Prediction of caesarean section for arrest of descent during the second stage of labour

Background: Friedman described the normal progress of labor in different curves for nulliparous and multiparous women in 1954. Any deviation from these curves during the second stage of labor is considered as failure to progress in the second stage of labor. The aim of the study is to define obstetrical risk factors for arrest of descent during the second stage of labour.Methods: All singleton, vertex, term deliveries with an unscarred uterus, between December 2013 to November 2016 (3 years) were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor.Results: The study included 7260 deliveries, of these 163 (3.3%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: primigravida (RR=7.8, 95% CI=6.9-8.7, p3.5 kg (RR=2.2, 95% CI=2.0-2.4, p<0.001). Deliveries complicated by arrest of descent resulted in cesarean section in 67% and 34% vaginal delivery.Conclusions: In this era of increased public awareness and medicolegal events it is very crucial to assess and evaluate every woman in labor and to identify in advance the possibility of arrest in advanced labor so that a timely obstetric intervention possibly Cesarean section can prevent unnecessary maternal- fetal complications

Conjoined twins: report of two cases and review of literature

Two pairs of conjoined twins were encountered at the SCB medical college cuttack, Odisha, India during the past 3 years. In the first set the prenatal diagnosis was not established and the case was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Emergency caesarean section done and a pair of thoraco-omphalopagus twins delivered. Both babies died soon after birth. In the second case the conjoined twins were diagnosed prenatally at 20 weeks of gestationon in routine anomaly scan as thoraco-omphalopagus twin with fetuses were positioned face-to-face and fused from sternum to umbilicus. Fetuses were found to have separate hearts, a fused liver and separate upper and lower gastrointestinal tracts. Each twin had two normal appearing kidneys and a urinary bladder. The couples were counselled about the various management options and referred to higher centre. But she was admitted at 34 weeks of gestation with preterm labour and emergency caesarean section done and a pair of male thoraco-omphalopagus twins delivered. Both babies were alive and referred to higher centre for further management. The prenatal identification of conjoined twins is of cardinal importance for the planning of delivery and possible separation

Mifepristone as pre-induction cervical ripening agent: a review article

Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome

Clinical analysis of post sterilization failure cases in a tertiary hospital

Background: The most common permanent method of family planning accepted in India is female tubal sterilization as it has a very low failure rate of 0.1-0.8% in the first year and overall pregnancy chances of 1 in 200. It can be done by open method but laparoscopic method has now gained wide popularity.Methods: Ours was a retrospective study of post sterilization failure cases admitted to Department of Obstetrics and Gynecology, Mahatma Gandhi medical College and Research Institute, Pondicherry within a 3 year time period between May 2014 to May 2017.Results: Within a 3 year period, 3 patients presented with intrauterine pregnancy whereas 28 presented as ectopic pregnancy following sterilization. Majority of patients belonged to 26-30 year age group and had 2 children. 35.7% of ectopics presented at 7-8 weeks gestational age. Over 70% of sterilization failures were done by open method and around 43% were done during caesarean section. Around 71.4% sterilization failures were seen within 5 years of sterilization but 1 patient presented as late as 17 years post sterilization.Conclusions: Female sterilization may result in failure even after years of sterilization. In present study, open sterilization had a higher failure rate than laparoscopic sterilization. The most common mode of sterilization failure was ectopic pregnancy. Therefore, patients undergoing sterilization must be counseled about chances of failure; even though it is a permanent method, and to consult immediately if missed period else at a later stage they may go in for rupture ectopic leading to high maternal morbidity and mortality

Comparative analysis of continuous and interrupted suturing techniques for repair of episiotomy or second degree perineal tear

Background: Perineal trauma is a serious and frequent problem after childbirth which is experienced by millions of women worldwide and the type of perineal repair may have an impact on pain and healing. The objective of this study was to assess the effects of continuous subcuticular versus interrupted transcutaneous sutures on women following episiotomy or second degree perineal repair following childbirth.Methods: A prospective comparative study comprising 141 women who had undergone vaginal deliveries with episiotomies or second-degree tearing of the perineum between August 2015 and July 2016Two groups were made among which one group was repaired with continuous, nonlocking sutures involving the vagina, perineum, and subcutaneous tissues and the other group had continuous, locking sutures of the vagina, interrupted sutures in the perineal muscles, and interrupted transcutaneous sutures. The threads used for stitching were identical in both groups i.e. rapidly absorbed polyglactin 910 suture material.Results: On the 2nd day after delivery, the perineal pain scores during lying, sitting and walking in the continuous technique(CT) group was less compared to the interrupted technique(IT) group(p value 0.009). On 10th day after delivery the perineal pain score during sitting and walking were statistically less (p value 0.027) in the CT group.  On 42th day there was no difference in pain score between both the groups. The amount of suture materials consumed in CT group was statistically less than IT group(p<0.001). There was no difference in incidence of wound dehiscence (p value 0.301) but superficial dyspareunia is more in IT group which is statistically significant.Conclusions: The episiotomy and perineal tear repairs with continuous suturing associated with lesser incidence of short or long term pain, lesser requirement of suture material without an increase in complication than interrupted suturing

