Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.
INTRODUCTIONThe global abortion rate is estimated at 28 per 1000 women of reproductive age but varies within regions. Medical abortion uses an anti-progestin, mifepristone (RU486), followed by a prostaglandin (misoprostol). Medical abortion is preferred from four up to seven or nine weeks.1 WHO 2014 has laid down guidelines for dosage of mifepristone and misoprostol-Upto 9 weeksMifepristone 200 mg oral, single dose followed by misoprostol 800 mcg vaginal, buccal or sublingual single dose. From 9 to 12 weeks-mifepristone 200 mg oral single dose followed by Misoprostol 800 mcg, then 400 mcg vaginal, followed by sublingual or vaginal every 3 hours up to 5 doses, 36-48 hours after Mifepristone.Vaginal bleeding with medical abortion generally lasts for 9 days on an average. Woman should seek medical ABSTRACT Background: Medical abortion uses an anti-progestin, mifepristone (RU486), followed by a prostaglandin (misoprostol). Objective of present study was to correlate findings of transvaginal ultrasound with histopathology for retained products of conception in medical abortions. Methods: An observational, prospective study was conducted on hundred women with gestation upto 12 weeks who underwent medical abortion with excessive or prolonged post abortal vaginal bleeding. Transvaginal scan followed by uterine evacuation was done under anesthesia, followed by histopathology. Results: Analysis was done statistically using Pearson Chi-square method. Sixty five percent subjects took MTP pill by unsupervised, self-intake and 35% on prescription. Among women who took misoprostol in dose of 400mcg, 89% had RPOC on histopathology. At the dose of 800 mcg, 73.3% had retained Products of Conception (RPOC) on histopathology. The correlation was found to be statistically non-significant (p value at 5% was 1.13). Ultrasound showed echogenic mass in the uterine cavity in 62 (62%) women, increased endometrial thickness ≥10mm in 13 (13%), gestational sac with no fetal pole in 6 (6%), blood clots in uterine cavity in 6 (6%), and empty uterine cavity in 3 (3%). Seventy five percent of women had histologically proven RPOC at endometrial cut off of equal to or greater than 10mm. The sensitivity, specificity, positive and negative predictive value of transvaginal ultrasonography in detection of retained products of conception were 92%, 60%, 87.3%, 71.4% respectively. The diagnostic accuracy was 84%. Conclusions: Transvaginal ultrasound for detecting retained products of conception in medically managed abortions has a high sensitivity and positive predictive value and is useful for screening women with clinically suspected incomplete abortion who require further intervention -medical or surgical.
Heterotopia is the occurrence of mature tissue at abnormal location. A very rare case of cartilaginous heterotopias in the broad ligament of a 47-year-old female is described. Literature contains very few references related to it. In this patient, there was no evidence of any malignancy in the abdomen or in any other part of the body, except cervical intraepithelial neoplasia changes in cervix. The peritoneal lesion was an incidental finding in this female who underwent total abdominal hysterectomy in view of low-grade squamous intraepithelial lesion of cervix on cervical biopsy. A firm to hard, white-colored, tubular, branched structure, embedded in left broad ligament reaching till serosa of left fallopian tube and undersurface of left ovary was present. Histopathology showed mature cartilage of hyaline type with well-formed chondrocytes and lacunae with surrounding fibrosis with no evidence of cytological atypia, reactive inflammatory changes, or foreign body reaction. This may represent metaplastic lesions of secondary Müllerian system or benign neoplastic lesions (chondroma) of submesothelium.
Placental polyp is an intrauterine polypoidal or pedunculated mass of placental tissue retaining for an indefinite period after delivery or abortion. Because of its rarity, the literature contains few references, and there are great varieties not only on its diagnosis but also the management. We present a rare case of placenta accreta presenting as a uterine polyp. This is the only one case diagnosed at our hospital and managed conservatively.
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