Shoulder dystocia, a rare complication of ruptured uterus: a case report and review

Shoulder dystocia is one of the most difficult complications of labor that is often unpredictable and hence unpreventable. In most cases, the cause is dystocia from the bony pelvis. The major brunt of complications is borne by the fetus. In neglected cases, grave maternal complications like obstructed labor and rupture of uterus may result. Very rarely, the reverse, uterine rupture leading to shoulder dystocia can also occur. The dystocia results from the soft tissue of the ruptured uterus itself. The present case is reported to emphasize the importance of early recognition of this condition. A gravida 3 para 2 woman presented in obstetrics emergency with delivery of head at home, six hours back, after being in labor for 8 to 10 hours. The uterine contractions ceased immediately following the delivery of the head. Her first delivery was by cesarean that was done for fetal distress. Second was an uneventful vaginal delivery at home. In this pregnancy, she presented with ruptured uterus .On laparotomy, the rupture was seen to involve the previous uterine scar. Lower segment was thick and previous uterine incision although transverse was situated higher up, above the lower segment. Rupture was repaired and patient recovered without any complications. In women with risk factors for uterine rupture, delivery should be conducted at hospitals with facilities for emergency cesarean. In this high risk group, if shoulder dystocia occurs, rupture of the uterus must be suspected as an underlying cause. Routine management protocols must be abandoned in favor of urgent laparotomy to improve the chances of fetal survival and save from litigation. At the same time, this case should not deter us from trial of labor after caesarean

Changing trends in intrauterine contraceptive device: from interval intrauterine contraceptive device to postpartum intrauterine contraceptive device: a prospective observational study in a tertiary care hospital in eastern Uttar Pradesh

Background: The current outburst of Indian population (1.21 billion as per census 2011) is because of the lack of awareness and acceptance of contraception in the immediate postpartum period. Postpartum intrauterine contraceptive device (PPIUCD) insertion can do wonders and curb this unmet need of family planning if good counselling and proper insertion techniques are followed.Methods: The present study was carried among 526 women in the department of obstetrics and gynaecology of Nehru Hospital in BRD medical college Gorakhpur, India. Intrauterine contraceptive device (IUCD) was inserted in 424 women in PPIUCD group and in 102 women in interval IUCD group after taking proper consent and following the WHO medical eligibility criteria for contraceptive use (MEC). Follow-up was done at 6 weeks and 6 months.Results: The acceptance rate of PPIUCD was 30.34% as compared to 18% in interval IUCD group (p-value <0.05). The chief reason for declining the use of IUCD was fear of excessive pain and bleeding (26.3%). Long term reversible method (32%) was the main reason given for accepting IUCD. There was no perforation or any other major complication at the time of insertion in both the groups. Rate of expulsion was 5.7% in PPIUCD and 2.22% in interval IUCD group p-value (>0.05).Conclusions: PPIUCD is a safe, effective, feasible and reversible method of contraception. It should be made a part of family health care programmes in India

of vitamin D deficiency with occurrence of pre eclampsia among inpatients of tertiary care centre, Gorakhpur, Uttar Pradesh, India

Background: Pre eclampsia has remained a significant public health threat in both developed and developing countries contributing to maternal and perinatal morbidity and mortality globally. Vitamin D has direct influence on molecular pathways proposed to be important in the pathogenesis of pre eclampsia, yet the vitamin D-pre eclampsia relation has seldom been studied. In the present study we aimed to assess the association of vitamin D deficiency with the occurrence of pre eclampsia. If indeed vitamin D deficiency is related to pre eclampsia, this correlation can inform future studies, which hopefully will ultimately lead to a decrease in the incidence of pre eclampsia hence a decrease in adverse maternal and fetal outcomes.Methods: We conducted a comparative cross sectional study carried out for a period of one year from August 2014 to July 2015. A total of 384 patients were selected. 192 pre eclamptic and 192 non pre eclamptic pregnant patients aged 16-45 years attending in-patient department of Obstetrics and Gynaecology BRD Medical college Gorakhpur were included in the study.Results: About 82.8% of pre eclamptic and 31.25% of non pre eclamptic patients were found deficient in vitamin D. Also, severe pre eclamptic patients had more severe deficiency of vitamin D. Majority of these patients (51.78%) had very low vitamin D concentration.Conclusions: Maternal vitamin D deficiency may be an independent risk factor for preeclampsia. Vitamin D supplementation in pregnancy should be explored for preventing preeclampsia and promoting neonatal well-being

