ABSTRACT
Meconium stained liquor is considered as a sign of non-reassuring foetal status and is associated with adverse foetal outcome. We wanted to evaluate the correlation of Meconium Stained Liquor (MSL) with cardiotocography (CTG) and observe the mode of delivery and foetal outcome in term pregnancy (37-42 weeks).METHODSThis is an observational study, conducted at A.V.B.R.H., Sawangi, Meghe, Wardha from September 2017 to August 2019 (2 years) among 140 pregnant women with Meconium Stained Amniotic Fluid (MSAF) in labour after artificial or spontaneous rupture of membranes. Continuous cardiotocography was done; foetal outcome and mode of delivery were recorded.RESULTSThe distribution of women according to grades of MSL, shows that 40.7 % had grade 1 MSL, 34.3% had grade 2 MSL, and 25% had grade 3 MSL. The distribution of women according to CTG characteristics, shows that 43.57% had normal CTG, 49.29 % had pathologic CTG, and 7.14% had suspicious CTG. The percentage of normal CTG was maximum in grade 1 MSL (80.70%), percentage of suspicious CTG was maximum in grade 2 MSL (10.42%), and percentage of pathologic CTG was maximum in grade 3 MSL (88.57%). Maximum women with grade 1 MSL had normal vaginal delivery (70.18%), while maximum women with grade 2 (79.17%) and grade 3 MSL (82.86%) had caesarean section. 93 (66.43%) neonates required only routine care at birth and 47 (33.57%) neonates required NICU admission. Out of these 47 neonates who were admitted in NICU, 7 (14.89%) neonates had birth asphyxia, 17 (36.17%) neonates required ventilator support, 15 (31.91%) later on developed meconium aspiration syndrome, 1 (2.13%) neonate developed hypoxic ischemic encephalopathy (HIE), 1 (2.13%) neonate developed neonatal sepsis, 1 (2.13%) neonate developed pneumonia, 2 (4.26%) neonates died on their day 2 of life; i.e. neonatal mortality is 1.4% out of total cases.CONCLUSIONSIncreasing grades of meconium stained liquor was associated with cardiotocography abnormalities and with low APGAR score at 1 min and 5 min, increased need for NICU admissions, longer duration of NICU stay, and neonatal morbidity and mortality.
ABSTRACT
Extrapulmonary tuberculosis accounts for a significant proportion of tuberculosis cases worldwide. Nevertheless, the diagnosis is often delayed or under dilemma or even missed due to insidious clinical presentation and unpredictable sensitivity of diagnostic tests. Here we describe a case of a 30-year-old woman of secondary amenorrhoea who was evaluated and posted for diagnostic hysterolaparoscopy and endometrial biopsy. The tubercular lesions identified on laparoscopy and endometrial tissue sampled was sent for TB-PCR, AFB culture and histopathology. TB-PCR and AFB culture reports were negative for tuberculosis, while her histopathology report was positive. She was started on category 1 anti-tubercular therapy. Her further course was uneventful and she started having normal menstrual cycles 9 months later.
ABSTRACT
An unusual case of bowel gangrene involving jejunum upto the middescending colon leading to septicaemic shock, presented as a case of placental abruption with IUD with shock. Case Report : The 25 year old primigravida patient with 34 weeks of gestation was referred from peripheral obstetrician to SVNGMC, in a state of shock with clinical features suggestive of concealed type of placental abruption with IUD. In view of placental abruption with shock, emergency caesarean section was performed. Per Operative Findings: Foul smelling peritoneal fluid, IUD. Baby with placental separation with RP clot and gangrenous bowel from jejunum to middescending colon. As such long segment of bowel was involved; surgeon decided resection and end to end anastomosis was not possible. Propable diagnosis like superior mesenteric artery thrombosis/ Embolism was made. pt was put on low dose inj. Heparin and later managed in Surgical I.C.U. & succumbed on day 3 postop. Conclusion: Hypercoagulable state normally found in pregnant women which is believed to result in superior mesenteric vessel thrombosis and then intestinal ischaemia. It is extremely important not to miss any complaint like pain in abdomen and other G.I. complaints that may have any surgical or medical pathology associated with pregnancy.