Comparison of the efficacy, safety, acceptability and fetomaternal outcomes of combination of mifepristone and foley’s catheter with foley’s catheter alone in induction of labour in term pregnancies with previous lower segment caesarean section

Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.

Study of risk factors for preterm deliveries in a tertiary hospital

Background: Preterm labour and preterm deliveries are very challenging obstetric complications. Early identification of risk factors may help identify women at risk for preterm deliveries.Methods: A one-year observational study was conducted in the department of obstetrics and gynecology, IGMC Shimla, Himachal Pradesh from 1st August 2017 to 31st July 2018. All mothers who delivered between 24 to 37 weeks were subjected to a detailed history with respect to age, parity, previous pregnancy outcomes and to identify the presence of any risk factors. A thorough obstetric and systemic examination was done. Parametric and non-parametric test of significance were used to find the association between different quantitative and qualitative variable.Results: Incidence of preterm deliveries was 11.4%. Maximum cases were of age group 25-30 years. 71.7% belonged to lower socio-economic status. 54% cases were seen in multigravida. History of previous abortion was seen in 18.4% and 9.7% had history of preterm deliveries. 12% cases had history of 1st trimester bleeding.  Spontaneous onset of preterm labour was seen in 55.1%. The significant risk factors associated were PIH and genitourinary infections.Conclusions: The risk factors of preterm birth to a large extent can be identified in antenatal period. Adolescent health education including good nutrition, good hygiene, counselling for contraception to reduce unintended pregnancies and birth spacing can lower the preterm birth rate. Better prenatal care, early identification of risk factors and complicated cases, regular follow up and proper management can help us in reducing preterm births.

Study of sociodemographic profile, maternal, fetal outcome in preeclamptic and eclamptic women: a prospective study

Background: Preeclampsia is pregnancy specific disease, lead to maternal, perinatal morbidity and mortality. This study is conducted to identify the socio demographic profile of subjects suffering from preeclampsia and its effect on maternal and fetal health.Methods: This prospective study was conducted at department of obstetrics and gynecology, Kamla Nehru State Hospital, Shimla, in this, 100 preeclamptic women were included. Preeclampsia was diagnosed with blood pressure of ≥140/90 mmHg noted for the first-time during pregnancy, after 20 wks of gestation and proteinuria. Demographic details were collected. Investigations i.e. hemogram, liver and renal function tests, coagulation profile and fundoscopy were done. Maternal and perinatal outcomes were recorded.Results: In this study, majority of the subjects were primigravida 65. In this, 11 subjects had systolic blood pressure of 140-159 mmHg and 89 subjects had systolic blood pressure of > 160 mmHg. 25 subjects had diastolic blood pressure of 90-109 mmHg and 75 subjects had diastolic blood pressure of > 110 mmHg. In this, 82 subjects had warning symptoms, mainly headache 49. 14 subjects showed hypertensive changes in fundus. Unfavorable Bishop Score, observed in 86 subjects and 78 subjects were induced after controlling blood pressure. Majority of subjects had vaginal delivery 73. Majority of the subjects had deranged liver function 61. Maternal morbidity was reported in 54 subjects. Intrauterine death reported in 14 subjects. Birth weight was < 2.5 kg was observed in 70 babies. Out of 74 live births, 53 neonates required admission in NICU and 16 neonates died in NICU.Conclusions: It may be concluded that, maternal and neonatal morbidity and mortality can be reduced by early identification of risk factors and timely intervention is the hall mark in preventing the maternal and perinatal morbidity and mortality.