A study of spectrum and outcome of liver diseases in pregnant women at BRD medical college

Background: Different spectrum of liver disease can affect outcome of pregnancy. The incidence of liver disorders in pregnancy varies in different parts of the world. The present study was designed to see the incidence, spectrum, and outcome of liver disease in pregnancy.Methods: All pregnant women with deranged liver profile, attending antenatal clinic and labour room in the department of Obstetrics and Gynecology of BRD Medical College over the period of one year (August 2015 to July 2016) were included in the study. Enrolled cases were followed up till discharge in respect to maternal and fetal outcome.Results: Liver disease was found in 214 (2.37%) cases out of 9011 pregnancies. Pregnancy specific liver disease was the most common type (85.98%). Among pregnancy specific liver disease Hypertensive disorders of pregnancy was the commonest abnormality (66.35%). Rest were Cholestasis, Acute viral hepatitis, Chronic liver disease, Hyperemesis gravidarum, Acute fatty liver of pregnancy. Out of 214, 22 patients dropped out. Overall maternal and perinatal mortality were 13.02% and 29.17% respectively.Conclusions: Liver disease in pregnancy is not uncommon and it can seriously affect pregnancy outcome if not treated properly on time. Early diagnosis (by clinical suspicion and blood investigation) and timely intervention can improve maternal and fetal outcome in pregnancy with liver disease

Comparison of maternal outcome in COVID-19 positive and negative antenatal women: a comparative study

Background: Coronavirus is an RNA virus causing respiratory and gastrointestinal infections. It caused SARS and MERS epidemics. In late 2019, a mutation called SARS-CoV-2 caused COVID-19, a severe respiratory illness. Pregnant women are at risk, but information is limited. The second wave affected pregnant women more. Maternal COVID-19 can lead to preterm births and caesarean sections. Vertical transmission to neonates is possible. Ongoing research is crucial to understand COVID-19's impact on mothers. Methods: A comparative prospective hospital-based study was conducted, including antenatal women with COVID-19 symptoms in the case group. The control group consisted of antenatal women who tested negative for COVID-19. The study analyzed 150 COVID-19-positive antenatal women and 350 COVID-19-negative antenatal women, excluding those who left the study prematurely or tested positive during the study period. Results: In the case group, no abortions were reported (0%), while in the control group, there was 1 abortion (0.29%). PROM occurred in 5.78% of cases and 1.43% of controls, with a significant difference. PPROM occurred in 2.31% of cases and 2.57% of controls, showing no significant difference. Preterm labor was observed in 11.53% of cases and 3.71% of controls, with a significant difference. Conclusions: Pregnant women with COVID-19 experience diverse symptoms, highlighting the importance of vigilant monitoring. Adverse maternal outcomes, including preterm labor and ICU admission, are more common in infected individuals. Managing comorbidities, such as diabetes, is crucial

Maternal and perinatal outcome in obstetric cholestasis- a prospective observational study

