Closure of Pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture

Background: Cesarean section is by far the commonest surgery performed worldwide. Most of these surgeries are performed by Pfannenstiel incision. Various techniques and material have been tried for skin closure in these surgeries. Each method has its own advantages and disadvantages. The objective of the study was to compare wound outcomes in Pfannenstiel incisions closed in interrupted mattress sutures and subcuticular suture with absorbable material, in a prospective study of cesarean deliveries.Methods: It was studied that 104 women who had cesarean sections with Pfannenstiel incision prospectively for wound outcomes in terms of wound complications (hematoma formation, infection, nonunion, dehiscence and need for resuturing), pain and cosmetic appearance in two groups. One with absorbable subcuticular sutures, another with interrupted mattress suture.Results: Women who had subcuticular stitches had less postoperative pain, better wound outcomes, faster recovery, early discharge from hospital and cosmetically superior scars as compared with interrupted mattress sutures.Conclusions: While search for the best method and material for skin closure continues, the subcuticular suture with an absorbable material seems to leave a cosmetically better scar with lesser wound complications

Prevalence and symptomatology of polycystic ovarian syndrome in Indian women: is there a rising incidence?

Background: Polycystic ovarian syndrome [PCOS] is a complex ill understood hormonal disorder resulting in myriads of symptoms like irregular menses, hyperandrogenism, metabolic disturbances and infertility. It occurs in about 8-11% of reproductive age group women. Recently changing lifestyles and rising obesity worldwide have contributed to rise in the incidence of PCOS. Objective of the present is to study the prevalence and symptomatology of PCOS in Indian women.Methods: 170 women in reproductive age group, with irregular menstrual cycles attending OPD, voluntarily participated in a cross sectional study. All were subjected to detailed history, examination and investigated with a battery of lab tests to confirm PCOS. Out of 170 women investigated 70 women with features of PCOS were included in the study (diagnosed as PCOS by NIH criteria).Results: The overall prevalence of PCOS in the study population was, 41%. It was 16% in married women and 24 % in unmarried girls. Common menstrual irregularity was-oligomenorrhea (40%), Menorrhagia (12.8%) amenorrhea (11%). Common symptoms were hirsutism, acne, infertility and alopecia.Conclusions: PCOS is rising in young women and to some extent the changing lifestyle in urban women may be linked to it. There in a world-wide increase in the incidence of obesity, diabetes mellitus and metabolic syndrome, PCOS and its accompanying insulin resistance is contributing to it. Treating PCOS and its complications is adding to health care burden

Non-surgical management of unruptured tubal ectopic pregnancy

Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Background: The acronym HELLP was coined by Loise Weinstein in 1982 to describe a syndrome consisting of hemolysis (H) elevated liver enzyme (EL) and low platelets (LP). The purpose of the study was to detect and evaluate the feto maternal outcome of HELLP and partial HELLP syndrome among preeclamptic patients.Methods: Study analyzed fetal and maternal outcome in 110 patients with HELLP syndrome and 89 patients with partial HELLP Syndrome and compared with 1100 patients of preeclampsia only.Results: 1210 patients were included in this study. Out of these patients HELLP syndrome, partial help syndrome and preeclampsia were 10% and 7.3% and 82.7%. The systolic BP, gestational age at admission and at delivery, hematological and biochemical parameters, vaginal delivery and type of anesthesia were significantly different in HELLP syndrome and partial HELLP syndrome than in pre eclampsia group. There was significant difference in perinatal outcome like birth weight, IUD, neonatal death and NICU-admissions. Eclampsia was significantly increased in HELLP syndrome and partial HELLP syndrome.Conclusions: HELLP and partial HELLP syndrome must be diagnosed as soon as possible. Partial HELLP and HELLP syndrome are equally dangerous. HELLP Syndrome is severe then preeclampsia in terms of maternal and perinatal outcome

