Abnormally invasive placenta: an overview of diagnosis and management options

Background: Abnormally invasive placenta, also known as morbidly adherent placenta, is a broad term that describes abnormal adherence of placenta to the underlying myometrium. Clinical risk factors include placenta previa and prior uterine surgery, including caesarean delivery. The diagnosis and management of women at risk is not only based on clinical parameters, but also driven by imaging, namely ultrasound and more recently magnetic resonance (MRI) imaging.Methods: This is a retrospective analysis of 10 cases of abnormally invasive placenta undertaken at Guru Gobind Singh Medical College and Hospital, Faridkot.Results: Hysterectomy done in six cases and uterus was preserved in four cases. Foetal outcome was on average side. Four foetal losses noted two because of prematurity and two due to excessive blood loss admitted with intra uterine foetal death. Two babies needed NICU care but successfully discharged.Conclusions: Newer approaches should be considered investigational until larger prospective series to become available, until then hysterectomy should remain the stay of treatment specially when the family is complete and there is life threatening Haemorrhage

An audit of hysterectomies at a tertiary care teaching hospital

Background: Hysterectomy is the second most common major surgical procedure performed on women all over the world next to caesarean section. Emergence of effective medical and conservative treatment for benign conditions in the uterus is now posing a question mark regarding the justification of hysterectomy. It has been realized that uterus should not be considered as a vestigial organ after child bearing. Apart from few population based studies, there is no national level survey done in India which give us the prevalence and indications for hysterectomy in India.Methods: Present study involved all patients who underwent Hysterectomy at Guru Gobind Singh Medical College Faridkot in a span of one year from 1st January 2017 to 31st December 2017.Results: In the year 2017, 250 hysterectomies were done, most common age group was 40-49 years (36.8%) and most common indication was fibroid uterus (40%) followed by ca ovary (19.6%), Abdominal route was most commonly preferred.Conclusions: Hysterectomy was justified in 98% women in our series based on post operative histopathological report of the specimen. However we hypothesize that 20 cases of DUB, 5 cases of CIN and 10 cases of endometriosis and 3 cases of chronic cervicitis could have been managed conservatively. 10 cases of obstetric hysterectomies could have been avoided by disseminating awareness among peripheral centres for early referral and by attempting a rather conservative approach of uterine artery embolizations. As the incidence of carcinoma is increasing in the Malwa region of Punjab people prefer hysterectomies instead of conservative treatment. Hysterectomy is used commonly to improve the quality of life and sometime it is life saving procedure. However it should be justified before taking a direct decision of sacrificing uterus

A knowledge, attitude, and practice study to identify factors associated with refusal of post-partum sterilization

Background: Aim of the study was to identify awareness among parturient women about the advantages of postpartum sterilization and common factors associated with its refusal. This study was conducted in Department of Obstetrics and Gynecology, GGS Medical College and Hospital, Faridkot. A cross-sectional study in women who delivered between August 2020 and March 2021 and gave consent. Methods: A total of 200 patients who refused postpartum sterilization were included as per the inclusion and exclusion criteria. Data collection included a questionnaire to assess their knowledge for this procedure and the reasons for refusal, age, socio-economic status, education status, occupation of head of family, family income, awareness of advantages and disadvantages and also prevalence of various misconceptions.Results: The 38 cases (19%) of refusals were of 20-24 years age group with maximum incidence 38.5% in 25-29 years. The chief reason for refusal was the desired chance for male child in next pregnancy resulting in maximum refusals 143 out of 200 (72%). Socioeconomic factors, educational background and work profile of the patients and family members also had influence in the decision of refusal. There were certain misconceptions in relation to refusals with almost 90% gave no preference to vasectomy, possibility of weight gain in 51%, disturbance in carrying daily work routine in 84%.Conclusions: This study suggests need of better counselling by the healthcare workers to implement small family norm which in turn can aid to reduce maternal mortalities

Clinico-epidemiologic profile and perinatal outcome of patients with oligohydramnios in third trimester in a tertiary care hospital

