A randomised controlled trial of oral misoprostol vs injection methylergometrine for prevention of post partum hemorrhage

Background: To compare the efficacy of 600mcg of oral misoprostol with 0.2mg of injection methylergometrine for the prevention of post partum hemorrhage.Methods: 200 apparently normal pregnant women were randomized to receive either 600mcg of oral misoprostol (study group) after delivery of baby or 0.2 mg of methylergometrine intravenously (control group) after delivery of placenta. Primary outcome was to know the incidence of post partum hemorrhage in both the groups. Secondary outcome measures were to look for mean blood loss, need for any other uterotonic agents, need for blood transfusion, need for surgical intervention, mean duration of third stage and side effects of both the drugs.Results: Out of 200 cases, two cases were excluded for the final analysis. Incidence of PPH was 9% in misoprostol group & 6% in methylergometrine group which was not significant (p >0.05). There were no significant differences among both the groups in mean blood loss, duration of bleeding, need for further oxytocics and duration of third stage. Shivering was significantly more common in misoprostol group (36% Vs 2% p< 0.0027). Conclusion: Efficacy of 600mcg of oral misoprostol is comparable to injection methylergometrine 0.2 mg intravenously for prevention of post partum hemorrhage. So, in settings where methylergometrine is used routinely for prophylaxis, oral misoprostol can be used with more ease & other advantages over injectables. Significantly more number of patients in misoprostol will have shivering as a major side effect, which should be kept in mind

Meconium stained liquor and perinatal outcome

Background: The aim of this study is to know the association between the meconium stained amniotic fluid and its association with the perinatal outcome.Methods: All the patients coming to present hospital for delivery with meconium stained liquor during the study period were included in the study.Results: 163 cases with meconium stained liquor (MSAF) were included in the study, 124(76.1%) and 39(23.9%) had thin and thick MSAF respectively. Among these cases, thick MSAF was more associated with high fetal heart rate (FHR) variability (p value- 0.030), associated with increased rate of operative interference (64.1%; p value- 0.001), abnormal Apgar score (p value-0.003 at 1min and 0.001 at 5min) and increased neonatal intensive care unit (NICU) admission (33.3%; p value - <0.001).Conclusions: Present study showed that thick meconium is associated with more complications like increased operative interference, birth asphyxia, meconium aspiration syndrome, low Apgar score, prolonged NICU stay and overall increased perinatal mortality compared to thin meconium stained liquor. As the gestational age increased the incidence of meconium increased and a greater number of thick meconium had abnormal CTG

To Evaluate the Indications of Caesarean Section among the Population of Karnataka: A Prospective Cross-Sectional Study

Background: The incidence of Caesarean Section (CS) is increasing day by day among urban and rural population globally. Hence, a need of the study was required to find out the incidence of CS among population in a backward district of Karnataka. Aim and Objectives: To evaluate the rising trends in CS rate in both primigravida and multigravida. Material and Methods: This cross-sectional study was carried out among 513 patients (92.7% rural and 7.3% urban) admitted in labour ward at a tertiary referral centre, Vijayapura, Karnataka. The indications were analysed by standard procedures and the decision for CS were under taken by qualified professionals accordingly. Results: Total incidence of CS in the present study was 200(38.98%) out of 513 patients admitted. Out of 200 patients who underwent CS, were found to be primigravida 83 (41.5%) and were multigravida 117 (58.5%). The most common indication of CS in this study was found to be the Foetal Distress (FD) (35.5%) followed by Cephalo-pelvic Disproportion (CPD) (21%) and others (43.5%). Study also shows 90% of rural patients (n=180) and 10% of urban patients (n=20) had underwent CS (n=200). Interestingly it was noticed that age group of 21-30 years had maximum number of CS (74%). Conclusion: The results indicate the high incidence of CS among rural population of Vijayapura, Karnataka of which the common indication was FD, dystocia and failure to progress of labour. The increased incidence of CS is in primigravida and primary CS in multigravida in the perspective of various societal and medico-legal issues

