The role of tourniquet in myomectomy: an observational study

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure.  Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation

Feto-maternal outcome in twin pregnancy

Background: Natural higher orders multiple conceptions are uncommon. The reported incidence ranges from 0.01% to 0.07% of all pregnancies. Multiple births are much more common today than they were in the past. Throughout the world, the prevalence of twin births varies from approximately 2-20 /1000 birth. Overall complications occur in approximately 83% of twin pregnancies as compared to 25% in singleton pregnancies. This delayed childbearing has resulted in an increased maternal age at conception.Methods: Present study is a randomized prospective study of 100 cases of twin pregnancies admitted at our institute from July, 2009 to October, 2011 including all emergency as well as registered cases. . Patients included in this study were from various socio-economic classes and they were having a different level of education. In all cases a detailed history was taken, all routine and specific investigations were done.Results: In this prospective study we observed 100 cases of twin pregnancies. In this study most of the patients (46%) delivered at 33- 36 weeks of gestation. 5%of patients had abortion at an early gestation. Majority of the patients delivered vaginally (61%), followed by LSCS (Lower Segment Caesarean Section) (38%). In this study low birth weight babies were the most common (188 babies) to the extent of 94%. We had 11% (22) extremely low birth weight babies. There were 13 neonatal deaths (6.5%). We observed the highest incidence of twins in the age group of 20 -29 years. The least were below the age of 20 years. The incidence among primigravida and multigravida was almost the same.Conclusions: Most of the complications in multiple gestations are preventable. High risk units in the obstetric ward and well developed NICU set up would reduce the maternal, perinatal morbidity and mortality

Prevalence of metabolic syndrome in women with polycystic ovarian syndrome: an observational study in a tertiary care centre in Pondicherry, India

Background: Polycystic Ovarian Syndrome (PCOS) is a multifactorial, polygenic and multisystem endocrine disorder affecting women in reproductive age. PCOS diagnosis is based on 2003 Rotterdam criteria It has been noted that hyperinsulinemia is a central factor in the pathogenesis of PCOS. Many studies show evidence of a critical link between PCOS and Metabolic Syndrome (MBS).Methods: It was a hospital - based observational study done over a period of one year with a sample size of 177.An observational study was done in patients satisfying the inclusion and exclusion criteria. After taking informed and written consent, history was obtained from the patient to know the age, socioeconomic status, present and past clinical history, menstrual and obstetric history, personal and family history and any other history as deemed necessary. Patient was clinically assessed to know the height, weight, body mass index.Results: The prevalence of MBS was 37.2%. The commonest age group was between 25- 35 years.There is no statistical association between educational qualification, economic status and the prevalence of MBS and There no significant association between the presence of acne, androgenic aloepecia and the presence of PCOS.While the presence of increased waist circumference > 88cms, USG findings consistent with PCOS, high blood pressure > 130/85 mm of Hg, elevated FBS > 110 mg/dl, low HDL <50 mg/dl were statistically significant.Conclusions: The results can be used to formulate a screening policy for metabolic syndrome, particularly in the low resource settings of developing countries

A retrospective study of ectopic pregnancy

Background: Ectopic pregnancy is one of the common acute abdominal emergencies posing a serious threat to life. The overall incidence of ectopic pregnancy is on a steady increase over the last two decades. Yet the case fatality rate has come down due to early diagnosis and management. 95% of ectopic pregnancies occur in the fallopian tube, and rest 5% cumulatively in the ovary, cervix, peritoneal cavity and previous caesarean section scar. The present study was done to analyse the associated risk factors, clinical manifestations and management options of ectopic pregnancy.Methods: This retrospective observational cohort study was done in the Department of Obstetrics and Gynaecology, at Sri Venkateshwaraa Medical College, Hospital and Research Centre, Ariyur, Puducherry, between January 2018- November 2021. Data was collected from the case sheets, operative notes and a retrospective analysis of the cohort of patients with ectopic pregnancy was done.Results: This retrospective study was conducted from January 2018 to November 2021 involving a total of 50 cases. We found that majority of tubal gestation occurred in the age group 26-30 years 58.6% and 13.7% in the age group more than 30 years. Majority of patients 65.5% underwent U/L salpingectomy.10.34% underwent salpingo oophorectomy. Fimbrial expression was done for two patients. Two patients underwent fimbriectomy. Cornual stump excision was done in two patients. Hemoperitoneum was detected in 55.17% of cases.Conclusion: Ectopic gestation can become an obstetrical emergency and reproductive capacity hampering morbidity if not diagnosed and treated on time. However having a high vigilance and evaluating every woman in the reproductive age group who presents with the classical clinical triad of amenorrhea, pain abdomen and bleeding per vagina can help in curbing the incidence in future.

