A retrospective study of emergency obstetric hysterectomy in a tertiary care center for a period of 5 years

Background: The study was conducted to determine the frequency, demographic characteristics, indication and fetomaternal outcome associated with emergency obstetric hysterectomy in a tertiary care center.Methods: Thirty cases of emergency obstetric hysterectomy performed during the five-year period from April 2011 to April 2016 were analyzed in the dept. of Gynae and obs. in Shri Guru Ram Rai Institute of Medical Sciences in Dehradun.Results: During the study period there were 30 cases of obstetric hysterectomy out of 8084 deliveries giving an incidence of 0.37%. Majority of the patients (60%) were unbooked and were in the age group of 26-30 (43.3%). Common parity group were 3, 4 and 5. Morbid adherent placenta was the most common indication contributing to 40% of the cases. There were four maternal deaths in the study. All were unbooked and three of them died of hypovolemic shock with cardiopulmonary arrest and one died of septicemia. Whereas there were 60% perinatal mortality and 26.66% NICU admissions.Conclusions: Emergency obstetric hysterectomy is a potentially lifesaving procedure which often puts obstetrician in dilemma at the time of decision making

Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis, but definitive diagnosis is made only during surgery. Authors are reporting a case of 30 years female G3P1L1A1 seven weeks pregnancy with previous lower segment cesarean section and previous history of right sided salpingectomy with no complaints. Ultrasound was advised to know the location of sac this time, in which, she was diagnosed as a case right sided unruptured live ovarian ectopic pregnancy. On examination, signs and symptoms of ectopic pregnancy were absent. On laparoscopy, she was diagnosed as a case of right sided live unruptured broad ligament ectopic pregnancy as her right ovary was absent because of previous surgery.  With advances in sonography and laparoscopic skills, more cases can be diagnosed in the first trimester and can be safely managed laparoscopically.

Comparison of metformin and insulin in the treatment of gestational diabetes: a retrospective study

Background: As various data are available on treatment of gestational diabetes mellitus (GDM), our aim is to compare the effect of treatment of metformin, insulin and diet control in GDM on maternal and neonatal outcomes.Methods: A retrospective study was conducted and it includes 50 women of GDM treated with Metformin, 50 women with insulin and 50 with only diet control without any drug.Results: The outcome was not much different in all groups studied. Maternal outcomes were similar in all three groups. The difference was: post prandial glucose values after 2 hour of oral glucose were slightly high in the insulin group than in the metformin group (p <0.003). Neonatal outcome was also not different in all groups. But the incidence of neonatal hypoglycemia was higher in the insulin group (p = 0.03).Conclusions: The study suggests that metformin is effective for GDM and maternal or neonatal outcomes were similar as compared with insulin

Epidemiology of MTP in a tertiary care center over a period of 3 years

Background: Medical termination of pregnancy was legalized in India under the MTP act of 1971 which states that all the women can legally have an abortion up to 20 weeks of gestation if indicated. This study is a retrospective analysis of incidence, indication, the age group availing the facility, socio-demographic and obstetric profile of MTP seekers and the method of contraception followed after MTP.Methods: A retrospective 3-year data was analyzed by MTP register of the hospital as a reference.Results: The incidence rate of MTP is 96/1000 live births in the institute. The main reason for MTP is failure of contraception which highlights the unmet need of contraception and counselling. Majority of the age group availing MTP belonged to 16-20 years. Most of the women were   from urban slums, were illiterate and belonged to class IV and V according to Prasad’s classification. Mostly MTP seekers were parous, having ≥2 living children, and maximum no. of them went to private hospitals for their previous MTP. Medical method was the most favoured method of the care giver as well as of the patient. OCP was the choice of contraception after MTP. Religious difference is still very evident in availing   MTP services which can be minimized by tactful counselling. Conclusion: MTP act of 1971 opened new horizons for the unwanted pregnancies. Young population opting for MTP indicates the unmet need of contraception and counselling suggesting that implementation and integration of MTP services should be at the root level

Chromatographical Analysis of Amino Acids in Sepia Mutant of Drosophila melanogaster under Stress of Cypermethrin and Alphamethrin

Insects are invertebrates that are taxonomically referred to as the class Insecta. They are the most numerous and most widespread terrestrial taxon within the phylum Arthropoda, and indeed the most diverse group of animals on the earth, with around 925,000 species described—more than all other animal groups combined. Insects may be found in nearly all environments on the planet, although only a small number of species have adapted to life in the oceans where crustaceans tend to predominate instead. HPTLC is a method commonly applied for the identification, assay and the testing for purity, stability, dissolution or content uniformity of raw materials (herbal and animal extracts, fermentation mixtures, drugs and excipients) and formulated products (pharmaceuticals, cosmetics, nutrients). These flexible and cost-effective techniques present the advantage of the simultaneous processing of standards and samples with versatile detection possibilities, including a great variety of post-chromatographic derivatization reagents

Rh sensitized pregnancy with high ICT titre wit favourable foetal outcome: a rare case

Leiomyosarcoma Rhesus (Rh) isoimmunization is the development of maternal IgG antibodies against fetal Rh Red Blood Cell (RBC) antigens. Transplacental passage of maternal Rh antibody (IgG anti-D) may result in Hemolytic Disease of the Newborn (HDN), a condition characterized by hemolysis, severe fetal anemia and generalized fetal edema (hydrops fetalis). The severity of Rh hemolytic disease may be assessed in the Immunized patient by several different means which include: past obstetric history, maternal antibody titer, ultrasonography, amniotic fluid bilirubin quantification, and percutaneous umbilical blood sampling. A past history of fetal demise, hydrops fetalis, intrauterine transfusion or neonatal exchange transfusion implies that the present pregnancy is or will be severely affected because Rh disease effects on the fetus generally recur or present progressively earlier or more severely with each successive Rh positive pregnancy. We present here a rare case of Rh sensitized pregnancy with high ICT titre who had normal fetal outcome

A six year appraisal of caesarean delivery at a teaching hospital in Uttarakhand

Background: Caesarean section is one of the commonest surgical procedures worldwide. Its upward trend and its indications in low resource setting makes regular appraisal of the practice necessary.Methods: A retrospective study. Labour ward logbook and case records were looked into, and all information extracted.Results: The prevalence of caesarean section in the study population was 32.18%. The most common indication of caesarean section was previous caesarean section (33%) followed by fetal distress (26.2%).Conclusions: Risk appraisal and all efforts must be geared towards reducing caesarean section rate. Certain measures have been recommended.

Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun, India

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement

Factors associated with induced second trimester abortion at a tertiary level hospital of Uttarakhand region: a 6-year retrospective study

Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security