A rare case of caesarean scar ectopic pregnancy: a case report

Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality.

A study on role of LATCH scoring in duration of exclusive breastfeeding in a rural tertiary care hospital, Puducherry: a prospective study

Background: Exclusive Breastfeeding (EBF) for 6 months is the optimal way of feeding infants. NFHS4 data shows 45.5% of children were exclusively breastfed at 6 months in Puducherry. The Global Nutrition Targets 2025 aims at increasing EBF rates in first 6 months up to at least 50%. The main objective is to find areas of needed intervention using LATCH scoring and to find factors responsible for fall in rates of EBF.Methods: A prospective study was conducted between November 2017 and April 2019 (1'years). Mothers were educated about breastfeeding. LATCH score assessed at 8 and 48 hours of life. At 48hours, score >8 indicates there is a high chance for EBF for next 6 months and score <8 indicates, mother is having difficulty in feeding and are intervened at this point. Data about EBF and reason for early weaning at 6 weeks and 6 months collected.Results: LATCH score at 8 hours was >8 in infants delivered via NVD: 50% as against 9.6% in babies delivered via LSCS. At 48 hours LATCH score improved in both groups: 60.8% in babies delivered via NVD, 38.3% in babies delivered via LSCS.' Compared to Primi-mothers, infants born to multigravida mothers had higher scores at 48 hours: 62.2% as against 31.1%. 84% were EBF at 6 weeks. 51% were EBF at 6 months. When mothers with LATCH score <8 at 48 hours were intervened, EBF rate at 6 weeks improved. Most common reason for early weaning at 6 weeks was maternal problems: 6.6% and at 6 months- due to influence of relatives: 27%.Conclusions: LATCH score helps in predicting breastfeeding duration as early as 48 hours of life. Low scores indicate, it requires intervention and identifies the areas of needed intervention. Counselling regarding EBF must include not only mothers but also relatives.

Obliterative le fort’s colpocleisis for acute kidney injury caused by pelvic organ prolapse in elderly woman

Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina, which sometimes causes hydronephrosis. Here authors report a case of an eighty five year old woman with a fourth degree uterine prolapse with obstructive uropathy. She was treated with a conservative surgery Le Fort’s colpocleisis. Following which the patient’s renal functions and symptoms improved. Hence authors conclude that colpocleisis can be considered as the option for elderly women who have completed the family with no desire to preserve the sexual function especially in women with co morbities where pelvic reconstructive surgeries pose a challenge.

The role of tourniquet in myomectomy: an observational study

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure.  Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.

Comparison of prophylactic versus regular use of antibiotics in elective major obstetrical and gynecological surgeries

Background: Surgical site infections better prevented by parenteral antibiotic in sufficient doses generally should be given before the operation which helps to achieve the therapeutic drug level both in the blood and related tissue during the operation. Ceftriaxone, when administered together as a prophylaxis can fulfil the above criteria of a good antibiotic. Thus, this study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries.Methods: This randomized controlled study was conducted in a tertiary care teaching hospital during the study period of June 2017 to April 2018 with 140 cases. Group A received a single dose of Injection Ceftriaxone 1g. Group B, received Injection Ceftriaxone 1 gm and Injection Metronidazole 500 mg for five days. The data was entered in excel sheet and analyzed using SPSS (Version 16).Results: The mean age group in Group A and Group B was found to be 34.24±10.5 and 35.97±11.89, respectively. There was no statistical significance between group A and B for incidence of infection in the post-operative period and duration of hospital stay. The mean value in group A for duration of surgery was found to be 67.5±13.5 and in group B mean value was 72.1±14.9. (p value <0.05).Conclusions: This study demonstrated that administration of prophylactic antibiotic rather than conventional antibiotic at caesarean and gynecological surgeries are not associated with significant difference in post-operative morbidities.