Obstetric hysterectomy: aretrospective study at a tertiary care centre

Background: To analyzethe cases of Obstetric Hysterectomy in view to evaluate the incidence, indication, maternal risk factors and complications associated with the surgery.Methods: Retrospective Observational analytical study of cases of obstetric hysterectomy performed at Obstetrics and Gynecology department of People’s Medical College and Research Centre, Bhanpur, Bhopal over a period of seven years was done. Evaluation of Maternal age, parity, gestational age, indication for hysterectomy, the type of operation performed, blood loss, blood transfused, complications, and hospitalization period was done.Results: The overall incidence of Obstetric hysterectomy in our study was found to be 0.33%, with a maximum number of patients 7 (33%) inthe age groupof 26-30 yrs.Patients who were para 3 or more were -12 (63%). The causes for an obstetric hysterectomy werePPH – 12 (63%); placenta previa – 5 (26%); ruptured uterus – 4 (21%). 9(47%) patients had a history of previous caesarean section. Out of the 19 hysterectomies performed, 12(63%) were total hysterectomy and 7(37%) were subtotal hysterectomy. Fever was the commonest complication 7(37%). There were two maternal deaths.Conclusions: Obstetric hysterectomy is a lifesaving procedure. The outcome depends on timely decision, good clinical judgement and professional surgical technique. It reduces maternal morbidity and mortality

Thyroid function in women with polycystic ovary syndrome

Background: This study aimed to assess the serum thyroid stimulating hormone (TSH) levels in women with polycystic ovary syndrome (PCOS), and its variation with obesity, insulin resistance and LH:FSH ratio.Methods: This was a facility based cross sectional study conducted for a period of 18 months on a total of 165 females with PCOS diagnosed based on Rotterdam 2003 criteria. A thorough history and clinical and anthropometric examination was conducted for all females. USG abdomen and serum TSH levels and fT4 were also done and the findings were recorded on questionnaire.Results: Subclinical hypothyroidism was documented in 17% females with PCOS. No statistically significant difference in mean values of LH:FSH ratio, insulin resistance, and obesity parameters were noted among euthyroid and subclinical hypothyroid females with PCOS (p>0.05). TSH levels in present study showed a statsitcally significant positive correlation with BMI.Conclusions: The proportions of thyroid disorders are higher in females with PCOS and they both may present with various similar clinical features. BMI in females with PCOS has significant positive correlation with TSH levels. However, it is not clear whether thyroid dysfunction has significant effect on insulin resistance

Internal iliac artery ligation to combat post partum haemorrhage: an institutional review of case series

Background: Internal iliac artery supplies the pelvic viscera. IIAL is a valuable surgical procedure to control intractable pelvic haemorrhage with the mainstay aim of uterus preservation. There is a reduction of 85% in pulse pressure and 48% in the blood flow in the arteries distal after internal iliac artery ligation. Thus, the expertise to perform IIAL should be present in armamentarium of every obstetrician and gynaecologist.Methods: Retrospective review of 22 cases who have undergone IIAL or Peripartum hysterectomy for management of Post- Partum haemorrhage in the study period of January 2012 till December 2015 in the Department of Obstetrics and Gynaecology of People’s College of Medical Science and Research Centre, Bhopal.Results: Internal iliac artery ligation was performed in 53% out of which 31.8%% was for placenta previa, 4.54% for adherent placenta, 9.1% IIAL for Atonic PPH. Whereas peripartum hysterectomy was performed in 38% cases out of which 13.6% had perforation of uterus. 9% underwent hysterectomy as well as IIAL. Blood loss more than two 2 liters within period of 60-90mins was effectively and dramatically controlled with IIAL. Thus, maternal mortality reduced while preserving fertility. Control of Pelvic hemorrhage was achieved in 100% of cases.Conclusions: Bilateral ligation of the internal iliac arteries is a safe, rapid and very effective method of controlling bleeding from UTERUS and genital tract. It plays a major role in safe guarding the patient from undergoing life threatening consequences due to pelvic haemorrhage

Audit of caesarean section for non-progress of labor

Background: There is alarming increase in the number of caesarean section in the recent past years and many of the indications are due to non-progress of labor. The aim of the present study is to evaluate various parameters and associated factors responsible for non-progress of labor and to study the neonatal outcome.Methods: Retrospective analysis of 42 emergency cases leading into caesarean section for non-progress of labor was done. Factors like age, parity, gestational age, duration of prolong labor, maternal and neonatal outcome was analyzed.Results: In our study mean age of the women who underwent caesarean section for non-progress of labor was 25 years±2.26. When the duration of labor was analyzed, maximum cases i.e. 60% non-progress of labor is seen in active phase, 30% cases had prolonged latent phase of labor, arrest of descent in 10% .There were 14 babies who were shifted to NICU, out of them 10 babies had Apgar score <7. Average baby weight was 2689grams±446.60. Median range of birth weight was 2800 grams.Conclusions: Maximum cases 60% were in active phase, 10% with non-progress in second stage of labor. Out of total cases, 33% of newborns had NICU admission, out of them 16% had poor Apgar score but rate of NICU admission due to non-progress of labor remained same. Hence early decision making in caesarean section will help in preventing neonatal complication. There was no neonatal mortality observed in the study

A study to identify clinical and laboratory parameters in cases of excessive vomiting in early pregnancy

