Background: Utero-placental insufficiency is one of the major causes of oligoamnios and diminished fetal movements (FM). Rapid intravenous isotonic fluid infusion within the cardiovascular reserve improves tissue perfusion in all systems. We tested the hypothesis that isotonic fluid challenge may improve uteroplacental perfusion, which may, in turn improve fetal oxygenation, liquor formation, and FM.Methods: In this descriptive study, twenty-three antenatal mothers with gestational age >26 weeks, and with amniotic fluid index (AFI) <8 cm were included. Intravenous isotonic fluid challenge with 2 or 3 pints of ringer’s lactate, at the rate of 180-200 drops/minute, twice daily for 2-3days and, L-arginine infusion, 300 ml/day alternate days for 2-3 doses were given. Women were advised to take more than 3 litres of water a day. AFI was recorded once daily for 5 days, and then biweekly. The fluid challenge was repeated whenever AFI diminished <8.00 cm. AFI and perceived FM were graded. Pregnancies were terminated when there was no response to fluid challenge. The trend of changes in AFI and FM grades, number of days pregnancies continued, and perinatal outcomes were recorded.Results: We noted recurrent fall in AFI after an initial arise in 20 women, which required recurrent fluid challenges. Pregnancies could be continued for 18±8.5 days (median±SD). Three women, with case of absent FM, reported FM within 1 hour after initiation of the fluid challenge. There were no perinatal deaths.Conclusions: Intravenous isotonic fluid challenge and L-arginine infusion, improves AFI and FM, and helps to prolong pregnancies towards viability.
Background: Spontaneous luminal recanalisation, and peritoneal fistula formation connecting the lumens of cut ends, are common causes for tubectomy failure. Failures rates are high with Pomeroy and Madlener methods. Uchida or Irvin techniques have lower failure rates. However, these techniques are not commonly practised because of technical complexity and long surgical time. We developed a novel surgical technique, which leaves the cut ends far away and peritonised.Methods: In our hospital, modified Pomeroy method, and Parkland method were used during 2000- 09, and our new method was used during 2010-19. In the new method, 0.5cm of the cut end of the tube was turned inside and tied to the stump in such a way that the stumps get peritonised. The failure rates were compared between the groups.Results: In the first group, 997 tubectomies were performed. Modified Pomeroy method was used in 360 women. Among them, one woman had a tubal ectopic pregnancy, and one woman had intrauterine pregnancy with a failure rate of 0.55%. Parkland method was used in 637 women. Among them, two women had tubal ectopic pregnancies with a failure rate of 0.31%. During the second 10 years, 637 tubectomies were performed using the new technique. None of the women had failure, with a failure rate of 0.0%. This difference is statistically significant with P<001.Conclusions: New tubectomy method is simple, and more effective in preventing recanalization than Modified Pomeroy and Parklands methods.
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