A retrospective analytical study of caesarean section in intrauterine foetal death cases in a rural medical college

Background: Intrauterine fetal death(IUFD) is an unhappy reality, a lamentable incidence for both the family and the caregiver. It is an important indicator of both maternal and perinatal health in a population. The study of fetal death is crucial in promoting actions for maternal and child health. Aim of this study was to determine the incidence, indications and maternal morbidity and maternal mortality associated with caesarean section in patients with IUFD and to establish the place of caesarean section in present day scenario.Methods: The study was a retrospective analysis of all caesarean section carried out in a case of IUFD in last 5 years (2013-2017). The indications, incidence, maternal morbidity, mortality was studied well in this time period in a rural medical college of West Bengal.Results: Total 108425 deliveries occurred in the hospital in last 5 years, out of which 31800 were caesarean section. 56 cases were done in case of diagnosed IUFD. There was 2489 number of IUFDs in the given period. The incidence of IUFD was 22.96 per 1000 deliveries. Induction was done in 2489 cases; 56 cases underwent caesarean section (2.25%) and rest was delivered vaginally.Conclusions: Early diagnosis, early referral and proper antenatal checkup can reduce the chances of IUFD and number of caesarean deliveries in IUFD. The role of cesarean deliveries in previous caesarean deliveries having IUFDs has been emphasized

A study of surgically managed ruptured ectopic pregnancies in a rural medical college hospital over a period of 5 years

Background: Although ectopic pregnancy is of interest to the embryologist, general practitioner, obstetrician, and abdominal surgeon for various reasons, our present study was undertaken to determine the incidence, epidemiological characteristics, clinical features, risk factors, diagnosis, management and operative findings of ectopic pregnancies at our hospital.Methods: This is a retrospective study of ectopic pregnancies that were managed operatively at Bankura Sammilani Medical College and Hospital from April 2013 to April 2018. Unruptured tubal ectopic pregnancy that were managed medically are excluded in this study.Results: The incidence of ectopic pregnancy was 0.59%, and the peak age of incidence was 20-25 years (33.84%) with third gravidas (46.3%) being most commonly affected. The most common symptoms were amenorrhea (96.92%), abdominal pain (90.76%), and vaginal bleeding (11.53%) and the most common signs were pallor (46.30%), shock (38.46%), and cervical motion tenderness (33.84%). Most common risk factors were past history of tubectomy (66.61%). The commonest site for tubal ectopic pregnancy was ampullary in 545 cases (84.89%). Salpingectomy done in 553 cases (85.07%) was the most commonly performed operation for ruptured tubal ectopic pregnancy.Conclusions: In the surgical management of ectopic pregnancy, the benefits of salpingectomy over salpingostomy are uncertain. The early diagnosis of an ectopic pregnancy reduces the presentation to response time, which is crucial in determining the morbidity, mortality and long-term effects for the patient. Although with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, the best regimen remains unclear. There have been advances made in the management of ectopic pregnancy but there are still questions to be answered

Perinatal mortality of placenta previa: a 1-year retrospective study

Background: Antepartum haemorrhage is one of the important causes of perinatal mortality and morbidity in India. The increased risk of perinatal morbidity and mortality in placenta praevia is due to preterm birth, low birth weight, birth asphyxia and neonatal sepsis. This is a retrospective study done over a period of 5years to determine the incidence, demographic features, risk factors, obstetric management, maternal mortality and morbidity, and perinatal outcome in women presenting with placenta praevia.Methods: This was a retrospective study done at Nil Ratan Sircar Medical College and Hospital over a period of five years starting from January 2016 to December 2017. Antenatal women with more than 28 weeks of gestational age with a complaint of painless vaginal bleeding or those diagnosed as having placenta praevia on routine ultrasound examination were included in this study and hospitalised.  Among them cases of placenta praevia were 21.Results: There were21 cases of placenta praevia registered amounting to 0.23% incidence. The various antenatal complications seen associated with placenta praevia were severe anaemia (14.28%), coexisting PIH (4.76%), IUD (4.76%), IUGR/Oligohydraminos (4.76%). All the patients in the study had undergone caesarean deliveries. Perinatal morbidity studied as percentage of new-borns requiring resuscitation followed by NICU admission was 33.3%. Among the delivered patients of placenta praevia incidence of perinatal mortality was 23.8%. Prematurity (42.85%) contributed to most cases of perinatal mortality, followed by RDS (14.28%) and asphyxia (14.28%).Conclusions: In this study placenta praevia is seen more commonly in 28-34 weeks of gestation and patients mainly presented with a bout of bleeding eventually had preterm deliveries. Although vaginal deliveries are appropriate in selected cases of placenta paevia liberal use of caesarean section in well-equipped hospitals with availability of blood transfusion services have helped to lower complications

