Uterine Arteriovenous Malformation As A Rare Cause Of Menorrhagia

Uterine arterio venous malformation is uncommon cause of menorrhagia. We report a rare case of arteriovenous malformation diagnosed after 18 years of suffering from menorrhagi

Maternal near miss and maternal death among women with hypertensive disorders in pregnancy: an observational study in a selected hospital in West Bengal

Background: Aim of the this study was to assess the prevalence of hypertensive disorder in pregnancy and the  incidence of maternal death and maternal near miss from the hypertensive disorders of pregnancy and utilization of maternal health care services by them. Methods: An observational study was performed at Purba Medinipur District Hospital, West Bengal from 1st April 2018 to 31st December 2020. The main outcome measures included incidence of potentially life threatening conditions, life threatening conditions maternal near miss cases and mortality developed due to PIH/preeclampsia/eclampsia and utilization of maternal health care services by them. Results: Present study reflected that the prevalence of hypertensive disorder in pregnancy was 9.01% (3543/39310) of total admission. The incidence of maternal mortality due to complication of hypertensive disorder was 7 out of total maternal mortality 30 during that period i.e. 23.3% of total mortality and incidence of MNM was 82 out of total 249 MNM cases during the same period i.e. 32.9% of total MNM cases. Utilization of maternal health care services revealed that there is a scope to increase the service delivery. Conclusions: Health care programmes need to enhance the existing efforts to improve timely health seeking behavior of women. There is a need of better quality antenatal care and extra resources are needed for identification and transportation of the women to reach hospital when the women develops complications. There is also a need of improvement of critical care in women who are suffering from life threatening condition

Routine episiotomy versus selective episiotomy in nulliparous women at term-randomized comparative trial

Background: Practice of routine episiotomy is debatable. The study aims to compare maternal and fetal outcome in routine episiotomy versus selective episiotomy in nulliparous women delivering at term.Methods: Two hundred nulliparous women at term were assigned randomly to receive routine or selective episiotomy during delivery. The primary outcome measures were anterior vaginal trauma, 1st degree perineal tear, 2nd degree perineal tear, 3rd degree perineal tear, 4th degree perineal tear and Apgar score at 1 and 5 minutes. Secondary measures of outcome included consumption of analgesics, anal incontinence, urinary incontinence and dyspareunia.Results: The episiotomy rate was 90% in routine episiotomy group and 42% in selective episiotomy group. Occurrence of second-degree perineal injury was more common in routine episiotomy group (90% versus 64%; p<0.0001). However, there was no difference in occurrence of 3rd degree perineal tear among the groups. More women in selective episiotomy group suffered from anterior vaginal wall tear (22% versus 54% p<0.0001). There was no difference among the groups in Apgar score, severity of perineal pain, analgesic use on day 2 of delivery, anal incontinence, urinary incontinence, dyspareunia and NICU admission of the neonate.Conclusions: Routine episiotomy is associated with a higher incidence of perineal injuries without any added benefit for the mother and the baby

Immediate induction of labor in premature rupture of membranes at term (PROMT)-vaginal Misoprostol tablet versus PGE2 gel: a randomized comparative study

Background: The aim of the study is to compare immediate induction with vaginal misoprostol tablet and immediate induction with vaginal PGE2 gel in women with premature rupture of membranes at term (PROMT).Methods: Nine hundred thirty-two women with PROM at term were assigned randomly to receive intravaginal 25μg misoprostol tablet, 4 hourly with a maximum of 5 doses or 0.5 mg vaginal PGE2 gel 6 hourly with a maximum of 2 doses. The primary outcome measures were cesarean section rate, admission to delivery interval and induction to delivery interval. Secondary outcomes included, mode of delivery, and maternal and neonatal safety outcome. Results were calculated applying Fisher Exact Test, Chi square test, t test and calculating the P-value using an alpha level of 0.05 for Type I error.Results: The mean time from admission to delivery was 13.16 hours in the misoprostol group and 13.56 hours in the PGE2 group (P= 0.3014). Induction to delivery interval was also comparable between the groups (10.23 h versus 10.18 h).Caesarean section rate did not differ significantly between groups (12.13% versus 15.74% ,P=0.135 RR 0.783 95% CI 0.568-1.079).More women in misoprostol group had instrumental delivery (7.57% versus 4.25%, P=0.031, RR 1.089 95% CI 1.04-3.03).The  neonatal outcomes were comparable between the groups . Maternal outcomes were not significantly different except incidence of analgesic use (P=0.009 RR 1.62 95% CI 1.03-1.30), meconium stained liquor (P=.0096 RR 2.03 CI 1.17-3.53) and   number of digital vaginal examinations (P&lt;.0001) in misoprostol group.Conclusions: Vaginal misoprostol is equally efficacious in labor induction and demonstrates a similar fetal and maternal safety profile to PGE2 gel

