Audit of peripartum hysterectomies at an Indian tertiary care centre: a 12-year review

Peripartum hysterectomy is performed in critical conditions like major obstetric haemorrhage, abnormally-invasive placenta, rupture uterus. In developing countries incidence is 0.2–5/1000 deliveries. It can also be done as non-emergent surgeries for suspected cases by pre-planning. If high-risk patients are identified, timely intervention done, yields better outcome. Data of peripartum hysterectomy patients during last 12 years collected. Demographic details, menstrual-obstetric history, high-risk factors, previous and current delivery details, postpartum haemorrhage, indication, operative details of peripartum-hysterectomy, maternal-perinatal outcome, blood loss, anaesthesia records, length of ICU and hospital stay quantity of blood and products transfused analysed. 18 cases of peripartum hysterectomy with incidence of 2.76 per 1000 deliveries     noted. 14-emergency, 4-electively done.  In current pregnancy 13 had caesarean deliveries, 5 had vaginal deliveries, all required emergency hysterectomy. Majority were 26-30 years, 83% multiparous. 11 required emergency hysterectomy. 27.77% were due to atonic PPH and 22.22% placenta accreta spectrum. Mean anaesthesia duration, ICU stay, mean blood loss, units of blood and products was more in emergency group. Maternal and perinatal outcomes were favourable in elective group. Keeping high index of suspicion for accrete, identifying risk factors for atonic PPH, managing proactively, results in favourable maternal-perinatal outcome

Correlation of levels of early second trimester beta-human chorionic gonadotropin levels with severity of preeclampsia

Background: Hypertensive disorders in pregnancy remains a leading cause of maternal morbidity and mortality all over the world as per World Health Organization (WHO), affecting 5-10% of all pregnant women. Screening women at an early stage and preventing complications are corner stone in the management of pre-eclampsia. Several studies have proven the reliability of beta-human chorionic gonadotropin (β-hCG) as predictor of preeclampsia. In this study we aim to find the correlation of increasing levels of β-hCG with severity of preeclampsia.Methods: In this study serum β-hCG estimation was done in 200 pregnant women between 13 and 20 weeks of gestation, selected randomly over a period of 1 year attending antenatal clinic by quantitative determination of β-hCG by electro-chemiluminescence immunoassay. Multiple of median (MOM) is calculated from charts of norms available. They were followed till delivery for development of pre-eclampsia. The following patients were followed up till delivery. Blood parameters, blood pressure readings, were done at 34 weeks for every patient and maternal complications were noted and results were analysed statistically.Results: The incidence of preeclampsia in this study population was 8% (16 out of 200). This study found a significant correlation between increasing levels of MOM’s of β-hCG with the severity of preeclampsia.Conclusions: In this study, there was significant association between MOM values of β-hCG with the parameters defining severity of preeclampsia. The results of our study show β-hCG to be not only a reliable marker for prediction of preeclampsia, but also its severity

Screening and diagnosis of gestational diabetes mellitus by IADPSG criteria

Background: GDM is a complex clinical entity and its screening, diagnosis, and management warrants attention. With this issue in mind, we aimed to study the prevalence of gestational diabetes mellitus in the antenatal group of patients attending tertiary hospital in New Delhi and its association with maternal outcome.Methods: 300 pregnant patients were enrolled in the first trimester and RBS (random blood sugar) was done. Those who had RBS >200mg/dl were labelled as overt diabetes and excluded from the study. The patients who were screened negative in phase 1 of screening were subjected to the next phase of screening at 24-28 weeks of gestation with 2-hour 75g OGTT using IADPSG criteria. Those who were diagnosed as GDM were followed in the antepartum, intrapartum and postpartum period.Results: The prevalence of overt diabetes and GDM in the study population is 1.33% and 13.33%. The prevalence of gestational hypertension, pre-eclampsia, chronic hypertension, polyhydramnios was 15%, 5%, 5%, 7.5% respectively. Normal and instrumental vaginal delivery was in 50 %, 5% patients respectively and 45 % had the caesarean section.Conclusions: The single step OGTT with lower threshold value cut-offs and single abnormal value for the diagnosis of GDM as advocated by IADPSG seem to be effective as it helps to screen and diagnose GDM at the same time as a single step procedure and thus more cost-effective

Evaluation of intrauterine pathologies by hysteroscopy in abnormal uterine bleeding

