Background: Pregnant women with type 2 diabetes mellitus (T2DM) pose an important public health problem, because diabetes not only affects the maternal and the fetal outcome but the women suffering with DM, their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Case description: A 28-year-old woman with the diagnosis of G3P1L1A1 with 32 weeks' gestational age with previous vaginal delivery and known case of chronic T2DM and hypothyroidism since 4-5 years. On admission, she was having altered sensorium, breathlessness, and palpitations. She was in latent phase of labor. Fetal heart sound was not heard on Doppler. Ultrasonography (USG) revealed intrauterine death of fetus. Her investigation reports suggested severe diabetic ketoacidosis (DKA). She was managed in medicine intensive care unit (ICU) where her labor progressed spontaneously and delivered a male dead baby, weighing 1500 g. It was sent for autopsy. Patient had postpartum hemorrhage and managed medically. But medical management did not suffice for her and so decision of laparotomy was taken with the plan of obstetric hysterectomy. Objectives: We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Early screening, detection of complications, close monitoring, and intervention are essential to reduce maternal and fetal short-and long-term adverse effects, especially in high-risk pregnancies. Pregnancy provides an opportunity to clinician to control the disease process and inculcate healthy lifestyle practices in these patients.

No abstract

No abstract

Rheumatic heart disease (RHD) is one of the most common cardiac conditions seen in India with mitral stenosis as the most prevalent cause affecting females more than males. With the increasing number of patients undergoing mitral valve replacement (MVR) and mandatory use of anticoagulants post-MVR, the patients presenting with drug-induced coagulopathy have increased. One of the rare complications of coagulopathy-related hemorrhage may be associated with a gynecological cause with maximum risk in women of reproductive age group. This chance of hemorrhage has increased due to various events that occur in reproductive organs, namely, ovulation, menstruation, trauma due to sexual intercourse, or pregnancy-related bleeding. Such bleeding is evident as external vaginal bleeding or hemoperitoneum. Hereby, we present a rare case of a 30-year-old woman, on anticoagulant therapy for MVR who presented with congestive cardiac failure associated with massive hemoperitoneum. On ultrasound-guided paracentesis, the cause of mild-to-moderate ascites was normal ovulatory bleed evident by the bleeding from the corpus luteal cyst.

Umbilical cord (UC) represents the “life source”, or the “entry and exit” point of humans which is the only source of energy. It is essential for the development, well-being, and survival of the nourishing baby. The characteristic of the coiling of the umbilical cord makes the cord a structure that is  both flexible and strong and provides resistance to  external forces which could compromise the blood flow to the foetus. UC is vulnerable to kinking, compressions, traction, and torsion, which may affect the intrauterine life and perinatal outcome due to coiling. One complete spiral of  360º of the umbilical vessels around each other is defined as Umbilical Coil. Abnormal coiling is defined as UCI less than the 10th percentile (i.e., Hypocoiled cord), UCI more than the 90th percentile (i.e., Hypercoiled cord), and the UCI between 10th and 90th percentile is Normocoiled cord. According to the literature studies, hypercoiled cords are usually associated with intrapartum foetal acidosis and asphyxia, foetal growth restriction, vascular thrombosis, and cord stenosis while the increased incidence of foetal demise, intrapartum FHR deceleration, low APGAR scores, preterm delivery, chorioamnionitis, structural and chromosomal abnormalities, and operative delivery have been associated more with hypocoiled cords. Hence, if the umbilical coiling index can be measured reliably in utero by ultrasound antenatally, then in future, it might become a promising prognostic marker for a better pregnancy and adverse foetal outcome.