OEIS complex: a rare foetal anomaly

OEIS (Omphalocele, extrophy of bladder/cloaca, imperforate anus, spinal defects) is a rare constellation of malformations involving multiple organs in humans. It is the most serious manifestation of exstrophy-epispadias sequence. The exact aetiology of this condition is not known. It is sporadic but genetic associations have also been hypothesised. It results from defective blastogenesis leading to improper closure of anterior abdominal wall and defective development of cloacae and urogenital septum. Incidence ranges from 1 in 200000 to 1 in 400000. Prenatal diagnosis of OEIS complex can be done by anomaly scan between 18 to 22 weeks of gestation. It carries a poor prognosis. Survival is nil or very less. Even if baby survives it requires multiple surgeries with many potential complications. We had an undiagnosed case of this complex presenting to us in advanced labour, but a timely ultrasound helped in the diagnosis and avoided an unnecessary caesarean section which we would have done for an elderly primigravida with breech presentation

The efficacy of transvaginal ultrasonography and office hysteroscopy in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a prevalent issue in women of child bearing age group. AUB can be uncomfortable and have a considerable impact on health-related quality of life. AUB is reported to occur in 9 to 14% women between menarche and menopause and reported prevalence in India is around 17.9%. Methods: It is a prospective observational study done in 75 patients with abnormal uterine bleeding attending the gynaecology outpatient department (OPD) at Shri B. M. Patil Medical College, Vijayapura, Karnataka. Patient was thoroughly examined and then transvaginal sonography (TVS) was done after obtaining consent. This was followed by office hysteroscopy(OH) and endometrial biopsy was taken for histopathological examination. Data were gathered and examined and cost analysis of each procedure was done. Results: The most frequent presenting symptom was heavy menstrual bleeding (49.3%). For proliferative and secretory endometrium, the sensitivity of TVS was 81.48% and for the detection of polyps, endometrial hyperplasia, and submucous fibroid it was 45.45%, 42.86%, 100% respectively. The sensitivity of OH for detection of polyps, endometrial hyperplasia, and submucous fibroid which was 46.15%, 100%, 100% respectively. The p value was &lt;0.05 which shows the statistical significance of both tests. TVS demonstrated low correlation for intracavitary diseases. OH was costlier when compared to TVS. Conclusions: TVS has more sensitivity and accuracy in detecting intramural pathologies. OH had showed greater diagnostic accuracy in identifying intra cavitary pathologies of uterus and doing intervention in the same setting

Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

Background: Prolonged pregnancy is one that exceeds 42 0/7weeks. Management of prolonged pregnancy is very challenging in modern obstetrics.Methods: It is prospective observational study in department of Obstetrics and Gynecology, Shri B.M Patil medical college and Research center, deemed to be University, Vijayapur, North karnataka. Study period was from January 2018 to January 2019.Results: Total of 186 pregnant women were included in the study. Results in terms of age, gravidity, gestational age, time of induction, mode of delivery, neonatal outcome and maternal complications.Conclusion: Pregnancies beyond 40 weeks require early detection, effective fetal monitoring and proper planning of labour. In pregnancies beyond 40 weeks, decision of induction should be taken cautiously as early induction leads to failure of induction and increased rates of lower (uterine) segment Caesarean section (LSCS), while delayed induction leads to increased fetal complications

A randomised controlled trial to compare the efficacy of preinduction with mifepristone 12 hours versus 24 hours prior for second trimister pregnancy termination

