Tubal choriocarcinoma: a rare entity

Choriocarcinoma is common after molar pregnancy and follows in almost 50% of such pregnancies, but in some rare cases it follows even after an ectopic pregnancy. Tubal choricarcinoma associated with an ectopic pregnancy has an aggressive course but it is curable

Obstetric hysterectomy: a surgical emergency 3 years review in a tertiary care centre

Background: Obstetric haemorrhage is a life threatening complication associated with increased maternal morbidity and mortality. Its incidence is 0.2-4 per 1000 deliveries in developed countries and much higher in developing countries. The main cause still remains rupture uterus, postpartum hemorrhage (PPH) and placenta accreta spectrum (PAS).Methods: A retrospective analysis of obstetric hysterectomies performed over a period of 3 years from July 2017 to June 2020 was done. Incidence, risk factors, indication, outcome and complications of obstetric hysterectomies were evaluated.Results: A total 72 cases of obstetric hysterectomy were performed over 3 years period. Out of 72 cases, 33%, 28% and 14% cases were of peripartum hysterectomy done due to rupture uterus, PAS and PPH respectively. There was an increase in the incidence of PAS compared to previous years. There was no observed difference among patients undergoing total or subtotal hysterectomies. No difference as regard to duration of surgery, pre-operative or post-operative hemoglobin, IV fluid and blood product transfusion was noted among elective and emergency procedures. Statistically significant blood loss was observed in emergency hysterectomy compared to elective hysterectomy with p value of 0.004. An average need of transfusions was double in case of peripartum hysterectomy done for PPH compared to rupture uterus or adherent placenta. Bladder injury, burst abdomen and resuturing were three important morbidities. Maternal mortality was 2.8% in our study population.Conclusions: Emergency obstetric hysterectomy still remains a live saving procedure in case of catastrophic intractable hemorrhage and rupture uterus. Proper antenatal supervision, identification of risk factors and timely referral can reduce the incidence of associated morbidity and mortality

Effect of intrauterine copper device on cervical cytology and its comparison with other contraceptive methods

Background: The intrauterine device (IUD) is the most commonly used reversible family planning method all over the world .The risk of cervical neoplasia associated with use of an intrauterine device (IUD), specially the copper releasing one, has been an important concern. The aim and objectives of the study was to determine safety of copper IUCD with regard to changes in cervical cytology and to compare the changes with other methods of temporary contraception.Methods: This was a prospective study carried out at a tertiary care institute for a period of 3 years. A total of 200 women of age group 18-40 years were included. 100 subjects who opted Cu-T 380A IUD were compared with 100 controls that had either opted other mode of temporary contraception like barrier, injectable, oral or did not use any method. Detailed history and examination of all subjects were done. All the women were subjected to conventional Pap smear and were followed at 6 months of interval for 1 year and then yearly up to 3 years. In each visit thorough pelvic examination was done and PAP smears were taken.Results: Among women using IUCD, 67.7% showed normal cytology as compared to 72.0% of the controls. On follow up, the incidence of normal cytology decreased (40%) with increased duration of use (up to 3 years). Incidence of inflammatory smear though first decreased up to 1 year (21.8%) but then gradually increased up to 2 years (37.0%) of use and then again decreased to 20.0% up to 3 years of use. ASCUS was found in only one case that used the device up to 2 years of use. LSIL was detected in 2 cases (20%) using IUD up to 3 years. No case of high grade intraepithelial lesion (HSIL) or invasive cancer was seen.Conclusions: There was no significant risk of cervical dysplasia or invasive carcinoma in IUCD users up to 2 years of use while other contraceptives (except barrier one) showed increased incidence of mild dysplasia (LSIL) after 1 year of use. Though risk of cervical malignancy is less with intrauterine copper devices, regular follow up should be done in long term users

Analysis of caesarean section rate according to Robson’s criteria in tertiary care centre

Background: Caesarean Section (C.S.) delivery rate is steadily increasing worldwide, including India. It is difficult to determine the optimum categorisation of C.S. Robson system is most widely accepted classification worldwide. The objective of the present study is to analyze the incidence of deliveries and caesarean section rate according to Robson’s criteria at SRMS-IMS, Bareilly, Uttar Pradesh.Methods: The record of total women admitted in labour unit from June 2017 to May 2018 were analyzed based on their age, parity, gestation age, mode of delivery and group they belong according to Robson’s classification.Results: Among 2560 women who delivered during the study period, 1030(40.23%) had caesarean section. Out of the total caesarean section 55.15% had primary caesarean section while repeat section were done in 44.85%. The most frequent indication for primary caesarean were fetal compromise and failure to progress while for repeat caesarean scar tenderness was the frequent indication. Robson’s group V had maximum caesarean section rate followed by group I. Breech presentation contributed to 11.55% to overall caesarean sections.Conclusions: In present study group V, I, II were found to be major contributors to overall caesarean section rates. Modifiable factor for reducing caesarean rate would be to improve successful induction of labour which would decrease primary caesarean rate hence the chance of repeat section