A comparative study of total laparoscopic hysterectomy and non-descent vaginal hysterectomy for treatment of benign diseases of uterus

Background: Hysterectomy is the most common performed major gynaecological surgery and the decision depends on indications for operation, surgeon’s training and preference, uterine size, adnexal pathologies and patient choice. To avoid laparotomy either total laparoscopic hysterectomy (TLH) or non-descent vaginal hysterectomy (NDVH) is the recently practised option. Objectives of the present study are to compare duration of operation, blood loss, ambulation time, post-operative pain and complications between TLH and NDVH.Methods: Patients undergoing above operation during January 2014 to December 2014 at N.R.S. Medical College, Kolkata, were included under the study. All patients were thoroughly examined and investigated and malignancies were excluded by Pap smear and or D&C. All patients were observed minutely during pre-operative, intra operative and post-operative period for any complications.Results: NDVH requires less operative time than TLH but intra operative blood loss, post-operative pain and ambulation time are slightly more.Conclusions: TLH requires infrastructural set up, greater surgical expertise, longer operative time and major intraopertive complications as compared to NDVH. In our low resource government hospital NDVH is better choice for removal of uterus in uncomplicated benign conditions

A randomized controlled trial of vaginal misoprostol tablet and intracervical dinoprostone gel in labor induction of women with prolonged pregnancies

Background: Objective of the study was to compare the efficacy of vaginal misoprostol and intracervical dinoprostone gel for induction of labor in women with unfavorable cervix beyond 41 weeks (287 days) of gestation.Methods: This randomized controlled trial was performed at a teaching hospital between January 2011 and December 2012. 192 women with singleton uncomplicated pregnancy with no previous uterine scar not going into spontaneous labor at 288th days of gestation .Misoprostol(25 mcg tablet)in the posterior vaginal fornix, four hourly, maximum six doses or Dinoprostone (0.5 mg gel) intracervical instillation ,six hourly, maximum three doses were given.Oxytocin was administered if needed. Primary outcome: Induction delivery interval (IDI) with incidence of delivery within 12 hours and 24 hours; mode of delivery: vaginal or caesarean section. Secondary outcome: maternal side effects, neonatal outcome. For statistical analysis chi-square test, student t- test and P-value determination were done.Results: The mean IDI was shorter in the misoprostol group compared to the dinoprostone group (p0.05). Adverse neonatal outcome (5-minutes Apgar score0.05).Conclusions: Vaginal misoprostol tablet is a safe and more effective method of induction of labour when compared with intracervical dinoprostone gel in prolonged pregnancies.

Clinical profile of children with metabolic liver diseases presenting in a tertiary care hospital of Eastern India

Background: Metabolic liver diseases (MLDs) in children can present with a wide range of clinical features. Aims and Objectives: This study aims to increase the high index of suspicion among physicians and awareness among caregivers regarding early diagnosis of MLD. Materials and Methods: This hospital-based prospective observational study has been conducted in the Paediatric Outpatient Department and Inpatient Department of RG Kar Medical College, Kolkata, over 2 years from 2021 to 2023. A total of 47 children aged up to 12 years were diagnosed as various MLDs who fulfilled inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on SPSS software. Results: The study sample was 47 children with MLDs. Mean age was 4.21±3.81 years. Males: female ratio was approximately 2.35:1. History of consanguinity among parents was present in 23.40% cases which affirmed the autosomal recessive mode of inheritance in most of the MLD. History of sibling deaths was there in 10 cases. The most common symptom was yellowish discoloration 21 (44.68%) followed by abdominal distension 12 (25.53%). There were diverse modes of presentations. The most common presentations were hepatomegaly 47 (100%) and splenomegaly 30 (63.83%). Of 47 MLDs, Wilson disease cases were maximum (27.66%) followed by glycogen storage disease (23.40%). Conclusion: High index of suspicion should be prevalent among physicians for early diagnosis of cases to reduce disease mortality and morbidity

Comparative study on ultrasonic placental grading among normotensive pregnancy and pregnancy-induced hypertension and its correlation with fetal outcome