Background: The objective of this study was to study the maternal and perinatal outcome of pregnancy complicated by obstetric cholestasis.Methods: This prospective observational study included 80 cases, diagnosed as obstetric cholestasis on the basis of symptoms of persistent pruritus (generalized or localized), biochemical evidence of altered liver function test and excluding other liver and skin disorder. Medical treatment and active management (fetal surveillance and termination of pregnancy at 37-38 weeks) were offered to all. Maternal and perinatal outcome were studied.Results: Incidence of obstetric cholestasis was 1.9%. Majority of women (55%) were primigravida and recurrence rate was 61.1% among multiparous women. Pruritus (generalized) was the cardinal symptoms in 90% patients and mostly (88.7%) presented and diagnosed after 28 weeks i.e. in third trimester. A total of 43.7%women had caesarean section (CS) which was quite high incidence. Most common pregnancy complications included preterm labor (25%), post-partum haemorrhage (13.75%) and preterm premature rupture of membrane (11.25%). Perinatal outcome revealed meconium aspiration (20%), preterm birth (30%), low birth weight (35%), fetal distress (18.75%) and intrauterine fetal death (2.5%). 43.75% neonates required NICU (Neonatal intensive care unit) admission. Serum transaminase levels tended to be higher in patients with poor perinatal outcome such as still birth, fetal distress and meconium stained amniotic fluid. LFT (liver function test) returned to normal in 95% of women and 100% women became symptom free after 6 weeks postpartum.Conclusions: Obstetric cholestasis has an adverse effect on the fetal outcome and hence early diagnosis with careful clinical examination and biochemical testing is essential. Serum abnormality in liver function test (transaminases) tended to be higher in women with poor perinatal outcome

Clinical bleeding patterns and management of abnormal uterine bleeding in non-pregnant women: a cross-sectional study

Background: Around 10 to 15 percent of women go through instances of unusual bleeding from their uterus at some point during their reproductive years. Additionally, up to one-third of women may come across irregular menstrual cycles. These irregularities often occur during two crucial phases in a woman's life: firstly, at the beginning of menstruation, which is known as menarche, and secondly, during the transition leading up to menopause, referred to as perimenopause. Aim of study was to determine the clinical bleeding patterns in nonpregnant women and its management. Methods: During the study period spanning from November 2021 to December 2022, a cross-sectional study examined non-pregnant females aged 15 to 55 experiencing abnormal vaginal bleeding (AUB) who provided consent. However, certain exclusion criteria were established to ensure that the study's findings remained pertinent to the target population. Females exhibiting vaginal bleeding attributed to pregnancy or pregnancy-related factors were excluded from the study, as were those with vaginal bleeding stemming from vaginitis, cervical benign, premalignant, or malignant conditions, or traumatic causes. Descriptive statistics were employed in the study. Results: Structural causes [PALM] accounts for 71 (61%) of cases whereas non-structural causes of chronic AUB account for 44 (39%) of cases. AUB-L, 45 (39.2%) was the most frequent finding in females with AUB. The second most common causes are AUB-O 23 (20%) followed by AUB-A 14 (12.2%), AUB-C 08(7%), AUB-M 07 (6.1%), AUB-E 06 (5.2%), AUB-P and AUB-I in 05 (4.3%) each and AUB-N 02 (1.7%). Conclusions: Focusing on Abnormal Uterine Bleeding (AUB), it was observed that AUB-L, attributed to leiomyomas, emerged as the most prevalent cause among affected females. Subsequently, AUB-O, arising from ovulatory dysfunction, and aub-a, linked to adenomyosis, ranked as the second and third most common causes, respectively. Among the clinical manifestations of AUB, prolonged bleeding was identified as the most frequent symptom, followed closely by heavy bleeding.

