Background:The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. Methods: Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, casefatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. Findings: There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22À1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03À1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy. Interpretation: Our study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic.
Recurrent pregnancy loss (RPL) has become an important cause of pregnancy loss, with major emotional implications to the couple experiencing such an event. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage and various infections are also considered risk factors for RPL. A thorough clinical history and examination, maternal serum biochemistry and ultrasound ndings are important to determine the treatment options and provide valuable information for the prognosis. A woman who do not have a explanation for the RPL maybe subjected to ano-genital swab culture to identify infections, as chronic and subclinical infections can cause abortion. As bacterial vaginosis has been already established with causing recurrent pregnancy loss and preterm delivery. Here we are presenting a case of successful pregnancy outcome following treatment for GBS vaginal infection where other possible aetiologies were ruled out.
Cornual ectopic pregnancy accounts for 2-4% of all the ectopic pregnancies with a mortality rate 6-7 times higher than that of the ectopics in general. It is a diagnostic and therapeutic challenge to the clinician with a significant risk of rupturing and bleeding. As of yet, the incidence of recurrent cornual ectopic pregnancies is unknown. This report described the case of a patient who developed two cornual ectopic pregnancies within a span of 3 years with an intervening full term normal vaginal delivery. The 1st cornual ectopic was successfully managed by laparoscopic resection, which was followed by an uneventful postoperative course. The following contralateral cornual ectopic was managed by laparotomy since the patient presented with large hemoperitoneum.
Routine caesarean myomectomy is not a standard procedure and has been condemned in the past due to fear of uncontrolled haemorrhage and peripartum hysterectomy. However, it may be considered a safe option in carefully selected cases in the hands of an experienced obstetrician. In this case, we describe a 35-year-old primigravida posted for elective caesarean section in view of breech presentation. Intraoperatively a 6 *7 cm anterior intramural fibroid was noted which was removed by intracavitary approach through lower segment uterine incision, thus reducing uterine scar and future adhesions. Increasing evidence suggests that myomectomy can be performed concurrently with caesarean section without an increased risk of blood transfusion or hysterectomy.
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