ABSTRACT
True knot is an extremely rare condition of the umbilical cord. It affects around 0.3-1.3% of all the pregnancies. It can be loose without obstructing the blood flow to the foetus or can be tight enough to exsanguinate the foetus by compromising the blood flow towards the foetus. A 26 years old, gravida 2, para 1, live 1, with previous 1 caesarean section with hypothyroidism came at 40 weeks POG in labour. No complaints. Antenatal history was uneventful. On examination, patient was stable. Patient was explained risk and demits of TOLAC verses ERCD and opted for TOLAC. Delivered a limp baby. There was presence of one tight loop of cord around neck and one tight true knot over the umbilical cord leading to stillbirth. The umbilical cord is the only blood supply to the foetus during the antepartum and intrapartum period. If the true knot is loose, it will not lead to foetal compromise since foetal circulation is maintained. However, at the time of fetal descent through the birth canal, the knot could be tightened. The tightening knot can occlude fetal circulation resulting in an intrauterine demise. The process of delivery should be very careful and if any fetal distress or non-reactive CTG is present, then an emergency caesarean section must be done. Routine continuous cardiotocography can be the best modality to pick distress at the earliest and to achieve a good outcome of the neonate. A good ultrasonologist can detect nuchal cord and true knot during the antenatal scan.
ABSTRACT
Background: Hysterectomy is the most commonly performed major gynecological procedure. It can be done by different routes like abdominal or vaginal or laparoscopic route. Vaginal route of hysterectomy is undoubtedly less popular these days due to inclination towards laparoscopic route by both surgeon as well as patients. Keeping this is mind we have planned this paper to share our experience of Non Descent Vaginal Hysterectomy at a tertiary level hospital.Methods: A retrospective study was conducted at the department of obstetrics and gynecology of Vardhmann Mahavir Medical College & Safdarjung hospital, New Delhi over the period of one year. All the patients undergoing non -descent vaginal hysterectomy for benign indication with adequate vaginal access, without suspected adnexal pathology, who did not have any uterine descent were included in the study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing was used to remove the uterus. Intraoperative findings and post-operative complications were recorded. Statistical analysis was done.Results: During the study period total 138 hysterectomies were performed. Most of the women were in the age group of 46 to 50 years (50%). All patients were parous. In 56% patients, uterine size was 8-10 weeks. Fibroid uterus (37%) followed by adenomyosis (27%) was the commonest indication for hysterectomy. The most common complication was febrile morbidity (n=13) followed by urinary tract infection (n=9).Conclusions: Non descent vaginal hysterectomy procedure in hand of a skilled surgeon can be done upto 14 weeks uterine size.
ABSTRACT
Purpose: To study the efficacy of supplemental occlu?pad therapy with partial occlusion in children with refractive anisometropic amblyopia. Methods: Thirty?one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu?pad for 1 h per day and three such sessions in a week. Results: The mean age was 6.8+/?1.4 years (range 5�years). A significant improvement of 3.2+/?1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 months. Conclusion: Occlu?pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia
ABSTRACT
Background: The adolescent girls constitute a heterogeneous group who are at risk of various reproductive and gynecological problems. A number of health schemes are already aimed at targeting the needs of this special population. This study was aimed at identifying the special needs of this population group in respect of medical and reproductive health so as to provide a feedback for ongoing health schemes.Methods: This study was a cross sectional analytical study conducted among adolescent girls attending various government and public schools in Lucknow city and adolescent girls presenting to Gynecology OPD of Queen Mary’s Hospital for various complaints in a span of one year from June 2007 to June 2008. After taking consent, the girls were subjected to a questionnaire consisting of epidemiological parameters and questions regarding menstruation, pregnancy, birth spacing, contraception, abortion, RTI/STD, sex education. This data was later analysed. Those presenting to the OPD of Queen Mary Hospital were subjected to further examination and tests depending on their complaints.Results: A total of 1127 adolescent girls in the age group of 10-19 consented and were included in the study. Awareness regarding the contraceptive methods available was present in only 57.8%. 14% (164) girls were aware of reproductive tract infections and sexually transmitted diseases. However, 61% (687) girls were aware about HIV/AIDS in particular. The mean age at menarche was 11.9±1.0 years. 21.5% had some menstrual problem. There were 34 cases of teenage pregnancy.Conclusions: Our study revealed substantial lacunae in the knowledge and attitude of young adolescent girls towards reproductive and sexual health. Despite various targeted health programs from the government, there is a still a need to further our efforts to improve access to health care and adopt methods to improve awareness regarding the health issues of adolescents.
ABSTRACT
OBJECTIVE: To determine the prognosis of antenatally detected renal anomalies by sonographic evaluation. MATERIALS AND METHODS: This was a follow-up study of all antenatally detected renal anomalies from January 2008 to Dec 2009 referred to fetal medicine clinic. Prenatal evaluation was done and cases were divided into four groups depending upon their prenatal sonographic findings. Post natal follow-up was done up to one year in cases of live babies. Autopsy was carried out in still born fetus after consent. RESULTS: The renal anomaly was detected in 55 cases, which were fully followed. The prognosis was said to be poor for group I cases with gross extra renal anomaly along with the renal anomaly, and for group II in which there was organic renal pathology with loss of renal function suggested by non-visualization of bladder and almost absent liquor. Prognosis was guarded and depended upon the gestational age of presentation in group III, which had obstructive uropathy; prognosis was good in group IV cases, which were mild, unilateral or which presented late. CONCLUSION: Prenatal sonographic evaluation gives reasonably accurate picture of the prognosis and can be very helpful in counseling the parents regarding prognosis and help in deciding the timing and route of delivery.