Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta to mandatory exclude overdiagnosis or migration. All cases of placenta previa need to be managed in a higher centre facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.
We report a rare case of complete duplication of the bladder, urethra and external genitalia associated with other multiple congenital anomalies, such as ventriculoseptal defect, malrotation of the gut, ectopic anal opening, malascended left kidney, rachischisis of the lumbar spine and sacrum, and an umbilical hernia. To our knowledge the occurrence of these associated anomalies in a single case of complete duplication of the bladder, urethra and external genitalia has not been reported previously.
We report a case of bilateral ureteropelvic junction obstruction associated with bilateral stones, one of which was large. An Anderson-Hynes operation was performed on both sides, the stones were removed and the patient became asymptomatic. To our knowledge the stone in our case is the largest and heaviest ever to be described in the literature.
INTEREST in the radiographic visualisation of the distal spermatic tract described as vaso-seminal vesiculography has varied during the past six decades. Belfield in 1913 first attempted radiography of the spermatic tract by cannulation of the vas deferens. Peruretheral catheterisation of the ejaculatory ducts for therapeutic purposes and for seminal-vesiculography was popularised by McCarthy and Ritter (1927). During the next two decades, several workers modified the technique of vaso-seminal vesiculography and advocated its use in the study of congenital and inflammatory lesions of the spermatic tract. With the advent of antibiotics and successful treatment of gonococcal urethritis and tuberculosis the incidence of prostato-vesiculitis diminished considerably. Consequently the indications and the need for vaso-seminal vesiculography did not arise so frequently. The technical difficulties in catheterisation of the ejaculatory ducts and its complications further discouraged its use.In the early 1950's several Latin-American and Scandinavian workers revived this procedure by cannulation of the vas deferens through a vasotomy. Pereira (1953) from Brazil discussed in detail the anatomical variations and changes in the spermatic tract induced by pathological lesions like tuberculosis, congenital anomalies and prostatic disease. Gerner-Smidt (1958), Vestby (1958) from Scandinavia, and other continental urologists pointed out the role of vasoseminal vesiculography as an adjunct to other methods of differentiating carcinoma from benign hyperplasia of the prostate. Nylander et al. (1961) described the results in congenital lesions like cryptorchism and testicular aplasia and, in addition, inflammatory lesions and prostatic enlargement. These authors advocated its use in congenital and inflammatory lesions but did not find it useful in differentiating carcinoma from benign hyperplasia of the prostate.The limitations and pitfalls encountered in conventional methods of diagnosing carcinoma of the prostate on the basis of the findings of rectal examination, X-ray, serum acid phosphatase estimation and biopsy are widely appreciated. The work of these Scandinavian workers stimulated urologists elsewhere to undertake vaso-seminal vesiculography at the time of routine vasligation as a prelude to prostatic surgery. Elliot et al. (1964) and Fetter and his co-workers (1962) described the results of their findings from the United States. Similar studies were made in certain centres in India (Khashu, 1966;Prasad and Kataria, 1966; Saha, 1966).A review of the reported series reveals conflicting opinions regarding its role in differentiating carcinoma and benign hyperplasia of the prostate. While Vestby reported 90 per cent positive results in carcinoma of the prostate, other observers failed to obtain more than 70 to 80 per cent positive results. Further, there is lack of unanimity regarding the criteria used for the various studies, and conclusions have apparently been drawn on the basis of limited data. In the present series an a...
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