Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1187
S. Vavilala, Manjula Budidapadu, G. Kolar
The reported incidence of fetal goiter is 1 in 40,000 live births. The effects of fetal goiter and thyroid dysfunction are significant. The objective of our study is to assess the safety, feasibility, and efficacy of intra-amniotic instillation of levothyroxine (LT4) in fetal goitrous hypothyroidism. A retrospective observational study of prenatally diagnosed cases of fetal goiter on routine antenatal ultrasound between January 2010 and January 2018 at Fernandez Hospital Foundation, Hyderabad, tertiary perinatal referral center. Data retrieved from electronic database. During this period, 9 cases of fetal goiter were diagnosed on routine ultrasonography with the incidence of 1 in 7,000 live births. The gestation age at diagnosis ranged between 21 weeks and 29 weeks (mean 26 weeks). Of the nine fetuses with goiter, two were excluded as one ended in a miscarriage at 22 weeks and the other was terminated elsewhere at 26 weeks. Data were analyzed in the remaining seven fetuses. Cordocentesis was performed in five fetuses and amniocentesis was performed in one woman with dichorionic diamniotic (DCDA) twin gestation which revealed hypothyroid status. Fetal therapy was offered to all the remaining seven fetuses with intra-amniotic instillation of LT4 100 to 200 μg at 2–3 weeks’ interval. First dose of LT4 was given at mean gestation of 27 weeks (range 23–30 weeks), and the mean time between the identification of fetal goiter and the first dose of LT4 was 6 days (range 2–15 days). Number of injections given ranged between 1 and 7. No adverse events were recorded. Follow-up sonogram showed subjective reduction in the goiter size. All the babies had hypothyroidism at birth. Our case series confirms the safety and feasibility of intra-amniotic instillation of LT4 for fetal goitrous hypothyroidism. Although fetal therapy has resulted in reduction in the size of the goiter, the thyroid hormone levels at birth were low. Further research is required to establish the proper management guidelines for this disorder. Budidapadu M, Vavilala S, Kolar G. Prenatal Diagnosis and Management of Fetal Goiter: A Case Series from Tertiary Perinatal Center in South India. Int J Infertil Fetal Med 2019;10(3):37–41.
{"title":"Prenatal Diagnosis and Management of Fetal Goiter: A Case Series from Tertiary Perinatal Center in South India","authors":"S. Vavilala, Manjula Budidapadu, G. Kolar","doi":"10.5005/jp-journals-10016-1187","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1187","url":null,"abstract":"The reported incidence of fetal goiter is 1 in 40,000 live births. The effects of fetal goiter and thyroid dysfunction are significant. The objective of our study is to assess the safety, feasibility, and efficacy of intra-amniotic instillation of levothyroxine (LT4) in fetal goitrous hypothyroidism.\u0000\u0000\u0000\u0000A retrospective observational study of prenatally diagnosed cases of fetal goiter on routine antenatal ultrasound between January 2010 and January 2018 at Fernandez Hospital Foundation, Hyderabad, tertiary perinatal referral center. Data retrieved from electronic database.