Background: Laparoscopic surgeries have attained the status of a gold standard for most of the abdominal pathology; we therefore performed this study to assess feasibility and safety of major laparoscopic surgeries like laparoscopic cholecystectomy (LC) and laparoscopic assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) under regional anesthesia that is combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum using intrathecal fentanyl with bupivacain.Methods: In a zonal government hospital, 50 patients were selected prospectively for LC and LAVH/TLH, under normal pressure (12 mmHg) pneumoperitoneum and under CSE over a span of fifteen months. Injection bupivacaine (0.5%) and 20 mg of fentanyl were used for spinal anesthesia. Plain bupivacaine (0.5%) was used for epidural anesthesia.Results: We successfully performed the operations in 48 patients without major complications. CSE was converted to general anesthesia in two patients due to distressing shoulder tip pain. Age varied between 25 and 70 years. Duration of operation time (skin to skin) was between 50 and 170 min. Five patients had urinary retention and one developed localized pruritis. There was no incidence of respiratory depression, aspiration or headache.Conclusion: Laparoscopic surgeries with normal pressure CO 2 pneumoperitoneum are feasible and safe under CSE. Incidence of postoperative shoulder pain was minimal due to use of intrathecal fentanyl and complications were less and easily manageable.
Background: The spectrum of liver disease is varied and is associated with increased maternal and perinatal morbidity and mortality when pregnancy coexists with the liver disease. This study aims to analyze the incidence, spectrum, clinical presentation and outcome of liver diseases complicating pregnancyMethods: A retrospective cohort study was conducted and data was collected from the hospital records of obstetric cases diagnosed with liver disease complicating pregnancy in a tertiary care hospital, over a period of two years.Results: A total 146 cases of liver diseases complicating pregnancies were recorded out of 5018 deliveries (2.9%). Intrahepatic cholestasis of pregnancy (n=52, 35.62%) and severe preeclampsia (n=47, 32.19%, with HELLP n=8, 5.48%) accounted for majority of cases. The incidence of chronic hepatitis B infection was 20.56% (n=30). There were two maternal deaths (1.37%) attributed to severe post-partum HELLP and severe preeclampsia with multi organ failure.Conclusions: Liver diseases in pregnancy have a non-specific presentation and may be associated with a wide range of conditions, early diagnosis and timely appropriate intervention can help reduce the mortality and morbidity.
Cervical tuberculosis is a rare entity with only limited number of case reports in the literature. A 53 year old, P1, post-menopausal housewife presented with history of one episode of post-menopausal bleeding and whitish discharge per vaginum. Speculum examination revealed an ulceroproliferative cervical growth. Clinically she was diagnosed to have carcinoma cervix. However, cervical biopsy confirmed the diagnosis of cervical tuberculosis. She was treated with anti-tubercular drugs for six months and has been disease free for the last two years. This case emphasizes the fact that though cervical tuberculosis is rare, it should be considered in the differential diagnosis of carcinoma cervix.
Background: Fetal distress is an important indication for emergency caesarean deliveries. The objective of this study is to identify the antenatal and intrapartum risk factors in emergency caesareans done for non-reassuring fetal status and compare with patients who underwent emergency caesareans for other indications.Methods: It was a retrospective study and data was collected from the labour room records of a tertiary care hospital. Patients undergoing emergency caesareans for fetal distress were the cases and the remaining emergency caesareans were the controls. Data was statistically analyzed.Results: There were 5184 deliveries during this period of which, 669 were emergency caesareans. 126 (18.83%) of these were due to fetal distress/ non-reassuring fetal status and 543 (81.17%) were for other indications. Caesarean due to fetal distress accounted for 2.43% of the total deliveries. There were more primigravidae (61.11% Vs 46.04%) in the fetal distress group (Odds Ratio 1.84, p=0.003). Intra uterine growth restriction (OR 5.44, p<0.0001) and antepartum haemorrhage mainly due to abruption (OR 11.19, p <0.0001) were other important antenatal risk factors. Those with neonates of birth weight between 1.5 to 2.0 kgs were more likely to undergo emergency caesarean for fetal distress (OR 1.78, p=0.0435). The risk of a lower APGAR was higher in the fetal distress group (12.59%). 28.34% neonates in this group required NICU admission.Conclusions: Primiparity, intrauterine growth restriction, antepartum hemorrhage and prematurity, have shown to significantly increase the risk of emergency cesareans due to non-reassuring fetal status. We need to improve antenatal care with a goal of early detection of the above risk factors for timely institution of appropriate intervention and thus contributing to a reduction of emergency caesareans due to fetal distress.
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