Emergency and elective caesarean sections: comparison of maternal and fetal outcomes in a suburban tertiary care hospital in Puducherry

Background: The aim of the current study was to compare the maternal and fetal outcomes of emergency and elective caesarean deliveries.Methods: A prospective case comparative study was conducted at the Government Maternity Hospital, Department of Obstetrics and Gynaecology, Puducherry, from August 2005 to July 2006.Results: A total of 301 caesarean deliveries occurred during the study period. The percentages of the primi-gravida as well as the nulli-parous women were significantly higher among emergency caesarean section than that in elective caesarean section (χ2=12.52, P<0.0001). The percentages of previous caesarean sections was significantly higher among those who had elective caesarean than those had emergency caesarean section in the present delivery (χ2=14.73, P=0.0001). Among emergency caesarean section 25.8% had abdominal distension, whereas it was present only in 8.7% of the elective cases. Of the 16 new born with postnatal complications in the emergency group, 14 died, one had convulsion and the remaining one was a stillbirth. In the elective group there were 4 deaths.Conclusions: It was inferred that both elective and emergency caesarean imposes certain complications to the mother and the fetes.  However, maternal and fetal complications were felt very high in emergency caesarean than elective. Proper planning can help obstetric practitioners to avoid complications

Spontaneous isolated bladder rupture following normal delivery

Spontaneous bladder rupture in a primipara after normal delivery within the first week of puerperium is a rare surgical emergency. The importance of suspecting and recognizing the voiding dysfunction in the postpartum period and early catheterisation to prevent such catastrophe is highlighted in this case report. We report a case of spontaneous intraperitoneal bladder rupture in a 26 year old primipara 3 days after normal delivery of a 3kg baby with episiotomy

Study of prevalence and factors associated with Maternal Near Miss (MNM) cases and maternal death at Rajiv Gandhi Government Women and Children Hospital, Pondicherry, India

Background: Maternal mortality is a critical event to assess the quality of a health care system. Analysing the maternal near miss provides a good opportunity for assessing the factors responsible for maternal mortality in that area. The objective of this study was to study the clinic-etiological profile of severe maternal morbidity/near miss case in a tertiary public maternity hospital using criteria from maternal near miss review operational guidelines Ministry of Health and Family Welfare, Government of India (2014).Methods: A prospective observational study included patients admitted to Rajiv Gandhi Government Women and Children Hospital, Pondicherry between August 2016 and July 2017. The patients who met Near Miss Criteria (a set of Clinical, Laboratory and Management based criteria) given by MoH and FW, Government of India (2014) were enrolled; their clinical and investigation parameters were recorded.Results: Out of 9583 live births, 27 (0.281%) were near-miss cases. The maternal near miss incidence ratio was low 2.81 /1000 live births, because of strict criterion of labelling near-miss cases. Maternal near miss to mortality ratio was 13.5:1, and mortality index was 6.89%, lower the index, indicates better quality of care. The mean age of the near-miss patients was 27.75 years. Most of the patients of near-miss were of multipara n = 17 (62.96%). Majority n = 16 (59.25%) of patients were at term gestation. The major causes of near miss were severe haemorrhage n = 11 (42%), Hypertension n = 9 (35%) and rupture uterus n = 4 (15%). Major intervention peripartum hysterectomy was needed in n = 7 (27%) and stepwise devascularisation only in another n = 5 (19 %) of near miss cases.Conclusions: Haemorrhage was the leading cause of near miss events. The study of maternal near miss provides an insight into the causes of maternal mortality in this region. The maternal morbidity and mortality can be reduced by providing proper antenatal care at primary and community health centre level and good intensive care and using maternal early warning system (MEWS) at tertiary level. Maternal near miss ratio is worth presenting in national indices

A rare case of secondary abdominal pregnancy following ruptured rudimentary horn

Abdominal pregnancies are classified as primary or secondary of which secondary abdominal pregnancies are more common. The incidence of abdominal pregnancy varies from 1 in 372 to 1 in 9,714 live births and accounts for 1.4% of ectopic pregnancies. Rudimentary horn pregnancy occurs in approximately 1/76 000 to 1/150 000 pregnancies. Abdominal pregnancies are classified as primary or secondary of which secondary abdominal pregnancies are more common. The incidence of abdominal pregnancy varies from 1 in 372 to 1 in 9,714 live births and accounts for 1.4% of ectopic pregnancies. Rudimentary horn pregnancy occurs in approximately 1/76 000 to 1/150 000 pregnancies. We report a case of secondary abdominal pregnancy in a 24-year-old primigravida at 19 weeks gestation who was asymptomatic on admission but a known case of unicornuate uterus with rudimentary right horn. Ultrasound revealed fetus in the abdominal cavity and was confirmed by MRI. Intraoperatively, fetus was found en sac in abdominal cavity and placenta in the cavity of the ruptured right rudimentary horn which was removed in toto with the horn

Umbilical true knot: a case study

Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. The incidence is not only very low, but it is often undiagnosed antenatally when present despite the availability of prenatal ultrasonography as in this case, where the diagnosis of true knot of umbilical cord was missed even when an ultrasonogram was done 1 week prior to the presentation of patient with decreased fetal movements to opd. Majority of times it does not have any relation with fetal outcome but in certain occasions it is associated with intrauterine fetal demise as in present case presented here. Risk factors include long umbilical cord, polyhydramnios, small fetus, male fetus, etc

A rare case of obstructed hemivagina and ipsilateral renal agenesis syndrome presented with haematocolpos and haematometra

