Cesarean section once performed, paves the way for a repeat cesarean often, which in turn results in multiple disadvantages. An attempt is made to view the place of vaginal birth after cesarean against the consequences of not giving such a trial and choosing to perform a repeat cesarean section. The aftermath and repercussions of a previous cesarean section on future obstetric and gynecological outcomes are hereby presented.
Objectives: To compare protein/creatinine ratio (P:C) in single voided urine sample with 24 hours urine protein for estimation of proteinuria in pregnancy induced hypertension (PIH).
Methods: A study was conducted in 50 hospitalized pregnant women with gestational age more than 20 weeks with suspicion of pregnancy induced hypertension. Urine sample for 24 hours urine protein followed by next voided spot sample for P:C ratio was collected. Linear regression was used to determine the correlation between 24 hours urine protein and P:C ratio.
Results: There was a significant correlation between 24 hours urine protein and P:C ratio(r=0.83, P=0.000). These also showed statistically significant linear relationship.
Conclusion: The spot urinary protein/creatinine ratio appears to be an excellent alternative to 24 hours urine protein. A level above 0.2 is a good indicator of significant proteinuria.
Objectives: To review the incidence, maternal profile, indication of emergency obstetric hysterectomy and the maternal morbidity and mortality following this procedure.
Methods: A retrospective analysis of emergency obstetric hysterectomies performed over a period of 6 yrs from 2001 to 2006 was done.
Results: During the study period, 112 emergency obstetric hysterectomies were performed giving an incidence of 0.73%. It was most common in the age group of 26-35 years (68.7%) and in women of parity 3-5 (85.7%). Rupture uterus was the most common indication accounting for 75% of the cases followed by atonic PPH (8%). Febrile illness and wound infection were the two most common morbidities. Maternal mortality was 5.35%.
Conclusions: Emergency obstetric hysterectomy still remains a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable hemorrhage. Availing proper antenatal care, identification of risk factors and timely referral to a tertiary institution can reduce the incidence of emergency obstetric hysterectomy and associated morbidity and mortality.
Objectives: To explore the feasibility of providing a modified mifepristone-misoprostol regimen in four free standing reproductive health clinics in Delhi and Kolkata, India. Methods: A total of 676 women with pregnancy durations of 56 days or less received 200 mg mifepristone followed by in-clinic administration of 400 mcg misoprostol, orally in Delhi and sublingually in Kolkata. Confirmation of abortion status occurred in the clinic 12 days later almost exclusively on the basis of clinical examination. Results: Successful medical abortions occurred in 92.5% and 99.3% of the women with known outcomes in Delhi and Kolkata, respectively. Nearly all the women were “satisfied” or “very satisfied” with their treatment and indicated that they would choose medical abortion again if needed or would recommend it to others. Conclusions: Medical abortion can be safely, effectively and acceptably administered in day care reproductive health clinics in India. Carefully designed studies should compare the efficacy of sublingual and oral misoprostol following mifepristone.
Objectives: To review the incidence, maternal profile, indication of emergency obstetric hysterectomy and the maternal morbidity and mortality following this procedure.
Methods: A retrospective analysis of emergency obstetric hysterectomies performed over a period of 6 yrs from 2001 to 2006 was done.
Results: During the study period, 112 emergency obstetric hysterectomies were performed giving an incidence of 0.73%. It was most common in the age group of 26-35 years (68.7%) and in women of parity 3-5 (85.7%). Rupture uterus was the most common indication accounting for 75% of the cases followed by atonic PPH (8%). Febrile illness and wound infection were the two most common morbidities. Maternal mortality was 5.35%.
Conclusions: Emergency obstetric hysterectomy still remains a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable hemorrhage. Availing proper antenatal care, identification of risk factors and timely referral to a tertiary institution can reduce the incidence of emergency obstetric hysterectomy and associated morbidity and mortality.
Objectives: To explore the feasibility of providing a modified mifepristone-misoprostol regimen in four free standing reproductive health clinics in Delhi and Kolkata, India.
Methods: A total of 676 women with pregnancy durations of 56 days or less received 200 mg mifepristone followed by in-clinic administration of 400 mcg misoprostol, orally in Delhi and sublingually in Kolkata. Confirmation of abortion status occurred in the clinic 12 days later almost exclusively on the basis of clinical examination.
Results: Successful medical abortions occurred in 92.5% and 99.3% of the women with known outcomes in Delhi and Kolkata, respectively. Nearly all the women were “satisfied” or “very satisfied” with their treatment and indicated that they would choose medical abortion again if needed or would recommend it to others.
Conclusions: Medical abortion can be safely, effectively and acceptably administered in day care reproductive health clinics in India. Carefully designed studies should compare the efficacy of sublingual and oral misoprostol following mifepristone.
Objectives: To evaluate the knowledge, attitude and practice among the health professionals regarding asymptomatic bacteriuria (ASB) during pregnancy.
Methods: 118 doctors practicing obstetricians responded to a questionnaire covering professional details of the doctor, awareness/knowledge about ASB in pregnancy, attitude towards screening and practice of treating ASB in pregnancy.
Results: 96.6% doctors were aware of ASB in pregnancy. 59.3% had knowledge about prevalence, maternal and neonatal complications. 76.2% screen for ASB during pregnancy using urine culture sensitivity mostly in the first trimester. Only 72 out of 90 doctors treat their patients and prefer penicillin/cephalosporin group of drugs upto 7-10 days. Private practitioners and doctors having postgraduate degree in obstetrics and gynecology more regularly screen and treat for ASB during pregnancy.
Conclusion: ASB in pregnancy with its associated maternal and fetal morbidity needs to be diagnosed and treated. More awareness and active participation of doctors is required for this entity.
Objectives: A retrospective study of last three years was undertaken to determine the histopathological spectrum of breast lesions with detailed study of interesting and uncommon cases, the features of which are helpful in management of the patients.
Methods: Clinical features and histopathological findings were studied in 176 cases with emphasis on uncommon cases.
Results: Out of the 176 cases, benign lesions constituted 80.70% and malignant 19.30%. The commonest benign tumor was fibroadenoma and the commonest malignant tumor was infiltrating duct carcinoma. Uncommon cases in benign group were duct ectasia with granulomatous mastitis, papilloma and galactocele. Metastasis of mixed mucinous carcinoma of the breast to axillary lymph node was an interesting case in the malignant group.
Conclusion: Identification of benign lesions like duct ectasia with granulomatous mastitis is important as it simulates malignancy. It is important to make distinction between benign and malignant papillary tumors because approach to the diagnosis and management differs. Galactocele is reported for its characteristic appearance. In the malignant group, metastasis of mixed mucinous carcinoma of the breast to lymph node was described as it carries poor prognosis.
