ABSTRACT
Background: Heavy menstrual bleeding (HMB) affects 10 to 35% of women. Studies indicate LNG-IUS which releases controlled amounts of levonorgestrel (LNG) is effective in non- surgical treatment for HMB and has fewer side effects when compared to the conventional pharmacological agents. It also improves the quality of life. Levonorgesterel releasing intra uterine system can be an alternative to hysterectomy in the control of HMB.Methods: Retrospective study of 2 years in a tertiary care centre, Kochi. 170 women with abnormal uterine bleeding were enrolled in the study. Clinical examination, routine investigations and imaging was done. Endometrial sampling done and followed with HPE reports in indicated cases.Results: Mean age was 41 years. 30.6% had menorrhagia. Adenomyosis in 44% and endometrial hyperplasia in 19. 4%. Lost follow up in 12.9% cases and expulsion in 3.6%. 4.1% were unsatisfied and had hysterectomy. The uterine width in adenomyosis was significantly reduced p <0.012. The mean ET in endometrial hyperplasia cases also significantly reduced with p <0.01. Satisfaction rate was 97%.Conclusions: LNG-IUS is having a high success rate in controlling menstrual symptoms, thereby improving the quality of life and avoiding hysterectomy in women with abnormal uterine bleeding. It is highly efficient in symptomatic relief of adenomyosis and reduction in the uterine volume (width). Endometrial hyperplasia showed complete regression with LNG-IUS.
ABSTRACT
Background: Emergency LSCS can be categorized based on RCOG guidelines into category I and II which indicates maternal or fetal compromise. Here an urgent delivery and the DDI (decision to delivery interval) within 30 and 45 minutes respectively is needed.Methods: This is a retrospective cross-sectional analysis conducted on a sample of 630 patients who underwent caesarean section over a year, from June 2016 to June 2017. The DDI were further classified into ≤30 and >30 minutes for category I, ≤45 and >45 minutes for category II LSCS. The primary objective is to determine whether DDI in Category I and II emergency LSCS has an impact on fetal outcome and secondary objective is to ensure that DDI is within the standard criterion as per RCOG protocol.Results: Out of 630 samples of caesareans, it was found that 173 falls in Category I and 189 falls in Category II. Out of 87 (50.29%) patients delivered within 30 minutes in Category I, 29 babies required NICU admission. DDI was more than 30 minutes in 86 (49.71%) cases in Category I out of which 38 babies got admitted in NICU with low APGAR scores. Out of 176 (93.12%) patients who delivered within 45 minutes in Category II, 56 babies required NICU admission. DDI was more than 45 minutes in 13 (6.88%) cases in Category II and all these babies got admitted in NICU.Conclusions: Decision -delivery interval has a significant impact on fetal outcome.
ABSTRACT
Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes.Methods: This is a prospective cohort study conducted in the department of Obstetrics and Gynecology which comprised of 450 singleton gestations between 18 and 24 weeks. The primary objective is to determine the association between placental location and pregnancy outcome and secondary objective is to find out the association between placental location and neonatal outcome. The study population was divided into two groups – central and lateral. Results were analyzed using SPSS version 20, Chi square test and independent two sample t-test.Results: The frequency of central placenta was 377 (83.8%) and lateral placenta in 73 (16.2%). Central placentation had an abnormal outcome in 182(48.3%), lateral placentas with abnormal outcome were 44(60.3%). Abnormal maternal outcomes like hypertensive disorders (33.3%), Intra Uterine Growth Restriction (10.2%), Antepartum haemorrhage (25%), Preterm birth (16.3%) were more in lateral placentation. The number of central placentas having NICU admissions were 62(16.4%) and lateral placenta with NICU admissions were 19(26%).Conclusions: There is a significant association between lateral placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes.