our knowledge, this is the third case of deltoid endometriosis reported till date.
Deltoid , Extrapelvic endometriosis , Dienogest , Soft tissue tumor , ExcisionWilliam Hunter (1718–1783) was a Scottish anatomist and physician. He started his career as a man midwife and went on to become the leading obstetrician in London. He prepared anatomically dissected specimens depicting anatomy of gravid uterus and undelivered fetus with placenta in different stages of gestation. Hunter compiled illustrations prepared from these specimens with his clinical notes and published his treatise Anatomia uteri humani gravidi in 1774. This article is a tribute to William Hunter as we approach the 250th year of publication of his work which is a significant milestone in the history of obstetrics and its practice.
This is a short commentary on one of the unusual complication of laparoscopic surgeries, which is difficult to diagnose, thus creating new challenges for a treating surgeon.
Background Uterine fibroid is a common gynaecological condition. But, one of its variants, called as parasitic fibroids, is a rare one and is difficult to diagnose because of their varied presentations. But, with the increase in laparoscopic surgeries, especially where morcellator is used, cases of parasitic fibroid are increasing.
Case Discussion Description A forty-two-year-old female presented with abdominal pain, not related to any gastrointestinal or urinary complaints. Patient had history of laparascopic myomectomy followed by morcellation in the past. Ultrasonography was suggestive of mass in right iliac region adjacent to ascending colon with whorl like appearance. Tumour markers were sent, diagnostic laparoscopy was performed which was suggestive of parasitic fibroid, arising from previous surgical port.
Conclusion Complications of parasitic fibroid can occur when morcelletor is used in laparoscopic surgeries, because of the growth of tissue which have spread in pelvic cavity. To prevent this complication, endobag morcellation should be used.
Clinical Significance History of morcellation, should be asked to females, presenting with varied abdominal complaints, and history of laparoscopic surgery, possibility of parasitic fibroid should be considered in these patients.
Parasitic fibroid · Laparoscopic morcellation · Endobag morcellation