INTRODUCTIONAny miscarriage is associated with distress and prompts questions about the optimal timing of the next pregnancy. How long a couple should wait before trying for another pregnancy after a miscarriage is controversial.1 Any delay in attempting conception could further decrease the chances of a healthy baby. The adverse effects of advancing age should be balanced against delaying subsequent pregnancies and advice should be tailored to the needs of individual women. Women wanting to become pregnant soon after a miscarriage should not be discouraged. There may be cases where a delay is desirable, for example if there are signs of infection, and women should be advised appropriately.2 Keeping all the above facts in mind we conducted a study in our department to determine whether the length of the interval between an abortion and next pregnancy is associated with increased risk of adverse pregnancy outcomes. Inter pregnancy interval (IPI) was calculated as the time period between last abortion and Last menstrual period (LMP) of the present pregnancy. METHODSWe conducted a one year study in department of OBG, KNH, IGMC, Shimla. 2 nd gravida women with history of abortion in the previous pregnancy coming after 20 weeks of pregnancy were included. Their IPI were noted. All the antenatal, intrapartum and postpartum complications were recorded. Their modes of delivery were studied. Any poor neonatal outcome was also noted. ABSTRACT Background:Obstetricians are often presented with questions regarding the optimal Inter-pregnancy interval (IPI), especially by women who had a spontaneous abortion. They often desire to conceive again with minimal delay. Methods: A study was conducted on 252, 2 nd gravida women with history of previous spontaneous abortion. Based on their IPI women were divided into 5 groups. Results: Most of the pregnancy complications like threatened miscarriage, premature rupture of membranes (PROM), diabetes, pre-eclampsia, preterm delivery, placental abruption, caesarean section and post-partum hemorrhage (PPH) were maximum in those who conceived after 24 months and least in those who conceived between 6-12 months. But intra uterine growth restriction (IUGR) was more in early conception group. Pregnancy outcome was also good in those who conceived within 6 months. Conclusions:Women who conceive between 6-12 months of an initial miscarriage have better outcomes and lower complication rates in their subsequent pregnancy. Based on the results, we support the recommendation of WHO that after an abortion, women should wait for at least 6 months before becoming pregnant again in order to prevent adverse perinatal and maternal outcomes in the subsequent pregnancy. As the pregnancy outcome is also good in those who conceived within 6 months, women wanting to conceive immediately due to increasing age or anxiety should not be discouraged and allowed to conceive.
Reconstructive flap surgery is commonly done in patients that have tissue loss from trauma or burns. It involves transporting live healthy tissue from one part of the body to the area with tissue loss or loss of skeletal support. Myocutaneous flaps are often used when the area to be covered needs more bulk and increased blood supply. Since its development in 1947 for repairing cardiothoracic tissue defects, the pectoralis major myocutaneous flap has been widely utilized in head and neck reconstructive procedures. This flap offers a one-stage reconstruction and provides a large cutaneous space that can be navigated to fix defects involving two epithelial surfaces. Though done as salvage flap nowadays after failure of a free vascularized flap, PMMC flaps are continually performed in developing countries with limited medical sources. Primarily implemented to repair head and neck defects, the PMMC flap can be executed at other sites as well. In this case report, we present the application of PMMC flap to cover exposed acromion in high voltage electrical burn patient.
Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.
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