Mifepristone as pre-induction cervical ripening agent in term pregnancy

We hereby report the results of a prospective randomized study where we compared efficacy of mifepristone and prostaglandin (PGE2) gel for pre-induction cervical ripening

A rare presentation of a pyosalpinx in a post-menopausal woman

Primary fallopian tube carcinoma is a rare tumour of the female genital tract with an incidence of 0.1-1.8% of all genital malignancies, which is generally an intra-operative or a histological diagnosis.  It is a tumour that resembles epithelial ovarian cancer. A 61-year-old postmenopausal woman presented with complaints of continuous bleeding per vaginum with history of loss of appetite and weight for 6 months. She was also a known diabetic and hypertensive. On examination, per abdominal, per speculum and per vaginal findings were unremarkable.  A transvaginal ultrasonography done previously showed fluid in the endometrial cavity suggestive of hematometra/pyometra due to cervical stenosis. A fractional curettage done previously had shown strips of acanthotic squamous epithelium in the endocervical curetting.   She underwent abdominal hysterectomy with bilateral salpingo ovariectomy. Histopathological findings were suggestive of primary fallopian tube adenocarcinoma. Hence the patient was advised chemotherapy followed by a second look laparotomy. Preoperative diagnosis of fallopian tube carcinoma is difficult due to the silent course of this neoplasm and is usually first appreciated at the time of operation or by a pathologist. The treatment approach is similar to that of ovarian carcinoma, and it should consist of a total abdominal hysterectomy with bilateral salpingo-ovariectomy, omentectomy and lymph node dissection from the pelvic and the para-aortic regions

Caesarean section scar endometriosis: a case report and review of literature

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare event which usually develops after pelvic operations involving the uterus and fallopian tubes. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. Its diagnosis can sometimes be difficult and may be confused with various other surgical conditions. We present here a case of abdominal wall scar endometriosis in a woman who has undergone caesarean delivery three years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this somewhat rare condition are discussed

A comparative study between manual vacuum aspiration and electrical vacuum aspiration for the first trimester medical termination of pregnancy

Background: The aim of this study is to compare the manual vacuum aspiration (MVA) and electrical vacuum aspiration (EVA) as the method for first trimester medical termination of pregnancy (MTP) in terms of efficacy, blood loss, duration, acceptability and complications. The study also compares paracervical block (PCB) and intramuscular sedation (IMS) i.e., injection pentazocine 30 mg and injection promethazine 25 mg as pre-operative analgesia for both the MTP procedures.Methods: The present study was conducted in the postpartum center and department of Gynecology and Obstetrics, SCB Medical College, Cuttack. A total 200 patients were studied of which randomly selected 100 patients underwent MVA and remaining 100 patients underwent EVA. Cases were compared with respect to their age, parity, blood loss, time taken and complications.Results: In the present study, MVA was effective in 97% and EVA in 98% cases. Thus, the two procedures did not show much difference as far as their effectiveness was concerned. Comparing intra and post-operative pain, PCB was significantly more effective in reducing pain as compared to IMS.Conclusions: MVA has a safety and efficacy profile similar to that of EVA. Furthermore, MVA is a simple, safe, effective procedure, portable and low cost technique. Hence, MVA is a promising method compared to EVA and can be practiced widely in rural areas where access to medical facilities are limited, high-tech equipments were not available and the power supply was erratic and maintenance of instruments were not up to the mark. The judicious use of MVA comes with a promise to make early abortions safe and easily accessible to women of both rural and urban societies belonging to any socio-economic strata

Pregnancy of unknown location (PUL): a case report and review of literature

While most pregnancies are obviously within the uterus, Pregnancy of Unknown Location (PUL) is used to describe cases where, there is a positive pregnancy test but no sign of a pregnancy inside or outside the uterus, on transvaginal ultrasound or even at laparoscopy. We report a case of multigravida with history of disturbed tubal ectopic pregnancy in previous pregnancy presented with lower abdominal pain and spotting per vaginum following 6 weeks amenorrhoea. The patient was clinically stable with no evidence of intrauterine or extrauterine pregnancy in transvaginal sonography with serum beta human chorionic gonadotropin (beta-hCG) above descriminatory levels. Provisional diagnosis of Pregnancy of Unknown Location (PUL) was made and serial beta-hCG levels shows increasing levels. Endometrial curettage done with histopathology report showed product of conception following which there was a fall in serum beta-hCG. She was finally diagnosed as a case of silent miscarriage. Expectant management has been shown to be safe and effective in reducing the need for surgical intervention but does require close surveillance of patients who present with PUL