Objectives : This study was conducted to analyze the maternal and fetal etiologies of intrauterine fetal death, and to assess the diagnostic accuracy of an antenatal ultrasound, in the year 2007-208, at Lady Goschen Hospital, Mangalore.
Methods : The study is a prospective, non interventional, observational study, with 28 women as the subjects. Women admitted to the labor room with intrauterine fetal death, were counseled for fetal autopsy after delivery. Written and informed consent was taken from the couple for the autopsy examination, and fetus with the placenta was sent to Kasturba Medical College, Pathology Department for histopathology.
Results : Peak incidence was seen among the women 25-30 years of age with most of them being gravida two (46.43%). Maternal hypertensive disorders (28.56%) and fetal anomalies (32.14%) were the most common associations with fetal death. Unexplained etiology of fetal death was associated with gestational age of 36 weeks or more (75%), mostly in primigravida (43%), with fewer than four antenatal visits. Ultrasound was able to detect 55.55% of fetal anomalies antenatally.
Conclusions : Fetal autopsy is a must in accurately diagnosing the cause of fetal death. This has a bearing on the future pregnancy
with respect to risks of recurrence.
Objective : To analyze the success rate of VBAC (Vaginal birth after cesarean section) with reference to various factors and derive simple and easily usable prognostic factors to predict successful VBAC.
Methods : (Study Design) In this retrospective observational study, 162 women who had undergone successful trial of labor were analyzed to study the factors which contributed to successful trial of labor over a study period of one year. Maternal age, prior antenatal visits, prior obstetric history, neonatal weight and interconceptional period were studied with reference to outcome of VBAC. Success of VBAC when compared with prior indication for CS was studied. The role of instrumental deliveries for VBAC was analyzed. Maternal and perinatal mortality and morbidity were assessed. Chi square test was used to analyze the significance of each factor.
Results : Success rate of VBAC was 75%. Maternal age, prior antenatal care, prior vaginal delivery, neonatal weight and interconceptional period were all statistically significant predictors (P<0.001) of successful VBAC. Instrumental deliveries were helpful in successful VBAC and can be used prophylactically to cut short second stage. VBAC had no adverse maternal or perinatal outcome.
Conclusion : VBAC
can be successfully tried in all women with prior cesarean section by careful selection and employing simple predictive factors
Objective(s) : To study the incidence, indications and outcome of reoperations done within 7 days of primary gynecological and obstetrical surgery in a teaching institution in last five years.
Method(s) : A retrospective analysis of early reoperations after primary gynecological and obstetrical surgery in last five years was done.
Result(s) : Total incidence of reoperations was 0.603%. Most common complications requiring reoperation were intraperitoneal hemorrhage(48.93%) followed by rectus sheath hematoma(21.28%), sepsis(12.76%), intestinal complications(6.39%), burst abdomen(6.39%) and post partum hemorrhage(4.25%). Women who underwent primary surgeries for gynecological and obstetrical conditions required reoperations in 0.77% & 0.45% cases respectively and mortality was in 10.71% & 15.78% cases respectively.
Conculstion(s) : Early reoperations were required in six cases per 1000 primary surgeries. Though more women required reoperations after gynecological
surgeries, mortality was more in reoperations done after primary obstetrical surgeries. Pregnancy associated or related complications, adequate attention during primary surgery and multidisciplinary approach are the important factors which may influence the outcome of primary surgeries.
Objective : To determine the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) in the evaluation of abnormal uterine bleeding (AUB) and to compare the diagnostic accuracy after hysterectomy.
Methods : Prospective comparative study of TVS and SIS in the evaluation of AUB who are being subjected to hysterectomy with uterus less than 12 weeks size.
Result : Fifty two patients were included in the study. 92% were premenopausal and 8% were post menopausal. Menorrhagia was the commonest symptom (73%) and most common finding was myoma. The overall sensitivity and specificity when correlated with intra-operative hysterectomy findings and HPE were 66% and 88% respectively for TVS and 82% and 95% for SIS respectively. The false positive and false negative rates were more in TVS compared to SIS. Commonest histopathology was intramural fibroid in 42% followed by sub mucous myoma in 21%.
Conclusion : SIS is a simple highly sensitive and
specific technique to detect intrauterine pathology in the evaluation of AUB when TVS findings are inconclusive
Objectives : To evaluate the technique of open band ligation for tubal sterilization with respect to age, parity, technical difficulty, operative time, intra/post operative complications, postoperative comfort and its suitability for mass sterilization during camp.
Methods : A prospective study of tubal ligation done at a major teaching medical college and hospital from December 2007 to October 2008. Total of 68 cases operated under spinal anesthesia by minilaparotomy and tube was ligated by open band ligation technique. Operations were performed during puerperal, interval and postabortal cases. Data were analyzed with respect to age, parity, technical difficulty, operative time, intra/post operative complications and postoperative comfort.
Results : Most of the patients (87%) were in the age group of 20-30 and 35% were below 25 years indicating long post-tubectomy period and 50% were second para. Tubal transection was seen in three patients. Febrile morbidity was seen in three patients. Most of the patients were comfortable in postoperative period within 24 hours. One patient had wound gape which required cleaning and dressing of wound and later secondary suturing. Failure of this technique has not yet been reported in this group of patients.
Conclusion :
Technique of tubal ligation with open band application was found to be easy to perform and with minimal risk and devoid of
complications such as slippage of ligature, stump hemorrhage and suitable for mass sterilization in camps and also easy for
teaching junior doctors or medical officers. Its also requires further study and follow up to comment on the failure rates.
Objectives : To study the contraceptive practices in perimenopausal women and to compare them between general population and staff nurses.
Methods : A questionnaire based study was done on 250 perimenopausal women (100 staff nurses and 150 women from general population) to evaluate the impact of literacy on the contraceptive choices among these women.
Results : Mean parity of the general population was more (3.2) as compared to the staff nurses (2.12) and this difference was statistically significant (p<0.001). Effect of literacy on reducing the parity was statistically significant (p=0.001) and was inversely related to it. Use of barrier method was more common in staff nurses as compared to general population (p<0.001). None of the women in either group were using oral contraceptive pills. Awareness about emergency contraception was more in staff nurses as compared to general population (p<0.001).
Conclusion : Intellectual status and literacy level has a definite role in using temporary
methods of contraception more effectively. There is a need for creating awareness about emergency contraception among
women more so amongst the general population