\u0000\u0000\u0000\u0000During this period, 9 cases of fetal goiter were diagnosed on routine ultrasonography with the incidence of 1 in 7,000 live births. The gestation age at diagnosis ranged between 21 weeks and 29 weeks (mean 26 weeks). Of the nine fetuses with goiter, two were excluded as one ended in a miscarriage at 22 weeks and the other was terminated elsewhere at 26 weeks. Data were analyzed in the remaining seven fetuses. Cordocentesis was performed in five fetuses and amniocentesis was performed in one woman with dichorionic diamniotic (DCDA) twin gestation which revealed hypothyroid status. Fetal therapy was offered to all the remaining seven fetuses with intra-amniotic instillation of LT4 100 to 200 μg at 2–3 weeks’ interval. First dose of LT4 was given at mean gestation of 27 weeks (range 23–30 weeks), and the mean time between the identification of fetal goiter and the first dose of LT4 was 6 days (range 2–15 days). Number of injections given ranged between 1 and 7. No adverse events were recorded. Follow-up sonogram showed subjective reduction in the goiter size. All the babies had hypothyroidism at birth.\u0000\u0000\u0000\u0000Our case series confirms the safety and feasibility of intra-amniotic instillation of LT4 for fetal goitrous hypothyroidism. Although fetal therapy has resulted in reduction in the size of the goiter, the thyroid hormone levels at birth were low. Further research is required to establish the proper management guidelines for this disorder.\u0000\u0000Budidapadu M, Vavilala S, Kolar G. Prenatal Diagnosis and Management of Fetal Goiter: A Case Series from Tertiary Perinatal Center in South India. Int J Infertil Fetal Med 2019;10(3):37–41.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46444142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1193
K. Rao, Deepika Krishna, S. Agarwal
Ab s t r Ac t Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It is difficult to decipher OHSS pathophysiology.1 The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Complications such as hemoconcentration, hypovolemia, and thromboembolism can occur. Withholding hCG, continuation of gonadotropin-releasing hormone analogs, coasting, agonist trigger, intravenous albumin, dopamine agonists, and cryopreservation of embryos are cornerstones of OHSS prevention.2 Mild OHSS usually requires no active therapy. Moderate and severe cases have to be treated. Surgery may be needed in ruptured ovarian cysts, torsion, or concomitant ectopic pregnancy. Transvaginal paracentesis is recommended in cases of severe ascites. Inpatient management is typically based on preventing complications such as derangement of kidney and liver functions, thrombosis, and severe respiratory depression. Recent ART treatment protocols behold more patient-friendly mild ovarian stimulation regimes that are individualized depending on patient’s ovarian reserve.3
Ab s t r Ac t卵巢过度刺激综合征（OHSS）是一种潜在的医源性危及生命的情况。OHSS的病理生理学很难解读。1其发生与血液中的雌二醇、卵泡数量和人绒毛膜促性腺激素（hCG）成正比，多囊卵巢疾病发生的几率更大。完全预防OHSS是不可能的，但内分泌概况和卵泡超声监测是其预测的主要依据。可能会出现血液浓缩、低血容量和血栓栓塞等并发症。抑制hCG、持续使用促性腺激素释放激素类似物、滑行、激动剂触发、静脉注射白蛋白、多巴胺激动剂和胚胎冷冻保存是预防OHSS的基石。2轻度OHSS通常不需要积极治疗。中度和重度病例必须接受治疗。卵巢囊肿破裂、扭转或伴随异位妊娠可能需要手术治疗。在严重腹水的情况下，建议经阴道穿刺。住院管理通常基于预防并发症，如肾和肝功能紊乱、血栓形成和严重呼吸抑制。最近的抗逆转录病毒疗法治疗方案显示，根据患者的卵巢储备，对患者更友好的轻度卵巢刺激方案是个性化的。3
{"title":"Prevention and Management of Ovarian Hyperstimulation Syndrome","authors":"K. Rao, Deepika Krishna, S. Agarwal","doi":"10.5005/jp-journals-10016-1193","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1193","url":null,"abstract":"Ab s t r Ac t Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It is difficult to decipher OHSS pathophysiology.1 The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Complications such as hemoconcentration, hypovolemia, and thromboembolism can occur. Withholding hCG, continuation of gonadotropin-releasing hormone analogs, coasting, agonist trigger, intravenous albumin, dopamine agonists, and cryopreservation of embryos are