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Background: The management of obstetrics and gynaecological emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. The main aim of the study was to access the burden of surgical emergency and to study the course of management at a tertiary care hospital.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period from January to December 2018.Results: A total of 73 patients presented to our emergency room who required urgent surgical intervention. All patients were resuscitated and surgery was done at earliest possible time. The age of patient ranged from 18 to 45 years. About 75.8% of female presented with the complaint of acute abdomen, followed by 32.9% with bleeding per vaginum. 16.4% had vomiting, 6.8% with fever and 4.1% with mass per abdomen. In majority of cases a diagnosis of ruptured ectopic pregnancy (34 patients) was made, followed by PPH in 14 patients and 12 cases of rupture uterus. Four cases of torsion of ovarian mass and 3 cases of septic peritonitis were operated. The most common surgery performed was salpingectomy followed by subtotal obstetric hysterectomy. A mortality rate of 8.2% was noted.Conclusions: This study emphasized the great role of timely surgical intervention as lifesaving procedures. Skilled clinicians and immediate intervention in a tertiary care is the main-stay of the emergency case management and are indispensable for decreasing mortality and morbidity.
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Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour.
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Background: Breech presentation is the commonest of all mal presentations. Vaginal delivery of breech presentation at term is associated with a much higher perinatal mortality and morbidity than that of vertex presentation.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period of six months from 1st May 2019 to 31st October 2019. Out of a total number of 4476 deliveries, 159 were breech pregnancy. It included all the women admitted in labour room or ward who delivered with clinical or ultrasound diagnosis of breech presentation after 20 weeks of gestation.Results: In the present study incidence of breech pregnancy was 3.6%. Authors observed the highest incidence of breech pregnancy in the age group of 20 to 25 years. Maximum (62.9%) cases delivered after 37 weeks of gestation. In our study 62.3% cases were primigravida and 37.7% were multigravida. Majority of cases (77.4%) delivered by caesarean section. Among all the babies born 50.6% were having birth weight of less than 2.5 kg.Conclusions: Authors need to study and analyse all cases of breech pregnancy individually to decide the management and mode of delivery depending on cases to case basis and expertise of the staff available. Delivery of breech foetus should be conducted by experience obstetrician after appropriate consent from pregnant women and her relatives.
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Background: This study was conducted to detect various presenting clinical features, type and severity of pelvic endometriosis according to revised American fertility society classification. Objective of this study was to assess outcome of endometriosis after medical and surgical treatment in form of pregnancy, reduction of symptoms like dysmenorrhoea, dyspareunia and others.Methods: This prospective study conducted at one of tertiary care teaching institutes for period of 3 years from January 2011 to December 2013. A total number of 100 patients of pelvic endometriosis were examined and divided according to Revised American Fertility Society Classification on bases of severity, type and clinical features and laparoscopic findings. After 1 year of follow up, outcome assessed after completion of medical and surgical treatment in form of pregnancy, reduction of dysmenorrhoea and dyspareunia and other symptoms.Results: This study showed most affected patients (46%) belongs to 26-30 years of age group, dysmenorrhoea was the most common presenting symptoms in 76% patients. Most common site affected (52%) was ovaries. Laparoscopy was done in 86% patients. Most patients (44%) were benefited with fulguration of endometriotic nodules. 62% of patients were given oral contraceptive pills or progesterone pills after definitive surgery as freely available in Governmental setup and fewer side effects as compared to Danazol and GnRH analogues. 40 patients became pregnant after medical and surgical treatment, where 60 patients had reduced dysmenorrhoea and 20 patients had reduced dyspareunia.Conclusions: Laparoscopy is gold standard diagnostic as well as therapeutic tool in pelvic endometriosis as it can rule out other causes of infertility without interfering normal anatomy.
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Background: Twin pregnancy being one of the causes of high-risk pregnancy is associated with both maternal and fetal complications. This study aims at analysing the fetal and maternal outcome in such cases. All cases were studied according to their parity, maternal age, fetal presentation, mode of delivery and gestational age.Methods: This prospective study was conducted at one of the tertiary care teaching institutes over a period of one year from January 2018 to December 2018. Out of a total number of 7295 deliveries, 130 were twin pregnancy. It included all women admitted in labour room with clinical or ultrasound diagnosis of twin pregnancy after 20 weeks of gestation.Results: In the present study incidence of twin pregnancy was 1.78%. We observed the highest incidence of twins in the age group of 20-29 years. The least incidence was below the age of 20 years. Incidence of twin pregnancy in our study in primipara was 47.7% and in multipara was 52.3%. Most of the patients (43%) delivered at 32-36 weeks of gestation. Maternal complications were noticed as anemia in 29.2% patients, pregnancy induced hypertension in 55.4% patients, post-partum hemorrhage in 4.6% patients, polyhydramnios in 3.1% patients, premature rupture of membranes in 8.5% patients, gestational diabetes in 0.8% patients and urinary tract infection in 2.3% patients. Majority of the patients delivered vaginally (60.8%), others by lower segment cesarean section (LSCS). In this study 95.8% babies were low birth weight. There were 34 neonatal deaths (13%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with significantly increased maternal morbidity, neonatal morbidity and mortality. Such pregnancies require good antenatal care, early detection of maternal and fetal complications and timely referral to a centre well equipped for management of such cases.
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Background: Placenta praevia is one of the serious obstetric problems with far reaching effects and a major cause of antepartum haemorrhage. The aim of the study was to evaluate the foetomaternal outcome of pregnancies with placenta praevia.Methods: The present study was a prospective case control study conducted in the Department of Obstetrics and Gynaecology, Lal Ded Hospital, Srinagar from August 2009 to October 2010.Results: Among the 100 cases of placenta praevia studied bleeding per vaginum was the most common presenting symptom. Major placenta praevia was more common (53%) than minor placenta praevia. 43% of the cases of placenta praevia delivered before 37 completed weeks as compared to only 6% in the control group. All cases of placenta praevia delivered by caesarean section. Maternal morbidity in terms of postpartum haemorrhage (32%), intraoperative bowel and bladder injury (2%) and intensive care unit admission (1%) was more in cases of placenta praevia. Foetal complications in terms of neonatal intensive care unit admission (19%), neonatal death (10%) and stillbirth (5%) were more in pregnancies with placenta praevia as compared to controls. 48% of patients with placenta praevia required transfusion of blood and blood products as compared to 4.5% among controls.Conclusions: There is a significant increase in maternal morbidity in pregnancies complicated with placenta praevia. Also, there is a higher incidence of foetal complications and neonatal death. Managing a case of placenta praevia is a challenge in present day obstetrics and it creates a huge burden on the health care system.