A case report: venous sinus thrombosis in pregnancy

Venous sinus thrombosis (VST) should be considered in the differential diagnosis of all unexplained central nervous system disorders of sudden onset. Etiological factors are subclinical forms of several common thrombophilic states occurring together, rather than the typical inherited and rare causes. Diagnosis is often missed because of the heterogeneity in clinical presentation and radiological investigation is essential for the diagnosis. Prognosis depends on the early detection. By correcting the cause, the complications can be prevented

Study of adequacy of informed consent in caesarean section in a tertiary care, teaching and research institute of Northern India

Background: Informed consent consists of availing information to the patient in an understandable manner without coercion to allow the patient to make an informed decision about their healthcare. In the case of caesarean section, information must include name, nature, proposed benefits of the procedure, risks of the procedure, alternative procedures, implications on the future reproductive health and anesthetic options. Aim and objective: To study the adequacy of informed consent in patients who undergo caesarean section at PT. B. D. Sharma, PGIMS, Rohtak.Methods: It was a cross sectional study. The study population was the group of patients who underwent emergency or elective caesarean section at PGIMS, Rohtak. A pretested questionnaire was adopted from a study carried out at School of Medicine, University of Zambia and was administered to the patients.Results: It was found that majority of the patients were in the age group of 21-30 years and most of them (71%) were from the rural areas. In 90% of the cases the outcome of caesarean section was term live births and majority of them (84%) were emergency caesarean section. The patients were asked fourteen questions regarding various aspects of informed consent based on the five point Likert scale.Conclusions: Majority of the caesarean sections were performed due to some emergency indications. It was found that overall patients were well informed about the procedure and the related consequences.

Pregnancy with third degree uterine prolapse: a rare case report

Occurrence of prolapse of uterus during pregnancy is an extremely rare event. Less than 300 cases have been reported in the literature till date. Incidence of uterine prolapse in pregnancy is 1 in 10,000-15,000 deliveries worldwide. A 35 year old G5P3L1A1 with history of five months amenorrhea was referred to our hospital in view of uterine prolapse. On enquiring she gave history of something coming out of vagina since one month. On local examination, third degree uterovaginal prolapse with cord prolapse seen. Patient went into labour spontaneously and expelled an abortus. She was discharged next day with advice regarding follow up visit after six weeks. Uterine prolapse during pregnancy is a rare occurrence which increases both maternal and fetal morbidity. There are many etiological factors which have been cited to be responsible for this condition, important ones are: Multiparity, vaginal delivery, advanced maternal age, increased body mass index. Elective caesarean section can be planned in cases with edematous and elongated cervix. Individualized approach and careful monitoring is the key to manage such patients. Uterine prolapse during pregnancy is a rare event. While managing such patients, an obstetrician should keep in mind threats of spontaneous abortion, preterm labour, cervical dystocia, etc

Study of pattern of nosocomial infections among post-operative patients following obstetrical and gynaecological surgeries in a tertiary care institute of northern India

Background: Hospital acquired infections (HAIs) are the major causes of morbidity and mortality, functional disability and financial burden among the patients admitted in hospitals. The nosocomial infection has thrown a big challenge to the health sector in both the developing and developed countries; therefore, it is important to put in place surveillance system for monitoring its incidence rate and planning early interventions for its prevention. The aim and objective of the study was to study the socio demographic profile of the patients who underwent Obstetrical and Gynecological surgeries and to identify the risk factors and causative organisms associated with the post-operative nosocomial infection and pattern of antibiotics sensitivity.Methods: It was a record based retrospective study carried out in a tertiary care referral institute. The case files of all post-operative patients from January 2015 to July 2015 were retrieved from the Medical Record department and an extensive analysis was carried out.Results: It was found that majority of the patients (75%) with nosocomial infection were in the age group of 20-35 years and all were married. Most of them (72%) were from the rural background. It was observed that around 9% patients reported nosocomial infection after emergency laparotomy procedure as compared to 8% of patients after elective procedure.Conclusions: In this study it was found that surgical site infection (SSI) was most common nosocomial infection followed by Urinary tract infection. The majority of surgical site infections can be prevented by the preoperative, intraoperative and postoperative phases of care

