Indications and rate of caesarean delivery at tertiary care hospital: a retrospective study

Background: Worldwide there has been an increase in the rate of caesarean delivery due to multiple factors. Objective of the study was to assess the prevalence and different indications of caesarean section in this institute.Methods: The aim of the study is to analyse the rates and indications of lower segment caesarean section (LSCS) in our institution. We conducted a retrospective study over a period of six months; 1st September 2016 to 1st March 2017 at SLBSGMC Mandi at Nerchowk. Total number of patients who delivered in our hospital during the defined study period was recorded and a statistical analysis of various parameters was done.Results: The total number of women delivered over the study period was 2075, out of which caesarean sections (CS) were 473. The overall CS rate calculated was 22.8%. Previous LSCS was the leading indication to the CS rate.Conclusions: Routine obstetric audits should be done to analyse the various indications of emergency and elective caesarean sections so that protocols and guidelines can be implemented to curtail the increasing trend of caesarean delivery

A retrospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction in labor

Background: The aim is to compare the improvement in pre-induction Bishop’s score, proportion of patients going in labor and induction–delivery interval after using the Misoprostol versus Mifepristone and Misoprostol as cervical ripening and labor inducing agent.Methods: It is retrospective comparative study conducted on 110 women. Women were randomized in group A and in group B of 55 patients in each group. Group A received tab Mifepristone 200 mg orally on day 1 followed by Misoprostol 25 ug after 48 hours and continued 6 hourly till maximum four tablets and group B patients received tablet Misoprostol 25ug and continued 25ug 6hrly maximum 4 doses. Women observed for improvement in Bishop‟s score, induction-delivery interval and requirement of subsequent doses of Misoprostol.Results: Present study concluded that tablet Mifepristone is an efficient cervical ripening and inducing agent of labor as pre-induction Bishop’s score was improved. 36.4%patients went into labor only with tablet Mifepristone. The mean induction-delivery interval was,19±12.2hrs in Group 1 as compare to 13.1±13.0 hrs in Group 2. Mean Bishop’s score observed in Group 1 were 2.5±1.78 and 1.67±1.25 in Group 2. It was observed that there was significant improvement in the Bishop’s score after giving Mifepristone to the patients; mean Bishop’s 24hrs after mifepristone were 4.03±1.80. Repeated dose of Misoprostol required in Group 1 was observed to be higher than group 2 as shown in table 8. Mean misoprostol doses required in group 1 was 2.56±1.15 as compared to 1.71±1.58 in group 2.Conclusions: Mifepristone with Misoprostol reduce the induction delivery interval and more potent in combination for induction of labour as compared to Misoprostol alone

A prospective study on effect of maternal BMI on fetal outcome

Background: The extremes of BMI have a major impact on pregnancy outcomes. The objective of this study was to assess antenatal, intra-partum complications, perinatal outcome in pregnant women with high BMI.Methods: This study was conducted in Department of Obstetrics and Gynecology, Kamla Nehru State Hospital for Mother and Child IGMC Shimla, on 1000 women attending antenatal outpatient department over one year w.e.f. 01-05-2011 to 30-04-2012. Detailed information regarding different variables like maternal age, parity, education status, occupation socioeconomic status and weight gain during pregnancy were recorded on a proforma, master chart framed and analyzed using Student’s t test.Results: The study observed that both being overweight and underweight predisposes women to complicated pregnancies. The incidence of preterm is more in underweight women and post- dated deliveries increased with increase in BMI. Incidence of stillbirth was maximum in obese women. Incidence of low birth weight babies was more among underweight and the incidence of macrosomia was more in obese women.Conclusions: Maternal BMI have strong association with pregnancy complications and outcome

Maternal and foetal outcome in second stage caesarean section: a prospective study

Background: Caesarean section is the most commonly performed abdominal operation in women all over the world. Caesarean sections during the second stage labour accounts for approximately one fourth of all primary caesareans.  Caesarean section at full cervical dilatation is technically difficult and is associated with increased trauma to the lower uterine segment and adjacent structures, as well as increased haemorrhage and infection. Aims and objectives were to determine the indications, maternal and foetal morbidity associated with caesarean section in the second stage of labour.Methods: This prospective study included consecutive 50 cases of caesarean section deliveries conducted in second stage of labor for singleton live pregnancies at term. The data collected in the study was analyzed in terms of maternal demographics, indications of caesarean section, intra-operative and postoperative complications and neonatal outcomes.Results: In our series of 50 deliveries, arrest of descent of fetal head due to malposition was the most common indication of caesarean section accounting for 74% and average procedure time was 45-70 minutes. PPH (62%) was the most common complication. Bladder injury was found in 14% cases. Neonatal outcome variables like APGAR<3 at 5 minutes, respiratory distress and neonatal death were observed in 7, 26 and 2 deliveries respectively.Conclusions: Women undergoing cesarean section in second stage of labour are associated with increased maternal and fetal morbidity. They require special care and hence operation should ideally be performed and supervised by an experienced obstetrician. A proper judgement is required to take a decision for caesarean section at full cervical dilatation

Frontonasal dysplasia- a rare case report

Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. We report here a rare case of a full-term male baby who presented with features of FND. There was no history of consanguinity, no positive family history. Antenatal ultrasonography was normal. Though this baby did not survive because the defects were not compatible for the survival. But the developing nations still have handicap in the management of such cases in term of fiancés, surgical correction of such major defects, education and social support in these patients.

