Influence of Exteriorised versus Intra-abdominal Uterine Repair Caesarean Delivery under Spinal Anaesthesia on Intraoperative and Postoperative Complications

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair Group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version25. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group

Comparison of Attendance of Patients Pre-lockdown and during Lockdown in Gynaecology and Antenatal Outpatient Department in a Tertiary Care Hospital of Nadia, West Bengal, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has brought about a paramount change in the life. This has lead to a reduction in the number of routine patients visiting the Outpatient Department (OPD) of various hospitals and this department was no exception. Aim: To compare the attendance of patient in Antenatal Care (ANC) and Gynaecology Out Patient Department (GOPD) between pre-lockdown and lockdown period due to COVID-19 pandemic. Materials and Methods: The study was conducted among patients attending the OPD in ANC and Gynaecology for 70 days lockdown from 23rd March to 31st May and 70 days immediate pre-lockdown period from 12th January to 22nd March 2020. Daily attendance was noted and types of patient attending in different sub clinics in Gynaecology OPD compared. Enrolment of new ANC patient and old booked cases was compared during both periods. Descriptive statistics were used and displayed as percentages. Results: There was a significant reduction in number of patients attending OPD in lockdown period. There was a total of 6088 (87.3%) reduction in number of patients in Gynaecology OPD and 2235 (69.6%) reduction of patients in ANC OPD which was found to be significant with p-value <0.001. Reduction of patient in lockdown days among new ANC was 574 while it was 1661 in case of old patients. The different sub clinics of GOPD like infertility (704), endocrine (1450), uro-gynaecology (656), STD/ PID (732), postpartum (597), cancer detection (316), abortion and medical termination of pregnancy (MTP) (330), others (1303) also witnessed a diminution of attendance. Conclusion: COVID-19 caused a significant decrease in footfall of patients in outpatient department due to lockdown, though the percentage of types of patient attending Gynaecology OPD was almost same