Background: Oligohydramnios has an incidence of around 1-5% of total pregnancies. It is associated with adverse perinatal outcomes like preterm delivery, low birth weight, foetal distress, and passage of meconium and NICU admission. Aims and objectives were to study the risk factors associated with oligohydramnios in pregnancy and to evaluate the perinatal outcome in patients with oligohydramnios. Methods: The present study was a prospective observational study of six months, which included 60 patients with gestational age >28 weeks, selected after verifying the inclusion and exclusion criteria. A detailed history and clinical examination done and relevant investigations sent. Patients were followed up postpartum till discharge from hospital.   Results: The prevalence of oligohydramnios is found to be 8.5% in our study and there were more primigravida (55%). Oligohydramnios was idiopathic in 50% of our patients, followed by presence of hypertensive disorders in 20%. Caesarean delivery was required in 48.3% of the patients. In terms of perinatal outcome, 46.6% of the babies were low birth weight, 38.3% preterm, NICU admission in 26.6% and stillbirth rate was found to be 6.6%. Conclusions: Oligohydramnios was an isolated finding in half of the cases and in these only adverse perinatal outcome noted was small for gestational age. When associated with risk factors, oligohydramnios was associated with increased perinatal morbidity and mortality in terms of prematurity, foetal distress, low birth weight, NICU admission, stillbirth.

A comparative study of efficacy of oral pregabalin and clonidine for attenuation of pressor response to intubation

Background: Endotracheal intubation is associated with hemodynamic stress responses. Various drugs have been used in the past to attenuate the pressor response; however, none has been proved to be ideal. Present study was planned to evaluate the oral pregabalin 150 mg and clonidine 200 µg for attenuation of pressor response to intubation.Methods: The study was conducted on 100 adult patients of either gender scheduled to undergo elective surgeries under general anaesthesia (GA). The patients were randomly allocated into 2 groups. In group A patients received pregabalin 150mg and in group B patients received clonidine 200µg orally. The hemodynamic parameters were recorded until 10 minutes after intubation. The sedation, anxiety and side effects were also assessed.Results: In clonidine group, the mean HR remained below the baseline value at all the time intervals. In pregabalin group, the mean HR remained below the baseline value at most of the time intervals but increased above baseline just after intubation (T0i) and 1 minute after intubation (T1i) where increase was only 1.488±1.20% and 0.45±1.16% respectively from baseline. In both pregabalin and clonidine groups, the mean SBP and MAP remained below the baseline value (Tb) at all the time intervals from T0.5 to T10i. Both clonidine and pregabalin provided adequate anxiolysis and sedation with pregabalin providing more pronounced sedation and anxiolysis than clonidine.Conclusions: Both clonidine and pregabalin are effective oral premedication drugs for attenuation of the pressor response to laryngoscopy and endotracheal intubation.

Uterine Invertion: An Acute Obstetric Emergency

Background: Uterine invertion is defined as the turning inside out of the fundus into the uterine cavity. It's a rare but serious obstetric emergency. Women can rapidly develop profound shock which can prove fatal. It is well established that mis-management of the third stage of labour (premature traction on umbilical cord and fundal pressure before separation of placenta) is the commonest cause of acute uterine invertion. Method: This is an observational study carried out at GGSMC Faridkot during period 2008-18. Result: In our study out of 17 patients of acute inversion uterus hydrostatic reduction was successful in 10 patients and manual reposition was successfully done in 6 patients. We lost 1 patient before any intervention. Conclusion: Non surgical technique like manual reposition and hydrostatic reduction can really save many lives. So it should be included in emergency obstetric drills and skills training

Assessment of quality of life after hysterectomy using european quality of life five dimension scale (EQ5D)

In several regions throughout the globe, caesarean sections constitute the most common nonobstetric surgery, followed by hysterectomy, which is the surgical excision of the uterus. While it is not the only solution for reproductive organ issues, it is the most effective technique to treat many illnesses over the long term. The uterus is a very critical reproductive organ for all age groups as this is not only essential for giving birth but also for hormonal-related physiology in women's life. The quality of life is impacted by a number of hysterectomy-related effects on females. Physical, psychological, environmental, and social relations are some of these impacts. All EuroQol five-dimensions (EQ5D) subscales significantly improved, as per the research 's findings. Preoperative psychosocial status, perioperative pain, indication of hysterectomy, complications occur during surgery, and mode of hysterectomy postoperative infection had been discovered as determinants of quality of life outcome following hysterectomy. In most of the subjects we noticed small, however, noticable improvements in all component of EQ5D Scale. The strengths of EQ5D questionnaire lie in its simplicity and moreover it is available in several languages