Suture versus vessel sealer in vaginal hysterectomy: an observational study

Background: Vaginal route is considered to be the method of choice for removal of uterus and, in the absence of gross pelvic disease, can be carried out in most patients. Recent studies have shown that less than one-third of hysterectomies are performed vaginally. This could be due to technical difficulties occurring while operating in the narrow surgical field. This study was taken up to find out the easier alternatives in securing pedicles by using Electrosurgical Bipolar Vessel Sealer in Vaginal Hysterectomy.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over a period of one year i.e. July 15 to June 16. A total of 62 patients posted for vaginal hysterectomy for benign conditions were enrolled after informed consent. Results were recorded under headings of procedure time (min), blood loss (ml), major intra-operative complications and post operative complications, post-operative pain (on VAS) and duration of hospital stay.Results: Mean procedure time in suture method was found to be 55.66min, whereas, in sealer group it was 27.75 min. Mean blood loss in the sealer group was 83.78ml, while, in suture group it was 156.62ml. Mean pain score on Visual Analogue Scale on POD 1 was 8.44±1.1522 for suture group and 6±1.325 for sealer group. Mean pain score on POD2 in sealer group was 3.48±1.325 and in the suture group it was 5.31±1.754 (P200ml was observed in 29.03% of suture cases, none in the sealer group (P-value .0006). Labial burn occurred in 2 out of 32patients in sealer group.Conclusions: From above study, we conclude that bipolar vessel sealer has shown a significant reduction in intra-operative blood loss, procedure time, immediate post-operative pain (POD1,2&3), mean length of stay in hospital, major intra-operative blood loss>200ml which was found in significant number of cases in suture group

Identifying the risk factors of antepartum haemorrhage and to evaluate the feto maternal outcome in antepartum haemorrhage cases

Background: Antepartum haemorrhage is an obstetric emergency contributing to a significant percentage of perinatal and maternal morbidity and mortality. Approximately 30% of maternal deaths are caused by ante-partum haemorrhage. In spite of a lot of improvement in antenatal care and intrapartum surveillance, antepar-tum haemorrhage has not reduced. Present study was conducted to assess the causes of APH and to compare the fetomaternal outcome among placenta previa and abruptio placenta group.Methods: The study was conducted in BRD medical college Gorakhpur, over a period of 1 year (October 2019 to September 2020) in which 100 cases of APH were taken and classified into placenta previa and abruptio placenta group and their fetomaternal outcome were compared.Results: In our study, out of 100 cases of APH 69% cases were of placenta previa followed by abruptio placen-ta in 29% cases and rest 2% cases were unclassified APH. Multigravida is the major risk factor in both placenta previa and abruptio placenta group. Second major risk factor in placenta previa group was h/o LSCS and in abruptio placenta group was HDP. Stillbirth was significantly seen in abruptio placenta group whereas Low birth weight babies (1.5-2.5 kg) were more in placenta previa group. Though the maternal outcome is poor in placenta previa group but the fetal outcome is worse in abruptio placenta group.Conclusions: APH neither can be reliably predicted nor can be prevented but only a comprehensive focused experienced team work can reduce maternal and perinatal morbidity and mortality

The outcome of preterm births in pregnant women with hypertensive disorders: an observational study

Background: Hypertensive conditions occurring during pregnancy are linked to heightened chances of severe consequences, including preterm birth, intrauterine growth restriction, perinatal mortality and morbidity, acute kidney failure, sudden liver malfunction, excessive postpartum bleeding, HELLP Syndrome, disseminated intravascular coagulation, and seizures. Methods: A prospective hospital-based study was conducted in a tertiary care hospital of eastern Uttar Pradesh, over the period of one year. The total sample size calculated was 235. Data was collected using the structured questionnaire. This study recruited the hypertensive pregnant women with a blood pressure reading of 140/90 mmHg or higher, irrespective of the timing of the blood pressure elevation, who visited the hospital for delivery over the course of one year. Various maternal variables were examined, including age, gestational age, number of previous deliveries, the status of the mother's blood pressure, and the type of delivery. Results: In the present study, the births revealed the following distribution among different hypertensive disorders: chronic hypertension preterm: 100.0% 06 vs. term: 0% 0, eclampsia, preterm: 60.4% 64 vs. term: 39.6% 42, mild preeclampsia, preterm: 55.3% vs. term: 44.7%, severe preeclampsia, preterm: 48.5% vs. term: 51.5%, and gestational hypertension, preterm: 23.5% vs. term: 76.5%. Conclusions: Based on the findings of this study, it was determined that hypertensive disorders play a pivotal role in influencing both the frequency of preterm delivery and the associated complications in infants resulting from premature birth