Background: Hypertensive disorders represent the most common medical complication of pregnancy Pre-eclampsia complicates approximately 2-7% of pregnancies and is a major cause of maternal and perinatal morbidity This has led to the interest in screening. The placenta is located laterally in majority of patients with abnormal flow velocity waveforms. In the light of these observations, we designed a prospective study to find out whether the lateral location of placenta as seen by ultrasound at II and III trimester of gestation can be used to predict the development of preeclampsia.Methods: A prospective observational study was done in PESIMSR, Kuppam, Andhra Pradesh. The aim of the study was to find out whether placental laterality as determined by ultrasound can be used as a predictor of development of gestational hypertension, development of preeclampsia/eclampsia During the study period of November 2013 to November 2014, all antenatal women attending the OPD in II and III trimester without any medical disorders likeDM, HTN, renal disease, cardiac disease or smoking, who undergo ultrasound in II and III trimester were included. The location of the placenta was determined by real time ultrasound in II and III trimester. The placenta will be classified as central when it is equally distributed between the right and the left side of the uterus irrespective of anterior, posterior or fundal position. When 75% or more of the placental mass is to one side of the midline, it is classified as unilateral right or left placenta. subjects were followed upto delivery for development of gestational hypertension/ preeclampsia/eclampsia as per the ACOG criteria.Results: 66% patients in the lateral placenta group developed preeclampsia. Only 36%in the central group developed preeclampsia. The association of lateral placenta as a predictor of preeclampsia had a P value of <0.001 which is statistically significant. Incidence of preclampsia is more in primigravidas compared to multigravidas. Most of the pre eclamptics had their onset at 29 – 32 weeks of gestation.Conclusions: The study shows that placental position determined by ultrasonogram in II and III trimester of gestation is an excellent screening tool for the prediction of pre-eclampsia. The test is ideal because it is simple, non-invasive, cost effective and convenient to the women.
To evaluate the role of non-descent vaginal hysterectomy in advancing gynaecological practice and to study the safety and feasibility of performing vaginal hysterectomy for non-prolapsed uterus as primary route in benign gynaecological condition. METHODS: A prospective study of 120 cases was conducted at the department of obstetrics and gynaecology of PES institute of medical sciences and research from January 2012 to December 2014 120 patients planned for hysterectomy for a wide range of benign indications like fibroid uterus, AUB, adenomyosis were chosen for non-descent vaginal hysterectomy. Data regarding age, parity, uterine size, and estimated blood loss, length of operation, intra-operative and postoperative complications and hospital stay were recorded. RESULTS: A total of 120 cases were selected for non-descent vaginal hysterectomy. Among them 113(94.16%) cases successfully underwent non-descent vaginal hysterectomy. Majority were aged 40-45 years (53.33%) with 8 nullipara and 21primipara. Commonest indication was fibroid (58%) and largest uterine size was 16 weeks. Different morcellation techniques were used in more than 10weeks sized uterus. Adnexal surgeries were performed in 11 cases without much difficulty. In uncomplicated cases average blood loss was 200 ml and operating time was 60minutes. Most of the patients were discharged by 4 th post-operative day, 7 patients were converted to abdominal route due to various difficulties, 3 patients had bladder injury and 1 patient was subjected to laparotomy due to hemoperitoneum post operatively. CONCLUSION: Proper training and proper case selection can lead a gynecologist to consider the vaginal approach as the standard route for hysterectomy and good patient compliance
Introduction:Labor pain is the most severe pain a women would experience and several treatment modalities have been adopted since decades. Labor analgesia using epidural technique is considered as the efficient and effective treatment options available. Parturients in India especially rural areas are less aware regarding labor analgesia using epidural technique. Aim: To study the effects of labor analgesia using epidural technique in nulliparous women. Materials and Methods: Sixty full term nulliparous women with singleton vertex pregnancy were made aware of labor analgesia using epidural technique and included, those willing were grouped epidural(n=30), those not keen were grouped control(n=30). In 1 st stage labor, parturients in epidural group received bupivacaine and fentanyl, whereas in control group received intramuscular Inj. tramadol, and Inj. pethidine if needed. Duration of 1 st and 2 nd stage labor, pain relief, maternal satisfaction, adverse effects, instrumental deliveries, 1 st and 5 th minute Apgar score and NICU admission were recorded. Results:The mean duration of first stage labor was shorter (p=0.071) in epidural group (250.17±106.33 minutes) compared with control group (302.0±111.99 minutes) and statistically insignificant prolongation (p=0.892) (18.73±6.82 minutes) of 2 nd stage labor as compared to control (18.33±14.53 minutes). Pain relief in epidural group was statistically significant (p<0.001). Instrumental delivery rate although higher in epidural group was statistically insignificant (p=1.00). The Apgar score at 1 st (p=0.306) and 5 th minutes (p=1.00), NICU admission rate were statistically insignificant (p=0.143) between groups. Conclusion: Labor epidural analgesia using Inj.bupivacaine and Inj.fentanyl provides good pain relief, safe for mother and baby. It does not affect labor duration, instrumental delivery rate or neonatal outcome.
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