ABSTRACT
Abdominal pregnancy refers to a pregnancy that has implanted in the abdominal cavity, the estimated incidence being 1 per 30,000 births. A 36-year-old primigravida with term pregnancy with fetal demise was referred to us. Examination was suggestive of single foetus of 30 weeks’ gestation with longitudinal lie and cephalic presentation with absent foetal heart sounds. The cervical os was closed, uneffaced. Ultrasound done at 18 weeks’ gestation had reported pregnancy in a bicornuate uterus. Present ultrasound revealed intrauterine foetal demise of 28.4 weeks. Cervical ripening, done using prostaglandins, mechanical dilation with Foley’s catheter and oxytocin, had failed, and thus patient was taken up for surgery. Findings revealed an abdominal pregnancy with a macerated fetus of 1070 grams (severely growth restricted). Placenta was found to be implanted on multiple areas of both small and large intestine and posterior peritoneum. Placenta was left in situ. Postoperative recovery was uneventful. She was given higher antibiotics, 4 doses of tablet mifepristone 200 mg and monitored regularly with ultrasound/ MRI and bHCG which showed slow placental resorption. Conclusion- Abdominal pregnancies, associated with a high maternal and perinatal morbidity and mortality, are diagnosed preoperatively only in 45% of cases. Thus, a high index of suspicion and improvement in diagnosis is the need of the hour. Successful management includes prompt intraoperative recognition and management of the placenta (we advocate leaving the placenta in situ), multidisciplinary approach with involvement of surgeons and interventional radiologists, access to blood products, meticulous postoperative care and close observation during the subsequent delayed reabsorption.
ABSTRACT
Background: HIV can cause considerable morbidity and mortality in those affected. An effective PPTCT programme helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.Methods: A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered at the hospital during a period of 9 years from January 2010 to December 2018. Pretest counseling, HIV testing, Post-test counseling were done and antiretroviral prophylaxis given as per the NACP guidelines. Sociodemographic characteristics, obstetric and maternal-foetal outcome of seropositive women and efficacy of PPTCT services were analyzed.Results: Out of the 58,205 antenatal mothers included, 55,256 (94.93%) accepted HIV testing. 171 of these tested positive (0.31%). 70 spouses of the 171 seropositive women tested positive, 53 tested negative and 48 did not undergo the HIV test. Majority of seropositive women were primigravidas; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. 7.6% had an MTP, 1.75% a spontaneous abortion and 0.58% an ectopic pregnancy. Of the 154 births, 35.71% underwent caesarean sections. There were 96.7% live births in our study and the perinatal mortality rate was 5.19%. After 2013, all mother-baby pairs were given ARV prophylaxis.Conclusions: Utilization of PPTCT services has increased through the years, decreasing the vertical transmission and seroprevalence rate. Increasing the acceptance rates of HIV testing, both by patients and partners may further help in curbing the spread of this condition.