A prospective study to evaluate the role of routine early third trimester ultrasound in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome using color Doppler

Background: Intrauterine growth restriction (IUGR) is a major and silent cause of perinatal morbidity and mortality. Rate of IUGR in developing countries is 6 times higher than that of developed countries. 14 to 20 million infants are affected with IUGR in developing countries annually. The highest incidence is found in south central Asia (33%) and India (21%). Aim of study was to evaluate the role of early 3rd trimester ultrasound in diagnosis and role of color Doppler in prediction of adverse perinatal outcome in IUGR.Methods: A prospective case-control study was conducted on 720 women admitted in GMH Rewa for one year. 360 antenatal cases diagnosed as IUGR on ultrasound were taken as study group, same number of non IUGR cases were taken as control. Study cases were followed with Doppler. The umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebro-placental ratio were calculated and the results were analysed.Results: Inferences drawn from the study were: rate of caesarean section was significantly higher (31%) in study group, perinatal outcome was poor in more number of cases (10.8%) in study group than the control group (3.4%), and the sensitivity and specificity of cerebroplacental ratio was more reliable indicator in comparison to that of UA PI and MCA PI in prediction of adverse perinatal outcome.Conclusions: Looking at the high burden of IUGR cases in our country and its adverse effects on perinatal outcome, if early third trimester ultrasound is made mandatory for all pregnant women, most of the IUGR cases can be detected and managed timely and perinatal outcome can be significantly improved

Emergency peripartum hysterectomy: a 3 year review at a tertiary care hospital in Vindhya region of India

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate