Emergency obstetric hysterectomy: a two-year observational study at tertiary care center in Berhampur, Odisha, India

Background: Emergency obstetric hysterectomy is an unequivocal marker of severe maternal morbidity and, in many respects, the treatment of last resort for rupture uterus, severe postpartum hemorrhage (PPH) and other such life-threatening conditions. In no other gynaecological or obstetrical surgery is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand it is the last resort to save a mother’s life, and on the other hand, the mother’s reproductive capability is sacrificed. This study is conducted with an aim to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency obstetric hysterectomy in a tertiary care centre.Methods: We conducted a prospective, observational, and analytical study over a period of two years, from September 2017 till September 2019. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur.Results: The incidence of EOH in our study was 12 following vaginal delivery and 44 following caesarean section. The overall incidence was 56 per 21,128 deliveries. Uterine rupture (37.5%) was the most common indication followed by atonic postpartum hemorrhage (25%) and placenta accrete spectrum (10.7%). The most frequent sequelae were febrile morbidity (25.7%) and disseminated intravascular coagulation (21.4%). Maternal mortality was 17.1% whereas perinatal mortality was 51.7%.Conclusions: A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of caesarean section and multiple pregnancies particularly in urban settings in developing countries

Maternal and fetal outcome in cardiac disease in pregnancy: a retrospective study at tertiary care center

Background: Cardiac disease in pregnancy is a high-risk pregnancy and major problem worldwide particularly developing countries. In present scenario the incidence of pregnancy with congenital heart disease is high in developed countries and they are landing with favourable outcome due to advance surgical correction of the defects. In developing countries, the incidence of RHD is still high. Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy in our hospital and to assess the obstetric outcome.Methods: A retrospective study carried out in 22 number of patients with cardiac disease at tertiary care center during the period of 2 years.Results: In present study the incidence of cardiac disease in pregnancy was observed to be 0.15%.Among them the prevalence of RHD was high (68.1%).Out of which the most common valvular lesion was mitral stenosis (46.6%) followed by mitral stenosis with mitral regurgitation (26.6%).50% of the patients were in NYHA class 2.Majority delivered vaginally with instrumental application in second stage (95.4%).Obstetric complications observed in form of anaemia, preeclampsia, abruption placentae and preterm labour and one maternal  mortality. Perinatal morbidities observed in form of prematurity, SGA, birth asphyxia, MSAF, NICU admission.Conclusions: cardiac disease has major impact on pregnancy and its outcome. It is a team effort by obstetrician, cardiologist, neonatologist to achieve successful pregnancy. Regular antenatal checkup and strict vigilance during the risk period when patient may develop complications as a result of haemodynamic changes can avoid the complications

Evaluation of risk of malignancy index in adnexal masses at a tertiary hospital: a prospective study

Background: The discrimination between benign and malignant adnexal masses is important in deciding clinical management and optimal surgical planning. The aim of the study was to evaluate the effectiveness of risk of malignancy index (RMI) to identify cases with high potential of ovarian malignancy at a tertiary hospital.Methods: This prospective study was conducted over a period of two years from September 2017 to August 2019 at obstetrics and gynecology department of M. K. C. G. Medical College and Hospital, Berhampur. A total case of 130 patients with adnexal masses who underwent surgical treatment were included as histopathological report was taken as gold standard to calculate accuracy of RMI.Results: Of the total masses, 85 (65.4%) were benign and 45 (34.6%) were malignant. The mean age of patients was 41.03±14 years. The best cut off value for the RMI-3 was 225 with highest area under the ROC curve 87%, sensitivity of 75.55%, specificity of 98.82%, PPV of 97.14%, NPV of 88.42% and an accuracy of 90.76%.Conclusions: The present study demonstrated that RMI was a reliable method in detecting malignant ovarian tumors. The RMI is a simple and practically applicable tool in preoperative discrimination between benign and malignant adnexal masses in non-specialized gynecologic departments, particularly in developing countries