PROM and it’s maternal outcome: a retrospective study in a rural medical college of India

Background: Premature rupture of membrane is the unconstrained break of layer before the beginning of  labor and can happen any gestational age even at 42 weeks of growth. Around 2-30 % of all pregnancy will encounter PROM and prompts 33% of preterm birth. The analysis of PROM is to a great extent clinical and is normally proposed by a history of watery vaginal discharge and affirmed on sterile speculum assessment. This examination was led to decide the occurrence, to discover the age, equality dispersion, gestational age dissemination, presentation of PROM and plan the line of the management.Methods: The cases selected in this study were those who had spontaneous rupture of membrane after 28 weeks of gestation but before the onset of labor pain. The study period was of one year from 1st January 2019 to 31st December 2019. The study was conducted in the labor room complex of Coochbehar Govt. Medical College and Hospital, WB India. The patients were admitted in the labor room through emergency. All datas were collected from labor room log book.Results: Total no. of deliveries were 10900 and total no of PROM were 545.Incidence of PROM is 5% in the present study. Maximum no of cases were in the age group between 20-29yr (63%). PROM mainly occurs in primigravida (50.45%). And low rupture of membrane was 91.8%. Cephalic is the commonest presentation (85%) in PROM and the incidence of caesarean section is 24.95%.Conclusions: PROM is the obstetric emergency and once the PROM is diagnosed it is important to weigh the risk of PROM and prematurity and make the right choice of conservative management and active management. If there is chance of maternal morbidity pregnancy should be terminated considering the maternal wellbeing first and then that of the fetus

An observational study to evaluate and compare the role of bilateral internal iliac artery ligation with uterine compression sutures for arresting postpartum haemorrhage in a tertiary care hospital in West Bengal

Background: Postpartum haemorrhage is the most important cause of maternal mortality which is near about 13% in developed countries and 34% in developing countries. When postpartum haemorrhage is not controlled even after aggressive medical management, immediate surgical intervention is needed which includes bilateral internal iliac artery ligation, B-Lynch compression sutures, hysterectomy as a last resort. Bilateral internal iliac artery ligation is much quicker and having lesser risk of uterine necrosis as compare to B-Lynch suture. That’s why a study was conducted to evaluate and compare the role of bilateral internal iliac artery ligation with B-Lynch compression sutures.Methods: A prospective observational study was conducted in the department of obstetrics and gynaecology in Burdwan medical college and hospital for a period of 3 years from 1st July 2019 to 30th June 2022. Out of total 62 cases of intractable postpartum haemorrhage, 31 cases underwent bilateral internal iliac artery ligation (group A) and another 31 cases underwent B-Lynch compression sutures (group B).Results: In this study, most of the women were in the age group of 21-30 years. both in group A and group B. Risk factors for postpartum haemorrhage in both groups were pre-eclampsia, abruption, placenta previa, nonprogress of labour, multiple pregnancy. Blood products requirements were much more in group B than group A. Hysterectomy needed in 12.9% cases of group A and 29.03% cases of group B. In terms of maternal outcome, out of total maternal death, 37.5% cases were under group A, 62.5% cases were under group B.Conclusions: In our study, need for hysterectomy was less in cases of bilateral internal iliac artery ligation compared with B-Lynch compression sutures. So, bilateral internal iliac artery ligation should be early resort to prevent hysterectomy in cases of atonic postpartum haemorrhage with low parity. As bilateral internal iliac artery ligation is a life saving procedure, every obstetrician must be able to perform it and should have proper knowledge of retroperitoneal anatomy to avoid injury of iliac veins and ureter

Clinico-radiological and pathological correlation of interstitial lung diseases: a prospective single centre study

Background: Current investigation was done to study the role of HRCT chest in the diagnosis and characterization of interstitial lung diseases, yield of transbronchial lung biopsy and role of multidisciplinary approach of diagnosis.Methods: We prospectively analyzed clinical features and radiological findings in 38 patients of ILD. Radiological diagnosis on HRCT was made in every case depending on type of predominant abnormality and pattern of involvement. Following this, TBLB was done in every case.Results: ILD was diagnosed in all cases on HRCT. Most common ILD type was UIP (31.5%) followed by sarcoidosis (21%) and NSIP (15.7%). Other ILD subtypes encountered were, RB-ILD, AIP and acute silicosis. In 68.4% cases, there was definitive diagnosis on TBLB. Out of which in 15.7% cases, HRCT and TBLB diagnosis were different. In 15.3% cases, TBLB gave diagnosis of only non- specific ILD.Conclusions: HRCT can detect ILD in 100% cases & can characterize ILD into various patterns. But, HRCT alone without clinical correlation and pathology can cause diagnostic confusion in many cases. However, multidisciplinary approach by engaging clinician, radiologist and pathologist can lead to accurate diagnosis in many cases of ILD. TBLB is a safe, minimally invasive procedure which can establish correct diagnosis in many cases especially in broncho-centric diseases

Assessment of arterial stiffness in stable patients of chronic obstructive pulmonary disease: a prospective case control study

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and represents a substantial socioeconomic burden. Co-morbidities are more in COPD patients. Cardiovascular disease is one of the co-morbid conditions in COPD. Arterial stiffness has a strong predictive value for cardiovascular events, which can be assessed non-invasively. Various predictors of arterial stiffness between stable COPD patients and healthy volunteers were measured and compared.Methods: COPD patients attending pulmonary medicine outpatient services were screened for enrolment. It was a prospective case control study with enrolment of fifty COPD stable cases and fifty healthy control, who were matched for their age and sex. All eligible participants were subjected to focused history and physical examination as per structured questionnaire, followed by spirometric examination, periscope test, arterial blood gas analysis and six- minute walk test (6MWT).Results: Increased arterial stiffness was observed in COPD patients over a wide range of severity of airway obstruction. Distance walked in 6MWT and spirometric values were significantly lower in COPD group as compared to healthy group.Conclusions: It was concluded that vascular changes, which are predictive of cardiovascular disease remain as cardiovascular risks in mild or early lung disease. A strong relationship between COPD, systemic inflammation, arterial stiffness and cardiovascular disease had been found which needs to be explored further. It was finally concluded that targeted therapeutic approach has broad aspect in reducing cardiovascular risks and has potential for improved prognosis in COPD

Quantitative computed tomography (CT) assessment of emphysema in patients with severe chronic obstructive pulmonary disease (COPD) and its correlation with age, sex, pulmonary function tests, BMI, smoking, and biomass exposure

Background: To evaluate the role of HRCT in quantifying emphysema in severe COPD patients and to study the variations in the pattern of emphysema in relation to age, sex, FEV1, smoking index, biomass exposure, and BMI. Material/Methods: Automatic lung segmentation of HRCT scans in 41 severe COPD patients (GOLD stage III or more) was done using an emphysema protocol. The extent of emphysema was assessed using the density mask method with a threshold of -950 HU (%LAA-950). The percentage of emphysema in each lung lobe and both lungs was correlated with 6 parameters - age, sex, BMI, smoking index, biomass exposure, and FEV1. Results: Smoking resulted in homogenously distributed emphysema regardless of the severity of smoking. BMI was inversely correlated with the extent of emphysema. A significant association was found between the percentage of emphysema in the right lower lobe and BMI (P=0.015), between biomass exposure and the percentage of emphysema in RUL, RLL, and both lungs (P values of 0.024, 0.016, and 0.036, respectively). The extent of emphysema was disproportionately low compared to the amount of obstruction on PFTs, indicating an airway predominant variety of COPD with significant biomass exposure. Conclusions: Smoking is associated with a relatively homogenous distribution of emphysema with no regional predilection. Biomass exposure produces predominantly right-sided emphysema. BMI decreases with increasing levels of emphysema in the right lower lobe. These risk factors of emphysema patterns are helpful in deciding on the management, including surgical options

Relaparotomy after caesarean section: a retrospective observational study in a tertiary medical college

Background: Relaparotomy is the term which defines operations performed within 60days after the initial surgery. Ralaparotomy following caesarean section may happen and that’s why a study was done to evaluate the risk factors, indications, procedures done during relaparotomy after caesarean section.Methods: A retrospective observational study was conducted in the department of obstetrics and gynaecology in burdwan medical college and hospital for a period of 3years from 1June 2019 to 31 May 2022. Total 32 cases required relaparotomy following caesarean section.Results: In this study, there were 25,527 caesarean deliveries out of 56,145 total deliveries over 3years time period. Among caesarean deliveries 32 cases underwent relaparotomy (0.12%). In most of the cases relaparotomies were due to intraperitoneal haemorrhage, rectus sheath hematoma, postpartum haemorrhage. Indications of cesarean section were severe preeclampsia, non-progress of labour, abruption, post cesarean section with scar tenderness, meconium-stained liquor with fetal distress. Most of the women were in the age group of 20-30 years. Resuturing of the bleeding points were done in most of the cases.Conclusions: As a lifesaving procedure, decision of relaparotomy should be taken as soon as possible. Proper hemostasis need to be ensured before closure of abdomen, as intraperitoneal haemorrhage is the most common indications for relaparotomy

Bleeding abdominal scar endometriosis-a case report

Presence of functional endometrial tissue anywhere outside the uterine mucosa is called endometriosis. It is hormone dependent and almost exclusively it affects the women of reproductive age. Abdominal scar endometriosis is a rare condition and it is due to deposition of endometriotic tissue in the wound site during various obstetric or gynecological operative procedures. Scar endometriosis followed by lower segment caesarean section (LSCS) is very rare and presents with co-menstrual pain and bleeding. Our case presented with active bleeding from abdominal LSCS scar during menstruation which is extremely a rare presentation. Wide excision and histo-pathological examination confirm the diagnosis. A 28-year-old lady with previous history of LSCS 2 years back presented with complaining of swelling and bleeding from the previous LSCS scar during menstruation, persisting for 4-5 days, repeatedly in every menstrual cycle for last 6 months. On examination a swelling with active bleeding from it was noted over the previous LSCS scar. Routine investigation and coagulation profile was with in normal limit and on ultrasonography a firm mass was noted. After wide excision and histo-pathological Examination, the diagnosis was confirmed. Co-menstrual swelling, pain and bleeding from the previous LSCS scar should not be neglected and may be due to scar endometriosis

A case of placenta increta in placenta previa: a rare case report

Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. When the internal os is covered partially or completely by placenta, it is described as a placenta previa. Simultaneously these two complications occurring in a post LSCS scarred uterus is a very rare scenario and anticipated frequently to cause catastrophic obstetric outcome. A 32-years-old woman of second gravida, para 1, with previous history of LSCS 7 years back, with living issue one, admitted in our hospital at 35 weeks 5 days gestation with asymptomatic placenta previa with placenta increta. The case was diagnosed effectively by ultrasonography. Intra-operatively, compression sutures and bilateral uterine artery ligature was tried to control hemorrhage which were failed and a quick decision of caesarean hysterectomy was done. Preserving both ovaries, total hysterectomy was the only option to save the mother in our case. Other options attempting to preserve uterus could have ended up with grave consequences in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post LSCS scarred uterus and it was successfully managed by judicious caesarean hysterectomy