Background: Around half of all pregnant women experience vomiting, and more than 80% of women experience nausea in the first 12 weeks. Women with severe nausea and vomiting during pregnancy may have hyperemesis gravidarum (HG), an entity distinct from nausea and vomiting of pregnancy (NVP), which if left untreated may lead to significant maternal and foetal morbidity. In our study, we studied, clinical and laboratory parameters in patients presenting with excessive vomiting. The study may help in evaluating what is the major clinical problem encountered during treatment and how many days of care are needed in such cases.Methods: The study design was a prospective observational study. Patients attending the ANC clinic and emergency indoor cases at Peoples college of medical sciences, Bhopal were considered as study population. 100 patients who satisfied inclusion and exclusion criteria were included in the study. Patient’s sociodemographic variables, detailed obstetric history, clinical and laboratory parameters were recorded. Results obtained were analysed and tabulated.Results: Persistence of vomiting in the first trimester leading to dehydration and hospitalization was documented in 12% of patients. The 5% of then had metabolic acidosis and 1% required correction of starvation ketoacidosis, but there was not significant weight loss observed in any of the case. Liver function test were normal in almost in all cases except 9% had raised serum alkaline phosphatase levels.Conclusions: All cases with vomiting in early pregnancy should receive attention and exclusion of all emergency clinical conditions. Patient should be screened for urine tract infection and diabetes in all cases.

Correlation of platelet indices with severity of pre-eclampsia: a prospective study from central India

Background: Although it is generally accepted that the haemoglobin concentration decreases and white cell count increases during normal pregnancy, there is less accord regarding changes in platelet indices. Present study was performed to know the relation of platelet indices with normal pregnancy, preeclampsia and severity of pre-eclampsia.Methods: Hundred pregnant women were studied at Department of Obstetrics and Gynaecology, PCMS and RC, Bhopal after dividing them in two Group N (n=50, normal pregnant women) and Group P (n = 50, pre-eclampsia patient). Platelet indices including platelet count mean platelet volume and platelet distribution width were estimated in all the patients. Data were analyzed using IBM SPSS ver. 20 software. Level of significance was assessed at 5%.Results: In Group P [34 (68%)] and Group N [21 (42%)] most of the patients had platelet count of <2 lac respectively. Whereas Group P, 16 (32%) patients had thrombocytopenia (platelet count between 50-1.5 lac) where as in Group N, none of the patients had lower platelet count. Most of the patients (55%) in study cohort had PDW of 15 fl out of that half of the patients in Group N had PWD as 15 fl whereas in Group P 60% had PDW value as 15 fl. Out of 50 preeclampsia patients 24 (48%) were of severe type, out of which 54% had platelet count <1.5 lac, 83% had PDW as 15-16fl, and 54% had MPV in the range of 10-11 fl.Conclusions: Platelet count decreases while MPV and PDW increase as pregnancy advances, and these changes are more pronounced in preeclampsia than normotensive pregnancy

Factors affecting post-operative wound gaping and their outcome in obstetrical and gynecological abdominal surgeries

Background: Postoperative wound gaping is a very traumatic event both for patient and treating doctor as it adds economical and psychological burden to the patient and the family. This study was conducted with the aim to find out the various factors affecting postoperative wound gaping and their outcome in obstetrical and gynecological abdominal surgeries.Methods: This Retrospective observational study was carried out in the Department of Obstetrics and Gynecology at Peoples College of medical sciences and research Centre, Bhopal, India from 1st May 2014 to 31st October 2015.Results: A total of 1310 patients underwent major obstetrical and gynecological abdominal surgeries, out of which 29 cases developed postoperative wound gaping with the percentage being 2.2%. The rate was found to be higher among the emergency obstetric case (51.7%). Associated risk factors being anemia (72%), obesity (65%), hypoproteinemia (62%) and diabetes (52%) among gynecological surgeries and prolonged rupture of membranes (53%), emergency LSCS and previous LSCS (47%) among the obstetric cases. The common causative organism was found to be E. coli (28.5%) followed by acinetobacter and pseudomonas.Conclusions: Anemia, obesity, hypoproteinemia, diabetes, history of previous surgeries, emergency operations are the high risk factors for wound gaping in both obstetrics and gynecology surgeries. Correction of anemia, diabetes preoperatively, high protein diet and prevention of other risk factors like avoiding prolonged labor, use potent antibiotics in cases of rupture of membrane, timely intervention, provide well equipped wards with clean environment would be rewarding for better outcome of the surgery

Audit of caesarean section for non-progress of labor

Background: There is alarming increase in the number of caesarean section in the recent past years and many of the indications are due to non-progress of labor. The aim of the present study is to evaluate various parameters and associated factors responsible for non-progress of labor and to study the neonatal outcome.Methods: Retrospective analysis of 42 emergency cases leading into caesarean section for non-progress of labor was done. Factors like age, parity, gestational age, duration of prolong labor, maternal and neonatal outcome was analyzed.Results: In our study mean age of the women who underwent caesarean section for non-progress of labor was 25 years±2.26. When the duration of labor was analyzed, maximum cases i.e. 60% non-progress of labor is seen in active phase, 30% cases had prolonged latent phase of labor, arrest of descent in 10% .There were 14 babies who were shifted to NICU, out of them 10 babies had Apgar score &lt;7. Average baby weight was 2689grams±446.60. Median range of birth weight was 2800 grams.Conclusions: Maximum cases 60% were in active phase, 10% with non-progress in second stage of labor. Out of total cases, 33% of newborns had NICU admission, out of them 16% had poor Apgar score but rate of NICU admission due to non-progress of labor remained same. Hence early decision making in caesarean section will help in preventing neonatal complication. There was no neonatal mortality observed in the study

Acute Encephalitis with Atypical Presentation of Rubella in Family Cluster, India

We report 3 atypical rubella cases in a family cluster in India. The index case-patient showed only mild febrile illness, whereas the other 2 patients showed acute encephalitis and died of the disease. We confirmed rubella in the index and third cases using next-generation sequencing and IgM