cornerstones of OHSS prevention.2 Mild OHSS usually requires no active therapy. Moderate and severe cases have to be treated. Surgery may be needed in ruptured ovarian cysts, torsion, or concomitant ectopic pregnancy. Transvaginal paracentesis is recommended in cases of severe ascites. Inpatient management is typically based on preventing complications such as derangement of kidney and liver functions, thrombosis, and severe respiratory depression. Recent ART treatment protocols behold more patient-friendly mild ovarian stimulation regimes that are individualized depending on patient’s ovarian reserve.3","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45870240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1191
Taghreed Shalabi, M. Abdel-Hamid, Mai Shaker
Hydatidiform mole, whether complete or partial mole, is one of the most common forms of gestational trophoblastic disease. It is characterized by extreme trophoblastic proliferation and atypical embryonic growth. Though almost all of complete hydatidiform moles are diploid androgenetic, scarce cases are biparental and caused mainly by mutations in NLRP7 and KHDC3L genes. NLRP7 mutations are more common and were reported in around 50–80% of cases from diverse populations while KHDC3 mutations were only found in 5–10% of cases. A healthy 40-year-old Egyptian woman was referred to the Clinic of Prenatal Diagnosis and Fetal Medicine Department for counseling. She was married for 20 years to a first-degree relative and experienced 17 consecutive pregnancy losses without having any live births. Uterus ultrasound revealed endometrial thickening and subseptate uterus and in her last pregnancy failure, she complained of abdominal pain and severe shortness of breath. Immunochemistry tests were positive for β-human chorionic gonadotropin and histopathology-confirmed choriocarcinoma. Genetic testing revealed two novel heterozygous variants in the NLPR7 gene. We presented a case with 17 recurrent hydatidiform moles that was complicated by choriocarcinoma due to novel variants in the NLRP7 gene. This is the first Egyptian case with recurrent hydatidiform mole. We identified novel NLPR7 variants, thus expanding the mutational spectrum associated with this rare disease. Shalabi TA, Abdel-Hamid MS, Shaker MM. Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma. Int J Infertil Fetal Med 2019;10(3):54–57.
葡萄胎，无论是完全葡萄胎还是部分葡萄胎，都是妊娠滋养细胞疾病最常见的形式之一。它的特点是滋养层增生严重，胚胎生长不典型。虽然几乎所有的完全包子痣都是二倍体雄激素发生的，但很少有病例是双亲本的，主要由NLRP7和KHDC3L基因突变引起。NLRP7突变更为常见，在不同人群中约50-80%的病例中报道，而KHDC3突变仅在5-10%的病例中发现。一名健康的40岁埃及妇女被转介到产前诊断和胎儿医学诊所接受咨询。她与一名一级亲属结婚20年，经历了17次连续怀孕失败，没有一个活产。子宫超声显示子宫内膜增厚和子宫下隔，最后一次妊娠失败时，她主诉腹痛和严重呼吸短促。免疫化学试验β-人绒毛膜促性腺激素阳性，组织病理学证实绒毛膜癌。基因检测显示NLPR7基因有两个新的杂合变异。我们报告了一例因NLRP7基因的新变异而并发绒毛膜癌的17例复发性葡萄胎。这是埃及第一例复发性葡萄胎病例。我们发现了新的NLPR7变异，从而扩大了与这种罕见疾病相关的突变谱。Shalabi TA, Abdel-Hamid MS, Shaker MM.一名连续磨牙妊娠并发绒毛膜癌的埃及女性患者NLRP7基因的两个新变异。国际不孕胎儿医学杂志2019;10(3):54-57。
{"title":"Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma","authors":"Taghreed Shalabi, M. Abdel-Hamid, Mai Shaker","doi":"10.5005/jp-journals-10016-1191","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1191","url":null,"abstract":"\u0000\u0000\u0000Hydatidiform mole, whether complete or partial mole, is one of the most common forms of gestational trophoblastic disease. It is characterized by extreme trophoblastic proliferation and atypical embryonic growth. Though almost all of complete hydatidiform moles are diploid androgenetic, scarce cases are biparental and caused mainly by mutations in NLRP7 and KHDC3L genes. NLRP7 mutations are more common and were reported in around 50–80% of cases from diverse populations while KHDC3 mutations were only found in 5–10% of cases.