ABSTRACT
Background: Ectopic pregnancy is defined as any intra or extra-uterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development. It is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies affecting approximately 2% of all pregnancies. The purpose of this study is to review cases of ectopic pregnancy and determine: incidence, high risk factors, types of clinical presentation, diagnostic methods, management, morbidity and mortality.Methods: The present study, conducted over a period of 2-year, total number of deliveries was 16,144 and total number of ectopic pregnancies was 116. More than half of the cases (56.04%) had one or the other identifiable risk factor. Results: Amongst the various risk factors studied, history of previous pelvic surgery (15.43%), history of Pelvic inflammatory disease (PID) (12.9%), use of Intrauterine contraceptive device (IUCD) (10.3%) and either spontaneous or induced abortion (7.76%) has been found. History of self-administered medical termination of pregnancy (MTP) pill was present in 3.45%. Repeat ectopic pregnancies were seen in 1.72%. There was no identifiable risk factor in 49.63% of cases.Conclusion: Ectopic pregnancy is a major challenge in obstetrical practice because of its varied clinical presentation. It can be diagnosed early by keeping a high index of suspicion. Undue delay in referral reduces significant morbidity and improves the chances of preserving future fertility. Mass education regarding safe abortion practices and post abortal care should be promoted. Unsupervised usage of MTP pill intake should be condemned.
ABSTRACT
Background: To analyse the requirement of high dependency unit (HDU)/intensive care unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome.Methods: Retrospective observational study was carried out from April 2015 to September 2018 at department of obstetrics and gynecology SSG Hospital, Vadodara India. Data related to indications for ICU admission, interventions required, length of stay and outcomes were collected, and results were analyzed.Results: Obstetric ICU utilization rate was 130 per 1000 deliveries. The major obstetric indications for admission were hypertensive disorders of pregnancy (42%) followed by anemia (25%) and post-partum hemorrhage (3%). In the rest of the patient’s majority (50%) had cardiovascular problems. Maternal mortality among these critically ill women was 3.76%. The death rate in the present study was high among patients admitted for non-obstetric (74.54%) as opposed to obstetric indications (25.46%).Conclusions: Establishment of well managed high dependency and intensive care unit in health care facilities dealing with high volumes of high-risk maternity cases reduces the maternal mortality significantly and results in improved maternal outcomes.
ABSTRACT
Background: Infertility is one of the commonest problems encountered in gynecology. Infertility appears to be a problem in 10-15% of Indian population. Tubal factors account for (20-40%) of infertility. The objective of the study was to demonstrate the role of hystero-salpingography and hystero-laparoscopy in evaluation of tubal factors for female infertility.Methods: Present study was carried out on 70 women attending the gynaecology OPD for investigation of infertility admitted between March 2014 to December 2014 in Gynecology ward, SSG Hospital attached to Government Medical College, Vadodara, Gujarat.Results: Out of 70 patients who underwent HSG tubal block was detected in 34 cases. Out of these 34 cases tubal block was detected only in 17 cases by laparoscopy and chromopertubation. One case which showed patent tubes on HSG had unilateral tubal block on chromopertubation test. Accordingly, sensitivity of HSG for tubal patency comes out to be 0.72, specificity of 0.94, positive predictive value of 97.43%, negative predictive value of 51.61%, positive likelihood ratio of 12.28 and negative likelihood ratio of 0.30.Conclusions: HSG being simple and less invasive technique along with higher specificity and lesser complications. Hystero-laparoscopy is a valuable technique for the complete assessment of female infertility.