Perineal scar endometriosis is a devastating illness with grave consequences. An early diagnosis is imperative as a delayed diagnosis results in extension of the disease process causing increasing damage to adjoining structures like the anal sphincter and rectum. A late recognition of the disease also prolongs the agony of the patient owing to its being a very painful condition. Two cases are presented of parous women in their early thirties who had episiotomy scars preceding the development of endometriosis. The cases were treated by a perineal incision and removal of suspicious structures. However, a recurrent endometrioma was formed in one case, which had to be excised again. In the other case, symptoms of recurrence had begun, which subsided after a dose of GnRh analogue (leuprolide acetate 3.75 mg). Both patients are on follow-up and are fine until now.

A 25-year-old woman presented with a history of secondary amenorrhoea for the last 3 years, coinciding with her delivery. She delivered at home and had massive postpartum haemorrhage. She was brought in a state of circulatory collapse to the nearest teaching hospital, where she was resuscitated. She developed anaemia, septicaemia and extradural empyema. The complications were managed and the woman improved. Presently, she approached us for infertility. She was investigated and diagnosed with postpartum hypopituitarism, that is, Sheehan's syndrome. Her gonadotrophin levels, luteinising hormone/follicle-stimulating hormone, were normal, serum oestradiol was low and serum prolactin was also on the lower side. She had started with genital atrophy and was given three cycles of cyclic oestrogen +progesterone combination. Ovulation was induced. She conceived and her antenatal period was uneventful. She delivered a full-term baby vaginally. However, she had inadequate lactation after delivery and lost the baby at one-and-a-half months’ age due to gastroenteritis.

No abstract

A 24-year-old woman with 21-hydroxylase deficient classic congenital adrenal hyperplasia, simple virilising form presented with secondary infertility. One year ago she had a spontaneous miscarriage in the second trimester of pregnancy. This time she conceived with prednisolone 5 mg and clomiphene citrate 100 mg. She was then continued with prednisolone during pregnancy. She had a spontaneous preterm delivery at 33 weeks. There was a marginal increase in the dose of prednisolone during pregnancy. There was no worsening of insulin resistance during pregnancy despite prednisolone administration. A normal healthy female infant was born and is being followed up on for ill-effects, if any, of maternal glucocorticoid administration during pregnancy. The baby girl has normal female external genitalia.