A clinical study of postdated pregnancy

Background: Objective of the study was to find out the incidence of maternal complications, perinatal mortality and morbidity in postdated pregnancies. Design of the study was prospective observational study.Methods: Patients who have completed 40 weeks of gestational age, patients who were sure of the date of last menstrual period (LMP) along with 1st trimester obstetrics scan were included. Patients not sure of LMP were excluded.Results: There is high fetal and maternal risk associated with postdated pregnancy. Total 100 cases were selected from antenatal clinic and Labour Room and were divided into two groups. Study group and control group, 50 cases in each. Induction rate is more in postdated pregnancies. Incidence of operative deliveries is 54% in study group. Postpartum haemorrhage and septicaemia are the most common maternal complication in the study group. Perinatal mortality is higher and more NICU admissions were required.Conclusions: Considering this, policy of early intervention should be undertaken in postdated pregnancy to avoid maternal and perinatal complications

Comparison between intravenous iron sucrose versus oral iron therapy in pregnant women with nutritional anemia: a prospective study

Background: In India, the prevalence of anemia during pregnancy may be as high as 80%. The objective of this study was determining the efficacy of intravenous iron sucrose and oral iron in nutritional anemic antenatal patients, presenting at Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun, Uttarakhand, India.Methods: The study was carried out in the department of obstetrics and gynecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India single center study was performed on 400 antenatal patients with nutritional anemia gestational age 14 to 36 weeks. Patients were divided in two groups A and B. Group A was treated with intravenous iron sucrose and group B was treated with oral iron sulfate.Results: There was significant improvement in the various hematological parameters in IV sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in IV sucrose group.Conclusions: This study has shown a significant improvement in the iron sucrose group. Iron sucrose is safe and well tolerated

Bowel injury: a rare but dreaded complication of unsafe abortion

Unsafe abortions represent a preventable yet major cause of maternal mortality and morbidity in India. Intestinal perforation is a rare dreaded complication of unsafe abortion. It is commonly seen in countries in which abortions are performed by people without proper training and proper instruments. Bowel perforation occurs when the posterior vaginal wall or the uterine wall is perforated. The ileum and the sigmoid colon are the most commonly injured portion of the bowel. Here, we report a case of ileal perforation following induced unsafe abortion which was managed successfully

Conservative management of Cesarean Scar Ectopic Pregnancy

Caesarean scar pregnancy (CSP) refers to a gestational sac that has implanted in the scar of a previous caesarean delivery due to incomplete healing of the caesarean scar, as may be seen in CSP occurring few months of caesarean delivery. It is the rarest kind of ectopic pregnancy which is usually misdiagnosed leading to life threatening complications, like rupture with haemorrhage and hemodynamic collapse. Therefore, a high index of suspicion is required to diagnose CSP. Here, we present two case reports of CSP presenting at 6 and 7 months after cesarean delivery, respectively. The first one presented to us as a case of incomplete abortion following medical abortion, and the second patient was referred to us as a case of cervical pregnancy. A decrease in the primary caesarean rate and prolongation of the inter-pregnancy interval is essential to avoid CSP

Factors associated with induced second trimester abortion at a tertiary level hospital of Uttarakhand region: a 6-year retrospective study

Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security

A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state

Background: Instrumental vaginal delivery is an age-long obstetric practice used to expedite vaginal delivery or avert recourse to caesarean delivery. Objective of the study is to compare maternal and neonatal outcomes of vacuum and forceps application in instrumental vaginal delivery.Methods: This is a retrospective observational study. Retrospective study of 70 consecutive ventouse and 70 consecutive forceps deliveries was done. Maternal and neonatal morbidity were compared in terms of perineal laceration, episiotomy extension, postpartum hemorrhage, apgar score, neonatal injuries and NICU admissions.Results: Maternal morbidity in terms of periurethral tear, second and third degree perineal tear were significantly more in forceps group (p=0.0332 and p=0.0173 respectively). However neonatal outcomes were found to be similar in both types of instrumental deliveries.Conclusions: Ventouse should be preferred over forceps whenever there is an indication for instrumental delivery (except in fetal distress) as it is associated with less maternal trauma and most of the neonatal morbidities were insignificant in comparison with both instruments