Background: Emergency peripartum hysterectomy (EPH) is a rare but a lifesaving procedure done as a last resort to save life of mother. We conducted this study to know the incidence, leading causes, risk factors and complications of EPH. Methods: We conducted a retrospective analysis of all the patients who underwent EPH from January 2008 to December 2015 at SDMCM and H. All patients who underwent EPH from 22 weeks of gestation to 6 weeks postpartum were included in the study. Results: There were 21 emergency peripartum hysterectomies, with deliveries during the same period being 27271 and the rate of EPH was 0.7 per 1000 deliveries. Most common indication for EPH was uterine atony (38%), followed by uterine rupture (23.8%) and morbidly adherent placenta (19%). Most of the patients (47.6%) had previous cesarean deliveries. EPH was done following cesarean in 66.6%. Subtotal hysterectomy was done in 61.9%. Intra-operative urinary bladder injury was seen in 14.2% of the patients. Conclusions: Uterine atony and uterine rupture continues to be the most common causes for EPH in our population. Multiparity is an important risk factor among patients with rupture uterus. Cesarean delivery and repeat cesarean deliveries are the likely risk factors for EPH.
INTRODUCTIONLabour-a term that in the obstetrical context takes on several connotations from the English language. According to the New Shorter Oxford English Dictionary (1993) toil, trouble, suffering, bodily exertion, especially when painful, and an outcome of work are all characteristics of labour. 1Induction of labour defined as stimulation of regular uterine contractions before the spontaneous onset of labour with or without rupture of membranes after 28 weeks of gestational age using mechanical or pharmacological methods in order to generate progressive cervical dilation and subsequent delivery. There are various methods of induction like medical, surgical, combined and mechanical. Each one has its merits and demerits. Currently most widely recommended method of induction is Prostaglandin E2 (PGE2). It has its own limitation like hyper stimulation. There is ongoing research for less painful effective ABSTRACT Background: This study evaluated the effectiveness of Extra-amniotic saline infusion (EASI) in comparison with that of intracervical Prostaglandin E2 (PGE2) gel for cervical ripening and induction of labour. Methods: The study conducted in SDM College of Medical College Dharwad, Department of OBG, from December 2012 to November 2013. Consecutive patients with unfavorable cervices requiring pre-induction cervical ripening and induction of labour for various indications were asked to participate in this study. 50 patients (Group A) underwent extra amniotic saline infusion and 50 patients (Group B) underwent PGE2 gel application. Post induction augmentation if required was administered. Labour profile outcomes were compared between the groups. Results: Results were comparable in terms of maternal age, indication for induction in majority of cases, preinduction Bishop Score, mode of delivery, complications and side effects, neonatal complications, and Apgar Score. The mean post induction Bishop Score was higher in EASI group by an average of 9. The mean duration of augmentation was more in PGE2 group by an average of 2 hrs. The induction delivery interval (IDI) was prolonged by an average of 3.5 hours in PGE2 group. Conclusions: For pre-induction cervical ripening the extra amniotic saline infusion is valid alternative for the PGE2 gel. Both the modes of induction were equally safe and effective in terms of mode of delivery and Apgar Score. EASI, however, had rapid cervical ripening and shorter induction delivery interval.
Bladder stones in children are common in developing countries and the procedure of choice for their removal is suprapubic cystolithotomy. It is standard practice to drain the bladder for a few days post-operatively to prevent urinary leakage. We have observed that, if the bladder is closed meticulously in 2 layers, bladder drainage by means of a catheter is not required. We have analysed 86 children treated by suprapubic cystolithotomy without a catheter. Size of the stones and intra-operative findings were noted and it was found that 85% of the patients had an excellent result; 10% had a satisfactory result and 4.7% were unsatisfactory. The advantages of the procedure and selection of the patients are discussed.
Introduction: In the past two decades globally, the incidence of ectopic pregnancy has been increasing exponentially. One of the major triggering factors being the introduction of medical assisted procreation techniques. The present study emphasis more on clinical presentations, risk factors, associated maternal morbidity and mortality with respect to ectopic pregnancy. Methodology: Patients diagnosed with ectopic pregnancy in reproductive age group (15-44 years) after clinical examination and investigations during one year period were included in the study. It was a prospective study using contingency table analysis and Chi-square test. Results: A total of 42 patients were diagnosed and treated as ectopic pregnancy during the study period. Risk factors were found in 37 patients, of which most common were white discharge per vagina (WDPV) in 20 and tubectomy in 6 patients. PID was seen in 5 and no risk factors in 5 patients. Of the 42 patients, 37 underwent surgery as primary modality of treatment and 5 patients underwent medical management. Only 2 patients had complete resolution with medical management while 3 failed medical management. Post operative period was uneventful. Conclusion: As the incidence of ectopic pregnancy has been on the rise, screening of high risk cases, early diagnosis and early intervention are required to enhance maternal survival and conservation of reproductive capacity.
Background: Pregnancy induced hypertension (PIH) is the most common medical disorder of pregnancy contributing significantly to maternal / fetal morbidity & mortality. Hematological abnormalities ranges from thrombocytopenia, raised liver enzymes, hemolysis to DIC and are the most ominous complications related to PIH. This study was conducted to assess the platelet count and its correlation with the severity of pre-eclampsia. Methods: A 1 year cross-sectional study was conducted in year of 2016 over 200 patients who attended labour room. Among them 100 normotensive women were included in control group and 100 women with BP 140/90mmHg and above, proteinuria, and eclampsia were included in the study group. Result: Among the 100 PIH cases, majority belonged to age group of 20-25 yrs with a mean of 22.74. 66% of PIH were primigravidas and 53% belonged to 37-40 weeks of gestation, 68% cases were severe preeclampsia and 16% 0f the cases had thrombocytopenia. Conclusion:This study gives an outline of investigation to be done which alerts the physician of the severity of the disease so that appropriate and timely management can be initiated. Estimation of platelet count being simple economical and rapid investigation can be used for early detection of severity of preeclampsia and to prevent further mortality and morbidity.
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