High grade endometrial stromal sarcoma: a clinician dilemma

Uterine sarcomas are relatively rare tumors of mesodermal origin. ESS occurs primarily in perimenopausal women in 4th and 5th decade of their life; about one third occurs in postmenopausal women. Here in we describe a case of 44 years old patient presented with one month history of foul smelling discharge per vagina and a pelvic mass. Ultrasound and MRI gave possibility of a large anterior wall and fundal fibroid with degeneration versus neoplastic endometrial thickening. The patient underwent exploratory laparotomy with total abdominal hysterectomy with bilateral salpingoophorectomy with pelvic lymphadenectomy. Histopathology showed tumor cells with round to oval nuclei with high mitotic activity, blood vessel proliferation between the tumor cells and extensive lymphovascular invasion. The pathological diagnosis was HG-ESS stage IB. The patient was referred to radiotherapy department for adjuvant therapy. HG-ESS is a rare clinical entity and considered as important differential diagnosis

Clinical profile, maternal and fetal outcome in pregnant women with COVID-19 infection: a retrospective observational study in a tertiary care hospital of Himachal Pradesh

Background: The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women confirmed with COVID-19 infections and their neonates to provide more reference to contribute in managing this noval viral disease.Methods: We conducted a retrospective study over a period of six months; 20 March, 2020 to 8 October, 2020 at SLBSGMC Nerchowk (Himachal Pradesh). Total number of pregnant women who delivered in our hospital during the defined study period was recorded and analysed.Results: The total number of women were delivered over the study period was 13, out of which caesarean sections (CS) were 7 and NVDs were 6 in number. All of them were diagnosed mild COVID-19, and none one of the patients developed severe COVID-19 or died. Their all newborns were recorded healthy except one was COVID positive and one neonate had birth asphyxia.Conclusions: Apparently no difference was observed in relation to onset of disease, symptoms, cure rates or severity in pregnant women when compared to non-pregnant women and healthy men of similar age groups. Pregnancy does not seem to deteriorate the course and prognosis of the disease. Maternal and fetal outcomes are apparently favourable in these patients. Lastly COVID-19 is not an indication of cesarean section. More multicentre studies are the need of the hour to formulate the authentic management guidelines for this novel disease

Accuracy and reliability of ultrasound estimation of fetal weight in women with a singleton term pregnancy

Background: Prenatal estimation of birth-weight is of utmost importance to predict the mode of delivery. This is also an important parameter of antenatal care. This study was conducted to evaluate the accuracy of estimated fetal weight by ultrasound, compared with actual birth weight.Methods: This was a prospective and comparative study comprising 110 pregnant women at term. Patients who had their sonography done within 7 days from date of delivery were included. Fetal weight was estimated by Hadlock 2 formula, the software of which was preinstalled in ultrasound-machine. The estimated fetal weight was compared to the post-delivery birth-weight. The Pearson's correlation coefficient was used and the accuracy of sonographic fetal weight estimation was evaluated using mean error, mean absolute error, mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight.Results: Mean estimated and actual birth weights were 3120.8±349.4 gm and 3088.2±404.5 g respectively. There was strong positive correlation between estimated fetal weight and actual birth weight (r = 0.58, p<0.001). The mean percentage error and mean absolute percentage error of ultrasound fetal weight estimations were 1.96±11.8% and 8.7±8.2% respectively. The percentage of estimates within ±10% of the actual birth weight was found to be 67.3%. In 23% of the cases, ultrasound overestimated the birth weight. In 13% of the cases, ultrasound underestimated the birth weight.Conclusions: There was strong positive correlation between actual and sonographically estimated fetal weight. So, ultrasonography can be considered as useful tool for estimating the fetal weight for improving the perinatal outcome

Puerperal sub-acute uterine inversion: a rare case report

Puerperal uterine inversion is a complication of third stage of labour, which can lead to maternal morbidity and mortality due to haemorrhage shock and infection. Early cases can be managed by manual reposition of uterus but neglected or late cases of uterine inversion are managed by Haultain`s repair. Here we are presenting a case of subacute uterine inversion referred from peripheral hospital managed by Haultain’s technique