ABSTRACT
Background: Caesarean delivery is one of the commonly performed surgical procedures in obstetrics in today's practice. The objective of this study was to estimate the overall incidence and indications of primary caesarean delivery among multiparous women and to study the immediate maternal and perinatal outcome.Methods: It was a prospective observational study done in Sikkim Manipal Institute of Medical Science, Sikkim, India. It included all pregnant women after 28 weeks of gestation who had normal vaginal delivery in previous pregnancy but underwent caesarean delivery during current pregnancy (n=120) from January 2016 to December 2016. Authors collected data using a pro forma. Relevant history including demographic details, relevant clinical, laboratory and radiological examination, indication for caesarean delivery, details of delivery and neonate, and duration of hospital stay were noted. Data was described using descriptive data like mean and percentages.Results: Out of 1646 deliveries conducted, 49% were by caesarean section. It included 7.29% primary caesarean delivery in multigravida. Majority of women (27%) were in the age group 25-29. Maternal request was the commonest indication for caesarean delivery (21.66%). Atonic PPH was the commonest intraoperative complication (2.5%). Surgical site infection was the commonest post-operative morbidity (3.33%). There were 51 perinatal morbidity and 2 perinatal mortality. There was no maternal mortality.Conclusions: Caesarean section rates in this study was higher than WHO recommendation (15% versus 49.69%). This shift in trend can be attributed to higher number of maternal request for caesarean delivery which can be avoided by good analgesic facility and good counselling.
ABSTRACT
Background: Endometriosis can be defined as presence of endometrial mucosa outside the uterine cavity. There are no specific signs and symptoms of endometriosis and the presentation may vary depending upon the site of involvement. It is one of the common causes of subfertility and infertility in young women. The Management of endometriosis may include medical as well as surgical intervention. Laparoscopic interventions have found to have encouraging results in terms of increasing chances of fertility in young women with endometriosis.Methods: This was a prospective study in which women who had infertility and subsequently diagnosed to be having endometriosis were included. A detailed history was taken with particular emphasis on duration of symptoms, presence of additional co-morbidities and duration of infertility was recorded. Diagnostic laparoscopy was done in all the cases. Depending upon location and severity of endometriosis adhesiolysis, excision and ablation of endometrial lesions was done. Patients were followed up and successful pregnancies (spontaneous as well as secondary to assisted reproductive techniques) were recorded.Results: Out of 200 studied cases endometriosis was seen in 23 (11.5%) patients. the most common affected age group was between 26-30 years (47.83%). 18 patients (78.26%) had primary infertility whereas remaining 5 patients (21.74%) were found to have secondary infertility. The most common site was found to be ovaries which was found to be involved in all the cases. cystectomy (30.43%), endometrioma drainage and fulguration (13.04%) or adhesiolysis (34.78%) were the commonly done surgical interventions in cases. out of 18 patients who had successful ovulation following laparoscopic intervention 12 (66.66%) patients completed their pregnancies successfully.Conclusions: Laparoscopic interventions in patients with infertility have diagnostic as well as therapeutic value and are found to have good outcome in terms of successful pregnancy.
ABSTRACT
Background: While the role of antenatal steroids administration to mother is proved in reducing neonatal morbidity and mortality in preterm gestation secondary to respiratory distress and hyaline membrane disease its role in patients undergoing elective cesarean deliveries at or near term appears to be controversial.Methods: This was a retrospective observational study in which women who have undergone elective cesarean delivery between 34-37 weeks of gestation were included. Those women who received two intramuscular injections of 12 mg betamethasone 24 h apart were included in group S whereas the women who didn’t receive such injections were included in group B. Outcome measures were incidence of transient tachypnea of the newborn, hyaline membrane disease and NICU admissions due to respiratory distress.Results: Neonates in the treatment group had a statistically significant lower overall incidence of transient tachypnea of newborn, respiratory distress syndrome and NICU admissions. The incidence of transient tachypnea of newborn and respiratory distress in Group S was 5% and 8.33% respectively where as TTN and respiratory distress was seen in 18.33% and 28.33% neonates in the group N. The over NICU admission rates, due to respiratory distress in group S and Group N were found to be 8.33% and 28.33% respectively.Conclusions: Antenatal administration of corticosteroids to women at or near term (34-37 weeks) is found to have a beneficial effect in reducing neonatal morbidity and NICU admissions secondary to respiratory distress in women undergoing elective CS.