A descriptive study: maternal and fetal outcome of grand multipara

Background: Pregnancies in grand multipara have been considered risky for many decades as there are higher chances of complications during pregnancy, labour and puerperium in these women. This study aims to find out various maternal and fetal complications associated with grand multiparty during pregnancy and labour.Methods: A descriptive observational study was conducted in the department of obstetrics and gynecology of S.K.H.M Medical College Nalhar, Mewat, from Jan, 2014 till Oct, 2014. It included 100 cases of grand multipara women. All the women who delivered at S.K.H.M and had five or more previous viable pregnancies were included in the study.Results: In the total 100 cases that were included in the study, the common medical illness found in grand multipara were anemia (92%), hypertension (13%), preeclampsia (9%) eclampsia (4%) and diabetics mellitus (2%). Other complications observed were mal-presentations (18%), intra-uterine deaths (18%), preterm labor (15%), placental abruption (8%), shoulder dystocia (6%), placenta previa (5%), obstructed labour (4%), and ruptured uterus (2%). Caesarian section was required in 28% of the cases. Third stage complications were also high in grand multi para e.g. PPH (14%), retained placenta (5%), uterine inversion (3%) and maternal mortality (4%). In perinatal outcomes the observations were lbw babies (15%), macrosomies (10%), and APGAR score (8-10) in 70% of the babies.Conclusions: Grand multiparity is still a major obstetric hazard which needs strict supervision and good antenatal care and active intervention at appropriate time. Extreme parity should be treated with extra care especially in populations with high rates of unbooked deliveries.

A study to determine scar integrity in pregnant women with previous lower segment caesarean section

Background: The purpose of this study was to assess the radiological characteristics of previous caesarean section scar and their correlation with clinico-pathological parameters, in order to decide mode of delivery.Methods: This prospective longitudinal study was conducted on 200 women who had previous caesarean section and were at 36 weeks or more of gestation period and came in labor or taken for caesarean section from the antenatal clinic of Department of Obstetrics & Gynecology, Subharti Medical College from the period January 2011 to December 2013.Radiological evaluation of previous caesarean section scar was done using transvaginal sonography (TVS) for all the women 54 women went through caesarean section and for them peroperatively mechanical measurement of scar thickness was done by ophthalmic calliper to correlate with the scar thickness in USG. Peroperatively scar tissue was taken for histopathological evaluation.Results: 168 women with previous caesarean section underwent trial of labor and 114 women had vaginal delivery (67.8%). As per this study there was a statistically significant correlation between scar thickness measured at or after 36 weeks of gestation and mode of delivery (p<.0001). Statistically significant correlation was also found between scar thickness measured prior to shifting for caesarean and peroperative scar thickness measurement by calliper. In histopathology, presence of fibro-collagenous tissue indicates weaker scar.Conclusions: TVS should be used as an effective tool to measure the scar integrity, which will be helpful in deciding the mode of delivery. This will improve predictability of scar dehiscence or scar rupture in labor and hence choice of patients for successful VBAC may be made with greater accuracy. The pathological and biomechanical behavior evaluation of scar was done in this study in order to strengthen the radiological finding to decide the mode of delivery

Asymptomatic presentation of silent uterine perforation by Cu-T 380A: a case report with review of literature

Copper containing intrauterine contraceptive device are used worldwide and considered to be safe, effective, reversible and long term method of birth control. While IUCDs are tolerated well by most of the women, they are also associated with adverse effects like bleeding and dysmenorrhea. Uterine perforation during Cu-T insertion is one of the rarest complications and 30% of which are asymptomatic and can be presented with serious complications if not diagnosed early. This complication can be avoided if proper techniques are used by gynaecologists and health professionals. Education and counseling of the women about feeling the IUCD string after every menstrual cycle and post insertion of IUCD is equally important to facilitate the early detection of misplaced IUCD to prevent serious complications like uterine perforation

Non-descent Vaginal Hysterectomy using Bipolar Vessel Sealing System VS Total Laparoscopic Hysterectomy for benign diseases of uterus: A prospective interventional study: Bipolar Vessel Sealing System VS Total Laparoscopic Hysterectomy