\u0000\u0000\u0000\u0000A healthy 40-year-old Egyptian woman was referred to the Clinic of Prenatal Diagnosis and Fetal Medicine Department for counseling. She was married for 20 years to a first-degree relative and experienced 17 consecutive pregnancy losses without having any live births. Uterus ultrasound revealed endometrial thickening and subseptate uterus and in her last pregnancy failure, she complained of abdominal pain and severe shortness of breath. Immunochemistry tests were positive for β-human chorionic gonadotropin and histopathology-confirmed choriocarcinoma. Genetic testing revealed two novel heterozygous variants in the NLPR7 gene.\u0000\u0000\u0000\u0000We presented a case with 17 recurrent hydatidiform moles that was complicated by choriocarcinoma due to novel variants in the NLRP7 gene.\u0000\u0000\u0000\u0000This is the first Egyptian case with recurrent hydatidiform mole. We identified novel NLPR7 variants, thus expanding the mutational spectrum associated with this rare disease.\u0000\u0000Shalabi TA, Abdel-Hamid MS, Shaker MM. Two Novel Variants in NLRP7 Gene in an Egyptian Female Patient with Consecutive Molar Pregnancies Complicated by Choriocarcinoma. Int J Infertil Fetal Med 2019;10(3):54–57.\u0000","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41417904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1188
R. Vembu, Mathivanan Nandini Devi, S. Nellepalli, M. Pandurangi, S. Nagireddy
To study the prevalence of metabolic syndrome (MBS) in different body mass index (BMI) group infertile women in both polycystic ovarian syndrome (PCOS) and non-PCOS subgroups. A prospective cross-sectional study of all infertile women attending the outpatient in the department of reproductive medicine and surgery in a tertiary care center catering patients from South India was conducted. These women were categorized based on BMI into groups as ≤23 kg/m2, 23.1–25 kg/m2, 25.1–27 kg/m2, 27.1–30 kg/m2, and >30 kg/m2. They were further subdivided as PCOS and non-PCOS based on Rotterdam criteria (2003). These women underwent screening for MBS according to the modified American Heart Association/National Heart Lung Blood Institute AHA/NHLBI (ATP III 2005) definition. The results were analyzed for significance by the unpaired t test and the Chi-square test. A total of 1,030 infertile women were analyzed. The mean age was 28.8 ± 4.5 years; mean BMI was 26.9 ± 3.7 kg/m2. More than 90% of women had waist circumference >80 cm. The prevalence of MBS among the infertile women was 35.3% and among PCOS and non-PCOS women was 44.7 and 28.9%, respectively. Even though there was statistically no significant difference in the metabolic parameters among PCOS and non-PCOS subgroups in different BMI cutoff levels, there was an increase in abnormal metabolic parameters with increase in BMI. The prevalence of MBS in the BMI groups among PCOS women was 11.1, 28.1, 29.7, 51.8, and 73.6%, respectively (p = 0.0005) and among non-PCOS women was 4.9, 20.4, 24.6, 41.6, and 66.7%, respectively (p = 0.0005). The BMI is an independent risk factor for MBS in both PCOS and non-PCOS infertile women. Screening for MBS in infertile women helps in early identification and primary prevention by lifestyle modification helps in delaying long-term consequences of type 2 diabetes mellitus and cardiovascular diseases. Vembu R, Nandini Devi M, Nellepalli SR, et al. Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women. Int J Infertil Fetal Med 2019;10(3):42–45.
