Background: Twin pregnancies are associated with many complications. Hence the mode of delivery and its effect on the maternal and foetal outcome is important.Methods: A retrospective study of twin pregnancies carried out from April 2015 to March 2017 in a tertiary hospital in north east, India. The maternal, foetal outcome and the mode of delivery data collected and analysed.Results: A total of 50 twin pregnancies studied. The prevalence of twin was 20/1000 deliveries. Most common age group was 20-29 years with a mean age of 28±5.7 years. A total of 24 (48%) had vaginal delivery and 26 (52%) had LSCS, 2 (4%) had the first twin as vaginal delivery and second twin LSCS. A statistical significance was seen in the mode of delivery of twin pregnancies conceived after ovulation induction, (p<0.05). The most common indication for LSCS was foetal malpresentation (14.58%) followed by foetal distress (12.5%) and elective LSCS (10.42%) on patient’s request. The most common complication was anaemia (28.08%) and PIH (27.08%). In the neonate prematurity was the most common morbidity. There was no association between the mode of delivery and the foetal outcome in the form of Apgar at 5 minutes, NICU admission and perinatal mortality.Conclusions: There is a rise of caesarean delivery in twin pregnancies, maternal request becoming one of the causes. Regular antenatal check-ups of pregnant women with counselling regarding the mode of delivery should be carried out.
A 28-year-old P2 was admitted with complaints of amenorrhea for 4 months with irregular bleeding per vaginum. She had complaints of difficulty in breathing and abdominal distension since 4 days. Urine for pregnancy test was positive. She had Hb of 3.5gm%. White blood count, platelets, coagulation profile, liver function tests and renal function tests were normal. Ultrasound showed grossly enlarged mass with miscellaneous echogenic shadows in the myometrium with loss of endometrial junction, multi cystic ovaries with massive ascites and a diagnosis of Gestational Trophoblastic Disease (GTD) was made. Her last child birth was 2 years back and she did not have any history of abortion or molar pregnancy in the past. The patient had features of hypovolemic shock with anaemia. She had received three units of blood transfusion and was on ionotropic support. Then the patient was referred to our institute for further management.
Background: To analyse the clinical features, diagnostic challenge and treatment options in patients presenting with pain abdomen and cryptomenorrhea in patients with vaginal obstructive lesions in comparison with those having normal vagina but having non communicating rudimentary horn with functional endometrium. Methods: The clinical details of patients presenting with cryptomenorrhea to our institute was studied. The data collected was from a period of 7 years; from March 2010 to April 2017. The clinical details were collected from cases sheets of the respective cases. Result: A total of 6 cases were studied. Among the 6 patients, all were within the age group of 13-20 years. 3 patients had abnormality in the form of vaginal agenesis, transverse vaginal septum and imperforate hymen. All the 3 presented with amenorrhea and severe cyclical pain. The other 3 patients had rudimentary non communicating horn with functional endometrium and had different clinical presentations. One had severe dysmenorrhoea, one had severe cyclical pain with amenorrhea and the third patient had been operated earlier and presented with severe dysmenorrhoea with an incision site sinus with discharge of menstrual blood abdominally along with vaginal passage of menses. Since reflux of menstrual blood is seen in all cases, endometriotic ovary was found in 2 cases. One had only hematosalpinx. Two patients have been operated earlier for endometriotic cyst but the abnormality in the uterus or vagina was not detected, leading to reoccurrence of symptoms. Conclusion: Cryptomenorrhea or hidden menses due to congenital malformation in the uterus or vagina is a rare condition but can lead to distressing symptoms of dysmenorrhoea in young girls. It can also cause endometriosis due to retrograde menstruation .Improper evaluation can miss the proper diagnosis and patient may be operated only for endometriosis of ovary as a cause for dysmenorrhoea. Not identifying and treating the primary abnormality will lead to recurrence of symptoms and repeat surgeries in patients.
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