No abstract

Development of severe fetal anemia due to red cell destruction in intrauterine life, most commonly implicated with hemolytic disease of fetus or newborn. Untreated cases lead to hydrops and even death of newborn. We are reporting a case of severe fetal anaemia successfully delivered after intrauterine transfusion. A 28-year-old female having bad obstetric history G10 P3600, came to our fetal unit at 23 + 4 weeks gestation. Middle cerebral artery peak systolic velocity (MCA PSV) value was 2.2 mom before 1 st intrauterine procedure. Subsequent intrauterine session was planned at 1–2 week interval. After completion of 3 rd intrauterine transfusion, MCA PSV value was 0.8 mom and baby was delivered at 32 + 1 week via lower segment cesarean section. Intervention at appropriate time, appropriate volume of selected unit and appropriate rate of transfusion definitely improves perinatal outcome.

Indications for laparoscopic surgeries are increasing in the current era in view of the advantages they offer in terms of less perioperative morbidities, early mobilization, and better cosmesis. These benefits are perceived even more in obese women. However, there are special challenges in this population, associated with their body habitus, poor visibility, and perioperative anesthesia risks. Difficulty in port closure is one such problem encountered in these women causing inadequate rectus suturing and leading to port site hernia. We report a case of a 59-year-old morbidly obese lady who underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for carcinoma endometrium. The intraoperative course was uneventful. In the postoperative period, she developed acute obstruction due to port site herniation of the small bowel, which was not suspected till postoperative day five. This was due to an inaccurate assessment of her abdomen because of her body habitus. A CT scan was done in view of the non-resolving obstruction, which revealed herniation of a small bowel loop through the umbilical port. Immediate correction was resorted to under local anesthesia. Rectus sheath closure was done in the same sitting. The patient had a quick recovery after that and was discharged three days later. Rectus sheath closure should be done for all ports 10 mm or greater in diameter. There should be a low threshold to get cross-sectional imaging in postoperative obese women with non-resolving gastrointestinal symptoms.

Vesicouterine fistula (VUF) also called Youssef's syndrome is a rare and the least commonly encountered entity among genitourinary fistulae. Treatment options range from excision of the fistulous tract with hysterectomy and primary closure of the urinary bladder to fistula repair. Migrated postpartum intrauterine contraceptive device is one of the rarest causes for VUF. Here, we are describing a case of incidentally diagnosed VUF with Type 2 Youssef's syndrome with migrated postplacental (postcesarean) intrauterine contraceptive device, treated with uterus-sparing laparoscopic VUF closure.