No abstract

BACKGROUND Caesarean section delivery, in spite of its popularity has its short-and long-term complications like infections, haemorrhage, adhesions, abnormal placentation, uterine rupture and hysterectomy. Many studies have shown an increasing incidence of abnormal placentation which includes placenta previa, placenta accreta, placenta increta and placenta percreta to be related with the rising trend of caesarean section delivery. Again, abnormal placentation is a life-threatening condition often associated with massive postpartum haemorrhage and in recent studies it is the most common indication for peripartum hysterectomy. Deliveries by caesarean section are also increasing in our institute. METHODS In this hospital based cross-sectional study, 91 peripartum hysterectomy cases received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, during a ten-year study period (January, 2009 to December, 2018) were included in the study. The gross and microscopic histopathological findings were statistically analysed in relation to age, parity, number of previous caesarean sections using SPSS software. Significance of the risk of abnormal placentation between cases of previous caesarean section and vaginal deliveries was evaluated by chi-square test (p-value of ≤ 0.05) and odds ratio (OR). RESULTS During the ten years study period, 91 peripartum hysterectomy cases were selected and studied. The overall rate of peripartum hysterectomy was 1.27 per 1000 births. The age of the cases ranged from 20 to 45 years and 81.3 % were multiparous (parity two and above). The main pathological lesions were abnormal placentation-41 (45.05%), ruptured uterus-16 (17.58%), uterine atony-21 (23.07%) and retained product of conception-13 (14.28%). In 32 (35.16%) cases, there was history of previous caesarean section once in 14 and twice in 18, of which 23 (71.88%) cases had abnormal placentation pathology comprising of placental praevia 12 (37.50%), placental accreta 4 (12.5%), placental increta 5 (15.62%) and 2 (6.25%) placental percreta. CONCLUSIONS Abnormal placentation which includes placenta praevia, placenta accreta, placenta increta and placenta accreta is one of the most important causes of intractable postpartum haemorrhage necessitating a peripartum hysterectomy. Previous caesarean delivery has a 5.82 times higher risk of developing placentation abnormalities in subsequent pregnancies than previous vaginal delivery.

The COVID-19 pandemic continues to be a rapidly evolving situation with limited data on its impact on pregnancy. The study was conducted to evaluate the maternal and perinatal outcomes of pregnant women in the first wave of COVID-19 infection Materials and Methods: Clinical records were retrospectively reviewed for 129 pregnant women with laboratory confirmed COVID-19 infection admitted in the Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal (Manipur, India) from 27 th July to 27 th November 2020. The maternal and perinatal outcomes were collected and analyzed. Evidence of perinatal transmission of the virus was assessed with SARS-Cov-2 Reverse transcriptase polymerase chain reaction testing done on oropharyngeal swab of neonate taken 24 to 48 hours after delivery. Results: Of the 129 cases, 119 (92.24%) were asymptomatic and two (1.55%) had severe symptoms with one necessitating intensive care unit (ICU) admission and ventilatory support, subsequently causing maternal death. There were three cases (2.33%) of abortion, two ectopic pregnancies (1.55%) and ten preterm deliveries (8.54%). Two cases of neonatal asphyxia were observed, both requiring admission with one resulting in neonatal death. Furthermore, two out of 83 neonates were tested positive for COVID-19 on oropharyngeal swab. Conclusion: Majority of the COVID-19 positive pregnant women were asymptomatic in the first wave and associated with good obstetric and perinatal outcome, however, severe case was associated with increased risk of ICU admission and mechanical ventilation ultimately leading to maternal death. Probable chances of vertical transmission of COVID-19 infection could not be ruled out at present.

Background: Accurate estimation of fetal weight is of paramount importance in the management of labour and childbirth. In developing countries including India, estimation of fetal weight by clinical method is important as ultrasound is not available in all health care settings. In view of this, the present study was conducted to estimate the fetal weight assessed by clinical and ultrasound method and correlating with the birth weight.Methods: A cross-sectional study was conducted to estimate fetal weight clinically by using Johnson’s formula and sonographically based on Hadlock’s formula in the Department of Obstetrics and Gynecology in collaboration with Department of Radiodiagnosis, Regional Institute of Medical Sciences, Imphal from October 2016 to March 2018. The study consisted of 525 pregnant women between 37 to 40 weeks of gestation in whom delivery was anticipated within one week of fetal weight estimation by clinical and ultrasound method and correlating it with the baby’s birth weight measured immediately after delivery. Analysis was done using Chi-square and Student’s t-test and p-value of <0.05 was taken as significant.Results: Both methods showed positive correlation with birth weight but clinical method (r=0.925) had stronger correlation compared with ultrasound method (r=0.508).Conclusions: Fetal weight estimation using Johnson’s formula had stronger correlation with the birth weight than ultrasound method and hence, useful for developing countries and all health care workers may be sensitized about the method.