ABSTRACT
Background: Fetal growth restriction (FGR) is one of the major factors of perinatal morbidity and mortality. Aim was to study the maternal and fetal risk factors associated with non- detection of fetal growth restriction.Methods: A retrospective analysis was done at a tertiary care hospital. 280 term newborn cases weighing <2.5 kg were selected and they were divided into two groups, Group I- FGR detected cases by ultrasound, and group II- FGR non detected cases. Data was collected from the labour room registers.Results: Incidence of FGR found to be 6.8%.The maternal biological factors found to be significantly associated with fetal growth restriction were gestational hypertension, chronic hypertension and anemia. Fewer ANC visits was associated with non-detection of FGR cases. Detection of FGR cases were more if the birth weight found to be <2 kg when compared to non detection of FGR cases.Conclusions: Anaemia and fewer ante natal visits were associated with non detection of FGR at term when compared with antenatally detected FGR patients.
ABSTRACT
Entero-uterine fistula is a very rare type of fistula between the small intestine and the genital tract. They may result from obstetric or gynaecological procedures like post D and C perforation of the uterus. Timely detection and management reduce morbidity and mortality of the patients. We present a case of entero uterine fistula in a lady which was diagnosed on second postnatal day when she complained of passage of stool per vaginum. She had a previous history of mid trimester abortion followed by D and C after which she remained hospitalised for a week for pain abdomen. The diagnosis of this fistula was based on her symptoms and clinical evaluation of passage of intestinal content through the cervix and CT scan finding of gas in the abdomen. Intraoperatively an ileal loop was found adherent to the posterior wall of uterus with large fistula between bowel and the uterus. There was no intraperitoneal faecal contamination. Adherent small bowel was separated from the posterior wall of the uterus and fistula dismantled. Side to side functional end to end anastomosis was done using TLC 75 stapler. Repair of the uterine rent was also done. Post op recovery was uneventful.
ABSTRACT
Background: Ectopic pregnancy is one of the most important causes of maternal mortality and morbidity in the first trimester of pregnancy. Objective of this study was to compare the safety, feasibility and advantage of laparoscopic approach with that of laparotomy in management of ectopic pregnancy.Methods: A retrospective study was conducted at two tertiary hospitals over a period of two years i.e.; from Aug 2015 to July 2017. Seventy-five patients who had histopathology confirmed tubal ectopic pregnancy were divided into two groups; laparoscopy (Group I, no-39) and laparotomy (Group II no-36). The main outcome measures were operative time, blood loss, and requirement of blood transfusion, requirement of analgesia and duration of hospital stay.Results: Seventy-five patients of ectopic pregnancy who were managed surgically were studied. There were 39 cases in laparoscopy group and 36 cases in laparotomy group. The incidence of ectopic pregnancy was 1.56% (out of all deliveries over 2 years). Ampullary region was the commonest site of ectopic pregnancy (74.6%). No difference was found in the two groups regarding age, site of tubal pregnancy, pre op Hb status and haemoperitoneum. Mean operating time was significantly shorter in the laparoscopy group 39 min (range 30 - 52 min) versus 50 min (range 40-60 min) in the laparotomy group. There was no difference between the groups regarding the treatment with blood products and perioperative complications. Hospital stay was significantly longer in the laparotomy group (3.5 days) as compared to 2 days in laparoscopy group. The duration of post op analgesia requirement was also longer in laparotomy group (4 days) as compared to 2 days in laparoscopy group.Conclusions: Laparoscopic management of ectopic pregnancy is a safe, effective and beneficial option in the hands of an experienced laparoscopic surgeon even in cases of massive haemoperitoneum. It definitely offers the advantage of shorter duration of surgery, faster post op recovery, shorter duration of hospital stays and lesser requirement of post op analgesia.