Background: Placenta is essential for the fetal well-being, growth, and development which can be evidenced as early as possible through ultrasound at 6 weeks of gestation. The placenta mediates the intrauterine interaction between a mother and her baby. Aims and Objectives: This study aims to compare the pattern of placental grading among normotensive and pre-eclampsia mothers in a tertiary care hospital. Materials and Methods: This hospital-based observational analytical study has been conducted in the labor ward and outpatient department of the Department of Obstetrics and Gynaecology, Bankura Sammilani Medical College and Hospital from April 2021 to September 2022. A total of 69 pre-eclampsia mothers (study group) and 69 normotensive mothers (control group) who fulfill inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on Statistical Package for the Social Sciences software. Results: A total of 138 pregnant women with 69 pregnant normotensive and 69 pregnant preeclampsia mothers were included in the study. The mean age of the study participants was 21.3 years (standard deviation=3.6). About 81.2% and 89.9% of the normotensive and hypertensive mothers, respectively, resided in rural areas. Cesarean/instrumental delivery was higher among the hypertensive pregnant women (42.0%) when compared to normotensive pregnant women (27.5%) and it was found to be statistically significant. Birth asphyxia was observed to be higher among the neonates in the hypertensive group (15.9%) when compared to the normotensive group (4.3%) and it was found to be statistically significant. Neonatal intensive care unit admission was more among the neonates of the mother with hypertension and it was found to be statistically significant. There was no significant difference in the birth weight of the newborn with the placental grading among the normotensive pregnant women. Conclusion: Ultrasonographic placental grading could be used as a screening tool for antepartum fetal surveillance in the obstetric population. Placental grading will help us to early diagnosis and to formulate line of management and timely intervention to reduce maternal and perinatal complications

A retrospective analytical study of caesarean section in intrauterine foetal death cases in a rural medical college

Background: Intrauterine fetal death(IUFD) is an unhappy reality, a lamentable incidence for both the family and the caregiver. It is an important indicator of both maternal and perinatal health in a population. The study of fetal death is crucial in promoting actions for maternal and child health. Aim of this study was to determine the incidence, indications and maternal morbidity and maternal mortality associated with caesarean section in patients with IUFD and to establish the place of caesarean section in present day scenario.Methods: The study was a retrospective analysis of all caesarean section carried out in a case of IUFD in last 5 years (2013-2017). The indications, incidence, maternal morbidity, mortality was studied well in this time period in a rural medical college of West Bengal.Results: Total 108425 deliveries occurred in the hospital in last 5 years, out of which 31800 were caesarean section. 56 cases were done in case of diagnosed IUFD. There was 2489 number of IUFDs in the given period. The incidence of IUFD was 22.96 per 1000 deliveries. Induction was done in 2489 cases; 56 cases underwent caesarean section (2.25%) and rest was delivered vaginally.Conclusions: Early diagnosis, early referral and proper antenatal checkup can reduce the chances of IUFD and number of caesarean deliveries in IUFD. The role of cesarean deliveries in previous caesarean deliveries having IUFDs has been emphasized

Maternal and early neonatal outcome among the elderly pregnant women delivered in a tertiary care hospital

Background: Elderly primigravida is defined as women thirty five years of age or above who is pregnant for the first time. The advancement in the artificial reproductive technology have played an important part in delaying the pregnancy. Maternal age is no longer only important factor in women wishing for conception. Nevertheless, the increased fetomaternal complication and consideration as a high risk leading to early intervention among these age group is of concern. Many women who wish to get pregnant on and after the age of 35 years are not fully aware of age-related decrease of fertility rate in female and the risk associated with this. Methods: This was institution based, observational descriptive study. Study was conducted at Bankura Sammilani Medical College & Hospital from May 2019 to October 2020 including 106 elderly pregnant women. Thorough history taking and clinical examination was done. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: Among 106 elderly pregnant women 83 (78.30%) were 35 – 37 yrs. of age group. Cause of delay in pregnancy of 42 (39.62%) was unknown. Whereas only 3 (2.83%) mothers’ cause of delay in pregnancy was Infertility. Mean value of gestational age of participants was 37.78. Mode of delivery of 55 (51.89%) was normal. Most of the new – born 101 (92.66%) have born lively whereas 8 (7.34%) new – born were stillborn. Most of the new – born i.e. 45(41.28%) out of 106 were LBW whereas only 5 (4.59%) new – born were IUGR. Conclusions: The elderly mothers with age more than 35 have increased risk during pregnancy and perinatal period. The role of the married couple and family is very important who should be discouraged for late marriage and late pregnancy