Background: Hysteroscopy is the gold standard for uterine cavity evaluation because it allows direct visualization of the uterine cavity, mitigate characteristics of lesions such as nature, size, shape, location and vascular pattern. Methods: This was a prospective observational study conducted in department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal (MP). Patients presenting to general gyne OPD with abnormal uterine bleeding at Chirayu Medical College and Hospital between January 2021 to May 2022 were studied. All patients selected for study had a thorough evaluation with detailed history, clinical examination, lab tests and sonography followed by hysteroscopy and endometrial biopsy. Results: Mean age of patients in our study was 44 years with majority of patients in 41-50 years age group. Predominant complaint reported was heavy menstrual bleeding (HMB) (47.50%) followed by HMB with frequent cycle (11.25%). Hysteroscopy detected intrauterine abnormality in 42.50% cases. Most common finding on hysteroscopy in our study was hyperplastic endometrium in 17.50% patients followed by endometrial polyp in 15% of patients. Atrophic endometrium was seen in 2.5% and 2.5% had submucous fibroid. Conclusions: Hysteroscopy allows diagnosis or exclusion of intracavitary pathologies, which are underdiagnosed on routine pelvic sonography. It also enables treatment in the same sitting with accurate tissue biopsy from the representative areas and facilitates planning of further management. When combined with endometrial biopsy and pelvic ultrasonography, it can establish an accurate diagnosis in a majority of patients thereby reducing the burden of hysterectomy

Acute abdomen in pregnancy, not to forget twisted ovarian cyst: a case report

Aim of the study was to present a case of acute abdomen in pregnancy with twisted ovarian cyst which is a rare entity. A primigravida with period of gestation 25 weeks presented to casualty with acute abdomen. Her USG Doppler revealed findings of ovarian mass of around 9 by 6 cm which underwent torsion. Patient was taken up for emergency laparatomy. Per operatively right sided tubo-ovarian mass-9×8×5 cm, dumbell shaped, fleshy, hemorrhagic and necrosed with one twist over the pedicle seen separate from the uterus. Left side tubes and ovaries seen normal, uterus-26-week size. Frozen section revealed benign pathology. Postoperatively patient was done well and delivered a healthy baby at term via cesarean section. High index of suspicion, regular antenatal follow up and analysis of related risk factors, early and prompt diagnosis and timely intervention in cases of ovarian torsion in pregnancy can change feto-maternal outcome. Meticulous planning and timely intervention under multidisciplinary care team at a tertiary care centre reduces feto-maternal morbidity and mortality

Comparison of dexmedetomidine versus midazolam for intranasal premedication in children posted for elective surgery: a double-blind, randomised study

Objective: The aim of this study was to compare the effect of dexmedetomidine with midazolam for intranasal premedication in children posted for elective surgery.Trial design: This was a prospective, randomised, double-blinded clinical study.Method: 60 children, 3 to 10 years of age, with American Society of Anaesthesiologists (ASA) physical status I, scheduled for elective surgery, were randomly divided into two groups, group D (dexmedetomidine) and group M (midazolam). Group D patients received intranasal dexmedetomidine 1 μg/kg and group M patients intranasal midazolam 0.2 mg/kg, approximately 30 minutes before induction of anaesthesia, in the form of a spray.Outcome: Preoperative effects on heart rate, blood pressure, sedation and anxiety including parental separation and mask acceptance were assessed.Results: Intranasal dexmedetomidine (1 μg/kg) premedication resulted in statistically significant but clinically unimportant lower heart rate and blood pressure at 10, 20, and 30 minutes following administration compared with intranasal midazolam (0.2 mg/kg). There were no episodes of hypotension or bradycardia. Children in group D achieved better parental separation and mask acceptance scores compared with group M.Conclusion: Dexmedetomidine resulted in better parental separation and mask acceptance scores than intranasal midazolam. Thus it would seem to offer some advantage compared with midazolam.Keywords: dexmedetomidine, intranasal, midazolam, paediatric patient

