Outlet Forceps in Modern Era, a Dangerous Instrument or an Art of Obstetrics?

Abstract Aim of this study was to assess feto maternal outcome in outlet forcep

Relationship between umblical artery Doppler and perinatal outcomes in Indian women with oligohydramnios

Background: Doppler study of umbilical artery is considered as independent predictor for perinatal adverse outcomes. Similarly oligohydramnios condition is also found to associate with perinatal mortality and morbidity. There is paucity of data regarding the relationship between abnormal Doppler of umblical artery with the perinatal outcomes in Indian subjects having oligohydramnios. Objectives of the study were, this study was done with the primary aim of evaluating any association between Doppler findings of umblical arteries with the adverse perinatal outcomes in Indian subjects having oligohydramnios.Methods: This was an observational study in the Obstetrics and Gynecology Department of a tertiary care hospital. Women who came for antenatal checkup and having oligohydromnios were recruited in the study. Doppler of umblical artery was done and these women followed up till labour. Sociodemographic profile and other prognostic factors were noted in predesigned Performa.Results: There were 56.1% (41 out of 73) outcomes were observed in the normal umblical artery Doppler and 51% (14 out of 27) in abnormal umblical artery Doppler. There was no statistically significant difference in outcomes (p=0.8). There was no significant difference in abnormal Doppler finding between mild and severe oligohydramnios.Conclusions: There is no relationship between abnormal Doppler findings and perinatal adverse events in oligohydramnios. Inherent methodological issues may be the reason for the same

Outlet forceps in modern era, A Dangerous instrument or an Art of Obstetrics?

Abstract : Objective: To assess Feto maternal outcome in outlet forceps delivery. Method: 69 patients in the Labour room who delivered by outlet forceps at Dept. of Obs. and Gyn. Medical college, Baroda, India were analyzed for Feto maternal outcome. Result: Incidence of Wrigley’s outlet forceps delivery is 0.74% in our study. 78.26% were applied for primipara, as may be due to rigid perineum in primipara. 71 % in the age group of 16-25 years, common age of primipara. Age and obstetric outcome it is observed that operative interference is required frequently. Indications of forceps were also comparable with common indications with others. 68.12% baby with normal APGAR scoring. While 2.90% develop Severe Birth Asphyxia and 11.59% required Nursery admission while 15.94% required resuscitation at the time of birth, these shows that with forceps delivery the outcome is comparable to the vaginal delivery. Impression marks over face, abrasion over face are also comparable. Only one neonatal death occurred that was due to Neonatal septicaemia and 4.35% develop cephalhematoma which is slightly higher. The vaginal and cervical tear rates are also comparable. Only Two Patients develop PPH, one (1.45%) traumatic, while other (1.45%) develop Atonic PPH which are comparable to normal vaginal delivery and even after Caesarean section delivery. Only 1.45% patients develop urinary incontinence. Conclusion: - Study performed using Wrigley’s outlet forceps application using ACOG guidelines, 2002/2011. We conclude that maternal and foetal outcome are comparable good with the vaginal delivery. Indicated forceps delivery can reduce the caesarean section rate. No major maternal or foetal morbidity / mortality found due to forceps in study group. We feel that the entire young obstetrician colleague must know the applications of forceps and should implement in practice to decrease the caesarean section rates. Even nowadays Government of India in BEmoc training for Medical Officer (MBBS) in service included the forceps and vaccume delivery in the training course so as to teach them the skill. So that they can help the Nation in lower down the Maternal Mortality Rate. So, we can say that the forceps application with all criteria’s fulfilled in a expert hand is an Art of Obstetrics and not a dangerous Instruments. [Med-Science 2012; 1(3.000): 171-176

Meconium and its Significance and Obstetric Outcome

MSAF is more common in primi gravidas as compared to multi gravidas. Postdatism, PIH, Eclampsia, IUGR, Oligohydromnios, PROM are main associating factors with occurrence of MSAF. ANC has limited role in preventing MSAF. Incident of abnormal fetal heart rate is 4 times and of variable heart rate is 5 times higher in MSAF group from control group. Most of the cases with abnormal heart rate pattern exhibit thick meconium and show significant association of fetal distress with character of meconium. Aggressive active management is required depending upon the character of meconium, heart rate pattern, stage of labour, expected time taken in delivery facility of neonatal care in place of delivery. Amnioinfusion is simple, safe and inexpensive procedure with almost nil complications though it does not decrease rate of cesarean section to statistically significant extent. [Med-Science 2015; 4(1.000): 1861-8

Risk of Malignancy Index (RMI) in the Pre-Operative Evaluation of Patients with Adnexal Masses

The aim of this study is to evaluate use of RISK of MALIGNANCY INDEX (RMI) in primary evaluation of adnexal masses without clear evidence of malignancy, by combining serum CA 125 levels, USG score and menopausal status. It is a cross sectional study conducted at Department of gynaec- oncology, Gujarat Cancer and Research Institute, Ahmedabad. A total of 40 women aged 20 to 65 years with ultrasound diagnosed adnexal masses, and serum measurement of cancer-associated antigen CA-125 levels, were studied. They all had surgical exploration (laparotomy) between May 2005 to July 2007 .The RMI was based on menopausal status, ultrasound morphology of adnexal masses and absolute level of serum CA-125. RMI cut-off of 200 was chosen. The various testing methods were evaluated for sensitivity, specificity, positive and negative predictive values. The best performance was with a RMI at a cut-off of 200 with a sensitivity of 66.66%, specificity of 63.15%, positive predictive value of 66.66% and negative predictive value of 65.15% to diagnose malignancy. When RMI was used, it is better in detecting benign tumour and malignant tumour rather than individual component. RMI to be a valuable, reliable and applicable method in primary evaluation of patients with adnexal masses, and a usable method for referral of advanced neoplasia to a more complex healthcare unit. [Med-Science 2016; 5(1.000): 1-11