Background: Relaparotomy in obstetrics following caesarean section or laparotomy is associated with high morbidity and mortality and hence, considered as maternal near miss. Selection of patient for the same is crucial. This study was done to know the incidence, indications, the risk factors, intraoperative procedures and mortality rates of relaparotomy. Methods: A retrospective analysis of relaparotomy after primary obstetric surgery over a period of two and half years (Results: During study period 28 cases of relaparotomy (18 inhouse and 10 referred cases) were identified. The incidence of relaparotomy was 0.24%. Intraperitoneal hemorrhage (39.2%) was commonest indication of reoperations followed by PPH (17.8%), rectus sheath hematoma (14.8%) and burst abdomen (10.7%). Obstructed labor (32.1%) was commonest indication of primary cesarean. Hysterectomy was required in 8 cases (25.7%), evacuation of blood for hemoperitoneum was required in another 8 cases. Most cases of hemorrhage were reopened within 24 hours, whereas most case of the rectus sheath hematoma, burst abdomen, and broad ligament hematoma were reopened between 5-9 days. Conclusions: Relaparotomy is often a lifesaving procedure. Decision to perform and manage relaparotomy should always be done by senior obstetricians. Meticulous surgical techniques to secure hemostasis at time of primary surgery should be adopted. Strict postoperative vigilance, is of utmost importance for early detection of intraperitoneal hemorrhage and other complications requiring relaparotomy as timely intervention.
Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.
I. IntroductionHypertensive disorder of pregnancy affects about 5-8% of all pregnant women worldwide [1]. The incidence of pregnancy induced hypertension (PIH) in the world varies in developing countries, from around 7% in Zimbabwe to around 0.81% in Columbia. In rural India the incidence is 10% [2]. Hypertension in pregnancy contributes significantly to maternal & perinatal morbidity and mortality. The relationship between placental morphology function and foetal outcome has been the subject of study for many years. Placenta is an important foetal organ which is an intermediate link between the fetus and the mother. Owing to the delicate and important nature of the placenta, it is sometimes referred to as the "mirror of the perinatal period which has not been sufficiently polished" [3,4].Proper functioning of the placenta is important for proper growth and development of the foetus in utero. Placenta being a foetal organ shows the same stress and strain, to which the foetus is exposed. Thus any disease process affecting the mother and foetus has a great impact on placenta and vice versa. Morphology of placenta varies during its short life span. Alteration in placenta as part of "ageing" phenomena are probably a part of maturation process and goes hand in hand with continued growth of placenta. The well being of the foetus is affected by many factors but a healthy placenta is the single most important factor in producing a healthy baby [5,6]. There is a widely and tenaciously held belief that during course of normal pregnancy the placenta progressively ages and that the term placenta is in verge of a decline into morphological and functional senescence [7]. Various complications in pregnancy have been correlated with specific micro and macroscopic placental changes. Compromised placental perfusion from uterine vasospasm almost certainly a major culprit in the genesis of increased perinatal morbidity and mortality [8] associated with pregnancy induced or pregnancy aggravated hypertension [9].Evolution of Ultrasonography has been very useful in Obstetrics and has found application in placental studies [10]. Sonography remains the imaging modality of choice for evaluation of the placenta. It is an important part of obstetrical evaluation of pregnancy. With grey scale Ultrasonography it is possible to identify changes in placental anatomy which formally have been recognized only by examination of the placenta after delivery. By serial ultrasound examination these changes can be detected as they occur, since placenta is a foetal organ it seems logical that it should mature in fashion similar to that of other foetal organ system. In order to categorize the phase of maturation of placenta Grannum & associates classified ultrasonic variations in placental appearance occurring during gestation and then to correlate these findings with an index of foetal lung maturity, . The advent of antenatal detection of foetal pulmonary maturity by measurement of L/S ratio in amniotic fluid has resulted in a significant reduction in b...
Background: Rupture uterus is a rare and often catastrophic condition. It is associated with a high incidence of fetal and maternal morbidity and mortality. It is a preventable condition. Timely diagnosis and management results in better outcome. The objective of this study was to determine incidence, risk factor, management, maternal and fetal outcome in cases of uterine rupture.Methods: A retrospective study of cases of ruptured uterus was done over a period of one year from January 2015 to December 2015. The case sheets of patients were traced through labor room register, operation theatre register and medical record section.Results: There were 57 cases of ruptured uterus out of total 8112 deliveries in labor room, giving incidence of 7.03/1000 deliveries (0.7%). The most common risk factor was previous caesarean section in 59.7% of cases. In 54.4% cases patients were multiparous (≥3). Most of the patients presented with poor general condition, abdominal pain and tenderness, palpable fetal parts and in shock in 68.4% cases. Patients were treated with immediate resuscitation and laparotomy followed by either repair or hysterectomy. There was high perinatal mortality of 89.5%. Maternal mortality was 3.5%.Conclusions: Proper antenatal care, appropriate counselling of patients with history of previous caesarean section for hospital delivery, training of skilled birth attendant can reduce mortality and morbidity associated with rupture uterus.
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