Twin pregnancies: incidence and outcomes in a tertiary health centre of Uttarakhand, India

Background: The frequency of twin pregnancies varies among different regions, countries and populations mostly due to the variation in dizygotic twinning. Twin pregnancy is associated with adverse maternal and fetal outcomes. This study was aimed to find out the frequency and outcome of twin pregnancies in a tertiary health centre of Uttarakhand.Methods: This is a retrospective hospital record-based study of the twin deliveries (with gestational age of 28 weeks and above) which took place in a tertiary health care centre of Uttarakhand from January 2016 to December 2017. Data regarding age, parity and registration status of women who delivered twins, factors associated with twin pregnancy, gestational age, fetal presentation, mode of delivery, pregnancy complications and neonatal outcome was collected and analyzed.Results: The frequency of twin pregnancy was found to be 1 in 52 pregnancies or 1.9%. Majority (56.4%) of the participants were in the age group of 21-25 years. 52.8% were multipara. 74.3% were unbooked. 3.7 % conceived after ovulation induction and 8.2% had family history of twins. Pre-term labour (58.3%) was the most common complication followed by malpresentation (around 37%). Cephalic-cephalic was the commonest fetal presentation (43.8%).58.3% neonates were premature at birth and 83.4% had low birth weight. Male-male was the commonest sex combination of twin pair (30.4%) followed by female-female (28.6%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with adverse maternal and fetal outcomes

COVID-19 and pregnancy outcomes: a retrospective study from a tertiary health care center of Uttarakhand, India

Background: Information regarding the effects of COVID-19 on pregnancy outcomes evolved rapidly in the recent years. This study aims to present the outcomes in COVID-19 positive pregnant women. Methods: This retrospective cohort study was conducted in a tertiary health care center of Uttarakhand, India from April 2021 to June 2021. The maternal and neonatal data for the included cases were extracted from hospital records and appropriately analysed. Results: The positivity rate of COVID-19 among obstetric population was 7.9% by universal screening protocol. 55.2% participants were in the age group of 25-30 years. Gestation age at presentation ranged from 6 weeks to 41 weeks. 47.3% participants had pre-existing comorbidities. 26.4% study subjects had pregnancy related comorbidities, the most common being gestational diabetes mellitus (14.7%), followed by pre-eclampsia (8.8%). Only 21.1% participants were symptomatic at presentation. Most common presenting symptom was fever (87.5%) followed by breathlessness (62.5%). 7.5% required invasive ventilation and 10.5% cases required intensive care unit (ICU) admission and 76.5% participants underwent caesarean section which was done for obstetric indications only. 3.9% participants died due to COVID-related complications. Nearly 35% neonates were preterm, 29.4% had low birth weight and 24.1% needed neonatal intensive care unit (NICU) admission. Nasopharyngeal swab for COVID reverse transcriptase-polymerase chain reaction (RT-PCR) after 24 hours of birth was negative in all neonates. There were 10 (14.7%) stillbirths. Conclusions: COVID-19 in pregnancy was associated with higher risks of gestational diabetes mellitus, preeclampsia and higher rates of invasive ventilation, ICU admission, caesarean sections, maternal mortality specially in women with pre-existing comorbidities, stillbirths, preterm births and NICU admission

A comparison of hysterosalpingography and laparoscopy in the evaluation of tubal factors in female infertility

Background: WHO defines infertility as “failure to conceive after having regular, unprotected intercourse for one year. Factors responsible - male factors (20-30%), female factors (40-55%), combined male and female factors (10-40%) and unexplained infertility (10-20%). Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. The aim of this study was to compare findings of HSG and diagnostic laparoscopy with chromopertubation for tubal patency in infertile women.Methods: An observational study, done on a total of 125 females suffering from primary and secondary infertility who underwent HSG and then 97 patients who gave consent, underwent diagnostic laparoscopy with chromopertubation. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.Results: Primary infertility cases were more than secondary infertility cases. Mean age of patients was found to be 28.92±5.33 years. Most common tubal abnormality found on hysterosalpingography and chromopertubation was bilateral tubal block. Inter rater kappa agreement used and significant agreement found between hysterosalpingography and chromopertubation with kappa value of 0.612.Conclusions: From this study authors conclude that HSG and laparoscopy with chromopertubation are complimentary to each other. Laparoscopy helps in identification of tubal and non-tubal factors like intra-abdominal and pelvic adhesions, endometriosis etc. and simultaneously they can be treated while HSG helps in evaluation of tubal factors as well as of intra-uterine factors like synechiae, polyps etc

Factors and outcome analysis of emergency peripartum hysterectomy in a tertiary care center catering to hilly terrain for a five-year period: a retrospective study

