Record based analysis of indications and complications of 500 cases of lower segment cesarean sections at a tertiary care hospital

Background: The drastically increasing rate of caesarean section is a topic of constant worry and analysis throughout the world. In order to understand the degree to which caesarean section may be preventable, it is important to know why caesarean section are performed. This study is aimed to find out the rate of caesarean section at our institute, various indications of the procedure and complications related to them.Methods: This study was carried out retrospectively in the department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal. Study period was from January 2017 to December 2017. 500 cases of lower segment cesarean section were studied including both elective and emergency caesarean sections. Statistical analysis of age, parity, period of gestation, indications of LSCS and complications was done.Results: The rate of caesarean section came out to be 47.7%, which is far above recommended. Majority of patients (81.6%) were in 21-30 years age group; while the number of primary and repeat caesarean section were comparable (40.8% and 59.2%respectively). Commonest indication was previous LSCS (31.6%) followed by fetal distress (21.6%). Surgical site infection was present in 4.6% cases whereas, post-partum hemorrhage occurred in 5.8% cases. Three patients underwent obstetric hysterectomy and two cases of maternal mortality were reported among post LSCS patients.Conclusions: Increasing rates of caesarean section has contributed to maternal morbidity along with financial burden. Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit rate of caesarean section

Gestational trophoblastic disease: a profile of 37 cases

Background: Objective of current study was to study the demographic details, pattern of presentation and response to the treatment in the patients presenting with Gestational Trophoblastic Disease (GTD).Methods: The present study was conducted in a tertiary teaching institute as a retrospective plus prospective study over a period of 5 years from August 2004 to August 2009. Total 37 cases were studied out of which 16 were studied retrospectively from the case record and 21 were studied prospectively. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy and the treatment received.Results: 37 cases of gestational trophoblastic disease were studied in a period of 5 years from August 2004 to August 2009. The incidence of gestational trophoblastic disease was 1in 600 deliveries with the mean age of patients being 26.9 years. Most common chief complaint at presentation was bleeding per vaginum after a period of amenorrhoea seen in 31 patients (84%) followed by hyperemesis seen in 8 (19%) patients. Out of 37 patients 29 (78%) had complete mole & 8 (22%) had partial mole, the ratio of being 3.6:1. Complete cure rate in present study was seen in 31 out of 37 (84%) patients and mortality was seen in 2.7%.Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. This is a highly curable tumor even in the presence of distant metastasis

Unforseen threats to perinatal health in COVID-19 pandemic

Aims & Objective: Antenatal care (ANC) is a fundamental component of routine maternal and child health services. After the onset of the COVID-19 pandemic, most countries have diverted their public health infrastructure to combating the novel coronavirus. Although mortality rates for COVID-19 appear to be low in children and in women of reproductive age4 these groups might be disproportionately affected by the disruption of routine health services, particularly in low-income and middle-income countries (LMICs). With this in mind, we sought to quantify the potential indirect effects of the COVID-19 pandemic on maternal health. Material and Methods: The present study was conducted in the Department of Obstetrics and Gynecology at our tertiary care center for a period of 6 months from May 1, 2020, to October 30, 2020. The number of admissions, deliveries, high-risk women, and referrals was assessed. These data were compared with those from routine pre-COVID-19 days, May 1, 2019, to October 30, 2019.Results: A fall in admissions of about 36.66% was seen during the pandemic time. It was observed that there was an increase in the number of high-risk pregnancies by 13.2 percentage points in the pandemic as compared to previous. The decrease and irregularity in the antenatal check-ups and follow-ups of women were reflected in terms of increase in the maternal mortality, stillbirths and rise in the number of low-birth-weight babies. Conclusion: Intelligent use of technology and triaging based on maternal weeks of gestations and high-risk factors may help in combating our health care system in dealing with unforeseen consequences of pandemic on maternal and child health

Vaginal vault carcinoma as second primary in a treated case of ovarian cancer

With the advances in the treatment of cancer, the chances of survival have increased today. The five-year relative survival rate is about 66%. With the increasing survival rate, it is important to identify the late effects of cancer and its therapy. One of the most serious events experienced by cancer survivors is the diagnosis of a new cancer. Case: A 32-year-old unmarried female diagnosed as ovarian cancer in the year 2010. She was treated with three cycles of chemotherapy followed by surgery. Histopathology was well-differentiated adenocarcinoma. She received three more cycles of chemotherapy after surgery. She was under follow-up and developed vaginal vault carcinoma after a disease-free interval of 2 years. The biopsy was suggestive of squamous cell carcinoma. She was treated with radiation for vaginal cancer successfully. This case indicates that female gynecological cancers with different histology may occur in minimum period of interval even in the absence of any predisposing factors like human papilloma virus infection

Gestational trophoblastic neoplasia: A 6 year retrospective study

Aims and Objectives: To study the clinical presentations of gestational trophoblastic neoplasia and its response to chemotherapy. Materials and Methods: This is a retrospective study of 28 women of gestational trophoblastic neoplasia evaluated over a period of 6 years from January 2004 to December 2009. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy, and the treatment received. All patients were scored on the basis of WHO scoring system. Patients with low risk (score /=7) received multiple agent chemotherapy with EMACO regimen. After completion of chemotherapy patients were followed for a minimum of 2 years. The response to treatment was evaluated during follow-up by clinical examination, beta hCG levels and imaging as and when required. Results: Out of 28 women only 27 could be evaluated, because 1 patient was lost to follow-up. Out of 27 patients, 18 patients (66.67%) achieved complete remission with the first-line chemotherapy and additional 25.92% (7/27) achieved complete remission with second line chemotherapy resulting in complete remission of 92.5% (25/27). Conclusion: Gestational trophoblastic neoplasia is curable if patient is properly evaluated and scored. It shows good response to chemotherapy

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous