Uterine rupture: review of cases from tertiary care centre in India

Background: Uterine rupture is rare catastrophic complication associated with high incidence of maternal and perinatal morbidity and mortality. This study aimed at assessing the incidence of uterine rupture; maternal and fetal outcomes in cases of uterine rupture and factors associated with it.Methods: This retrospective study was carried out in the department of obstetrics and gynaecology, Late Baliram Kashyap memorial government medical college and Shaheed Mahendra Karma memorial hospital, Bastar, Chhattisgarh, India. All the cases of rupture uterus, who were admitted with the diagnosis or who had rupture during their stay in our hospital during the study duration of July 2018 to March 2020 were included in our study- 37 cases.Results: Out of 37 cases of ruptured uterus 8 rupture occurred in women with prior lower segment caesarean section (LSCS) and 29 occurred in women without prior LSCS. There were equal numbers of cases (17 cases each, 45.9%) in the age groups 25-30 years and 31 years and above. Incidence of rupture was highest in multiparous (3 and above). 70.3% of rupture were un-booked patients. 89.2% were referred from periphery. 86.5% of ruptures occurred at more than 37 weeks. 54% of rupture had of inter pregnancy interval of less than 24 months. Most common predisposing factor for uterine rupture in our study was obstructed labor. The most common site of rupture was found to be anterior surface of lower segment of uterus. Maternal morbidities seen include need for blood transfusion in 94.5% of cases. Among the maternal morbidities noted, severe anemia requiring blood transfusion was most commonly observed.Conclusions: Rupture of the pregnant uterus should be looked as a preventable entity. All possible efforts to reduce the incidence and the resultant maternal morbidity and mortality due to uterine rupture should be undertaken

COVID-19 and pregnancy- review of cases from a tertiary public hospital in Mumbai

Background: In December 2019 a novel strain of coronavirus, was first isolated by the Chinese Center for Disease Control and Prevention. This strain connected to the cluster of acute respiratory illness cases from Wuhan, China was later officially named as severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). On 30th January 2020, WHO declared the outbreak of SARS-Cov-2 a public health emergency of international concern, and on 11th March 2020 declared it to be a pandemic. Pregnant women are known to be at higher risk of severe morbidity and mortality from respiratory infections such as influenza and SARS, making a strong case for pregnant women to be considered an at-risk population for COVID-19. This study aimed to assess the clinical picture, obstetric outcome and neonatal outcome in COVID positive pregnant cases.Methods: We did a retrospective observational cohort study in the department of Obstetrics and Gynecology at a tertiary teaching hospital in Mumbai.Results: In the study duration, 148 were diagnosed as COVID positive (~12%). 9 patients had COVID related symptoms on admission. The obstetric outcome in symptomatic patients was noted to be good. We noted 79.01% of the pregnancies reached term. Cesarean section rate in COVID positive patients was comparable to non-COVID patients in the study duration. Neonatal outcome was only 4 babies of COVID positive mothers were diagnosed positive.Conclusions: Our study shows pregnancy outcomes are not significantly worsened by the COVID-19 infection in spite of the risk factors associated with pregnancy per se and influenza infection in pregnancy