Background: Emergency peripartum hysterectomy (EPH) is a life-saving surgery associated with significant morbidity and mortality. In the state of Uttarakhand, due to the hilly terrain and poor ante-natal awareness, type 1 and 2 delay is expected in seeking health care. Thus, the present study was conducted in a tertiary care hospital to evaluate the incidence, risk factors, indications, and outcomes of EPH.Methods: Medical records of 63 patients who underwent EPH from January 2015 to December 2019 were retrospectively analyzed for the patient characteristics, high risk factors, indications and type of hysterectomy and outcome.Results: The incidence of EPH at our institute was 2.78 per 1000 deliveries. Most patients (89.89%) were referred cases. There were 4 home deliveries and 4 patients referred for obstructed labour.  The average parity was 2.71±1.13. Thirty-four patients (53.97%) presented in the emergency department in shock. The leading indication was uterine atony (46.03%) followed by rupture uterus (26.98%) and placenta accreta spectrum (23.81%). All patients needed blood transfusion. Intensive care unit admission was required in 88.89%. The maternal mortality was 15.87%.  All the three levels delays contributing to poor outcome were identified. Conclusions: Uterine atony and rupture of non-scarred uterus due to obstructed labour were the prominent indications of EPH. Strengthening of referral system and timely referral of high-risk patients to a setup with facilities for management of high risk obstetric cases can play an important role in decreasing the incidence and morbidity and mortality of EPH

Placental location and development of preeclampsia: a longitudinal study

Background: Preeclampsia is one of the leading causes of morbidity and mortality worldwide. A number of pregnant women suffer from it after 20 weeks of their pregnancy. The study was designed to know the association between location of placenta and the development of preeclampsia in pregnant women. the purpose of the study is to determine the incidence of lateral location of placenta and to study the relation between placental location and development of preeclampsia.Methods: A prospective study conducted on pregnant women who attended the antenatal clinic of SRHU Hospital over period of 12 months. The study was hospital based longitudinal study with a sample size of 100 cases presenting over a period of 12 months in Obstetrics and Gynecology Department. Simple Random Sampling was used for random selection of antenatal case at 18 to 24 weeks gestation with singleton pregnancy, after taking written consent and agreeing for follow-up till delivery.Results: Out of the total 100 cases taken for the study, there were 68 cases of lateral placenta and 32 cases of central placenta. Most of the cases belonged to middle class living in urban areas. The development of preeclampsia is mainly due to mineral deficiency and high systolic BP.Conclusions: In present study, 48.5% patients with lateral placenta and 46.9% with central placenta developed pre-eclampsia.  There was a significant association that was found between laterality of placenta and development of PIH. The laterally located placenta is associated with increased risk of developing preeclampsia. Therefore, looking for placental laterality at the time of a mandatory antenatal ultrasound scanning (level II) may serve as a non-invasive test to predict pre-eclampsia

Urogenital myiasis – An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient’s unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options

Sex Ratio at Birth and its Determinants: A Cross Sectional Hospital Based Study

Introduction: Sex ratio is used to reflect gender equity of the population. Sex ratio in India has shown an upward trend since Census 1991 but during the same period, child sex ratio (0-6 years) has shown a declining trend. Sex ratio at birth affects child sex ratio. This study was planned to determine the sex ratio at birth among deliveries conducted in a government tertiary care hospital of Kumaon region of Uttarakhand. Materials and Methods: A cross-sectional hospital based study conducted in tertiary care centre of Nainital district. Partcipants were selected using systematic random sampling. A pre-tested and pre-structured questionnaire was used to collect information. Data analysed using SPSS version 17 and is presented as numbers, percentages and ratios. Results: Sex ratio at birth was 852 girls to 1000 boys. The highest sex ratio of 1059 was found among the first birth order offsprings which declined to 897,654 and 619 as the birth order increased to second, third and fourth respectively. Sex ratio at birth in rural population was higher (953) than in urban (752). Sex ratio at birth among literate mothers was 857 and in illiterate mothers it was 829. Conclusion: Sex ratio at birth increased with advancing maternal age and literacy status of females whereas it decreased with increase in birth order and number of live females in the families

A rare case of genital myiasis in a woman with psychiatric disturbance

A middle-aged psychiatric woman was brought to the casualty by national health ambulance. The patient was a destitute and had psychiatric illness. Local examination revealed irreducible third-degree uterovaginal prolapse with necrotic ulcerated areas infested with maggots. The patient was managed conservatively with the removal of maggots with 100% turpentine oil, culture-sensitive antibiotics, and local antiseptics. With treatment, the prolapsed mass got free of maggots, the ulcerated areas healed, and prolapsed mass became reducible