Changing trends in the indications of obstetric hysterectomies in teaching rural hospital

Background: Obstetric hysterectomy (OH) still remains lifesaving procedure. OH still poses a major obstetrical morbidity in the developing world due to lack of human, infrastructural and monetary resources. Irrespective of attempts like good antenatal care and delivery planning in modern obstetrics to prevent major obstetric complications; unfortunately, OH needs to be performed at times even today. The aim of present study was to determine the changes in the indications of obstetric hysterectomy.Methods: A retrospective review based on hospital data of all the patients’ records subjected to OH from January 1994 to September 2001 (Gr. A) and from January 2006 to December 2015 (Gr. B) was done and analyzed for incidence and changing trends in the indications.Results: The incidence of OH during two periods from January 1994 to September 2001 (Group A) and from January 2006 to December 2015 (Group B) in the Department of Obstetrics and Gynecology at Shri. Bhausaheb Hire Govt. Medical College, Dhule was 3.27/1000 and 0.97/1000 deliveries. Incidence is reduced by more than three folds. In both groups maximum patients were below 30 yrs of age and multipara. The commonest indications for OH in both groups were uterine rupture, uncontrolled Atonic PPH and placental causes. The incidence of uterine rupture as a cause for OH was reduced from 78.16% to 43.24%, while that of Atonic PPH has increased from 16.09% to 28.37% and placental causes has increased from 4.59% to 9.45%. Among the risk factors for OH, the incidence of prolonged or obstructed labour has reduced from 66.66% to 21.62% and that of malpresentations has reduced from 27.58 to 5.4%.Conclusions: There is definite reduction in the incidence of OH, frequency of uterine rupture, obstructed labor and malpresentations in Gr. B due to timely referral, improved infrastructure and transportation facilities

Ten years’ trend of HIV seroprevalence among Indian pregnant women attending antenatal clinic at tertiary hospital in Dhule, Maharashtra, India

Background: In India, HIV epidemic is in fourth decade and has the heterogeneity. The trend indicated HIV infection spreads from high risk behavior groups to general population. Maternal to foetal HIV transmission rate is found to vary from 20 to 25% in absence of any interventions. Newly infected persons contribute to the total number of persons living with HIV, they will progress to disease and death over the time and are a potential source of further infection. Maternal HIV status directly affects the perinatal transmission and hence the paediatric HIV cases. This transmission of HIV from mother to child can be prevented by appropriate measures. So this study is intended to identify ten years’ trends in HIV seroprevalence among antenatal population at a tertiary hospital in Dhule, Maharashtra, India.Methods: Retrospective study of ICTC evaluation of pregnant women attending antenatal clinic at obstetrics and gynaecology department of Shri Bhausaheb Hire Government Medical College in Dhule, Maharashtra, India. Blood samples were collected after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per WHO and NACO guidelines. The data of ten years period from January 2004 to December 2013 was evaluated to identify the trends of HIV seroprevalence among pregnant women attending antenatal clinic.Results: 309 pregnant women were HIV positive out of 70453 tested from 84608 ANC women during the study period. The overall prevalence for the 10 years was 0.44%. HIV prevalence had reduced from 0.89% in 2004 to 0.17% in 2013. Maximum HIV positive women i.e. 63.2% were 18 to 23 years old, primigravida (53.8%) and from rural area (58.5%). Mother to foetal transmission was noted 10 babies were detected to be HIV positive while 223 were HIV negative. 10 HIV positive mothers decided for MTP, while in 36 neonatal death was noted.Conclusions: Declining HIV seroprevalence rate is noted among pregnant women attending the antenatal clinics from 2004 to 2013. The effective implementation of prevention of parent to child transmission of HIV/AIDS (PPTCT) programmed is helping in control of the spread of HIV