Background: Induction of labour in a scarred uterus is a controversial topic in Obstetric practice, but in carefully selected and monitored cases never the less the outcome is gratifying. When the baby is non-salvageable, or in cases of IUFD, it is always desirable to achieve a vaginal delivery. Many of the professional organizations recommend induction of labour in previous LSCS. Thus, this study was done to evaluate the success rate, determinants of failure and complications of induction of labour with foley’s catheter in patients with previous 1 LSCS.Methods: 62 patients were recruited over a period of 1 year and studied at Vani Vilas Hospital, Bangalore Medical College and Research Institute, all with previous 1 LSCS. 34% of them were with past h/o 1 or more vaginal delivery. 8% were term pregnancies, 64% were between 28-32 weeks. Induction was done for IUFD in 56% and, HDP warranting termination in 44%. Induction done with Foley’s catheter, expulsion of catheter with filled bulb and uterine contraction initiation was taken as successful induction. The patient profile in cases of failure was noted.Results: 83% was the success rate for induction out of which 30% cases required additional PGE2 gel. Oxytocin and ARM alone or together were used for augmentation in 90% cases. Induction to foley’s expulsion average duration was 14 hours. Post expulsion delivery happened at an average time interval of 5 hours. One patient had rupture uterus during the course of augmentation.Conclusions: Induction can be done safely in carefully selected cases of previous LSCS with Foley’s Balloon.
Background: HIV is prevalent in epidemic proportions in India. Identifying the target population and effective intervention reduces chances of vertical transmission and new infection. Authors studied the seroprevalence of HIV among women attending obstetric care in a tertiary care hospital of South India and associated maternal and perinatal outcomes among seropositive women.Methods: Retrospective descriptive study of all women who were screened for HIV at Integrated Counselling and Testing Centre, Vani Vilas hospital, from January 2014 to December 2017 in their antenatal, intranatal and postnatal period. Demographic data of seropositive women, obstetric outcomes and status of children at 18months were obtained.Results: Of the 35,455 women who were screened, 0.28% were found positive for HIV. Percentage prevalence of HIV was highest in 2014 (0.32%). Majority of the seroprevalence belonged to age group of 25-29 years (44%), 32% illiterates, 82% homemakers and 79% belonged to urban areas. Unknown partner status in 22% and majority were diagnosed in antenatal period (66%). Of them 82% had favourable CD4 count. 74 % of them delivered live baby. Three maternal deaths were observed and anaemia (65%) was the major associated co-morbidity. Vaginal route was common mode of delivery (84%). Thirteen babies required NICU admission and 6 neonates deaths were encountered. Exclusive breastfeeding was practised in 91% of live births. 62% of children were found seronegative at 18 months follow up.Conclusions: Authors observed with adequate treatment to mother and prophylaxis to the baby, the burden of vertical transmission can be significantly reduced.
INTRODUCTIONAs the general longevity is improving, pelvic floor disorders are becoming more prevalent in women. Life time risk of surgery for pelvic organ prolapse (POP) or incontinence is estimated to be 11% with a reoperation rate of 29% for failure.1 Over the next 30 years the demand for treatment of POP is expected to increase to 45% as the number of women over 50 years increases. 2The increasing aging population also expects a good quality of life and sexual satisfaction. There is also an increase in number of women undergoing hysterectomy at a young age and hence at risk of complications including vault prolapse (VP).The vaginal vault is the expanded proximal portion of the vaginal canal. Post hysterectomy vaginal vault prolapse is defined as descent of the vaginal cuff scar below a point that is 2 cm less than total vaginal length above the plane of hymen by the International Incontinence Society. Although it is not a common condition occurring only in about 1% of hysterectomies, the incidence is definitely on the rise, as much as five fold, thanks to the extended longevity of women. ABSTRACT Background:Vault prolapse although an uncommon condition is an annoying problem to the patient often requiring repeat surgery for relief. The objective of this study was to study the clinical parameters of patients of vault prolapse, predisposing factors, pre-op and post-op symptoms, treatment provided and outcomes of the same over ten years at Vani Vilas Hospital, Bangalore Medical College. Methods: A retrospective study was conducted on all patients admitted with vault prolapse and treated for the same from 2005 to 2014. Data was collected and analyzed. Results: commonest symptom associated was mass per vagina with difficulty in voiding urine (80%). Straining at stools and sexual dysfunction was seen in fewer than 30%. 64% of our patients had TAH and the mean duration before symptoms was 12 years (11.7 years). Majority of our patients underwent sacrospious fixation (42%) while 24% underwent traditional repair. Abdominal sacrocolpopexy was performed on 8 patients. Intra-op complications of haemorrhage seen in 1, ureteric injury in 2 and injury to rectum in 1 patient. ICU admission was required for 5. 80% 0f the patients were available for follow up at 2 weeks and 6 weeks and >90% expressed subjective improvement in symptoms. Only one underwent re operation at 3 months for failure. Conclusions: Vault prolapse is not an uncommon condition following hysterectomy especially if it was done at a young age. Careful selection of patients, measures to prevent this condition during primary hysterectomy is the need of the hour.
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