Twin Pregnancy in a Woman with Uterus Didelphys

Uterus didelphys is one of the congenital uterine anomalies due to defective medial fusion of mullerian ducts. This anomaly is known to have poor reproductive outcome and women with this condition often have to be treated for infertility. Multiple gestation is rare with this condition. An 18 years old primigravida presenting with threatened abortion at eight weeks, was found to have uterus didelphys. She was managed conservatively, aborted one of the fetuses at 16weeks of gestation, and went till term to deliver a healthy baby by cesarean section

Diosmin versus tranexamic acid in heavy menstrual bleeding: a randomized controlled trial

Background: Heavy menstrual bleeding (HMB) is defined as cyclical bleeding at regular intervals but excessive in amount which affect the physical, social and mental aspects of life of a woman. The prevalence is 10-30% in reproductive age women and 50% in perimenopausal women. HMB is not just a clinical burden but also a huge social and economic burden. The aims and objective of my study is to compare the efficacy of diosmin and tranexamic acid in acute HMB in terms of average duration of menstrual cycle, PBAC/PABC score, endometrial thickness, hemoglobin concentration and finally need for other modes of treatment.Methods: The study was a randomized control trial in which the patients (sample size-72) were divided into two groups- group D (n=36) and group T (n=36). Group D was treated with tab diosmin 500 mg thrice daily from day 1 to day 5 of menstrual cycle. Similarly group T was treated with tab tranexamic acid 500 mg thrice daily from day 1 to day 5 of menstrual cycle. The PBAC score was taken at the end of three months along with endometrial thickness and hemoglobin concentration. The results were compared with values obtained before initiating treatment.Results: In this study after 3 months of treatment; the patients in group D had an initial PBAC score of 423.52 and at the end of treatment it was decreased to 149.89 (p<0.0001). Reduction was 60.5%. Group T patients had an initial PBAC score of 441which was reduced to 177.94 (p<0.0001) after treatment. The reduction in this group was 59.6%.Conclusions: In this study it was found that both tranexamic acid and diosmin were effective in reduction of HMB, in terms of PBAC score, average duration of menstrual cycle and endometrial thickness. But the in reduction in PBAC score was similar in both the groups. The failure rates were also similar in both the groups, but improvements in hemoglobin concentration were only margina

A Study of Antepartum Cardiotocography in Mothers with Reduced Fetal Movement at Term and Its Correlation with Fetal Outcome

Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. Reduced or absent fetal movements may be a warning sign of impending fetal death. According to the various tracingsobtained on cardiotocography (CTG), categorization can be done into normal, suspicious or abnormal/pathological and therebyfetal jeopardy can be reliably predicted. This study was designed to evaluate the CTG findings in mothers with complaint ofreduced fetal movement and their fetal outcome at term. It was seen that abnormal and suspicious CTG were more commonlyassociated with meconium-stained liquor at delivery; also they were associated with a higher rate of cesarean section with fetaldistress being the most common indication among these two groups

Paraparesis Following Spinal Anesthesia in a Patient After Cesarean Section: A Rare Entity

Paraparesis, as a complication after spinal anesthesia, is very rare. It may occur due to presence of undiagnosed spinal tumor or spinal shock after lumbar puncture. We describe a 22-year-old mother who had cesarean section under spinal anesthesia and developed paraparesis in postoperative period. She had history of facial palsy and hearing impairment for last 9 years. Magnetic resonance imaging (MRI) revealed spinal space-occupying lesion (extramedullary meningioma) at D-5/D-6 level. Careful observation and examination in postoperative period after regional anesthesia is necessary for early diagnosis and management

Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial

Background and Aims: Insertion of nasogastric tubes (NGTs) in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events. Methods: In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54), Group W (ureteral guide wire group, n = 54), Group F (neck flexion with lateral pressure, n = 54) and Group R (reverse Sellick′s manoeuvre, n = 54). The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted. Results: All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick′s method. However, on intergroup analysis, neck flexion and reverse Sellick′s methods were comparable but significantly faster than the other two methods with respect to time taken for insertion. Conclusion: Reverse Sellick′s manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques