Prospective study to evaluate management of ectopic pregnancy in a tertiary care centre

Background: To study the pattern of management of ectopic pregnancy in a referral Centre in North India.Methods: This prospective study was conducted over a period of one year in the department of obstetrics and gynecology, in a tertiary care Centre in North India. Total number of cases who reported to hospital with ectopic pregnancy during the study period were 110. All the cases were analyzed and managed either with conservative, medical or surgical treatment depending on the condition of cases at the time of presentation to the hospital. Frequencies of different variables were compared by chi square test using Graphpad Prism 9, p value less than 0.05 was considered statistically significant.Results: The incidence of ectopic pregnancies reported in present study was 18.62 per 1,000 deliveries. Total of 110 cases with ectopic pregnancy reported to hospital during the study period. Mean age of the cases was 28.72 years. Out of 110 cases, laparotomy was performed in 100 cases and medical management in 10 cases. Medical management failed in one case and necessitated surgery in that case. There was no maternal mortality during the study period.Conclusion: Most of the cases presented late to the hospital due to lack of awareness, topographically tough terrain in Himachal with limited transport facilities which delayed management of ectopic pregnancy and precludes conservative management either in the form of medical management or conservative surgery. Screening of high-risk cases, early diagnosis, early referral and early intervention reduces the maternal mortality and morbidity. So awareness at the primary health care level is the necessity of the hour

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

Background: The purpose of this study was to determine the effects of altitude on severe preeclampsia and eclampsia and subsequent perinatal outcome.Methods: This prospective study was carried out during 1st March 2011 to 29th February 2012 in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla situated at a height of 2200m from sea level. All the subjects with severe preeclampsia or eclampsia were included in the study and their perinatal outcome was noted.Results: There were a total of 5897 deliveries. There were 423 cases of PIH making an incidence of severe preeclampsia and eclampsia 15.4% and 7.3% among PIH, respectively. Majority of cases (60.4%) belonged to age group 18-25 year with mean systolic blood pressure in eclampsia was 184.3±18.6 mm of Hg and in severe preeclampsia was 171.5±13.9 mm of Hg. Mean diastolic blood pressure was 125.8±12.6 mm of Hg in eclampsia and 118.6±4.3 mm of Hg in severe preeclampsia. Various other complications in eclampsia and severe preeclampsia cases included IUGR (35.1%) cases, abruptio placentae (15.9%), HELLP syndrome (9.6%) cases, spontaneous preterm labour (21.3%) and intrauterine death (6.4%). Live births were 85.1%; fresh still births were 8.5%. Mean birth weight was 2192.5±572grams. Respiratory distress syndrome was seen in 21.3% neonates, Hyperbilirubinemia was seen in 26.2% neonates intracranial bleeding was seen in 7.5% neonates. Perinatal mortality was 27.7% which constitute14.9% still birth neonatal deaths.Conclusions: Efficacy of MgSO4 in prevention and treatment of eclamptic convulsions is time tested and supported with a variety of studies. Since its narrow therapeutic and toxicity is major concern, the use of low dose MgSO4 protocols is a viable alternative to standard dose therapy. However, because of small study design further studies on the larger scale are required to support routine clinical use of low dose protocols

What is better: cryocautery or electrocautery for cervical erosion?

Background: Present study was conducted with a background in mind to compare the efficacy of electrocautery and cryocautery for the management of cervical erosion. Aim of this study was to compare the efficacy of electrocautery and cryocautery for the treatment of cervical erosion and to check cost effectiveness.Methods: A comparative study was conducted at Maharishi Markandeshwar medical college and hospital, Kumarhatti (Solan) between July’13 to June’14 among 100 patients of reproductive age group with cervical erosion. They were grouped into 2 groups A (Electrocautery) & B (Cryocautery) and data obtained was analysed by paired t-test.Results: Though in short- term follow-up at 4-6 weeks after cautery, apparently electrocautery was superior to cryocautery in terms of erosion healing rate 92% vs. 76% as P value (0.4557) is not statistically significant, but in long-term follow-up at 12-14 weeks there was no significant difference in erosion healing but electrocautery was cost effective.Conclusions: Both types of cautery were equally good for treatment of cervical erosion in long-term follow-up. But electrocautery occupies less space and there is no chance of gas leakage in electrocautery, so electrocautery is more cost effective.

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

Background: The purpose of this study was to determine the effects of altitude on severe preeclampsia and eclampsia and subsequent perinatal outcome.Methods: This prospective study was carried out during 1st March 2011 to 29th February 2012 in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla situated at a height of 2200m from sea level. All the subjects with severe preeclampsia or eclampsia were included in the study and their perinatal outcome was noted.Results: There were a total of 5897 deliveries. There were 423 cases of PIH making an incidence of severe preeclampsia and eclampsia 15.4% and 7.3% among PIH, respectively. Majority of cases (60.4%) belonged to age group 18-25 year with mean systolic blood pressure in eclampsia was 184.3±18.6 mm of Hg and in severe preeclampsia was 171.5±13.9 mm of Hg. Mean diastolic blood pressure was 125.8±12.6 mm of Hg in eclampsia and 118.6±4.3 mm of Hg in severe preeclampsia. Various other complications in eclampsia and severe preeclampsia cases included IUGR (35.1%) cases, abruptio placentae (15.9%), HELLP syndrome (9.6%) cases, spontaneous preterm labour (21.3%) and intrauterine death (6.4%). Live births were 85.1%; fresh still births were 8.5%. Mean birth weight was 2192.5±572grams. Respiratory distress syndrome was seen in 21.3% neonates, Hyperbilirubinemia was seen in 26.2% neonates intracranial bleeding was seen in 7.5% neonates. Perinatal mortality was 27.7% which constitute14.9% still birth neonatal deaths.Conclusions: Efficacy of MgSO4 in prevention and treatment of eclamptic convulsions is time tested and supported with a variety of studies. Since its narrow therapeutic and toxicity is major concern, the use of low dose MgSO4 protocols is a viable alternative to standard dose therapy. However, because of small study design further studies on the larger scale are required to support routine clinical use of low dose protocols