Background: Breech presentation is the commonest malpresentation accounting for 3-4% of all deliveries at term. The most common cause for breech presentation is preterm delivery. The safest route of delivery for breech had long been a topic of debate and after the results of term breech trial mode of delivery has become abdominal route even in teaching institutions.Methods: This is a retrospective cross sectional study conducted at department of obstetrics and gynaecology, Government medical college, Kozhikode, for a period of 2 years from 01 January 2016 to 31 December 2017. Mothers with gestational age between 28 weeks to 41 weeks with singleton live fetus with breech presentation who had either vaginal or caesarean delivery were included. The case notes were retrieved from the medical records department.Results: A total of 823 breech deliveries occurred during the study period. Of the total mothers 429 were primies and 394 were multies. Common causes identified were prematurity, intrauterine growth restriction, uterine and fetal anomalies. Mode of delivery was caesarean in more than 80% of cases.Conclusions: Incidence of breech presentation was 3.2% during the study period. Increasing incidence of caesarean delivery is seen in breech presentation. Persistent breech presentation at term is most commonly seen in patients with associated oligamnios, intrauterine growth restriction, and uterine anomalies.
Background: Fibroids are the commonest benign tumour arising from the smooth muscle from uterus. Effects of fibroids on pregnancy and the effects of pregnancy on fibroids are a frequent clinical concern since these tumors are common in women of reproductive age. Most pregnant women with fibroids do not have any complications during pregnancy related to the fibroids. Pain is the most common problem and there may be a slightly increased risk of obstetrical complications like miscarriage, preterm labor and delivery, malpresentation and placental abruption.Methods: A retrospective study was carried out to study the fetomaternal complications in fibroid complicating pregnancies. Duration of study period was one year. Study was from 1 January 2019 to 31 December 2019 in government medical college, Kozhikode. Patients beyond 28 weeks of gestational age with fibroid complicating pregnancies were included. Case records were reviewed from medical records library government medical college, Kozhikode. Detailed review of patients including history, examination and ultrasound scan reports, mode of delivery, antepartum, intrapartum, postpartum complications and details of babies were also taken.Results: During the study period a total of 112 cases of fibroid complicating pregnancies were included in the study out of 15875 total number of deliveries. Majority of patients belonged to age group between 30 to 35 years (40.17%) and 28.1% belonged to between 35 and40 years. 63.39% of patients were multies. In most of the cases fibroid was diagnosed by the first trimester ultra sound itself. Size of uterus remained corresponding to gestational age in more than half of cases (56.25%). There was increased incidence of caesarean delivery (56.25%), preterm delivery (7.2%) and placenta praevia (2.8%) postpartum haemorrhage (10.71%) in the studied cases.Conclusions: Fibriod complicating pregnancies are associated with higher incidence of obstetric complications during all the phases of pregnancy. Proper antenatal care and assessment can reduce the adverse outcomes to a greater extent.
Aim: To describe two cases of late presentation of acardiac twin in monochorionic gestation, which was earlier diagnosed as a vanishing twin in first trimester scans and later on found to be an acardiac twin (TRAP sequelae) on follow-up scans. Background: Monozygotic twinning is complicated by anomalous vascular connections in the placenta resulting in clinical syndromes such as twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), and twin reversed arterial perfusion sequence (TRAPS; acardiac twinning). Twin reversed arterial perfusion sequence is a condition arising due to paradoxical retrograde transfusion by a structurally normal "pump" twin, there is a disruption of organ development in the perfused twin. Case description: Twenty-one-year-old G2A1 who was initially diagnosed with vanishing twin in the 14-week scan, which was later on found to be acardiac twinning at 29 weeks and presented with PPROM. She went into spontaneous labor and there was a dilemma regarding delivering her vaginally or by cesarean section. The second case of primigravida, initially diagnosed as single fetal demise at 12 weeks and found to have TRAP sequelae later on at 31 weeks, was admitted and underwent elective LSCS at 32 weeks on maternal request. Conclusion: This lays down the importance of early diagnosis with dedicated ultrasound and management at tertiary care centers for better perinatal outcomes. Clinical significance: The phenomenon of the "vanishing twin" refers to the occurrence of a single fetal loss in a twin gestation during the first trimester. Such cases seen in the first trimester may be a case of acardiac twins, which might become evident later in a growth scan. Hence, it is important to be alert to the possibility of missing an acardiac twin since it is associated with 50% mortality of the pump twin.
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