Adenomyosis: correlating clinical suspicion with histopathological diagnosis in a retrospective study

Background: Adenomyosis and leiomyoma are the common causes of abnormal uterine bleeding (AUB). In this study it is aimed to evaluate the correlation of clinical and histopathological examination (HPE) of these entities leading to abnormal uterine bleeding.Methods: This retrospective study was carried out on hysterectomy specimens of subjects who presented themselves in the department of obstetrics and gynaecology of Sri Guru Ram Das Institute of medical sciences and research, Amritsar with chief complaints of AUB not responding to conservative treatment.Results: A total of 100 women with clinical diagnosis of AUB in which hysterectomies were performed, leiomyoma was found in 42% cases, adenomyosis in 22% cases. The most frequent combination of diagnosis was leiomyoma and adenomyosis i.e. 26%. In 9% cases chronic cervicitis and ovarian cyst were detected. In one case endometrial malignancy was found.Conclusions: Though adenomyosis and leiomyoma are clinically diagnosed along with other pathological conditions of the reproductive organs but their confirmation is still to be relied upon HPE; a most important investigation.

Current status of cesarean section myomectomy-prospective ongoing study

Background: The aim of the study was to assess the feasibility, safety and efficacy of performing myomectomy during cesarean section.Methods: It was prospective study conducted in Sri Guru Ram Das University of Health and sciences which is a tertiary care referral centre. Myomectomy was conducted in 34 pregnant women during elective or emergency cesarean section. Analysis was done with reference to age, parity, character of myomas, intraoperative and post-operative morbidity, duration of surgery and duration of stay in hospital.Results: In this study 34-58 fibroid of various size (2-14 cm) were removed in 34 patients during cesarean section. Majority of fibroids were located in body of uterus (65.5%) and in anterior wall (55.2%) and all them were sub serosal. No significant difference was found in mean preoperative hemoglobin (11.8±0.7) and postoperative hemoglobin (10.9±0.8). No patient had postpartum hemorrhage requiring cesarean hysterectomy. Only two patient needed blood transfusion postoperatively. Mean time taken for surgery was 58.4±8.94 minute and average duration of hospital stay was 6.7±1.6.Conclusions: With the advent of better anesthesia, easy availability of blood and blood component, cesarean myomectomy is safe surgical procedure when performed by experienced obstetrician in carefully selected patients.

Obstetrics ICU admissions: learning objectives

Background: The management of critical illness in pregnancy requires intensive monitoring of obstetric patients in the intensive care unit. Systematic way of surveillance will allow the measurement of outcomes of interest and associated risk factors. Intensive care unit is highly specified and sophisticated area of hospital which is specifically designed, staffed, furnished and equipped, dedicated to the management of critically sick patients, injuries or complications. The aim of this study was to know the frequency of ICU admission in obstetrical patients, to analyse the medical or surgical comorbidity related to obstetrical problems, to segregate the cause of morbidity and to identify the risk reducing strategies.Methods: This observational study was conducted in 40 ICU patients in present institute from 1st December 2016 to 28th February 2019. The present study was divided into two groups in group I, intervention was done first followed by ICU intervention and in group II, ICU stabilization was done first followed by obstetrical intervention. The parameters noted were age, parity, gestation age, diagnosis on admission, associated medical and surgical comorbidity, reason for ICU admission, any surgical procedure performed, details of treatment given in ICU like ventilator support, blood transfusion, dialysis or ionotropic support. Patients outcome, review of mortality and area of improvement were also noted.Results: There were 17.5% mortalities observed in present study. The most common ICU intervention was blood transfusion (81.19%) followed by mechanical ventilation (37.8%). Commonest cause of mortality was multiorgan dysfunction (28.5%) followed by hypertensive disorder of pregnancy (14.3%), peripartum cardiomyopathy (14.3%), acute fatty liver of pregnancy (14.3%), septic shock (14.3%) and acute febrile illness (14.3%). Most of the patients were unbooked (74.3%), 47.2% cases did not receive antenatal care.Conclusions: There is need for antenatal registration of all pregnant women and institutional deliveries should be the aim. There should be antenatal detection and management of medical and surgical comorbidities. There is need for training in emergency obstetrics so that complication can be recognized and managed at an optimum time.