Obstetric hysterectomy: analysis of 50 cases at a tertiary care hospital

Background: Despite advances in modern medical sciences, there is a plethora of morbidity which continues to affect women during childbirth, necessitating removal of the uterus in the peripartum or postpartum period. This study analyses 50 cases of obstetric hysterectomy done in a single institute.Methods: After Institutional Ethics Committee approval, a retro prospective analysis of hospital records of 50 cases of obstetric hysterectomy was done over a five year period in the department of obstetrics and gynaecology at a tertiary care referral centre-KEM hospital.Results: During the study period, there were 50 cases of obstetric hysterectomy out of 43839 deliveries giving an incidence of 0.12%. Mean age of women undergoing obstetric hysterectomy was 29.9 years. 86% of these were multiparous. The most common indication was morbidly adherent placenta (38%) followed closely by followed by rupture uterus (34%) and uterine atony (20%). Total hysterectomy was the most preferred type of hysterectomy (74%). Urinary tract injury and hypovolemic shock were the most frequently encountered complications. The maternal mortality rate in our study was 4%. 86% of the babies born had Apgar score of 9/10. 44% of babies required admission to neonatal intensive care unit.19.6% of the patients had still born babies and there were 4 neonatal deaths.Conclusions: Obstetric hysterectomy is associated with increased risk of maternal and perinatal morbidity and mortality

Comparison of maternal and fetal outcomes in gestational diabetes mellitus diagnosed either by oral glucose tolerance test or diabetes in pregnancy study group India

Background: The optimal strategy for screening and diagnosis of Gestational Diabetes Mellitus (GDM) is still controversial and elusive. There is possibility of difference in maternal and fetal outcome depending on the diagnostic method used. This study throws light on the efficacy of two screening tests “Oral Glucose Tolerance Test’’ and “Diabetes in Pregnancy Study Group India” and to know maternal and fetal outcome in pregnancy complicated by GDM in Indian setting.Methods: Depending on the diagnostic method used 100 GDM patients were divided in 2 groups: 1. OGTT, 2. DIPSI. Maternal outcomes were measured in terms of pregnancy induced hypertension, polyhydramnios, preterm labour, genital tract injury and methods of termination of pregnancy, gestational age at delivery. Congenital malformation, macrosomia, hypoglycemia, hyperbilirubinimia, respiratory distress, duration of NICU stay was studied in newborns.Results: 22% of DIPSI group and 26% of OGTT group had PIH as comorbidity. Preterm delivery was noted in 22% of DIPSI group and 30% of OGTT group. 50% patients of both the groups underwent LSCS. No intrapartum complications were seen in 82% of patients. Malformations were noted in 18% of DIPSI group and 14% of OGTT group. In DIPSI group 14% of baby had macrosomia compared to 10% and in that of OGTT group.In neonates, hypoglycaemia, respiratory distress syndrome and hyperbilirubinemia seen in 46.8%, 31% and 42.6% respectively in DIPSI group compared to 50%, 45.5% and 47.7% respectively in OGTT group.Conclusions: No statistically significant difference was noted with respect to maternal and fetal outcomes between the two groups

Pregnancy outcome with hepatitis E infection

Background: Hepatitis E is usually a self-limited viral infection in men and non-pregnant women, but during pregnancy it is associated with high maternal and perinatal mortality. This needs to be studied for early diagnosis and better management.Methods: The study commenced after the approval of Institutional Ethics Committee. This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology and Department of Medical Intensive Care Unit in present tertiary care hospital between February 2012 and July 2017. An analysis of 120 cases was made over a period of five years.Results: In this study the incidence of pregnant patients with hepatitis E was 3.09 per 1000 deliveries. It was found that majority of the patients which were diagnosed with hepatitis E were young and belonged to the age group of 21-25 years. Most of the affected patients were primigravida with increasing severity of the disease in their third trimester. The maternal morbidity was 51% with a mortality rate of 20%. The percentage of still birth was 25.64% with increased incidence of preterm deliveries and poor perinatal outcome.Conclusions: Early diagnosis and rapid management of the complications such as correction of abnormal coagulation and supportive management is the best treatment available at present. ICU admission and with strict maternal and foetal monitoring can help improve the outcome and thereby reducing the maternal and perinatal mortality