Alternative management in a case of placenta accreta with previous caesarean

The rate of caesarean is increasing day by day, and with it the chance of repeat caesarean. This has led to a rise in the chance of occurrence of placenta accreta. Control of bleeding is the main goal in such cases, which usually necessitates hysterectomy. But alternative methods are useful when retaining fertility is important. We present this case of a 30 yr old female who was admitted as a case of central placenta previa with previous caesarean. Per operatively, placenta was attached along the incision and baby was delivered by separating the placenta attached above the upper margin of incision. On attempting to remove the placenta attached to lower part of incision, it was found to be adherent along the previous scar. So placenta was removed piece meal, some part was left behind. Box sutures were taken over that part and uterine packing was done to control the bleeding. Post operatively the patient was fine and given injection Methotrexate on 8th day following the regime of 1, 3, 5, 7 days. She failed to expulse the placenta by 6wks, so D&E was done and retained products were removed. Leaving the placenta in situ followed by Methotrexate and interval removal of placenta can thus be helpful in conserving the uterus and hence, the fertility

Hysteroscopy today: is it yet a conventional diagnostic technique in abnormal uterine bleeding?

Background: To assess the efficacy of hysteroscopy over dilatation and curettage in diagnosis of abnormal uterine bleeding. Methods: A total of 51 women in reproductive and peri- menopausal age group (19-55 years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by D&C/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings.Results: Majority of patients belonged to 36-40 years of age group. Majority (40%) presented within 6 months of complaints. Hysteroscopically, 46% had abnormal findings 12% had cervical polyps, 12% fibroid polyps, 18% endometrial polyps, 2% had adhesions (Ashermann’s syndrome) and 2% had a forgotten intrauterine contraceptive device. On histopathology (D&C) 64% cases had normal/proliferative/atrophic endometrium, 12% had hyperplasia and 6% had polyp.Conclusions: Hysteroscopy provided additional information for some of the pathologies which would otherwise be undiagnosed by HPE.

Mullerian anomalies: a cause of primary amenorrhea

Background: The objectives of this study were to determine the etiologic causes of amenorrhea, the prevalence of müllerian anomalies as a cause of primary amenorrhea and the different varieties of müllerian anomalies causing primary amenorrhea.Methods: This study included all the women presenting with primary amenorrhea who presented to the department of obstetrics and gynecology, Sir T Hospital and Government Medical College, Bhavnagar from 1st January 2010 to 30th June 2012.Results: The causes of primary amenorrhea of our study due to obstructive anomalies were 37.72(n=5) and müllerian agenesis were 57.14% (n=8) and androgen insensitivity 7.14 (n=1).Conclusions: Mullerian agenesis is the most prevalent cause of primary amenorrhea in our study

Maternal mortality in tertiary care hospital: a 2-year review

Background: Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement.Methods: This was a 2-year retrospective study. Epidemiological data was collected from the Last 2 years of Facility Based Maternal Death Review Form. Maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed.Results: A total of 72 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years (40.27%), multiparous women (70.83%), women from rural areas (65.27%), illiterate women, unbooked patients (83.33%), and patients of low socioeconomic status. Direct causes accounted for 62.4% of maternal deaths where as 37.4% of maternal deaths were due to indirect causes.Conclusions: There is a wide scope for improvement as a large proportion of the observed deaths could be preventable

Maternal serum βhCG level and uterine artery doppler studies as predictors of pregnancy induced hypertension and intra uterine growth restriction: a prospective study

Background: PIH, a pregnancy-specific disorder, is one of the major causes of maternal and perinatal morbidity and mortality worldwide.PIH and fetal growth restriction are important causes of perinatal and maternal morbidity and mortility.Methods: Hundred Indian pregnant women in their second trimester (13-20 weeks) and in their late second trimester (24-28 weeks) investigated for their serum β-hCG level and uterine artery Doppler studies respectively, attending OPD/IPD in Sir T. hospital, Bhavnagar from June 2014 to June 2015.Results: There is no clinical significance between parity and occurrence of PIH (p=0.2) and FGR (p=0.7). Out of 77 patients with their β hCG level ≤2 MoM, 2 patients (2.59%) developed PIH and FGR. And from 12 patients with their β hCG level ≥2 MoM 10 patients (80%) developed PIH and FGR which is highly significant (p<0.001). The study establishes the validity of beta HCG as a predictor of PIH and FGR with the sensitivity of 83.3%, specificity of 97.5%.Conclusions: This study can be concluded by there is a strong association between high maternal serum ß-hCG level, abnormal uterine Doppler studies with predicting adverse outcome of pregnancy like PIH and FGR. There is also a good association between high maternal serum ß-hCG level and rising severity of the disease