Aim: To compare the surgical outcomes of Non-descent Vaginal hysterectomy using Bipolar vessel sealing system and Total Laparoscopic Hysterectomy with reference to Intraoperative time, Intraoperative blood loss and Postoperative pain. Methods: The study was conducted on 100 patients who required hysterectomy for benign diseases of uterus and were fit to undergo both modalities of surgery (TLH/NDVH). 50 patients that underwent Total Laparoscopic Hysterectomy and 50 patients that underwent NDVH with BipBIPVSS were part of Study Group. Results: The mean intraoperative time taken in performing NDVH using Bipolar BIPVSS (28.06 min) was significantly less than the mean time taken in performing TLH (92.62 min). The intraoperative blood loss in NDVH with BIPVSS was 41.70 ml and TLH was 89.24 ml. The postoperative pain in both the study group was not statistically significant as both the groups had similar experience and P value is &gt;0.05. Post operative major complication of bleeding in ovarian artery and hemoperitoneum was observed in a patient of NDVH with BIPVSS while one case of Thermal Rectal injury and one case of bladder injury were observed in TLH group. Conclusion: The route and procedure of Hysterectomy will depend on various factors, however NDVH with BIPVSS has certain advantage over TLH as it takes lesser times, lesser blood loss and gives similar pain experience if not better than TLH

A study to determine scar integrity in pregnant women with previous lower segment caesarean section

Background: The purpose of this study was to assess the radiological characteristics of previous caesarean section scar and their correlation with clinico-pathological parameters, in order to decide mode of delivery.Methods: This prospective longitudinal study was conducted on 200 women who had previous caesarean section and were at 36 weeks or more of gestation period and came in labor or taken for caesarean section from the antenatal clinic of Department of Obstetrics &amp; Gynecology, Subharti Medical College from the period January 2011 to December 2013.Radiological evaluation of previous caesarean section scar was done using transvaginal sonography (TVS) for all the women 54 women went through caesarean section and for them peroperatively mechanical measurement of scar thickness was done by ophthalmic calliper to correlate with the scar thickness in USG. Peroperatively scar tissue was taken for histopathological evaluation.Results: 168 women with previous caesarean section underwent trial of labor and 114 women had vaginal delivery (67.8%). As per this study there was a statistically significant correlation between scar thickness measured at or after 36 weeks of gestation and mode of delivery (p&lt;.0001). Statistically significant correlation was also found between scar thickness measured prior to shifting for caesarean and peroperative scar thickness measurement by calliper. In histopathology, presence of fibro-collagenous tissue indicates weaker scar.Conclusions: TVS should be used as an effective tool to measure the scar integrity, which will be helpful in deciding the mode of delivery. This will improve predictability of scar dehiscence or scar rupture in labor and hence choice of patients for successful VBAC may be made with greater accuracy. The pathological and biomechanical behavior evaluation of scar was done in this study in order to strengthen the radiological finding to decide the mode of delivery

Stem cells – the tiny procreators: a review article

Stem cells are known to be the most fascinating components of biology today and the basis for the research on these depends on the knowledge about how an organism develops from a single cell and also how healthy cells are capable of replacing the damaged cells in adult organisms. This area of science has led the scientists to investigate the possibility of cell based therapies to find treatment for many of the incurable diseases. This mode of treatment is referred to as regenerative/reparative medicine. But like many expanding fields of scientific enquiry, research on stem cells raises scientific questions about healing, ethics etc., as rapidly as it generates new discoveries.&nbsp

Differentiation of the β-thalassemia Trait from Iron Deficiency Anaemia by Red Cell Indices among Pregnant Women in Southern Haryana, India: A Cross-sectional Study

Introduction: Due to similar red cell morphology, patients of beta Thalassemia Trait (b-TT) are often misdiagnosed as Iron Deficiency Anaemia (IDA) and given unnecessary iron medication. Facilities for diagnosing them are usually not available in underserved areas where health system and laboratory facilities are not strengthened. Aim: To differentiate b-TT from IDA by red cell indices among pregnant women in Southern Haryana, India. Materials and Methods: This hospital-based, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Shaheed Hasan Khan Mewati Government Medical College, Haryana, India, from May 2020 to October 2020. Total 148 antenatal women were screened for presence of anaemia by their haemoglobin level at the time of admission. Types of anaemia were documented. After staining, it was examined for red cell morphology and various red cell indices were also noted. Data collected was entered in Microsoft excel 7, then data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software package. Results: Of total 148 pregnant women, 104 were found to be anaemic thus the overall prevalence of anaemia was found to be 70.27% (104/148). Most of pregnant women were in the age group of 18-24 years (54.8%). Microcytic hypochromic picture (38.4%), followed by normocytic hypochromic to microcytic hypochromic (20.1%) was predominant on Peripheral Blood Film (PBF) examination followed by dimorphic anaemia. Red Blood Cell (RBC) count was found to be normal in 85.5% cases followed by decreased count in 14.4% cases. None of the case had increased RBC count. Mean Corpuscular Volume (MCV) was normal in 58.6% of cases followed by decreased below 80 fL in 28.8% of cases. Conclusion: Higher prevalence of anaemia in pregnant women indicates that anaemia still continues to be a major health problem in India. In resource constrained settings, where definitive diagnostic facilities do not exist, red cell indices may be used to differentiate b-TT from IDA among pregnant wome