Estimation and comparison of serum lipid profile of women with pregnancy induced hypertension and normal pregnancy

Background: Hypertensive disorders during pregnancy are the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Raised blood pressure in pregnancy is the major cause of fetomaternal morbidity and mortality. The most important feature in preeclampsia is hypertension which is supposed to be due to vasospastic phenomenon in kidney, uterus, placenta and brain. Altered lipid synthesis leading to decrease in PGI2:TXA2 ratio is also supposed to be an important way of pathogenesis in pregnancy induced hypertension.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum lipid profile was estimated by semiautomatic analyzers. Statistical analysis of data was done by student’s t-test and p-value.Results: Mean total cholesterol in pregnancy induced hypertension was 278.5±52.52 mg/dl and normal pregnancy was 245.47±20.075 mg/dl. Mean triglycerides in pregnancy induced hypertension was 249.88±92.575 mg/dl and normal pregnancy was 206.89±46.345 mg/dl. Mean HDL in pregnancy induced hypertension was 43.69±4.135 mg/dl and normal pregnancy was 49.9±6.501 mg/dl. Mean LDL in pregnancy induced hypertension was 174.43±39.083 mg/ dl and normal pregnancy was 151.22±19.92 mg/dl. Mean VLDL in pregnancy induced hypertension was 46.885±15.143 mg/dl and in normal pregnancy was 40.964±9.061 mg/dl, total cholesterol, low density lipoprotein, very low density lipoprotein, triglycerides were increased in pregnancy induced hypertension when compared to normal pregnancy, which is statistically significant.Conclusions: We concluded that the Patient who developed pre-eclampsia have abnormal lipid profile. This abnormal lipid profile is responsible for endothelial dysfunction. This endothelial dysfunction may play a key role the pathophysiology of pre-eclampsia. Early detection of these parameters may help patient by preventing complications and is going to aid in better management of pre-eclampsia.

Maternal and fetal outcomes in pregnancy induced hypertensive patients and normotensive patients

Background: Hypertensive disorder of pregnancy complicates 5 to 8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Hypertensive disorders of pregnancy account for nearly 18% of all maternal deaths worldwide, with an estimated 62000-77000 deaths per year.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in Eclampsia ward fulfilling the inclusion criteria were studied. Fetal and maternal outcomes data recorded and documented. Statistical analysis of data was done by student’s t-test and p-value.Results: In PIH 68% women had normal vaginal delivery (p=0.004) 10% women had instrumental delivery. In PIH group 22% women had emergency caesarian section and in normotensive group 10% women had emergency caesarian section. In PIH group 58% delivered at term and 42% had preterm delivery. In normotensive 95% delivered at term and 5% had preterm delivery (p <0.001). PIH group 29% women developed IUGR whereas in normotensive group all women had normal growth velocity (p <0.001). In PIH group 69% mothers had newborn with birth weight <2.5 kg and 31% women had newborn with birth weight >2.5 kg (p=0.0009). While In normotensive group only 9% women had newborn with birth weight <2.5 kg. In PIH group, 24% newborn babies needed NICU admission and in normotensive group only 5% newborn needed NICU admission (p=0.001). In PIH group 76% women had normal maternal outcome (p <0.001). 11% had associated abruption (p=0.0019). In the rest 13% patient develop PRES.Conclusions: We concluded that there is a significant rise of complication in mothers having PIH and also there is an increased risk of delivering low birth weight and preterm babies. The early use of antihypertensive drugs, optimum timing of delivery and strict fluid balance, anticonvulsants in cases of eclampsia will help to achieve successful outcome.

Assessment of maternal serum β hCG level in pregnancy induced hypertension and normotensive patients and to correlate between the level of β hCG with the severity of pre-eclampsia and eclampsia

Background: Hypertensive disorders during pregnancy are one of the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Spectrum of this disease ranges from mildly elevated blood pressure with minimal clinical significance to severe hypertension with multi organ dysfunction. Pre-eclampsia complicates about 2-8% of all pregnancies. Pre-eclampsia incidence in India is about 8-10%. Various studies have depicted that, there is a strict relationship between PIH and elevated serum β-hCG level.Methods: This one-year prospective case control study toteled 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum βhCG levels were estimated by chemiluminescent microparticle immunoassay. Statistical analysis of data was done by student’s t-test and p-value.Results: The mean β hCG level in PIH patients was found to 36851.59 mIU/ml with standard deviation of 22916.58 while the mean β hCG in normotensive patient was 15433.26 mIU/ml with standard deviation of 6861.56. (p <0.001). The mean β hCG level in gestational hypertensive patients was 25206.19 mIU/ml with a standard deviation of 8696.9. The mean β hCG level in pre-eclamptic patients was 61697.67 mIU/ml with standard deviation of 18498.57. The mean β hCG level were 84106.38 mIU/ml with standard deviation of 11295.05 in the eclamptic patient. The above values were statistically significant (p <0.001).Conclusions: We concluded that there was a striking relation between the PIH including pre-eclampsia and eclampsia with the elevated serum βhCG level. Concluding that early detection of altered serum βhCG shell aid in better management of pre-eclampsia and eclampsia cases which would play a pivotal role in improving the maternal and fetal outcome.

