Evaluation of effect of pospartum intrauterine contraceptive device

Background: This study was done to compare and evaluate safety, efficacy and complications of PPIUCD and interval IUCD insertion and to generate evidence on the safety and effectiveness of these two types of IUCD insertions.Methods: This prospective study was carried out at tertiary care center and Teaching Institute in the Department of obstetrics and gynecology. All enrolled patients in obstetrics and gynecology from 1/2/16 to 31/7/16 were included in this study. Women fulfilling inclusion criteria were included in the study after informed consent. Study protocol was approved by ethics committee.Results: A total of 44 women fulfilling WHO standard medical criteria for PPIUCD insertion and willing to comply with study protocol had PPIUCD insertion.  Cause of removal was mainly bleeding (2 cases, 50%) in interval IUCD group. 4 cases of spontaneous expulsion noted in vaginal delivery group prior to 6 weeks. The cumulative rate of complications were higher in PPIUCD group in our study (12 out of 44 i.e. 27.27% and 4 out of 20% in PPIUCD group and interval IUCD group respectively). Compliance of patient was highest in trans cesarean group 87.5%.Conclusions: Postpartum insertion of PPIUCD is safe effective, feasible and reversible method of contraception

Ovarian huge serous cystadenoma with torsion in adolescent girl: a case report

In adolescent Ovarian cysts are an extremely common gynaecological problem. Majority of ovarian cysts are benign with few cases being malignant. Ovarian serous cystadenomas are rare in children. A 14-year-old presented with severe abdominal pain and abdominal distention. She underwent emergency laparotomy and surgical removal, the mass was found to be torsion of ovarian serous cystadenoma-fibroma on histology. In conclusions, germ cell tumours the most important causes for the giant ovarian masses in children. Epithelial tumours should not be forgotten in the differential diagnosis

Preterm premature rupture of membranes: maternal and perinatal outcome

Background: This is an observational analytical study carried out in department of obstetrics and Gynecology, in a tertiary care center to determine the factors influencing fetal and maternal outcome, prognosis and complications in preterm premature rupture of membrane cases.Methods: The present study is a prospective observational study of perinatal and maternal outcome in 100 cases of preterm premature rupture of membranes in between 2837 weeks gestation with singleton pregnancy, from 1st March 2013 to 28th February 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestations, uterine or fetal anomalies etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patients need.Results: In this study maternal morbidity was 16%. Perinatal morbidity was 33% and most common causes were hyperbilirubinemia (23%), RDS (21%).  Perinatal mortality was seen in 15% and mainly due to RDS (53%). Twenty-five (25%) neonates were delivered by cesarean. The main indications for cesarean being malpresentation (36%) followed by fetal distress (24%).Conclusions: PPROM is one of the important causes of preterm birth that can result in high perinatal morbidity and mortality along with maternal morbidity. Looking after a premature infant puts immense burden on the family, economy and health care resources of the country. An understanding of gestational age dependent neonatal morbidity and mortality is important in determining the potential benefits of conservative management of preterm PROM at any gestation

Huge cervical pedunculated leiomyoma with uterine prolapse: a case report

Leiomyoma uterus is the most common benign solid tumor in female. Most of it situated in the body of the uterus.  cervical myoma account 3%-8% of uterine myoma. Cervical myoma can frequently cause diagnostic dilemmas. Pedunculated cervical myoma can arise from the endocervical canal or from the uterine cavity and protrude through the cervix, may become necrotic, infected and gangrenous due to inadequate blood circulation through a long pedicle or if the pedicle of leiomyoma twists. This can cause menometrorrhagia, recurrent vaginal discharge leading to anemia and sepsis. A case of huge pedunculated cervical leiomyoma has been reported here. A 40 years old female, para 4, with menometrorrhagia, excessive vaginal discharge and severe anemia with haemoglobin 5gm% and challenging huge cervical pedunculated leiomyoma of size 13cm*9cm*9cm prolapsed outside introitus which is congested necrotic, infected causing uterine prolapse with bilateral hydroureter and hydronephrosis. Patient underwent bilateral internal iliac artery ligation and fibroid excision followed by total abdominal hysterectomy with bilateral salpingectomy after tracing both ureters.  Post-operative period was uneventful. Histopathology was confirmatory of leiomyoma

Adjuvant urokinase: percutaneous drainage of post lower segment cesarean section intra-abdominal abscess

The mortality in abdominal abscess is high, however the outcome has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, and site.  The single abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters.  Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage but the success rate is lower for abscesses that have septa and are multilocular. Several clinical and in vitro studies suggest urokinase may be useful in such cases. To the knowledge, however, there has been no case of post LSCS intra-abdominal abscess in which intracavitary urokinase was administered. Therefore, we report a case of post LSCS multiseptated intra-abdominal abscess occurring in a 21-year-female. Conventional percutaneous tube drainage failed, but the use of transcatheter intracavitary urokinase was successful.  Our results showed no significant change in hematologic studies and no bleeding complications. Intracavitary urokinase can be given safely during percutaneous drainage of an abscess, with no associated bleeding complications or changes in coagulation parameters

Clinical versus ultrasonographic fetal weight estimation and its correlation with actual birth weight

Background: This is a prospective study was conducted at Obstetrics and Gynecology department, tertiary care Hospital, to compare the accuracy of clinical and ultrasonographic estimation of fetal weight at term with actual birth weight.Methods: The present study is a prospective comparative study of fetal weight estimation in Antenatal women with term gestation (37week to 42week of gestation) singleton pregnancy with vertex presentation, who had gestational age confirmed by dates and ultrasound scanning of30 kilogram/meter2) are excluded from the study. Estimation of fetal weight is done by clinical method and ultrasonography. Birth weight after delivery was recorded in grams by electronic weighing machine and tabulated.Results: Clinical as well as ultrasonography estimates observed to be strongly correlate with actual birth weight. Both the methods had more sensitivity in birth weight range 2500-4000gm than 4000g. The overall mean absolute percentage error of the clinical method (7.2±7.7) was smaller than that of the sonographic method (16.2±11.1). In low birth-weight (<2,500g) group, mean absolute percentage error was 9.0±11.3 with USG and same with clinical was 11.7±9.0. No statistically significant difference was observed.Conclusions: The present study concludes that clinical estimation of birth-weight is as accurate as routine ultrasonographic estimation.Clinical palpation should be considered as diagnostic tool for FWE and is equally reliable even when done by trained medical person. It is cheap and easy to teach. The need is to practically apply this method in obstetrics and guide the management decisions

Factors affecting stillbirth: prospective study

Background: Stillbirth is defined by WHO as the birth of a baby with a birth weight of 500 gm or more, 22 or more completed weeks of gestation or a body length of 25 cm or more, who died before or during labour and birth.Methods: This was prospective observational study of factors affecting stillbirth was conducted in tertiary hospital for a period of 1 year from 1st June 2014 to 31st May 2015. During the study period, 200 parturient of gestational age 28 weeks or more and fetal weight 1000 gm or more with or without medical disorders were included.Results: The total number of births during study period was 11,951. Stillbirth rate in the present study was 16.73 per 1000 births. Most of stillbirths were seen in the antepartum period (76%) when compared to intrapartum period (24%). Maximum stillbirths occurred in gestational age of 36 weeks and above (52%) and fetal weight between 2001-2500 gm (27.50%). Patients with inadequate antenatal care, less than three visits had 86% stillbirths.Conclusions: Proper antenatal care, prompt referral services and availability of emergency obstetric care will provide a pivotal role for reduction of stillbirths