A clinical review of obstetric hysterectomies done in medical college, Kottayam for a period of six years

Background: Obstetric/peripartum hysterectomy is a hysterectomy performed for any indication during pregnancy, labour or puerperium. It is important to know the general incidence, changing trends and indications of this surgery. The objective of the study is to find out the incidence of obstetric hysterectomy, type of obstetric hysterectomy done, indications of the procedure, maternal clinical profile, postoperative complications and the maternal and fetal outcome.Methods: A retrospective, descriptive case series study of all pregnant women who underwent hysterectomy in a six year period has been done.Results: 57 women underwent hysterectomy. The incidence of obstetric hysterectomy in this study is 0.17%. Mean age of the women was 30.3 years. Mean parity was two. 1.75% of cases were unbooked. 24.56% of cases underwent obstetric hysterectomy following vaginal delivery and 74.44% of cases had the procedure following abdominal route of delivery. 56.14% of cases underwent obstetric hysterectomy for postpartum hemorrhage, 36.84% underwent it for morbidly adherent placenta. 90.47% of morbidly adherent placenta had previous caesarean section as a major risk factor. 12.3% of mothers died postoperatively.Conclusions: By good obstetric practices, proper diagnosis of morbidly adherent placenta, bringing down the number of unnecessary caesarean section the incidence of this procedure can be brought down

Prevalence of menopausal symptoms and perceptions about menopause among postmenopausal women attending Gynaecology OPD at GMC Idukki, India

Background: Idukki is a hilly tract area in the state of Kerala. No studies regarding menopause has been reported from Idukki. This study is done among postmenopausal women in an attempt to shed light on the prevalence of menopausal symptoms and perceptions of postmenopausal women in a panchayat in Idukki district which is typically a rural area. Primary objectives of the study were to find the prevalence of menopausal symptoms in post-menopausal women attending the outpatient department of Government Medical College, Idukki, India and to find the perceptions about menopause among these post-menopausal women. Secondary objectives were to find the mean age and pattern of attainment of menopause among postmenopausal women and to find the treatment seeking behavior of the post-menopausal women residing in this area.Methods: A cross-sectional observational study is done among 100 postmenopausal women attending the outpatient department of Obstetrics and Gynaecology. Questions are asked based on interview schedule. The results are then analyzed.Results: The mean age of menopause was 45.69± 4.35. 78% of population had one or more symptoms in the menopausal period. Only 19.5% of the symptomatic women took treatment. 77% had positive perceptions.Conclusions: The awareness of these women in this area is poor thus limiting the treatment seeking behavior. Improvement of awareness is a must to improve the quality of life of post-menopausal women

Maternal and neonatal outcome in primigravida with mobile head at ≥39 weeks of gestation

Background: Primigravida with mobile head at ≥39 weeks of gestation are prone to the probability of caesarean section. With this study we aimed to identify the maternal and neonatal outcome of primigravida with mobile head at ≥39 weeks of gestation under the watchful expectancy and good conduct of labour.Methods: A cross sectional study was conducted among primigravida with mobile head at ≥39 weeks admitted for delivery in the department of obstetrics and gynaecology, govt. medical college, Kottayam, Kerala, from February 2021 to September 2021. A sample size of 247 was identified considering 28% proportion of presentation with deflexed head, 95% confidence interval and 2% margin of error. A detailed history, physical examination and ultrasonography was performed.Results: Of the 250 participants, the mean age of the study subjects was 24.97±3.93 and mean body mass index (BMI) was 23.72±4.78 kg/m2. The most common cause for mobile head was a deflexed head (35.2%). A lower segment caesarean section (LSCS) was conducted in 28.8% participants while vacuum assistance ad forceps assistance was required for 9.6% and 4.4% participants respectively. The most common indication for LSCSC being moderate to thick meconium-stained amniotic fluid (MSAF) 23% followed by 1st degree CPD failed trial in 17% cases. A significant association with maternal morbidity was observed in undiagnosed placenta previa (p=0.039) and vacuum-assisted deliveries (p=0.001). We observed that 3.6% of babies have meconium aspiration syndrome, and 8% of new born were admitted in intensive care for foetal distress.Conclusions: Primigravida with mobile head at term during labour requires intense monitoring. Although the duration of labour appeared to be prolonged in a small proportion of patients with watchful expectancy and good conduct of labour and timely intervention, vaginal delivery is possible with minimal maternal and neonatal morbidity.

A clinical review of obstetric hysterectomies done in medical college, Kottayam for a period of six years

Background: Obstetric/peripartum hysterectomy is a hysterectomy performed for any indication during pregnancy, labour or puerperium. It is important to know the general incidence, changing trends and indications of this surgery. The objective of the study is to find out the incidence of obstetric hysterectomy, type of obstetric hysterectomy done, indications of the procedure, maternal clinical profile, postoperative complications and the maternal and fetal outcome.Methods: A retrospective, descriptive case series study of all pregnant women who underwent hysterectomy in a six year period has been done.Results: 57 women underwent hysterectomy. The incidence of obstetric hysterectomy in this study is 0.17%. Mean age of the women was 30.3 years. Mean parity was two. 1.75% of cases were unbooked. 24.56% of cases underwent obstetric hysterectomy following vaginal delivery and 74.44% of cases had the procedure following abdominal route of delivery. 56.14% of cases underwent obstetric hysterectomy for postpartum hemorrhage, 36.84% underwent it for morbidly adherent placenta. 90.47% of morbidly adherent placenta had previous caesarean section as a major risk factor. 12.3% of mothers died postoperatively.Conclusions: By good obstetric practices, proper diagnosis of morbidly adherent placenta, bringing down the number of unnecessary caesarean section the incidence of this procedure can be brought down