Primary abdominal pregnancy causing diagnostic dilemma: a case report

The aim of the study was to present a case of primary abdominal pregnancy, a rare entity and highlighting the diagnostic dilemma and importance of surgical management. Primigravida with an amenorrhea of 35 days presented to the casualty with acute abdomen, with faintly positive UPT test and USG pelvis was suggestive of ill-defined hypoechoeic mass lesion in right sided adnexal region abutting right ovary. Intra-operatively, blood clots with products of conception were found adherent to anterior layer of right broad ligament. Uterus, both fallopian tubes and both ovaries found intact with normal morphology. On histopathology, no chorionic villi was found inside the lumen of the fallopian tube. Presence of occasional ghost chorionic villi embedded in blood clots, scattered cytotrophoblast and syncytiotrophoblasts also seen in the sample obtained from the anterior leaf of broad ligament. Primary abdominal pregnancy is not only rare but the diagnosis is also a challenge. It can be diagnosed conclusively after laparotomy. There are no symptoms which are pathognomonic for abdominal pregnancy. The symptoms are akin to other types of ectopic pregnancy, so a high index of suspicion is highly necessary for diagnosis. The keys to management are an early diagnosis and prompt surgery

A REVIEW ON STHAULYA (OBESITY) AND ITS MANAGEMENT THROUGH AYURVEDA

Although man has developed sophisticated machines, medical equipment and potent medicines, in spite of all these upgrade, he is lacking proper health. In a quest to achieve more of worldly pleasures and luxury, people are adopting a faulty lifestyle and the disease-causing risk factors and stress in their life are on increase mode. This is the fundamental reason being surge of lifestyle disorders these days. Where obesity is main and root cause of many other lifestyle disorder. A detail description of obesity by name of Sthaulya found in Ayurvedic literature but the material is Scatter and different opinion by different Acharya were there. Ayurveda manage the disorder in a holistic approach with Diet, Lifestyle, medication and Sodhanakarma. So, in present study detail review of Sthaulya with the aim to enlighten the different treatment approaches for the management of Sthaulya (Obesity)

Effects of retro-walking and spinal flexion exercises in postural low back pain

Purpose: to determine the effects of retro-walking along with spinal flexion exercises in postural low back pain. Materials & Methods: total subjects were 30 selected out of 69 according to the inclusion and exclusion criteria and were divided in two groups – Group A and Group B. Both groups are experimental and have 15 subjects in each group on the basis of inclusion criteria. The purpose and procedure of the study were explained in details and consent from the taken and they were free to withdraw any time without giving any reason. Results: independent t-test was used to find the significant difference between before and after intervention result in both groups. Before the intervention, table 1; the value of t-test of numeric pain rating scale was –1.628 wit significance value 0.115 of both groups; group A and B. whereas the value of t-test of oswestry disability index was –1.374 of both groups with significance value 0.180 of group A and 0.183 of group B. After intervention, table-2; the value of numeric pain rating scale and oswestry disability index was 0.000 and 0.000 in both groups. There was 95% of confidence interval adopted for the significant differences between the groups. Conclusions: there were reduction in pain and disability in both groups. The statistically reduction in pain and disability in group A following 4-weeks protocol of retro-walking along with spinal flexion exercises in postural low back pain suggests including retro-walking with conventional management protocol for patients with postural low back pain

Genetic Affinities of the Central Indian Tribal Populations

Background: The central Indian state Madhya Pradesh is often called as ‘heart of India ’ and has always been an important region functioning as a trinexus belt for three major language families (Indo-European, Dravidian and Austroasiatic). There are less detailed genetic studies on the populations inhabited in this region. Therefore, this study is an attempt for extensive characterization of genetic ancestries of three tribal populations, namely; Bharia, Bhil and Sahariya, inhabiting this region using haploid and diploid DNA markers. Methodology/Principal Findings: Mitochondrial DNA analysis showed high diversity, including some of the older sublineages of M haplogroup and prominent R lineages in all the three tribes. Y-chromosomal biallelic markers revealed high frequency of Austroasiatic-specific M95-O2a haplogroup in Bharia and Sahariya, M82-H1a in Bhil and M17-R1a in Bhil and Sahariya. The results obtained by haploid as well as diploid genetic markers revealed strong genetic affinity of Bharia (a Dravidian speaking tribe) with the Austroasiatic (Munda) group. The gene flow from Austroasiatic group is further confirmed by their Y-STRs haplotype sharing analysis, where we determined their founder haplotype from the North Munda speaking tribe, while, autosomal analysis was largely in concordant with the haploid DNA results. Conclusions/Significance: Bhil exhibited largely Indo-European specific ancestry, while Sahariya and Bharia showed admixed genetic package of Indo-European and Austroasiatic populations. Hence, in a landscape like India, linguistic labe