Analysis of cesarean deliveries in a tertiary hospital as per Robson ten group classification system

Background: Cesarean section is the most commonly performed surgery in the department of gynecology. However, it has its own merits and demerits which affect the mother and the baby in the present as well as subsequent pregnancies. There is a rising trend of cesarean deliveries not only in India but worldwide. So, there is a dire need to audit these cesarean sections and make necessary recommendations accordingly to curb the rising incidence of cesarean deliveries in near future. Hence, the present study analysed the leading groups contributing to high cesarean rates at a tertiary hospital of Armed Forces using Robson ten group classification.Methods: This study was conducted in a Tertiary Hospital of Armed Forces at Chandigarh. All patients who delivered in this hospital between January 2016 to December 2018 were included in this study as per the Robson ten group classification.Results: number of patients who delivered during the time period January 2016 to December 2018 was 3136. Number of patients who delivered vaginally during the same period was 1865. Number of patients who delivered through cesarean section were 1271. Group 5 was the leading contributor to cesarean deliveries followed by groups 2 and 4 subsequently. However, there was significant contribution by group10 to the list.Conclusions: Groups 5, 2 and 4 are the leading contributors to cesarean sections at our institute. So, author need to introspect the labour room protocols and change our norms especially about fetal distress based on CTG monitoring and perform versions in mal-presentations if not contra-indicated to reduce cesarean section rates in near future. Even rising rates of cesarean section in elderly primis, patients conceived after infertility treatment and increasing trends of cesarean delivery on maternal request needs to be checked to reduce the rates of primary cesarean sections

PRES, a diagnostic dilemma in pregnancy: three case series with unusual presentation

Authors report a series of three cases of unusual presentation of posterior reversible encephalopathy syndrome in pregnancy. First patient, 29 years old G2P1L1, who was a booked case at our hospital, presented with complain of no fetal movement perception for 3 days at 27 weeks of period of gestation. No history of hypertension and even no record of hypertension after admission. On USG detected to have severe early onset IUGR and AEDF in Umbilical artery doppler. Went in to spontaneous labor and delivered vaginally a preterm neonate of birth weight of 740 gms at 27 weeks 06 days of period of gestation. Postpartum period was uneventful till day four and on day five of postpartum she developed severe headache and seizure. MRI done which was suggestive of PRES. Second patient 27 years old primi gravida with 37 weeks 01 day, booked at our hospital with regular ANC visit brought with history of headache, vomiting with semi-conscious state with diminution of vision till finger count only. She developed seizure thrice while examination. Antenatal period was uneventful with no history of hypertension. Underwent emergency LSCS on same day and delivered a 2.8 kg healthy female neonate. Patient treated as a case of eclampsia and later MRI findings were suggestive of PRES. Third patient 19 years old primigravida booked ANC case at another hospital. She underwent emergency LSCS at 39 weeks POG for fetal distress at same hospital. Antenataly no history of hypertension or any other co-morbidity. On fourth post-op day, she developed headache and vomiting followed by one episode of seizure and after initial management she transferred to our hospital for further management. When we received patient, she was on Magsulph infusion considering postnatal eclampsia. We managed with Inj Lorazepam 2 mg intravenous and later with Inj Levetiracitam. Final diagnosis has been made as PRES after MRI and MRV brain. We found very atypical presentation of all three cases with difficulty in diagnosis and challenging management, so we are reporting these cases

Maternal and neonatal outcome of twin pregnancies with single fetal demise

 Background: In current study we managed twin pregnancies having single fetal demise with a successful outcome. Generally monochorionic and monoamniotic pregnancies are having high probability of complications, so we have to be more watchful in these pregnancies. Termination of pregnancy is not the only option as we can manage and prolong pregnancies with a good outcome by strict monitoring of patients. Aim of our study was to look for fetomaternal outcome in twin pregnancies with single fetal demise.Methods: This is a retrospective study done between July 2017 to June 2020 at Command hospital, Panchkula, Haryana. Total 3249 deliveries have been conducted during above said period. Out of which 47 deliveries were having twin pregnancy. We had six twin pregnancies who reported with one fetal demise. These cases were managed with regular monitoring of coagulation profile and strict fetal surveillance for surviving twin. The cases were studied for antenatal, postnatal and any neonatal complication.Results: No antenatal, postnatal maternal or any neonatal complication observed in this study. During study period we delivered total 3249 patients, out of which 47 were twin pregnancy. Out of these 47 (1.44%) twins’ pregnancies 33 (70.31%) were DADC and 14 (29.69%) DAMC. We studied six twin pregnancies who had single fetal demise. Conclusions: Even with single fetal demise pregnancies can be continued till term with strict monitoring for maternal and fetal complications. Termination is not the only answer in twin pregnancies with single fetal demise. Although our study was small, it indicates that in case of twin pregnancy with single fetal death and under good surveillance, the live fetus can be salvaged.

Hysteroscopic evaluation of postmenopausal bleeding patients and its correlation with histopathological examination

Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information