Rudimentary horn pregnancies: dilemmas in diagnosis

Rudimentary horn pregnancy is a rare obstetric entity and the diagnosis and management may pose some problems especially in a low-resource center. We report a case of G1P0 with pregnancy of 28 weeks gestation with diagnosed intrauterine fetal death, which was suspected as extra uterine pregnancy bases on failed attempts of termination of pregnancy and on laparotomy, a dead fetus of 16 weeks was found in left unruptured noncommunicating horn of unicornuate uterus. Diagnosis of rudimentary horn pregnancy is difficult and can be missed in ultrasound. It requires a high index of suspicion.

To study pattern of obstetric cases referred at tertiary care centre in Central India

Background: Maternal morbidity and mortality remains a major challenge to health systems worldwide. Referral services for identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness of referral are challenge to obstetricians, since delay in referral affects maternal outcome adversely, hence the identification of at risk patients and obstetric emergencies and their timely referral is of immense importance. The aim of this study was to review the pattern of obstetric cases referred to tertiary care centre, to identify their clinical course, mode of delivery and maternal outcomes.Methods: It was prospective observational study carried out from January 2015 to July 2016. Study population was all Obstetrics patients referred to Department of Obstetrics and Gynecology of Kamla Raja Hospital, G.R. Medical College, Gwalior, Madhya Pradesh, a tertiary care centre during the study period.Results: The total number of referred cases in above study period was 4085.The proportion of referred cases in the tertiary care hospital was 20.86%. Mode of transport used by the referred patients were hospital ambulances (38%) and private vehicles (62%). Most common diagnosis at the time of referral was anaemia (27.8%). Out of the total referred cases, 48% had vaginal delivery (either spontaneous or induced), 28% had caesarean section and 24% were managed conservatively. Hypertensive disorders (25.4%) constitutes the leading cause of maternal deaths amongst the referred cases.Conclusions: Peripheral health care system needs to be strengthened and practice of early referral needs to be implemented for better maternal outcome

H.C.G (Human Chorionic Gonadotropin) versus Magnesium sulphate in suppression of preterm labour

Introduction: Preterm labour is a major healthcare problem throughout the world, it is a major cause of perinatal mortality and morbidity. Methods: Prospective comparative study conducted in the Department of Obstetrics & Gynaecology at Kamla Raja Hospital, Gwalior, M.P, from August 2011 to September 2012. Sample Size: 80. 50 patients were given H.C.G. and 30 were given Magnesium sulphate to suppress preterm labour. Statistical analysis done using Chi square test in SPSS software and p value < 0.05 was considered significant. Results: Mean duration between initiation of treatment & suppression of contractions was 3.1 hrs & 2.9 hrs in women receiving H.C.G. & Magnesium sulphate respectively (p value<0.0001). Mean prolongation of pregnancy was 31.4 days and 30.33 days in women receiving H.C.G. & Magnesium sulphate respectively (p value = 0.78). Average rate of labour within 48 hrs after beginning of treatment was 8% and 6.67%, in H.C.G. & Magnesium sulphate grp respectively, p value=0.43. None of the women receiving H.C.G. had any side effects, all 30 women receiving Magnesium sulphate had minor maternal side effects, p value (<0.0001). Mean birth weight was 2.35 kgs and 2.19 kgs respectively in women receiving H.C.G. and Magnesium sulphate reapectively, (p value = 0.22). Conclusion: Magnesium sulphate is better tocolytic drug, showing statistically significant lesser time between the initiation of treatment & suppression of contractions, as compared to H.C.G. Women receiving Magnesium sulphate suffered from minor side effects; however those treated with H.C.G. had no complaints