Background: Since the second trimester termination of pregnancy is on rise due to the detection of anomalies, this study aims to provide a safe regimen with respect to efficacy, side effects and acceptability for second trimester pregnancy termination.Methods: It is a randomized controlled trial, conducted on 48 cases at BLDE Medical college, Vijayapur, Karnataka. They were divided into two groups; all patients were given mifepristone 200mg orally followed by misoprostol 400mcg vaginally after 12 hours in group I and 24 hours in group II respectively. Subsequent doses were decided depending on the Bishops score. Results were analyzed in terms of induction-abortion interval and dosage of misoprostol.Results: The mean induction abortion interval was 563.9 minutes (9.3hrs) in group I and 714.6 minutes (11.9hrs) in group II; but was statistically not significant (p value 0.611) The total dose of misoprostol used was 783.3mcg in group I compared to 550mcg in group II, but was statistically not significant. The success rate was 100% in both the groups as none of them had incomplete abortion. There were no cases of uterine rupture, infection, need for check curettage and laparotomy.Conclusions: Our study proves that the interval between mifepristone and misoprostol can be safely reduced to 12 hours without affecting the efficacy. But in gestational age <16 weeks and primigravida 24 hours interval may be of benefit. Both the regimens were 100% successful

A Randomized Controlled Trial to Compare the Efficacy of Three Different Methods of Maternal Hydration for Oligohydramnios

Background: Oligohydramnios is defined as an Amniotic Fluid Index (AFI) of less than normal for that gestational age. It is mainly associated with increased perinatal morbidity and mortality due to cord compression, fetal distress, pulmonary hypoplasia. So, an effective medical therapy is very important to prevent the complications. Aim and Objectives: To compare efficacy of maternal hydration with oral water, 1Lof Ringer Lactate (RL) + 1Lof 5% Dextrose (5% D) and 2L of 0.45% Normal saline (0.45% NS) in increasing AFI in patients with oligohydramnios. Material and Methods: Patients who had been diagnosed as oligohydramnios (with AFI<8cm) by Ultrasonography (USG) were included in the study. Both Fetal Growth Restriction (FGR) with oligohydramnios and idiopathic oligohydramnios were studied. Totally 108 cases were allocated into 3 groups depending on the computer generated randomized table. Group A was given oral hydration i.e., 2L of water in 2 hours. Group B received 1L RL+ 1L 5% D in 2 hours intravenously and Group C was given 2L0.45% NS in 2 hours intravenously. AFI and Symphysiofundal Height (SFH) was assessed after 2 hours and 24 hours after the hydration therapy. Results: All the types of hydration therapy had significant increase in AFI and SFH at 2 hours and 24 hours. In group A, mean increased from 4.91 ± 1.58 to 5.88 ± 1.86 and 6.49 ± 2.22 at 2 hours and 24 hours respectively. Similarly in group B, mean increased from 4.98 ± 1.86 to 5.79 ± 1.89, 6.18 ± 2.23 at 2 and 24 hours respectively. In group C, mean value increased from 5.58 ± 1.31 to 7.32 ± 1.40, 8.32 ± 1.77 at 2 hours and 24 hours. There was significant increase in group C when compared to other two groups and there was no statistically significant difference between group A and group B. There was significant rise in SFH in all the three groups at 2 hours and 24 hours. Both FGR with oligohydramnios and idiopathic oligohydramnios responded well to any type of hydration, but 0.45% NS was significantly better in unexplained oligohydramnios. None of the patients had any major side effects. Conclusion: Both oral and IV hydration with hypotonic solution increases the level of amniotic fluid in cases of oligohydramnios. But 0.45% NS was shown to be significantly better than oral hydration and IV hydration with RL+5% D especially in idiopathic oligohydramnios. SFH can be used to assess the amount of amniotic fluid clinically whenever AFI by ultrasound is not feasible

Unusual Presentation of Cystic Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is the most common thyroid malignancy, accounting for 80% of all thyroid cancers. The most common presentation of thyroid cancer is an asymptomatic thyroid mass or a nodule. Usually as thyroid enlarges, it extends in to mediastinum. Papillary thyroid carcinoma presentation as multiple true cystic swelling extending from neck to anterior chest wall in subcutaneous plane is not present in the literature. We present a rare case of cystic papillary thyroid carcinoma which is presented as subcutaneous swelling with sinus formation