Parenteral methotrexate as a conservative mode of therapy has been described in a few cases of w x placenta accreta 1᎐4 . We report a case which was successfully managed with oral methotrexate therapy. A 25-year old woman was referred to our tertiary level hospital for management of placenta accreta after a term vaginal delivery of a 2750 gm female baby in a maternity center. After delivery, the placenta could not be delivered by controlled cord traction. Manual removal of placenta was also tried under general anesthesia. However, the plane of cleavage between placenta and uterine wall could not be defined. At admission, her general condition and vital signs were stable. The uterus was well contracted and the umbilical cord was visible at the vulva. Ultrasonography showed Ž . multiple placental cotyledons 7.4= 6.5 cm in the uterine fundus, no retroplacental hypoechoeic U Corresponding author, D-IIr34, Kidwai Nagar East, New Delhi 110023, India.zone of decidua and absent myometrial infiltration. Her hemoglobin was 11 gmrdl. Total and differential leukocyte counts, platelet counts, serum creatinine and liver function tests were within normal range. As there was no post-partum hemorrhage and the patient desired future pregnancy a decision was made to treat her with oral methotrexate therapy, 0.3 mgrkg per day in three divided doses, as described in the management of w x gestational trophoblastic disease 5 . Broad spec-Ž trum antibiotics ampicillin, gentamycin and . metronidazole , intravenous oxytocin and oral Ž . methylergometrin 0.2 mg three times daily were also started. Her hemoglobin, leukocytes, platelet counts, liver and kidney functions were assessed daily during the course of treatment and remained within normal range. On the third day of admission she developed a high grade fever. A high vaginal swab culture showed Klebsiella growth sensitive to ciprofloxacillin. She was put on oral ciprofloxacillin in the dose of 500 mg 0020-7292r98r$19.00 ᮊ 1998 International Federation of Gynecology and Obstetrics Ž . P I I S 0 0 2 0 -7 2 9 2 9 7 0 0 2 5 2 -X
Purpose Incorrectly placed copper T 380A leads to increased contraception failure. This study aimed to find an association between the ultrasonographic position of the copper T 380A in the immediate postpartum period and the adverse effects observed during the period of 6 months after its insertion. Methods This descriptive study was carried out in the Department of Obstetrics & Gynaecology of a tertiary-carecenter of India from September 2011 to February 2013. The women eligible for immediate postpartum copper T 380A insertion with previous regular menstrual cycles for at least 6 months before the current pregnancy, and those who were willing for follow-up visits and had easy accessibility to the hospital, were recruited. A clinical evaluation and ultrasonographic assessment of Intra-Uterine-Contraceptive-Device (IUCD) after insertion was carried out after enrolment. The complications (expulsions, vaginal discharge, menstrual irregularity, and lower abdominal pain) were subsequently assessed during a 6-month follow-up period. The primary objective was the ultrasonographic assessment of the placement of IUCD immediately after insertion. The incidence of complications and their association with the presence of malposition was also studied. Results Hundred patients were evaluated during the study period. Forty-four (44 %) women were found to have malpositioned IUCDs on ultrasonographic evaluation done following insertion. The complications among the IUCD users included menstrual irregularity (27.17 %), pain in lower abdomen (20.65 %), vaginal discharge (7.6 %), and expulsions (9.7 %). The IUCD expulsions, menstrual irregularities, and pain were significantly more in patients with malpositions (p \ 0.05). Conclusions Malpositioning of IUCD is common immediately following insertion and is significantly associated with more complications during the follow-up.
INTRODUCTIONFamily planning is adopted voluntarily, upon the basis of knowledge, attitude and responsible decisions by individual and couples, to promote the welfare of the family and thus, contribute effectively to the social development of the country (WHO, 1971). 1India was the first country in the world to start a National family planning program in 1956 to address the problems associated with increasing population. These programmes have been in operation in India for more than five decades. Despite constant efforts by the government, unmet needs still remain. There is high demand (92-97%) and high unmet need (up to 60%) for birth spacing or family planning in developing countries in first year postpartum. 2 Since the inception of the programme several knowledge, attitude and practice studies have been conducted. The main objective is to spread the knowledge of family ABSTRACT Background: The objectives of the study were to assess knowledge, attitude and practice in post-partum intrauterine contraceptive device method of family planning and to know about willingness for post-partum intrauterine contraceptive device (PPIUCD) when knowledge is provided for the same. Methods: This is a cross sectional observational study including 1200 patients of immediate post-partum period (<48 hrs of delivery), delivered at Safdarjung hospital. Women were evaluated with the help of a pre-designed and pretested questionnaire. Results: Out of 1200 women 864 (72%) were aware of some family planning method but only 672 (56%) had used some family planning method in the past. 108 (9%) women had knowledge regarding Post-partum intrauterine contraceptive device (PPIUCD). Among these, 72 (6%) women opted for PPIUCD. After knowledge regarding PPIUCD had been given, 80 more women adopted this as a method of contraception. So total 152 (12.67%) opted PPIUCD. Conclusions: This study highlights that awareness and knowledge does not always lead to use of contraceptives. A lot of educational and motivational activities are needed.
Background: During past few years, there is increasing trend in trial of labor in cases of previous lower segment caesarian section (LSCS). It needs vigilant approach in identifying signs and symptoms of giving way of previous scar. This study is to see the intra-operative uterine scar condition and feto-maternal outcome in patients of previous LSCS with scar tenderness.Methods: This is a prospective study done in Safdarjung hospital, New Delhi. It includes 120 patients of previous lower segment caesarian section with scar tenderness operated as emergency cases over a period of one year. It excludes elective repeat LSCS.Results: During this period repeat emergency LSCS was done in 862 cases and scar tenderness was seen in 120 cases (13.92 %). Out of 120 cases enrolled for the study intra-operative scar was intact in 69 cases (57.5%). Scar was thinned out in 27 cases (22.5%). Scar dehiscence was found in 21 cases (17.5%). Rupture occurred in 3 cases (2.5%) out of which 2 were Fresh still births. NICU admission was done in 11 cases (9.17%). 1 neonatal death occurred. No maternal death was recorded. Average hospital stay was 6 days. Blood transfusion was needed in 23 cases (19.2%).Conclusions: Scar tenderness is a very important tool for predicting scar integrity. All cases of previous LSCS should have institutional delivery.
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