Background: The last 30 years have witnessed the dramatic increase in the incidence of placenta accreta spectrum (PAS) disorders from 0.12% to 0.31%. The spectrum of abnormal placental invasion ranges from the subclinical findings of adherent placental basal plate with the myometrial fibres to the substantial presentation of placenta percreta. Methods: In this retrospective study of 10 years, there were 81,650 deliveries at our tertiary care center and 28 patients were diagnosed with PAS disorders. The placental localization and diagnosis of placental spectrum disorders were confirmed with ultrasound and color doppler. Results: Total deliveries during the 10 years study were 81,650, out of which 27 cases met the diagnostic criteria of PAS with ultrasound and 1 case diagnosed intraoperatively resulting incidence of PAS to 0.035%. There is increase in incidence of PAS from 0.0125% in 2010 to 0.1% in 2019. All these patients were planned for elective cesarean section at 35 weeks gestation, but 2 of them presented in emergency with bouts of bleeding and required immediate intervention. Massive hemorrhage was reported in 12 (42.8%) cases and 26 (92.9%) cases required blood transfusion. Bladder injury was reported in 6 (21.4%) case. Maternal mortality has been noted in 1(3.5%) case which was complicated with disseminated intravascular coagulation and acute renal failure. Conclusions: Favorable outcome in PAS disorders can only be achieved with preoperative multidisciplinary input and perioperative measures require adequate time in order to be instituted.
Background: Eclampsia refers to occurrence of generalized tonic clonic convulsions (GTCS) followed by confusion or coma during pregnancy or puerperium in patients with preeclampsia excluding other neurological conditions. Purpose of this study was to evaluate the risk factors, management protocols and determine maternal and perinatal morbidity and mortality in patients of eclampsia.Methods: This is retrospective study of 180 cases of eclampsia carried out from June 2017 to December 2019 including all the antepartum, intrapartum and postpartum cases at tertiary care centre. Immediate management was focused to control the convulsion and lower the blood pressure followed by NST and USG foetus with Doppler study.Results: In this study, 72.2% cases reported antepartum eclampsia while 27.8% cases were postpartum and overall incidence was 0.91% of total deliveries conducted during the study period. Incidence was higher in primigravida (74.4%) and below 25 years age (68.8%). Magnesium sulphate was effective in 94.4% cases. Study reports 63 normal vaginal delivery, 5 assisted vaginal delivery, 110 caesarean section and 2 women expired undelivered. There were 10 maternal deaths.Conclusions: Time interval between eclamptic seizures and initiation of therapy is an important prognostic factor affecting maternal and perinatal outcome. Public awareness regarding the importance of regular antenatal visits can help in reducing chances of development of eclampsia. Even though various drugs and methods have been tried for the treatment of eclampsia, the definitive management is the delivery of foetus after control of convulsion, hypertension and should be managed at tertiary care hospital.
Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication.
Background: Hypogastric artery ligation (HAL) was first introduced by the end of the 19th century to control intractable haemorrhage from the uterus of women with advanced cervical cancer. Bilateral HAL is a lifesaving procedure in massive pelvic haemorrhage.Methods: This is a retrospective study of 58 cases in which HAL was performed in the obstetrics and gynecology department at tertiary care center from January 2000 to December 2020. History, operative procedure findings, immediate and late postoperative complications, morbidity and mortality data were collected and reviewed from records.Results: In this study, total of 58 women who underwent HAL s; 53 bilateral and 5 unilateral. Fifty-three women required HAL for obstetric indications, in 5 cases it was required for gynaecological indications. 20 cases (34.5%) underwent bilateral HAL for atonic PPH, 16 cases (27.6%) during obstetric hysterectomy for morbidly adherent placenta, 5 (8.6%) for colporrhexis, 2 (3.4%) for broad ligament hematoma, 1 (1.7%) for colporrhexis and left sided broad ligament hematoma, 2 cases (3.4%) for secondary PPH and 7 cases (12.1%) for the ruptured uterus. In gynecological cases 4 cases (80%) underwent after vaginal hysterectomy to control pelvic haemorrhage and 1 case (20%) underwent HAL after myomectomy.Conclusions: HAL is an important surgical procedure and should be performed to reduce blood loss when conservation of the uterus is desired. It is also useful in controlling haemorrhage after major gynaecological surgeries and secondary hemorrhage following hysterectomy.
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