{"title":"Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women","authors":"R. Vembu, Mathivanan Nandini Devi, S. Nellepalli, M. Pandurangi, S. Nagireddy","doi":"10.5005/jp-journals-10016-1188","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1188","url":null,"abstract":"\u0000\u0000\u0000To study the prevalence of metabolic syndrome (MBS) in different body mass index (BMI) group infertile women in both polycystic ovarian syndrome (PCOS) and non-PCOS subgroups.\u0000\u0000\u0000\u0000A prospective cross-sectional study of all infertile women attending the outpatient in the department of reproductive medicine and surgery in a tertiary care center catering patients from South India was conducted. These women were categorized based on BMI into groups as ≤23 kg/m2, 23.1–25 kg/m2, 25.1–27 kg/m2, 27.1–30 kg/m2, and >30 kg/m2. They were further subdivided as PCOS and non-PCOS based on Rotterdam criteria (2003). These women underwent screening for MBS according to the modified American Heart Association/National Heart Lung Blood Institute AHA/NHLBI (ATP III 2005) definition. The results were analyzed for significance by the unpaired t test and the Chi-square test.\u0000\u0000\u0000\u0000A total of 1,030 infertile women were analyzed. The mean age was 28.8 ± 4.5 years; mean BMI was 26.9 ± 3.7 kg/m2. More than 90% of women had waist circumference >80 cm. The prevalence of MBS among the infertile women was 35.3% and among PCOS and non-PCOS women was 44.7 and 28.9%, respectively. Even though there was statistically no significant difference in the metabolic parameters among PCOS and non-PCOS subgroups in different BMI cutoff levels, there was an increase in abnormal metabolic parameters with increase in BMI. The prevalence of MBS in the BMI groups among PCOS women was 11.1, 28.1, 29.7, 51.8, and 73.6%, respectively (p = 0.0005) and among non-PCOS women was 4.9, 20.4, 24.6, 41.6, and 66.7%, respectively (p = 0.0005).\u0000\u0000\u0000\u0000The BMI is an independent risk factor for MBS in both PCOS and non-PCOS infertile women.\u0000\u0000\u0000\u0000Screening for MBS in infertile women helps in early identification and primary prevention by lifestyle modification helps in delaying long-term consequences of type 2 diabetes mellitus and cardiovascular diseases.\u0000\u0000Vembu R, Nandini Devi M, Nellepalli SR, et al. Impact of Body Mass Index on the Prevalence of Metabolic Syndrome among Infertile South Indian Women. Int J Infertil Fetal Med 2019;10(3):42–45.\u0000","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41956165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1192
Ketki S. Kulkarni, Minal Dhanvij, A. Goel
Pregnancies with hydatidiform mole and a live fetus are extremely rare, arising in about 1 in 20,000–100,000 pregnancies. Multifetal gestations are increasing due to increase in infertility treatment, and so the complications related to it are on the verge of rising. Also, the partial mole with live fetus is a rare entity, and only few cases are reported in the literature. The objective of the study is reporting a rare case and reviewing the available literature in an attempt to make clinical guidelines. We are reporting a case of 36-year-old, elderly primigravida with in vitro fertilization conception at 29.1 weeks of gestation with severe preeclampsia. She was triplet gestation in early ultrasonography scan reports, and fetal reduction was done at 11 weeks and reduced to twins. A lower segment cesarean section was done, and a healthy male fetus of 1,100 g was delivered. Placenta of the live triplet and the fetus papyraceous (200 g) was delivered with a thin cord attached to hydatidiform molar placenta and vesicles. The dilemma is whether to continue such pregnancy or to terminate it, as it is a critical issue to solve. The watchful monitoring of such cases can provide optimum outcome and prevention of metastasis. How to cite this article: Kulkarni KS, Dhanvij MP, Goel A. Complicated Triplet Gestation Reduced to Twins with Partial Hydatidiform Mole and a Coexisting Live Fetus: A Case Report Managed in a Tertiary Care Center. Int J Infertil Fetal Med 2019;10(3):58–62.