A comparative study of neonatal and maternal outcome between forceps delivery and vacuum extraction

Background: Aims and objectives of the study were to compare maternal and neonatal outcomes of forceps versus vacuum application in assisted vaginal delivery. Methods: This prospective study was conducted in a tertiary care hospital of West Bengal over one year. Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 100 cases were included of which 50 patients selected for forceps delivery and 50 patients for vacuum extraction. The instruments were either silastic cup vacuum extractor or Wrigley`s outlet forceps. Maternal morbidity was studied in terms of cervical tears, vaginal lacerations, episiotomy extension, perineal tears, PPH, and retention of urine. Neonatal morbidity was studied in terms of Apgar score, instrumental injuries, cephalhematoma, NICU admission and the outcome was compared. Chi square test was used to analyze the data. Results: Observations maternal morbidity viz. episiotomy extension, traumatic PPH were significant in the forceps group (p=0.01). With regards to neonatal morbidity, SNCU admission were significantly higher in forceps delivery (p=0.02) and incidence of cephalohematomas were more in ventouse delivery (p=0.02). Conclusions: Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.

A Study To Evaluate The Aetiological Factors And Management of Puberty Menorrhagia

Introduction: This study aims to evaluate the incidence, clinical presentation, etiological factors and treatment outcomes of the patients suffering from puberty menorrhagia. Methods: 65 patients with puberty menorrhagia attending the outpatient as well as indoor department of NRS Medical College, Kolkata during the period from February, 2005 to July,2006 were included in the study. They were prospectively analysed to assess the aetiological factors and the outcome of treatment required to manage these cases.Results – The incidence of puberty menorrhagia was 9.6% in our study. 40%s patients had menarche between 12-13 years. 61.6% had anovulatory dysfunctional uterine bleeding(DUB). 15.4% had hematological causes. Hypothyroidism, endometrial tuberculosis, polycystic ovarian disease were other important causes. 40% were relieved with tranexamic acid, 26% required hormone treatment and 35.3% received blood transfusion.Conclusion: Anovulatory DUB is the cause of menorrhagia in most of the cases .Medical treatment is mostly effective while surgical procedures are limited to few specific cases

Cytologically Diagnosed Ovarian Carcinoma Turned Out To Be a Case of Chronic Ectopic Pregnancy

Background and ndash; The diagnosis of chronic ectopic pregnancy is often difficult as there is a shortage of literature in which this disease is diagnosed as an entity separate from the condition of acute ecopic pregnancy. Experience with fine needle aspiration cytology in chronic ectopic pregnancy is not reported previously. Case - A 29-year-old para 3 woman presented with lower abdominal pain and irregular menstruation since two months Transvaginal ultrasonography showed a well defined heterogenous, solid-cystic right adnexal mass with normal serum beta HCG , and mildly elevated CA 125 level . Fine needle aspiration cytology from the mass suggested possibility of serous cyst adenocarcinoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy and infra-colic omentectomy was done. Pathological findings were consistent with chronic ectopic pregnancy. Conclusion and ndash;It is possible to retrieve trophoblastic cells through fine needle aspiration even after 2 months of tubal rupture and this experience can be utilized to diagnose chronic ectopic pregnancy preoperatively. [J Interdiscipl Histopathol 2014; 2(2.000): 116-120