Retrospective audit of genital prolapse management

Background: Pelvic organ prolapse is a descent of the pelvic organs into the vagina, frequently associated with local pelvic symptoms. Pelvic floor support is essential to maintain the normal anatomy. Recent studies of genital prolapse suggests that it is more important to improve the patient satisfaction and reduce complication than to achieve anatomical success. The purpose of the audit of genital prolapse management in this retrospective study is to know and understand the decision making, selection of patients for a particular surgery and to know and avoid the complications of genital prolapse management.Methods: This retrospective descriptive study was conducted at SVMCH and RC during the period of January 2020 to December 2021. The detailed analysis of the cases, symptomatology, surgical methods, complications and follow up were studied.Results: We managed 110 cases of genital prolapse. 35 patients had massive/ huge genital prolapse (POP Q Stage 4). 75.4%were found in the age group beyond 55 years, 66.3% were multiparous. 31% of the patients came with massive prolapse (POP Q-stage IV), 5% showed cervical elongation ,7% showed vault prolapse, Majority of our patients (63%) were managed by vaginal hysterectomy with pelvic floor repair. Followed by pessary, Fothergill’s surgery, Purandare’s surgery, Le forte’s, sacrospinal fixation, hysterosacropexy, pessary with thiersch stitch.Conclusions: The choice of management of genital prolapse has to be tailored according to the patients needs and pathology. The younger trainees have to be trained to get the skills of various surgeries of genital prolapse

Retrospective study of post-operative care in pandemic in tertiary care centre

Background: COVID-19 pandemic has unfortunately changed the surgical interventions and the post-operative management worldwide. Most of the medical institutes in India had formulated their own protocols from the beginning of the pandemic in March 2020 to stop all elective surgical procedures as soon as possible. However emergencies and all types of obstetric as cases were not stopped as it was unavoidable conditions.Methods: This retrospective observational study was done in the department of obstetrics and gynaecology, at Sri Venkateshwaraa Medical College, Ariyur, Puducherry, during the period April 2020-December 2020. Data was collected from the case sheets and operative notes and retrospective analysis was done.Results: On analysing we have realised that LSCS rate was higher and induction for trial of labour was kept minimal. We had 3 infective morbidity in the form of wound infection and 1 patient was returned to the operation theatre for reexploration. Arranging the blood during the pandemic was also a tedious task.Conclusions: In the present era of pandemic, where the patient load is high, we can rely on post graduate students to look after the post-operative patients through effective communication with the available consultants

A retrospective pilot study analyzing the effects of various factors and benefits of various drugs used in treating late admitted cases of acute ischemic stroke

Background: In Indian scenario, most of the cases of acute ischemic stroke are admitted and initiated treatment when the stipulated period of 4-6h for thrombolytic therapy is crossed. It is unclear on to benefits of treating such patients and our study aims at analysing the clinical and demographic factors associated with achieving improvement in functional ability in this special category of patients.Methods: Review of case records of acute ischemic stroke patients admitted after 6h of onset of stroke to a tertiary care teaching hospital of north Karnataka, India, over a period of one year with minimum of seven days of treatment was done. Drug utilization pattern, severity of ischemic stroke, baseline demographic and clinical data were extracted. The neurological recovery at the end of treatment period was analysed by using Barthel Index (BI) score. All the factors and drug utilization pattern were described using descriptive statistics and their correlation with BI score was analysed by spearman’s correlation coefficient.Results: Of the total 446 case records with diagnosis of stroke, only 39 met the eligibility criteria and included in the study. Statistically significant correlation to BI score was seen with severity of stroke, day-1 SBP, use of physiotherapy, time lapsed in initiating treatment, amount of decrease in SBP and baseline serum creatinine level.Conclusions: Our study helped in generating the hypothesis on effects of various factors and therapeutic modalities on neurological recovery of late admitted cases of acute ischemic stroke