No abstract

A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.

Objective: The study has been designed to assess the knowledge of ethics amongst young students and professionals, and practices of health care ethics among medical professionals in a government teaching hospital in India. Methodology: A cross-sectional study was carried out at one of the teaching hospitals in Southern India with a sample size of 84 among fresh medical graduates, post-graduate trainees, and young consultants with work experience of 6 months to 8 years. The data were collected by means of a structured and validated questionnaire, and the questionnaire was administered before and after a lecture/seminar on ethical principles, and results were analyzed using SPSS software. Results: The maximum participants were in the age group of 20 to 24 years with 0–2 years of clinical experience. The basic awareness and practices before the workshop were quite less when compared to after the workshop which showed a very good improvement in the correct responses to the questions. The maximum change seen, reflected in curiosity to learn bioethics. The workshop was an eye-opener for many participants in terms of the Nuremberg Code and its origin. The ethics committee was an alien concept to many participants, and it was reflected in the response postworkshop. The students felt a strong need to discuss ethics and implement them postworkshop. The segment on attitudes in clinical practice showed an impact on autonomy and truth-telling (32% to 50%). The segment on ethical practices reflected a confused audience. The increase in sensitivity to police information, and the concept of error of judgment and negligence were positive. The fact that medical practitioners are legally bound to help accident victims showed a positive response. Conclusion: Based on the assessment of pre-and post-workshop, there is a strong need to stress the ethical principles and revision of these ideas from time to time. Workshops and interactive sessions are a good way for periodic assessment and reinstatement of these values in our research and clinical practice. Thus, these should be part of the curriculum across all educational institutions for budding primary care providers and family physicians.

Parasitic fibroids (PFs) are rare extrauterine fibroids classified as Type 8 leiomyomas as per The International Federation of Gynecology and Obstetrics (FIGO) classification, without uterine myometrial involvement or attachment. Due to its very low incidence, unusual locations, and atypical presentations, these fibroids cause lot of clinical dilemmas to treating physicians. Hereby, we are presenting an interesting case of PF which is presented to us as a case of abdominopelvic mass. Here, we learned that whenever female patients with abdominal mass and prior surgical history, PF should be considered possibilities to avoid on-table intraoperative surprises where a multidisciplinary surgical team may be required depending upon location and organ involved. We were fortunate that our PF was attached to the omentum and sigmoid colon by connective tissue and feeding vessels and could be removed without much deliberation.

Objective: The objective of this study was to investigate if intrauterine infusion of granulocyte colony-stimulating factor (G-CSF) or platelet-rich plasma (PRP) can improve endometrial parameters and the pregnancy rate in patients undergoing fresh embryo transfer with normal endometrial thickness. Materials and Methods: We conducted a retrospective observational study, at one of the assisted reproductive technique centers in central India. Data were collected from the institutional record system which was established as per the standard protocols. Data on a total of 225 patients who had an endometrial thickness >7 mm without any adjunct and underwent fresh embryo transfer in their first in vitro fertilization cycle during the past 2 years were collected and were categorized into three groups: Group A who had received intrauterine infusion of G-CSF (n = 75), Group B who received intrauterine infusion of PRP (n = 75), and Group C who (control group) received no intervention (n = 75). Results: The implantation rate was significantly higher in Group A (37.24%) than in Groups B and C (21.91% and 21.37%, respectively). No significant difference was found in the clinical pregnancy rate among Groups A, B, and C (50.68%, 40.54%, and 37.84%, respectively). Endometrial thickness increased significantly in Group A by approximately 2.3 mm. No significant change in other endometrial parameters in the three groups. The number of biochemical pregnancies was higher in the G-CSF group compared to the other two groups. Conclusion: Intrauterine infusion of G-CSF in women receiving fresh embryo transfer with normal endometrial thickness can increase endometrial thickness and the implantation rate without affecting other endometrial parameters and the cumulative pregnancy rate.