Potter’s syndrome: a case report

Potter’s syndrome is a rare congenital disorder characterized by characteristic atypical appearance of a newborn due to the oligohydroamnios experienced during the intrauterine life. Its incidence varies from 1 in 2000 to 1 in 5000. 40 years old G7P4L1 A2 at 37 weeks of period of gestation was admitted at a tertiary care institute with labour pains. Her previous obstetric history included three full term vaginal deliveries, two of the babies expired in postnatal period of 2 months and 7 days age respectively. One was alive and healthy. In fourth pregnancy she underwent emergency LSCS, but baby expired 5 months after birth. She had history of 2 abortions which were spontaneous and not followed by curettage. She also gave history of intake of some drugs at 6th week of gestation prescribed by a local Baba to have a male child. Her ultrasonography revealed fetus with bilateral renal agenesis. On per abdomen examination, clinically liquor was very much reduced, Fetal heart sounds were not heard. She delivered vaginally a still born fetus with ambiguous genitalia, anal atresia and malformed limbs. The fetus had typical facial appearance of “potter facies”. Potter’s Syndrome or Sequence is a rare fatal disorder. Apart from typical Potter’s facies, pulmonary hypoplasia, skeletal deformities are associated with this condition, severity depends on the degree and duration of oligohydramnios. Therefore, it is very important to pick up this condition during antenatal ultrasound at earlier gestation so that timely decision regarding further workup and pregnancy termination can be undertaken. This case report emphasizes upon the importance of regular antenatal check ups and examination in each and every patient as it picks up the suspicious cases which can lead to further workup, definite diagnosis of the condition and timely decision regarding management

Bladder hematoma as an unusual cause or consequence of obstructed labour

Bladder hematoma is a rare complication but also an unusual mechanical cause of obstructed labour, whose incidence in India is 1-2%. The most common reason for intraluminal urinary bladder hematoma is trauma, but it can occur with cystitis, pelvic malignancy and irradiation. A large hematoma may mimic a neoplastic mass on imaging. We reported a first case of bladder hematoma as a cause or result of obstructed labour in a multipara where the diagnosis was made intraoperatively. This bladder complication also became the indication for classical caesarean section, the technique which is almost obsolete nowadays, where the indication for classical caesarean section was obligatory

A retrospective analysis of ectopic pregnancy at a tertiary care centre: one year study

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality especially in developing countries where the majority of patients present late with rupture and hemodynamic compromise. The aim of this study was to determine the risk factors, clinical profile of the patients and management options for ruptured ectopic pregnancies.Methods: We conducted a retrospective study about ectopic pregnancy at obstetrics and gynaecology department over a period of one year, from 01 January 2015 to 31 December 2015. Information on the biosocial data, clinical symptoms and signs, risk factors for the disease, site of ectopic pregnancy and treatment options, quantity of hemoperitoneum and need for blood transfusion was extracted. The data was analyzed and presented in frequency tables and charts.Results: Frequency of ectopic pregnancy was 1.6% of total 10235 deliveries. 131 (89.1%) cases were of ruptured ectopic pregnancy. 147 patients underwent laparotomy while 22 patients were managed conservatively. All patients were symptomatic at presentation. Majority (86, 50.8%) of the patients were in the age group of 20-24 years. 33 (19.5%) patients were nulliparous. Risk factors were found in 86 (50.8%) patients. Majority (38, 44.1%) had history of previous tubal surgery (tubal sterilization and/or recanalisation) as risk factor. The highest number of ruptured ectopic occurred between 7-12 weeks of gestation. Most common surgical procedure employed was salpingectomy in 140 (95.2%) patients.  There was no maternal mortality due to ectopic pregnancy.Conclusions: Ectopic pregnancy is still a major life threatening emergency condition which if treated early has good prognosis. Most cases present late making tubal conservation inapplicable. Efforts should be made towards woman education, improved hospital accessibility and better diagnostic skills

Sociodemographic profiling and study of maternal and perinatal outcome in patients suffering from eclampsia

Background: Eclampsia is defined as the occurrence of convulsions, not caused by any coincidental neurological disease such as Epilepsy, in a woman whose condition also meets the criteria for preeclampsia. The incidence is about 1:1600 pregnancies. Eclampsia is an acute obstetric emergency and quick treatment and timely decision making is required to get the best maternal and fetal outcome. The aim and objectives of the study was to socio demographic profile of the patients admitted with eclampsia and maternal and perinatal outcome in patients with eclampsia.Methods: It was a record based retrospective study. The hospital files of patients admitted for the treatment of eclampsia during Oct 2012 to Dec 2013 were retrieved and were extensively studied. The data was entered in Microsoft excel and data base was created, appropriate statistical tests were applied and results were studied.Results: It was found that majority of patients (74%) belonged to age group of 21-30 years, were un booked (96%) and 65% belonged to rural areas. Sixty five percent (65%) of patients were admitted at less than 37 weeks of the gestational age and 67% of patients were primigravida. Majority of them had history of being normotensive. Majority of patients (62%) were delivered by Caesarean section.  Maternal mortality was found in six percent of the patients.  Conclusions: Eclampsia is a frightening complication of pregnancy. It is life threatening to mother and fetus, however early treatment and delivery improves maternal and perinatal outcome

A study of high-risk factors in ante-natal women at a tertiary care centre

Background: High-risk pregnancy refers to any condition in pregnancy that increases risk for morbidity or mortality in mother, fetus and neonate. Globally, nearly 5,29,000 women die due to pregnancy related complications. In India, 20-30% of the pregnant patients contribute to high risk group. This study was conducted to determine different high-risk factors prevalent in antenatal women in Haryana. Objective of this study was to find out prevalence of different high-risk factors in antenatal women.Methods: Data of all antenatal high-risk patients attending OPD during one year was taken from hospital record registers. Maternal characteristics such as age, gravida/parity, gestational age, and gestational age at the time of first visit were noted. High risk factors identified were noted.Results: The records of total 10073 antenatal women were analyzed, 1283 were included in the high-risk group. Most prevalent high-risk factors found were previous cesarean section (31.04%), anaemia (31.02%), malpresentation (12.93%) and thyroid disorders (13.09%).Conclusions: Antenatal surveillance for the high-risk factors complicating pregnancy may prevent or treat most of the complications. Authors should develop strategies for early screening of high-risk pregnancy cases to prevent maternal and perinatal mortality and to improve the maternal and perinatal outcome

A retrospective study of maternal and perinatal outcome in patients of postpartum haemorrhage in a tertiary care hospital

Background: Postpartum hemorrhage is one of the most important causes of maternal mortality and morbidity. Maternal Hemorrhage is the commonest cause of maternal mortality in India. Identification of risk factors, early diagnosis and timely intervention can help in reducing significant maternal morbidity and mortality due to post-partum hemorrhage. The aim and objectives of the study was to study socio-demographic profile of patients admitted with the diagnosis of post-partum Haemorrhage, to study the various risk factors and causes of post-partum Haemorrhage, to study maternal and perinatal outcome in patients suffering from post-partum haemorrhage.Methods: It was a record based retrospective study. Files of the patients admitted with diagnosis of postpartum haemorrhage from September 2014 to February 2015 were retrieved and detailed analysis was done regarding patients’ socio demographic characteristics, various risk factors, causes and maternal and perinatal outcome.Results: It was a record based retrospective study. It was found that majority (88%) of the patients belonged to age group of 21-30 years. Majority of them (59%) were from rural background. It was found that the commonest (26%) risk factor associated with postpartum hemorrhage in our study was prolonged labour, followed by ante partum hemorrhage (20%). It was found that the commonest (68%) underlying cause of postpartum hemorrhage was atonicity of uterus, followed by genital tract trauma (24%).Conclusions: Postpartum hemorrhage is one of the biggest menace in today’s times. It adds to significant maternal morbidity and mortality