Pregnancy with Uterine Prolapse - Rare Cases with Distinct Labour Outcomes

Agarwal, Himanshi; Acharya, Neema; Shrivastava, Deepti; Mohammad, Shazia

doi:10.14260/jemds/2021/74

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…A surgical procedure leads to major physical and an emotional risks, in addition to social and financial costs [14]. Other related studies were reviewed [15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Physiotherapeutic Approach in Stress Urinary Incontinence with Prolapsed Uterus: A Case Report

Palkrit

Naqvi

Burhani

2021

JPRI

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The International Continence Society (ICS) describes incontinence as an objectively demonstrable loss of urine which is not voluntary and that is a social and/or sanitary issue. The complaint of leakage of urine, which is not voluntary on an effort made, on exertion, on sneezing or while coughing is described as Stress urinary incontinence (SUI). The intra-abdominal increases as the effort or exertion increases, and the urethral sphincter is not capable to sustain a pressure greater than the pressure applied on the urinary bladder. Eventually, leakage of urine occurs during the daily activities like lifting, laughing, jumping, while sneezing or coughing. In women, stress urinary incontinence is most common category of incontinence of urine. Even though it isn’t a lethal illness. SUI has a number of negative effects on women's quality of life, including restricting social interaction and relationship and the personal relationships but also physical activity. Cystocele is the weakness of pubocervical fascia, which makes the urinary bladder to descend downwards and backwards against the anterior wall of the vagina. If this is a not taut then it will protrude. In more extreme cases a pouch of bladder sets up which holds on to the residual urine. The conservative treatment, a nonsurgical therapy, includes ameliorating the living standards, urinary bladder training, pelvic floor muscle exercises and strengthening. Kegel exercises are the most effective form of strengthening muscles of pelvic floor in addition are a noninvasive therapy and the use of vaginal weights or cones are not included. The rehabilitation and strengthening muscles of pelvic floor is facilitated and promote urine storage. The combination of Kegel’s exercise along with other interventions for a span of six weeks has shown a significant improvement in the symptoms.

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“…A surgical procedure leads to major physical and an emotional risks, in addition to social and financial costs [14]. Other related studies were reviewed [15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Physiotherapeutic Approach in Stress Urinary Incontinence with Prolapsed Uterus: A Case Report

Palkrit

Naqvi

Burhani

2021

JPRI

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“…It has been reported that when the knot tightens, the umbilical cord vessels get compressed leading to a 4-fold increase in fetal loss. However, a number of authors have concluded that ultrasound prenatal diagnosis, especially during third trimester is important as it facilitates in checking fetal well being during pregnancy and in labour [10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

True Umbilical Cord Knot Leading to Fetal Distress – an Obstetric Emergency

Patel

Pajai

2021

JPRI

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Background: Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. Though the incidence is lower, it often goes undetected in antenatal period despite the availability of prenatal sonography and may lead to a compromised fetal outcome as presented in this case. In this case the presence of true knot of umbilical cord was missed despite routine sonography done just 1 week prior to delivery, when patient presented to casualty with complains of decreased fetal movements since 24 hours. This modality is said to be associated with adverse fetal outcome such as birth asphyxia or in adverse cases intra uterine fetal demise. Risk factors include long cord, polyhydramnios, small sized fetus, etc. Case Summary: 27 years old gravida two, para two, with 1 live issue with k/c/o hypothyroidism with previous lesions came with complaints of decreased fetal movement since 24 hours at 36 weeks 3 days of gestational period. The patient recorded regular ANC checkups and routine investigations within normal limits. Her USG scan done at 34.2 wks showing single loop of cord around neck and normal doppler findings. On examination her vitals were normal .Her abdominal examination showed uterus of 34 wks size, longitudinal lie, cephalic presentation and irritable with mild contractions present with scar tenderness . Her FHS were present/irregular/112 bpm with less variability. On p/v examination os was admitting tip of finger, cervix soft, 25% effaced, station high up, presenting part vertex, membrane present. She was advised admission and a cardio-tocography (CTG) was done which showed recurrent deep atypical variable decelerations with decreased beat to beat variability. An emergent cesarean section was taken. Newborn was a female diagnosed with true umbilical cord knot, 2 cm away from fetal insertion with cord length of 84 cm. The baby was shifted to NICU in view of respiratory distress. Conclusion: Despite of modern day ultrasonography and Doppler studies, true umbilical cord knot still remains a lesser diagnosed entity and so every pregnant patients should be monitored carefully with a watch for daily fetal movement count (DFMC)and weekly non stress test (NST) for fetal well being.

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“…The foetal right ventricular function is seen depressed due to magnesium sulphate. The reason for all above adverse effects can be stated as these drugs traverse the placenta quickly but their excretion is slower by the kidneys of the foetus as compared to the kidneys of the mother [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Role of Tocolytics in Preterm

Sharma

Pajai

Jajoo

2021

JPRI

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Tocolytics are the drugs that are used to prolong the time of child birth, for a short period - up to 2 days. If the labour starts too early during pregnancy also termed as preterm birth, which is supposed to be one of the major cause of neonatal mortality and morbidity, all over the world. Administration of tocolytic agents can help in preterm labour to delay the preterm labour by 48 hours. Tocolytics temporarily slow the contractions and hence it is possible to transport the patient to a hospital, where specialized care can be provided to premature baby and also corticosteroids can be administered, which help mature the baby’s lungs. Different class of drugs are studied as tocolytics. Beta-Adrenergic receptor agonists like Terbutaline, Ritodrine, Fenoterol, Metaproterenol, Hexoprenaline, Albuterol, Orciprenaline, Nylidrin. Calcium channel blockers like Nicardipine and Nifedipine. Magnesium Sulfate. Nonsteroidal anti-inflammatories or prostaglandin inhibitors like Indomethacin, and Oxytocin inhibitors like Atosiban were found effective in different studies with some side effects, are discussed here briefly. Some Nitrates, alcohol, Progesterone have also been tried with not much significant effect. Calcium channel blocker specially Nifedipine is most studied and found to be safer and effective for tocolysis. Individual uterine relaxant therapy should take into account individual differences in metabolism and response to drugs.. Short term use of tocolytics has been proven more effective and safer than longer use of it for pre-term labour.

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Pregnancy with Uterine Prolapse - Rare Cases with Distinct Labour Outcomes

Cited by 5 publications

References 23 publications

Physiotherapeutic Approach in Stress Urinary Incontinence with Prolapsed Uterus: A Case Report

Physiotherapeutic Approach in Stress Urinary Incontinence with Prolapsed Uterus: A Case Report

True Umbilical Cord Knot Leading to Fetal Distress – an Obstetric Emergency

Role of Tocolytics in Preterm

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