ABSTRACT
Background: Incidence of caesarean section is rapidly rising over the last two decades and 25% is contributed by second stage caesarean section. Demographic factors influencing fetomaternal outcome in second stage caesarean section include BMI, socioeconomic status, booking/ unbooking status, gravidity and maternal height.Methods: The present study was prospective observational study conducted in the department of obstetrics and gynaecology at Lady Hardanger Medical College New Delhi from December 2015 to March 2017. 80 women were enrolled in the study. A detailed history and examination of each patient was carried out. Women were observed during lab our till second stage caesarean section.Results: Mean age of population was 25.26±3.75 ranging from 19-40 year. 76.25% included in study were booked and 11.25% were unbooked, 42.5% belonged to lower middle class and 31.25% belonged to upper middle class. 47% women had height of <150 cm and 70% had a BMI between (25-29.9) kg/m. 43% women had gestational age between 39-40 weeks.Conclusions: Second stage caesarean section was more common in young age group and primigravidae. Higher BMI was not only operative but obstetrical risk as well.
ABSTRACT
Background: Incidence of caesarean section is rapidly rising over last two decades and one fourth is contributed by caesarean section in second stage. The objective of this study was to study of fetomaternal outcome in second stage caesarean section.Methods: Prospective observational study was done in 80 women undergoing second stage caesarean section from December 2015 to March 2017 at Lady Hardinge Medical Collage Delhi. These women observed from labour to caesarean section in second stage of labour till post-operative period for any complication. Intraoperative and postoperative complications were observed in these women.Results: Caesarean section rate was 22% in which 3.9% were done in second stage of labour. Most common gestational age being 39-40 weeks (47%). Most common indication being deep transverse arrest (41.25%). Intraoperative complication as bladder injury (5%), extension of uterine incision (23%), PPH (33%) and need for blood transfusion (31%) and post-operative complication as wound sepsis in 58% and 20% requiring resuturing, post-operative fever, prolong hospital stay, prolonged catheterization etc. neonatal complications as severe birth asphyxia (2.5%), respiratory distress (55%), need for mechanical ventilation.Conclusions: Thus, caesarean section done in second stage of labour is associated with increased maternal and neonatal morbidity.
ABSTRACT
Mullerian anomalies are a rare disorder and pregnancy in a rudimentary horn is one of the rarest forms of an ectopic pregnancy. This rarity proves to be an obstacle in the timely diagnosis and management of such cases. Thereby, it often culminates in catastrophic events such as rupture of the rudimentary horn which can claim the life of the mother. In this case report, we study the presentation of a 27-year-old primigravida who was presented at 16 weeks gestation, with an intrauterine fetal demise and failed induction of labor. This case report highlights how the diagnosis of a rudimentary horn pregnancy is often missed and the pregnancy was prolonged. We also aim to emphasize the importance of keeping the possibility of a rudimentary horn pregnancy in mind while dealing with the failure of second-trimester pregnancy termination.
ABSTRACT
BACKGROUND & OBJECTIVE: Extended-spectrum beta-lactamases (ESBLs) are rapidly evolving group of beta-lactamase enzymes produced by the Gram negative bacteria. These enzymes have been derived from TEM and SHV genes by mutations and have been well described in Klebsiella pneumoniae. Information on molecular types of ESBL positive Klebsiella sp. is lacking from India. We therefore undertook this study to look for the TEM and SHV genes in ESBL positive Klebsiella sp. isolated from the patients admitted to a tertiary care hospital in north India. METHODS: A total of 204 multidrug-resistant isolates of Klebsiellae obtained from clinical samples; blood (n=108), urine (n=15), pus (n=2) and sputum (n=79) were obtained and screened for resistance to 3rd generation cephalosporins (3GC). The ESBL status was determined by double disk diffusion test (DDDT) and further by ESBL E-test. Multiplex PCR specific for TEM and SHV genes was performed to distinguish four different genotypes: TEM-positive, SHV-positive, TEM- and SHV-positive and non-TEM non-SHV ESBL types. RESULTS: Eighty six per cent (175 of 204) of the isolates were found to be resistant to at least one of the 3GCs, of which 97.1 per cent (170) of Klebsiella sp. isolates were confirmed to be positive for ESBL. Of these 170 isolates, 95 were randomly selected for PCR of TEM and SHV genes. Isolates having both TEM and SHV genes were common (67.3%) whereas only 20 per cent isolates possessed TEM gene and 8.4 per cent SHV gene alone. INTERPRETATION & CONCLUSION: Our findings showed that the majority of the ESBL positive clinical isolates of Klebsiella sp. carried both TEM and SHV genes followed by TEM alone. Such studies need to be done in various geographical regions of the country to know about the prevalent genotypes for better management of infection.