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N. Hephzibah Kirubamani ¹, Shruthi Kamal ²

Affiliations
1 Obstetrics & Gyneacology, Saveetha Medical college-Saveetha University, Chennai
2 Surgery, Saveetha Medical College-Saveetha University, Thandalam, Chennai, Tamil Nadu, 602 105

Abstract

Fibroids, also known as leiomyomas, are the most common benign uterine neoplasms. Although benign, they can undergo malignant transformation. Metastatic breast cancer is rarely identified in a uterine leiomyoma. Herein we are reporting a case of a 52-year postmenopausal patient who presented with rapidly increasing huge abdominal mass with a size that was almost reaching xipisternum. She underwent modified radicalmastectomy for infiltracting intraductalcarrcinoma two years ago and was tamoxifen since then. After investigation like abdominal and Pelvic USG,C.T abdomen suggested Leiomyosarcoma and subtotal hysterectomy was done due to technical difficulty. Pathological analysis revealed metasatic lobular breast carcinoma involving the uterine fundus and leiomyoma. This case is reported for its rarity, as Metastasis of extragenital neoplasms to the uterus is extremely rare and lobular breast cancer metastasizing to a leiomyoma in a patient using tamoxifen.

Keywords

Uterine Mass, Metatasizing to Leiomyoma, Lobular Cancer of Leiomyoma

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R. Raziya Sultana ¹, S. N. Zafarullah ², N. Hephzibah Kirubamani ³

Affiliations
1 Deptartment of Physics, Justice Basheer Ahmed Sayeed College for Women, Chennai-600018, IN
2 Department of Physics, Easwari Engineering College, Chennai-600089, IN
3 Saveetha Medical College, Saveetha Nagar Thandalam, Irrungattukottai, Kanchipuram–602105, IN

Abstract

This study is an attempt to evaluate and compare the spectral difference in saliva and serum between healthy pregnant women and anomalies pregnant women due to folic acid deficiency, using Fourier Transform Infrared Spectroscopy. Folic acid is required for the development of a healthy fetus and plays an important role in the development of the fetus spinal cord and brain. The present work is to study the folic acid deficiency in pregnancy-Anomalies (open neural defect) and compare the results with the normal healthy pregnant women. The results showed that there is a significant difference between the folic acid of healthy pregnant and anomalies (open neural defect) in pregnant women both in saliva and serum sample. From the spectral study, the intensity ratio parameters R₁ (I₁₃₃₈/I₃₄₁₅) R₂ (I₃₅₄₆/I₁₆₃₆) R₃ (I₂₈₅₄/I₃₄₁₅) R₄(I₁₇₄₃/I₃₅₄₆) R₅ (I₁₄₈₂/I₁₅₁₁) R₆ (I₁₄₈₂/I₁₆₉₆) R₇ (I₁₁₃₅/I₁₆₀₇) R₈ (I₂₉₂₇/I₁₆₀₇) R₉ (I₂₉₂₇/I₁₆₀₄) R₁₀ (I₁₄₉₂/I₁₅₁₁) have been introduced and computed. The outcome of the results shows that FTIR can be used in the qualitative and quantitative investigation of biological fluids to distinguish sample sets from healthy and diseased groups. The internal standard method is adopted in characterizing the samples quantitatively.

Keywords

Folic Acid Deficiency, FTIR, Pregnant Women, Saliva

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N. Hephzibah Kirubamani ¹

Affiliations
1 Saveetha Medical College, Obstetrics & Gynaecology Department, Thandalam, Kancheepurum, Tamil Nadu–602105, IN

Abstract

Tubal sterilization is the permanent and effective contraception method. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. One of the complications after tubal ligation is ectopic pregnancy. It is a prospective study conducted at Saveetha Medical College obstetrics and Gynaecology Department. We report series of ectopic gestation following sterilization during the period - June 2012 to June 2013. Various data were analysed, namely age at which sterilization was done, method of sterilization done, how many years later ectopic was developed, type of presentation, management offered to them. There were total 12 ectopic pregnancies during the study period. Out of this 11 ectopic were subsequent to tubal sterilization. Maximum age distribution were 7 cases between 25-35 yrs, 5 cases were of 36-40 yrs, none above 40 yrs. Nine cases occurred within 10 years, after 10 yrs two cases. The highest incidence of ectopic were in 8 cases was following Puerperal sterilization. In 5 cases the common complaint was amenorrhea with pain abdomen and urinary tract infection in 2 cases. Common site of ectopic was ampullary region in 8 cases. All of them were ruptured ectopic due to delay in diagnosis. Ten cases underwent bilateral salpingectomy; one case of Cornual ectopic gestation hysterectomy and one case of primi salpingectomy of the affected side done. Women undergoing tubal sterilization should be informed that ectopic pregnancy may occur even long after the procedure as shown in our study. Awareness regarding this should be there among attending doctors and health personnel.