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a syndrome characterised by obstructed hemivagina, ipsilateral renal agenesis and uterine didelphys. It is a rare congenital anomaly results from defective fusion of the Müllerian ducts during development of the female reproductive system. It is also known as Herlyn-Werner-Wunderlich syndrome. Aim of the study was to project a rare case of developmental anomaly of Mullerian system. OHVIRA syndrome is rare anomaly. The most common presentation of this syndrome is a mass secondary to hematocolpos, pain, and dysmenorrhea. Incidence rate is 0.1-3%. Other symptoms are swelling of the abdomen, nausea and vomiting due to pelvic pain, and fertility may also be affected. Diagnosed by magnetic resonance imaging (MRI) and ultrasound. This case was managed by diagnostic laparoscopy with resection of vertical vaginal septum. Other treatment option is vaginoscopic incision of the oblique vaginal septum. High level of clinical suspicion and early surgical intervention will prevent further complications

Microperforate hymen and labial fusion: an unusual case

Genital tract abnormalities are uncommon, occurring in approximately 7% of female population. Among these cases, hymenal abnormalities are the most frequent, with imperforate hymen occurring in 1 in 2000 girls. Imperforate and microperforate hymen is a congenital disorder of hymenal configuration which does not permit normal menstrual flow. We report a case of 26 year old primigravida at 28 weeks gestation with threatened preterm labor and was incidentally found to have fused labia minor and microperforate hymen. Scope examination through the hymen revealed a normal looking vagina and cervix. Urethral meatus was not made out. She was taken up for elective caesarean section at 37 weeks of gestation with hymenectomy. Intraoperatively, urethral orifice was identified after incising the fused labia minora. A uterine angle fibroid was found, myomectomy done. No uterine anomalies were noted

Emergency and elective caesarean sections: comparison of maternal and fetal outcomes in a suburban tertiary care hospital in Puducherry

Background: The aim of the current study was to compare the maternal and fetal outcomes of emergency and elective caesarean deliveries.Methods: A prospective case comparative study was conducted at the Government Maternity Hospital, Department of Obstetrics and Gynaecology, Puducherry, from August 2005 to July 2006.Results: A total of 301 caesarean deliveries occurred during the study period. The percentages of the primi-gravida as well as the nulli-parous women were significantly higher among emergency caesarean section than that in elective caesarean section (χ2=12.52, P&lt;0.0001). The percentages of previous caesarean sections was significantly higher among those who had elective caesarean than those had emergency caesarean section in the present delivery (χ2=14.73, P=0.0001). Among emergency caesarean section 25.8% had abdominal distension, whereas it was present only in 8.7% of the elective cases. Of the 16 new born with postnatal complications in the emergency group, 14 died, one had convulsion and the remaining one was a stillbirth. In the elective group there were 4 deaths.Conclusions: It was inferred that both elective and emergency caesarean imposes certain complications to the mother and the fetes.  However, maternal and fetal complications were felt very high in emergency caesarean than elective. Proper planning can help obstetric practitioners to avoid complications

Spontaneous isolated bladder rupture following normal delivery

Spontaneous bladder rupture in a primipara after normal delivery within the first week of puerperium is a rare surgical emergency. The importance of suspecting and recognizing the voiding dysfunction in the postpartum period and early catheterisation to prevent such catastrophe is highlighted in this case report. We report a case of spontaneous intraperitoneal bladder rupture in a 26 year old primipara 3 days after normal delivery of a 3kg baby with episiotomy

Study of prevalence and factors associated with Maternal Near Miss (MNM) cases and maternal death at Rajiv Gandhi Government Women and Children Hospital, Pondicherry, India

Background: Maternal mortality is a critical event to assess the quality of a health care system. Analysing the maternal near miss provides a good opportunity for assessing the factors responsible for maternal mortality in that area. The objective of this study was to study the clinic-etiological profile of severe maternal morbidity/near miss case in a tertiary public maternity hospital using criteria from maternal near miss review operational guidelines Ministry of Health and Family Welfare, Government of India (2014).Methods: A prospective observational study included patients admitted to Rajiv Gandhi Government Women and Children Hospital, Pondicherry between August 2016 and July 2017. The patients who met Near Miss Criteria (a set of Clinical, Laboratory and Management based criteria) given by MoH and FW, Government of India (2014) were enrolled; their clinical and investigation parameters were recorded.Results: Out of 9583 live births, 27 (0.281%) were near-miss cases. The maternal near miss incidence ratio was low 2.81 /1000 live births, because of strict criterion of labelling near-miss cases. Maternal near miss to mortality ratio was 13.5:1, and mortality index was 6.89%, lower the index, indicates better quality of care. The mean age of the near-miss patients was 27.75 years. Most of the patients of near-miss were of multipara n = 17 (62.96%). Majority n = 16 (59.25%) of patients were at term gestation. The major causes of near miss were severe haemorrhage n = 11 (42%), Hypertension n = 9 (35%) and rupture uterus n = 4 (15%). Major intervention peripartum hysterectomy was needed in n = 7 (27%) and stepwise devascularisation only in another n = 5 (19 %) of near miss cases.Conclusions: Haemorrhage was the leading cause of near miss events. The study of maternal near miss provides an insight into the causes of maternal mortality in this region. The maternal morbidity and mortality can be reduced by providing proper antenatal care at primary and community health centre level and good intensive care and using maternal early warning system (MEWS) at tertiary level. Maternal near miss ratio is worth presenting in national indices