No abstract

No abstract

Diagnosing the aetiology of jaundice is extremely important in pregnant patients as certain conditions like Acute fatty liver of pregnancy (AFLP), HELLP syndrome and intra-hepatic cholestasis of pregnancy (ICP) may require early termination of pregnancy even in the presence of jaundice and or coagulation failure. Once diagnosed, prompt delivery is associated with a significantly improved outcome. A 20 years old primigravida patient with 34 weeks pregnancy presented to outpatient department of obstetrics and gynecology department of SBH Government Medical College, Dhule, with nausea, vomiting, jaundice, ascites and coagulopathy. The patient was subjected to detailed work-up including laboratory investigations and radiological examinations. A diagnosis of acute fatty liver of pregnancy was made based on the Swansea criteria. The labour was induced with delivery of live male fetus of 2.1 kg in good condition. The case of AFLP was managed using supportive treatment in intensive care unit with blood products, careful fluid management and prevention of hypoglycaemia. Careful history and physical examination in conjunction with compatible laboratory and imaging results are often sufficient to make the diagnosis and liver biopsy is rarely indicated.

Background: Obstetric hysterectomy (OH) still remains lifesaving procedure. OH still poses a major obstetrical morbidity in the developing world due to lack of human, infrastructural and monetary resources. Irrespective of attempts like good antenatal care and delivery planning in modern obstetrics to prevent major obstetric complications; unfortunately, OH needs to be performed at times even today. The aim of present study was to determine the changes in the indications of obstetric hysterectomy.Methods: A retrospective review based on hospital data of all the patients’ records subjected to OH from January 1994 to September 2001 (Gr. A) and from January 2006 to December 2015 (Gr. B) was done and analyzed for incidence and changing trends in the indications.Results: The incidence of OH during two periods from January 1994 to September 2001 (Group A) and from January 2006 to December 2015 (Group B) in the Department of Obstetrics and Gynecology at Shri. Bhausaheb Hire Govt. Medical College, Dhule was 3.27/1000 and 0.97/1000 deliveries. Incidence is reduced by more than three folds. In both groups maximum patients were below 30 yrs of age and multipara. The commonest indications for OH in both groups were uterine rupture, uncontrolled Atonic PPH and placental causes. The incidence of uterine rupture as a cause for OH was reduced from 78.16% to 43.24%, while that of Atonic PPH has increased from 16.09% to 28.37% and placental causes has increased from 4.59% to 9.45%. Among the risk factors for OH, the incidence of prolonged or obstructed labour has reduced from 66.66% to 21.62% and that of malpresentations has reduced from 27.58 to 5.4%.Conclusions: There is definite reduction in the incidence of OH, frequency of uterine rupture, obstructed labor and malpresentations in Gr. B due to timely referral, improved infrastructure and transportation facilities.

Background: Hysterectomy is a common gynecological surgery performed in premenopausal and menopausal age group. Different types of approaches are there with their advantages and disadvantages, it is mainly indicated for noncancerous conditions. Till today three different surgical approaches to hysterectomy are available: vaginal, abdominal and laparoscopic. TLH has been reported to result in shorter procedure durations, lower blood losses, and shorter hospital stays.Methods: This is a retrospective case study, was carried out over a 5-year period in a tertiary care institute. Study done on patients attending gynecology OPD at our tertiary care institute during the period since September 2013 to September 2018.Results: In present study out of 646 endoscopic hysterectomies in last five years authors studied 420 Total Laparoscopic Hysterectomies. Conversion to open surgery rate was 0.3%. Mean age was 49.26 years (SD-9.53), Performed for various indications with various BMI patients. Mean surgical duration was 116.55 minutes with SD 26.27. Major complication rate was 2.85% with 2 cases of bowel injuries and 3 cases of urological injuries.Conclusions: Total laparoscopic hysterectomy appears safe and effective approach for variety of indications with minimal morbidity. Beneficial for all age group all nulliparous /multiparous patients as well as obese patients. With the knowledge of all complication and its prevention, maximum surgeons can give benefit of advantages of total laparoscopic hysterectomy to all women. More and more randomized clinical trials will motivate surgeons for this approach.