Prevalence of vitamin D deficiency in postmenopausal women and its association with fasting blood sugar

Background: Vitamin D is indispensable for human body as it caters for both skeletal as well as extra-skeletal needs, especially in postmenopausal women. Aim of this study was to know the prevalence of vitamin D deficiency among apparent healthy postmenopausal women and to find its association with fasting blood sugar.Methods: This was a cross-sectional observational study of postmenopausal women attending Gynae OPD of Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly, over a period of six months. Apparently healthy postmenopausal women were selected after satisfying inclusion-exclusion criteria and were subjected to fasting blood sugar and serum 25-hydroxy-vitamin D level. They were categorized as vitamin D deficient, insufficient or sufficient according to corresponding levels of 30ng/ml respectively. Upper reference level for fasting blood sugar was taken as 110mg/dl. Statistical analysis was done to see the association between vitamin D deficiency and fasting blood sugar.Results: Mean age of study group was 56.9 years and the average age of attainment of menopause was 50.3 years. Prevalence of vitamin D deficiency (57.4%) including insufficiency (13%) among postmenopausal women was high 70.4%, but there was no association between hypovitaminosis D and fasting blood sugar (p=0.949).Conclusions: Despite high prevalence of vitamin D deficiency among Indian postmenopausal women, there is no correlation between it and fasting blood sugar

Caesarean scar endometriosis: a rare site of extrapelvic endometriosis

Scar endometriosis is a rare presentation of extrapelvic endometriosis. A caesarean section scar is the most common site. The typical clinical presentation is that of a palpable firm subcutaneous nodule near surgical scars associated with cyclic pain and swelling during menses. It is often misdiagnosed with other abdominal wall and scar related pathological conditions. Diagnosis is mainly based upon a high index of suspicion. USG with color Doppler can clinch the diagnosis in patients with typical clinical features. FNAC may be inconclusive. MRI is the most sensitive but expensive modality to make the diagnosis. Wide local excision is the treatment of choice. We report a case of caesarean scar endometriosis and discuss about incidence, pathophysiology, diagnosis and treatment of this condition

Severe acute maternal morbidity: study of epidemiology and risk factors

Background: For last decade, severe acute maternal morbidity (SAMM) has emerged as a promising alternative to maternal mortality reviews. Maternal mortality may represent the tip of iceberg whose large base is formed by SAMM. The objective was to study the cases of critically ill obstetric i.e. pregnant and puerperal patients requiring intensive care due to severe acute maternal morbidity (near miss cases) and to analyze the common preventable risk factors associated with them.             Methods: This is a retrospective cohort study of women admitted during pregnancy or within 6 weeks postpartum, to multidisciplinary intensive care unit (ICU) of a tertiary-care teaching hospital, Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP, India, from April 2013 to April 2016. The data was collected pertaining to demographics, obstetric history, any pre-existing medical illness, reasons for admission to ICU, treatment given and their outcome in terms of maternal morbidity and mortality.Results: The study found the prevalence of SAMM to be 1.87%. The average age of admission was 26.6 years and most were primigravidas (42%), unbooked (97%) coming from rural areas (75%). The most common obstetric cause of ICU admission was hypertensive disorders of pregnancy and the most common non-obstetric cause was sepsis. Maternal mortality index was 25.8% and fetal mortality rate was 257 per 1000 births among SAMM cases.Conclusions: Study of risk factors associated with SAMM can provide important contributions to improve quality of available health care system in order to achieve reduction in maternal mortality

Unzipping flood vulnerability and functionality loss:tale of struggle for existence of riparian buildings

Floods pose significant risk to riparian buildings as evidenced during many historical events. Although structural resilience to tsunami flooding is well studied in the literature, high-velocity and debris-laden floods in steep terrains are not considered adequately so far. Historical floods in steep terrains necessitate the need for flood vulnerability analysis of buildings. To this end, we report vulnerability of riparian-reinforced concrete buildings using forensic damage interpretations and empirical/analytical vulnerability analyses. Furthermore, we propose the concept and implications of functionality loss due to flooding in residential reinforced concrete (RC) buildings using empirical data. Fragility functions using inundation depth and momentum flux are presented for RC buildings considering a recent flooding event in Nepal. The results show that flow velocity and sediment load, rather than hydrostatic load, govern the damages in riparian RC buildings. However, at larger inundation depth, hydrostatic force alone may collapse some of the RC buildings