Keywords

Risk For Ectopic Pregnancy, Tubal Ectopic, Tubal Sterilization

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N. Hephzibah Kirubamani ¹

Affiliations
1 Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai 600072, IN

Abstract

Background: Reliable, reversible most widely used, contraceptive method worldwide is intrauterine device (IUCD). The association between tubo ovarian abscess formation and the presence of an intrauterine device is well recognized. Case Report: We report a case of forgotten IUCD for 22 years in 41 years woman with Tubo Ovarian mass. No history suggestive of STD or chronic illness or immunocompromised condition. After first child (22 years ago) she never conceived, had on and off abdominal pain, patient was unaware of IUCD insertion and did not had any gynaec checkup. She was admitted for abdominal pain since 2 days. Abdominal palpation revealed vague tenderness in left iliac region and mass about 8x6 cm size. No guarding or rigidity. Her pelvic examination revealed the IUCD string with mild discharge and IUCD was removed. Bimanual examination revealed marked cervical motion tenderness and left adnexal tender. Tense mass felt per abdomen was felt per vaginum. Rectal examination was normal. USG - Abdomen and Pelvis-complex TO mass left side about 5cmx8cm with minimal fluid on POD. Patient was on IV fluids and parenteral antibiotics. After two days patient developed general peritonitis, hence emergency Laparotomy was done. After informed consent Total abdominal Hysterectomy with omentectomy was done. Histopathology confirmed bilateral tubo ovarian abscess and Omentum - Micro abscess. Conclusion: Only after concerned IUCD to be introduced and long-term users of IUCDs remain at risk for serious, indolent pelvic infections and hence counseling should be given before insertion and need for follow up should be stressed.

Keywords

Contraceptive Safety, Counseling for IUCD, IUCD Complication, IUCD Procedures, Pelvic Inflammatory Disease, Risk Factors

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R. Tillak Raaj ¹, M. Aruna ¹, A. Shahana Ikhlas ¹, R. Priya Dharshini ¹, N. Hephzibah Kirubamani ¹

Affiliations
1 Saveetha Medical College and Hospital, Thandalam, Chennai – 602105, Tamil Nadu, IN

Abstract

Objective: To estimate the gestational age by using symphysio fundal height and abdominal girth and to correlate with USG gestational age. The simplest way to determine gestational age is to examine the mother by palpating the abdomen and estimating the size of her uterus compared with a landmark such as umbilicus. Measuring symphysio fundal height and abdominal girth can be used as a sensitive indicator in estimating the gestational age. Methods: About 180 women were enrolled in this prospective population based observational study, who were attending Saveetha Medical College and Hospital Obstetric OPD and the gestational age was estimated by measuring symphysio fundal height abdominal girth and correlating it with ultrasound finding. Result: About 80.52% of gestational age found by symphysio fundal height correlated with the gestational age found by LMP and 77.73% of gestational age found by symphysio fundal height correlated with gestational age found by USG. About 72% of the gestational age estimated by abdominal girth correlated with the gestational age found by LMP and 66.57% of gestational age found by abdominal girth correlated with gestational age found by USG. About 19.479% of gestational age determined by symphysio fundal height did not correlate with gestational age found by LMP; they were further evaluated by USG to find the accuracy and the cause. The USG results showed the following- 4.5% were having low growth profile, 5.8% were found to have intrauterine growth retardation (IUGR), 7.97% had macrsomia due to gestational diabetes and 1.2% was polyhydramnios. Even the USG findings in cases not correlating with abdominal girth the same reasons were obtained in 19.479% and the remaining 8.52% among the 72% of gestational age found by abdominal girth not correlating with LMP were found to be false positive. Conclusion: SFH was found to have high sensitivity in estimating the gestational age when compared to gestational age estimated by abdominal girth, even in the presence of USG and hence it can be used as a good indicator in low setting areas.

Keywords

Abdominal Girth, Correlation, Gestational Age, Symphysio Fundal Height, Ultrasound.

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N. Hephzibah Kirubamani ¹, M. R. Meenatshi ²

Affiliations
1 Department of Obstetrics and Gynaecology, Saveetha Medical College and Hospital, Saveetha University, Thandalam, Chennai – 602105, Tamil Nadu, IN
2 Saveetha Medical College and Hospital, Thandalam, Chennai – 602105, Tamil Nadu, IN

Abstract

It was thought that Umbilical Cord Coiling plays an important role in protecting the umbilical cord from external pressure such as tension, pressure, stretching or entanglement. The mechanism of coiling still remains undetermined. According to several studies abnormal umbilical coiling is associated with poor perinatal outcomes. Objectives: To evaluate the sonographic accuracy in determining Umbilical Coiling Index (UCI). To correlate it with postnatal examination of umbilical coiling and its association with obstetric and perinatal outcome. Material and Methods: Prospective observational study was conducted at Saveetha Medical College Obstetrics Department. For 200 pregnant women USG umbilical coiling index was measured during routine foetal evaluation between 28 to 40 weeks. USG-Umbilical Coiling Index was correlated with postnatal umbilical coiling index and its association with obstetric& perinatal outcome was calculated. Sonologist was blinded for pregnancy outcome. Results: USG –UCI was normal in 52%, hypocoiling 12% and hypercoiling 36%.In normal coiling there was no antenatal or intranatal problems. In hypocoiling Spontaneous Preterm Delivery was 50% and Low Birth Weight was38.9%, FGR 11.1%. In hypercoiling group Oligohydramnios was 14.8%, Intrapartum fetal distress33.3%, Meconium staining of liquor 16.6 %. In normal coiling all of them delivered naturally. In hypocoiling and in hypercoiling mode of delivery either forceps 7% or LSCS 41%.NICU admission in hypocoiling was 18 % and in hypercoiling 3%. Perinatal mortality was NIL. USG-Umbilical Coiling Index Sensitivity 97.8 specificity, 62.5%, Positive predictive value 96.77% Negative predictive value 71.4%. Conclusion: In our study there is a good correlation between USG-UCI and postnatal UCI. Our study confirms that there is an adverse perinatal outcome with both hypocoiling and hyper coiling of the umbilical cord.

Keywords

Hypocoiling, Hypercoiling, Perinatal Outcome, Umbilical Cord, Umbilical Cord Coiling, UCI-Umbilical Coiling Index

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