Pregnancy with complete heart block is rare, its management is not streamlined and requires a multidisciplinary team approach involving the obstetrician, cardiologist, anaesthesiologist and neonatologist. High index of suspicion in a woman with slow heart rate and electrocardiographic examination will ensure the diagnosis of this condition. Such patient can be managed conservatively or may require temporary or permanent pacemaker implantation. We present a 26-year-old primigravida with complete heart block at term pregnancy. She was asymptomatic throughout her pregnancy with pulse rate between 50 and 60 beats per minute. Vaginal delivery was planned under continuous ECG monitoring. Isoprenaline drip and temporary pacemaker were kept stand-by. However, for obstetric reasons caesarean section was performed successfully under spinal anaesthesia without a pacemaker. Method of anaesthesia was planned to keep the haemodynamics stable and drugs causing bradycardia were avoided.
BACKGROUND The term "Relaparotomy" (RL) refers to operations performed within 60 days in association with the initial surgery. The aim of current study was to investigate the indications, risk factors, procedures undertaken during relaparotomy after caesarean section (CS). METHODS We conducted a retrospective observational study in all patients undergoing relaparotomy after caesarean section, at a tertiary care centre in Odisha over a period of 2 years from January 2017 to December 2018. RESULTS The total incidence of relaparotomies was 0.7 % and the incidence among the sections conducted in our hospital alone was 0.2 %. Obstructed labour (20 %), oligohydramnios with fetal distress (20 %) are major indications of caesarean section. Most of the surgeries (60 %) took place within the first 24 hours of the primary surgery. Most common indication of relaparotomy in our study was postpartum haemorrhage (63.3 %). All women were in the age group of 20 - 35 years and most of them were multiparous (60 %). Pre-existing anaemia is the major (50 %) comorbid factor associated with atonic postpartum haemorrhage which leads to relaparotomy. Major indication of relaparotomy in the present study was haemorrhage (76.5 %). CONCLUSIONS Undertaking proper precautions to ensure proper haemostasis and asepsis, taking calculative decision before embarking a hasty decision is important in decreasing the incidence of relaparotomy. KEYWORDS Relaparotomy, Caesarean Section, Postpartum Haemorrhage, Asepsis
Background: To study the fertility outcome after tubal recanalisation done for sterilisation reversal and various factors affecting successful recanalisation. Methods: It is a perspective study of 30 cases who undergone tubal recanalisation for reversal of sterilisation in SCB Medical and hospital, Cuttack from October 2015-october 2017. Result: Loss of child was the commonest reason for seeking reversal of sterilisation. Out of 30 patients, the conception rate was 19(63.3%), 18 were intrauterine, one was ectopic, 15 live birth, 1 aborted and 2 are ongoing pregnancies. The conception rate was high when the age of the patient was less than thirty years (78.8%), interval between sterilisation and its reversal was less than 4 years (83.3%), when it was following laparoscopic sterilisation (68.4%), when the site of anastomosis was isthmo-isthmic (63.1%) and when the remaining tubal length was more than 6 cm (83.3%). Conclusion: Recanalization procedure being simple and effective method in respect to IVF is increasing in demand for sterilisation reversal. Successful fertility outcome after tubal recanalisation depends on age of the patient.type of previous sterilisation,site of sterilisation and anastomosis and final length after tubal recalisation. During sterilisation gynaecologist should remember laproscopic sterisation is preferred and site of occlusion is isthmus so that every sterilised women can undergo recanalization operation if circumstances arises later in life.
A descriptive study with quantitative approach was under taken on 50 significant family members of mentally ill patients selected by non probability convenient sampling technique at Mental Health Institute (COE), SCBMCH, Cuttack to assess the psychosocial problems and coping strategies of significant family members of mentally ill patients. Data was collected from 10.02.2020 to 10.03.2020 through questionnaire on psychosocial problems formulated in the form of 4-point likert scale. and COPE Inventory by Carver et al. rated on a 4-point scale format. Collected data were analyzed by using descriptive and inferential statistics. Findings revealed that Highest Percentage (40%) of the family members were in the age group of 48–60 years. A majority (66%) of them were male and (92%) of them were Hindus and (8%) of them were Muslim. Majority (60%) of them were married (36%) of them were farmer. Highest percentage (30%) of them were illiterate and majority (50%) of them were having income ≤ Rs.5000 and (56%) of them from nuclear family. Highest percentage (58%) of them were from rural area and (44%) of them were mother. Majority (38%) of them had >5 years of illness and (76%) of them were having no family history. Most of the significant family members of mentally ill patients (84%) under this study had moderate problem whereas (8%) of them had mild and also (8%) severe problems. The coping strategy most often used by the significant family members of mentally ill patients was restraint coping mean score (15.64±0.66) and instrumental social support mean score (15.64±0.52) and the least used was Humor mean score (4.04±0.28) and Alcohol disengagement mean score (4.38±0.28). The internal consistency of COPE Inventory exhibited Cronbach’s alpha (α) coefficients ranging from 0.93 (Emotional social support) and Instrumental social support (0.90) to 0.41 (Restraint coping). However, the (Restraint coping) shows lower alfa (α). Mostly Problem focused coping strategies (14.12±1.37) was used by the significant family members of the mentally ill patients.
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