A Ureteral Mass Presenting As Deep Vein Thrombosis: A Very Rare Presentation

Deep Vein Thrombosis (DVT) is a dreaded condition, caused by an interplay of a triad of factors consisting ofhypercoagulability, vascular endothelial dysfunction, and stasis. Stasiscan lead tothe development of DVT due to mass external compression over pelvic veins. Here, we present the case of a 45-year-old female who presented with sudden onset left lower limb swelling who was diagnosed to have left iliac venous thrombosis caused by external compression due to an advanced ureteric malignancyunderlining the need for a thorough evaluation in such patients to reveal a more sinister pathology.

Adrenocortical Carcinoma With Contralateral Renal Metastases And Tumor Thrombus: A Case Report

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy. ACC with renal vein or inferior vena cava (IVC) thrombus is very rare. ACC with contralateral renal metastasis with renal vein thrombus has never been reported. Here we report first such case in the literature where a 40-year-old male presented with right flank pain and weight loss. Definitive reoperative diagnosis failed to be established. Intraoperatively, there was right adrenal mass with left renal vein thrombus invading its wall and extending upto IVC. Right adrenalectomy with left radical nephrectomy with thrombectomy was done. On cut specimen, there was a small mass lesion in the left kidney (upper pole). The diagnosis of ACC with left renal metastasis and renal vein tumor thrombus was confirmed by pathological and immune-histochemical examination. We faced various perioperative challenges in our case. Care must be taken in preoperative diagnostics, intraoperative planning, and postoperative management as ACC may present with contralateral renal metastasis and tumor thrombus.

Laparoscopic Management Of A Giant Prostatic Utricle: A Case Report And Review Of Literature

Prostatic utricle is a Mullerian duct remnant with an incidence of 1 %. Excision of utricle is challenging because of the close proximity of seminal vesicle, ejaculatory ducts, bladder, rectum, ureter, and nerve plexus. Here, we report the case of a 23-year-old male presented with complaints of painful terminal hematuria associated with clots along with retrograde ejaculation. The abdominal and local examination was within normal limits. MRI pelvis showed a large non-communicating cystic structure present in the pelvic cavity, compressing posterior wall of the urinary bladder, seminal vesicle, anterior wall of the rectum and also causing left hydroureteronephrosis. After evaluation, the patient was diagnosed with giant prostatic utricle cyst. Laparoscopic excision of prostatic utricle cyst was done successfully. Postoperative period was uneventful and the patient was discharged in satisfactory condition. Laparoscopic excision of prostatic utricle cyst is technically challenging but with acceptable complications and good surgical results

Surgical Management Of Penile Mondor’s Disease: Case Report And Brief Review Of Literature

Penile Mondor’s disease (PMD) is a rare condition characterized by thrombosis of superficial dorsal vein of the penis. PMD is usually caused due to vigorous sex or repeated trauma to the penis leading to painful swelling of the penis. Most of the patients improve gradually on conservative treatment. Very rarely cord like lesion persists and causes painful erection and intercourse, meriting surgical management. Here, we report the case of a traumatic Thrombophlebitis of Superficial Dorsal Vein of Penis managed surgically along with a brief explanation of the surgical technique. Color Doppler was helpful in delineating the whole extent of thrombus in the vein. Excision of the whole length of the thrombosed vein was done. Abstinence from sex was advised for six weeks and the patient improved symptomatically