有葡萄胎和活胎的妊娠极为罕见，约为2 - 10万分之一。由于不孕症治疗的增加，多胎妊娠正在增加，因此与之相关的并发症也在上升。此外，部分痣伴活胎是一种罕见的实体，文献中只有少数病例报道。本研究的目的是报告一个罕见的病例，并回顾现有的文献，试图制定临床指南。我们报告一例36岁高龄的初产妇，妊娠29.1周体外受精，伴有严重的先兆子痫。在早期的超声扫描报告中，她是三胞胎妊娠，在11周时进行了胎位减少，并减少为双胞胎。做了下段剖宫产，生下了一个1100克的健康男婴。活三胞胎胎盘和胎纸状胎盘(200 g)用细脐带附着于葡萄胎胎和囊泡上娩出。这种困境是继续妊娠还是终止妊娠，因为这是一个需要解决的关键问题。对此类病例的密切监测可以提供最佳结果和预防转移。Kulkarni KS, Dhanvij MP, Goel a .复杂的三胞胎妊娠减少到双胞胎，部分葡萄胎和共存的活胎:一个三级保健中心管理的病例报告。国际不孕胎儿医学杂志2019;10(3):58-62。
{"title":"Complicated Triplet Gestation Reduced to Twins with Partial Hydatidiform Mole and a Coexisting Live Fetus: A Case Report Managed in a Tertiary Care Center","authors":"Ketki S. Kulkarni, Minal Dhanvij, A. Goel","doi":"10.5005/jp-journals-10016-1192","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1192","url":null,"abstract":"\u0000Pregnancies with hydatidiform mole and a live fetus are extremely rare, arising in about 1 in 20,000–100,000 pregnancies. Multifetal gestations are increasing due to increase in infertility treatment, and so the complications related to it are on the verge of rising. Also, the partial mole with live fetus is a rare entity, and only few cases are reported in the literature. The objective of the study is reporting a rare case and reviewing the available literature in an attempt to make clinical guidelines. We are reporting a case of 36-year-old, elderly primigravida with in vitro fertilization conception at 29.1 weeks of gestation with severe preeclampsia. She was triplet gestation in early ultrasonography scan reports, and fetal reduction was done at 11 weeks and reduced to twins. A lower segment cesarean section was done, and a healthy male fetus of 1,100 g was delivered. Placenta of the live triplet and the fetus papyraceous (200 g) was delivered with a thin cord attached to hydatidiform molar placenta and vesicles. The dilemma is whether to continue such pregnancy or to terminate it, as it is a critical issue to solve. The watchful monitoring of such cases can provide optimum outcome and prevention of metastasis.\u0000How to cite this article: Kulkarni KS, Dhanvij MP, Goel A. Complicated Triplet Gestation Reduced to Twins with Partial Hydatidiform Mole and a Coexisting Live Fetus: A Case Report Managed in a Tertiary Care Center. Int J Infertil Fetal Med 2019;10(3):58–62.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41985737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-23DOI: 10.5005/jp-journals-10016-1189
D. Shrivastava, Arzoo M Chadha, M. Salve, Asawari A Deo
Endometrial osseous metaplasia is a rare pathological condition characterized by the presence of bone-like tissue in the endometrium and can be a cause for menstrual abnormalities and infertility as bone in the endometrium can act like an intrauterine contraceptive device. It is a rare entity with an estimated incidence of 3/10,000. Exact etiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells, which results in the formation of bones. The possibility of malignant mixed Mullerian tumor should also be kept in mind. Here, we report one such case of primary infertility in a 27-year-old woman presenting with history of oligomenorrhea. Endometrial stromal (osseous) metaplasia is a condition that is rarely seen and may have a potential to be overlooked and misdiagnosed. It is important to recognize the non-neoplastic nature of this condition to avoid misinterpretation as malignant mixed Mullerian tumor of the uterus. Its contraceptive nature makes it an extremely rare but treatable cause of infertility. Complete removal of bony spicules by hysteroscopy can help regain fertility.
