ABSTRACT
Background: Population explosion is a major issue especially in our country with the second largest population in world next only to china starting the use of contraception in postpartum period is an effective method of increasing the gap between two pregnancies and hence reducing the family size. Objective was to study the efficacy of DMPA injection in postpartum period for contraception.Methods: The study was a prospective study conducted on 100 patients during June 2018 to May 2019 in the department of obstetrics and gynaecology, S. P. Medical College Associate A. G. H., Bikaner, Rajasthan, India.Results: In present study mild irregular bleeding was present in 21, 35 and 38 cases at initial visit, at 3 months and at 6 months follow up respectively. Moderate irregular bleeding was present in 8 cases at initial visit, 27 cases at 3 months and 18 cases at 6 months follow up while 37 and 43 cases had severe irregular bleeding at 3 and 6 months follow up respectively. At baseline, 89 and 10 and 1 cases had their blood sugar <100, 100-120 and >120 respectively, at 3 months follow-up, 94, 6 and 0 cases had their blood sugar level <100, 100-120 and >120 respectively while at 6 months follow-up 97, 3 and 1 cases had their blood sugar level <100, 100-200 and >200 respectively.Conclusions: Injection DMPA use in postpartum period is safe, effective and reversible method with no deleterious metabolic effects and do not need special training to administer to it, so it is a good option of contraception for women who are lactating.
ABSTRACT
Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare mean duration of labour andmaterno-foetal outcome of induced versus spontaneous labour among nulliparous women using modified WHO partograph.Methods: The study was conducted in nulliparous women coming at term in active phase of labour (with cervical dilatation at least 4 cm) either spontaneous or induced, both labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery and the materno foetal outcome.Results: A total 100 women were compared in each group. There was no difference in mean age group, BMI, gestational age. More women had spontaneous vaginal delivery among those with spontaneous labour (76% versus 58%) (p=0.033). The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes) (p=0.0212). The mean Apgar scores were comparable in two groups. Induced labour is comparable to spontaneous labour regarding fetomaternal outcomes but with increased rate of caesarean deliveries.Conclusions: Study concluded from our study that in spontaneous group mean duration of labour was less than induced group and most of the patient delivered vaginally. In induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. Maternal complications were also found more in induced group than spontaneous group whereas neonatal outcome was similar in both the groups. We observed in our study that induced labour can be a safe procedure among nulliparous women if labour is partographically monitored by WHO modified partograph.
ABSTRACT
Chronic inversion of uterus is a rare clinical entity which is usually associated with obstetrics complication and rarely with gynaecological disorder like fibroid present at fundus of uterus. We here present a case of 40-year-old female P3L3 with chronic inversion of uterus with fundal fibroid which present with 3year history of abnormal vaginal bleeding. Ultrasonography and MRI revealed cervical fibroid. Due to AUB secondary to cervical fibroid decision of hysterectomy was taken. On laparotomy chronic uterine inversion was present which was corrected by haultain’s procedure. Then hysterectomy was done. Histopathology report suggestive of uterine leiomyoma at fundus of uterus. Chronic uterine inversion associated most commonly with fundal submucous leiomyoma. Other causes are leiomyosarcoma, endometrial carcinoma, cervical carcinoma, rhabdomyosarcoma, mixed mullerian sarcoma. It is an extremely rare gynaecological condition and can be misdiagnosed as cervical fibroid, advanced cervical malignancy or other causes of AUB in females. It could be labelled as gynaecological near miss so a high index of suspicion is necessary for it’s diagnosis.