{"title":"Osseous Endometrial Metaplasia in a Case of Primary Infertility","authors":"D. Shrivastava, Arzoo M Chadha, M. Salve, Asawari A Deo","doi":"10.5005/jp-journals-10016-1189","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1189","url":null,"abstract":"Endometrial osseous metaplasia is a rare pathological condition characterized by the presence of bone-like tissue in the endometrium and can be a cause for menstrual abnormalities and infertility as bone in the endometrium can act like an intrauterine contraceptive device. It is a rare entity with an estimated incidence of 3/10,000. Exact etiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells, which results in the formation of bones. The possibility of malignant mixed Mullerian tumor should also be kept in mind. Here, we report one such case of primary infertility in a 27-year-old woman presenting with history of oligomenorrhea. Endometrial stromal (osseous) metaplasia is a condition that is rarely seen and may have a potential to be overlooked and misdiagnosed. It is important to recognize the non-neoplastic nature of this condition to avoid misinterpretation as malignant mixed Mullerian tumor of the uterus. Its contraceptive nature makes it an extremely rare but treatable cause of infertility. Complete removal of bony spicules by hysteroscopy can help regain fertility.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42772897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.5005/JP-JOURNALS-10016-1207
Roopa Padavagodu Shivanada, S. Guruvare, Shubha Rao, Radhakrishnan Periyasamy
{"title":"Conjoint Twins: “Constant Togetherness” a Sign of Double Trouble","authors":"Roopa Padavagodu Shivanada, S. Guruvare, Shubha Rao, Radhakrishnan Periyasamy","doi":"10.5005/JP-JOURNALS-10016-1207","DOIUrl":"https://doi.org/10.5005/JP-JOURNALS-10016-1207","url":null,"abstract":"","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":"24 1","pages":"72-75"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76948061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.5005/jp-journals-10016-1184
P. Dasari, Ashraf M Ali, T. Chitra
Ab s t r Ac t Background: Torsion of gravid uterus is a rare and sporadic event, and its association with previable preterm premature rupture of membrane (PPROM) is not reported in literature. Case description: A 35-year-old third gravida with previous two early pregnancy losses was managed conservatively following previable rupture of membranes at 20 + 6 weeks of gestation. Torsion of gravid uterus to 180° was diagnosed at elective cesarean section performed at 32 + 2 weeks in view of Breech presentation with severe oligoamnios and tubular cervix. An alive baby of 1.48 kg with good APGAR score was extracted through a low vertical incision given on anterior surface of uterus after detortion. Discussion: Torsion is diagnosed when uterus rotates itself on its long axis 45° or more, and the etiology may be fibroid uterus adhesions and ovarian cysts. Preoperative diagnosis is rare except when magnetic resonance imaging is performed. Most of the cases reported in the literature are diagnosed at cesarean section undertaken for fetal distress or nonprogress of labor. In the case presented here, there were no predisposing factors except that she was on prolonged bed rest due to PPROM, and there was a cornual implantation of placenta. Conclusion: Conservative management of maternal position may predispose to uterine torsion, and in such cases, vigilant monitoring and timely termination can save the fetus. Clinical significance: Presence of a tubular cervix with mal-presentation is one of the clinical features to suspect torsion during pregnancy and labor.
Ab s t r Ac t背景：妊娠子宫扭转是一种罕见的偶发事件，其与前置性早产胎膜早破（PPROM）的相关性在文献中没有报道。病例描述：一名35岁的第三名孕妇，前两次早孕失败，在妊娠20+6周可预见的胎膜破裂后进行保守治疗。鉴于Breech表现为严重羊水过少和宫颈管型，在32+2周进行的选择性剖宫产手术中诊断为妊娠子宫扭转180°。切除子宫后，通过在子宫前表面进行低垂直切口取出一个APGAR评分良好的1.48kg活婴儿。讨论：当子宫绕长轴旋转45°或以上时，诊断为扭转，病因可能是子宫肌瘤粘连和卵巢囊肿。除进行磁共振成像外，术前诊断很少。文献中报道的大多数病例都是在剖宫产时诊断为胎儿窘迫或未产程。在这里介绍的病例中，除了她因PPROM而长时间卧床休息和胎盘角植入外，没有任何诱发因素。结论：保守产妇体位可能易发生子宫扭转，在这种情况下，警惕监测并及时终止妊娠可以挽救胎儿。临床意义：宫颈管表现不全是妊娠和分娩期间怀疑扭转的临床特征之一。
{"title":"Uterine Torsion Associated with Previable Preterm Premature Rupture of Membranes Diagnosed at Cesarean Section","authors":"P. Dasari, Ashraf M Ali, T. Chitra","doi":"10.5005/jp-journals-10016-1184","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1184","url":null,"abstract":"Ab s t r Ac t Background: Torsion of gravid uterus is a rare and sporadic event, and its association with previable preterm premature rupture of membrane (PPROM) is not reported in literature. Case description: A 35-year-old third gravida with previous two early pregnancy losses was managed conservatively following previable rupture of membranes at 20 + 6 weeks of gestation. Torsion of gravid uterus to 180° was diagnosed at elective cesarean section performed at 32 + 2 weeks in view of Breech presentation with severe oligoamnios and tubular cervix. An alive baby of 1.48 kg with good APGAR score was extracted through a low vertical incision given on anterior surface of uterus after detortion. Discussion: Torsion is diagnosed when uterus rotates itself on its long axis 45° or more, and the etiology may be fibroid uterus adhesions and ovarian cysts. Preoperative diagnosis is rare except when magnetic resonance imaging is performed. Most of the cases reported in the literature are diagnosed at cesarean section undertaken for fetal distress or nonprogress of labor. In the case presented here, there were no predisposing factors except that she was on prolonged bed rest due to PPROM, and there was a cornual implantation of placenta. Conclusion: Conservative management of maternal position may predispose to uterine torsion, and in such cases, vigilant monitoring and timely termination can save the fetus. Clinical significance: Presence of a tubular cervix with mal-presentation is one of the clinical features to suspect torsion during pregnancy and labor.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46944481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.5005/jp-journals-10016-1185
S. Wanjari
Ab s t r Ac t Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.
Ab s t r Ac t目的：强调输血的一种罕见并发症，这种并发症可以根据怀疑及早发现，尤其是在症状轻微或非典型时。背景：输血相关急性肺损伤（TRALI）是一种罕见的输血并发症，可能危及生命。TRALI最常见于含有血浆的血液制品。输血成分可以是新鲜冷冻血浆（FFP）、全血浓缩血小板、单采血小板和包装红细胞。TRALI被认为是由靶向人类白细胞抗原（HLA）的供体衍生抗体激活受体中性粒细胞引起的。病例描述：我们在此介绍一位26岁的女士的病例，她被诊断为异位妊娠破裂，血红蛋白为5.6g%。进行了剖腹探查术，她在术中和术后接受了三次输血。几个小时后，我们注意到她没有将SpO2维持在室内空气中。胸部X光片显示有浸润，ECHO正常。诊断为TRALI后，她开始接受鼻内吸氧治疗，并接受了调查。她对注射氢化可的松和利尿剂反应良好，并在72小时内康复。结论：TRALI是所有在输血过程中或输血后出现呼吸困难和肺功能不全的患者应考虑的临床诊断。及时的认识和适当的治疗对其管理至关重要。临床意义：TRALI的典型表现包括输血后6小时内出现呼吸困难和呼吸急促。TRALI应与输血相关循环超负荷（TACO）和其他输血反应以及心脏病和肺栓塞区分开来。在轻度病例中，鼻腔输氧足以达到临床改善。在严重的情况下，可能需要机械通气。我们的患者对氢化可的松、利尿剂和2升/分钟的吸氧反应良好。
{"title":"Transfusion-related Acute Lung Injury in a Case of Ruptured Ectopic Pregnancy","authors":"S. Wanjari","doi":"10.5005/jp-journals-10016-1185","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1185","url":null,"abstract":"Ab s t r Ac t Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48593646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.5005/jp-journals-10016-1182
Aishwarya Pargaonkar, Rukmini Talagadadeevi, V. Parvathi
{"title":"Genetic Counseling in Reproductive Issues: Emphasis on the Genetic Aspects","authors":"Aishwarya Pargaonkar, Rukmini Talagadadeevi, V. Parvathi","doi":"10.5005/jp-journals-10016-1182","DOIUrl":"https://doi.org/10.5005/jp-journals-10016-1182","url":null,"abstract":"","PeriodicalId":38998,"journal":{"name":"International Journal of Infertility and Fetal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46506882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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