ABSTRACT
Spontaneous bladder rupture after normal vaginal delivery is a rare complication. Patients may present with abdominal distention, fever, haematuria, oliguria and deranged KFT (kidney function test). We are reporting two cases of primigravida with postpartum bladder rupture, one case was diagnosed at laparotomy and the other preoperatively. A patient who presents with retention of urine, haematuria ascites and deranged KFT after uneventful normal vaginal delivery, spontaneous bladder rupture should be suspected. Early diagnosis and management can decrease the morbidity.
ABSTRACT
Background: According to UNICEF, globally 800 million women die due to preventable causes related to pregnancy and childbirth; 20% of which occur in India. It is therefore imperative to understand the level of knowledge about danger signs among pregnant women to augment timely redressal of preventive obstetric causes of mortality.Methods: A hospital based, cross sectional study was conducted at the ANC Clinic in Safdarjung Hospital, New Delhi from 2nd July to 27th July 2018. Convenient sampling was used to identify and interview 354 pregnant women, using a semi structured questionnaire. Data was entered and analysed with SPSSv21. Results were presented as frequencies and proportions. Chi square was used to test for association between qualitative variables, and p-value less than 0.05 was considered significant.Results: 48.3%, 35.6%, and 40.1% of pregnant women had knowledge about danger signs during pregnancy, labour and postpartum respectively. Majority of the women had knowledge about abdominal pain (58.4%) and severe fatigue (80.7%) as danger signs of pregnancy, while bleeding (82.5%) was the most common response as danger sign of labour. More than half had knowledge about heavy bleeding (59.9%) as danger sign of postpartum. The women lacked awareness about Convulsions (92.9%) as danger signs of pregnancy and labour, as well as smelly vaginal discharge (79.6%) in postpartum.Conclusions: Knowledge of obstetric danger signs among pregnant women is still lower. It needs further awareness as it can help in early diagnosis and referral of patients thus reducing maternal mortality and morbidity.
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Context: The biopsy of cervix can be obtained by various methods with availability of newer modalities like loop elec-trode. Objectives: To compare the histo-pathological parameters and clinical outcome of cervical biopsy obtained using punch biopsy forceps versus loop electrode. Methods: Women attending OPD were screened for cervical pa-thology, and colposcopy was done for those who screened positive. Patients who required cervical biopsy after col-poscopy were allocated into 2 group; one undergoing LEEP biopsy and other half biopsied with Punch forceps. During procedure patients were evaluated for the intra–op pain and bleeding and their severity. The histo-pathological di-agnosis was carried out and the sample was studied for its size, adequacy, and presence of any thermal or crush ar-tefacts. Result: The two methods of biopsy were comparable in intra-op parameters, except for the increased re-quirement for additional haemostasis in LEEP biopsy. There was no case of bleeding from biopsy site at the follow-up visit. LEEP biopsy was associated with continued vaginal discharge more often than punch biopsy. An adequate sam-ple for histopathological diagnosis was obtained in 91.25% of all cases. The comparative findings were reflective of comparable efficacy of both methods in providing an acceptable tissue sample for diagnosis. Conclusion: After ana-lysing and comparing the aforementioned parameters, we opined that neither method can be deemed clearly supe-rior to the other as a cervical biopsy procedure.
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Clinical Trials as Topic/standards , Female , Humans , India , Informed Consent , Labor Pain , PregnancyABSTRACT
Background: Hyoscine N-butyl bromide (HBB) acts by inhibiting cholinergic transmission in the abdomino-pelvic parasympathetic ganglia, thus relieving spasm in the smooth muscles of gastrointestinal, biliary, urinary tract and female genital organs, especially the cervico-uterine plexus and aiding cervical dilatation. AIM: The study was undertaken to observe the effects of 40 mg intravenous HBB as a labor analgesic and labor accelerant. Settings and Design: This prospective randomized control trial was carried out on 104 primigravidae with single live fetus in cephalic presentation, with spontaneous onset of labor, between 37-40 weeks of gestation. Materials and Methods: Women were consecutively randomized into study (group I) and control (group II) groups, each with 52 patients after excluding high risk factors like preeclampsia, antepartum hemorrhage, previous uterine scar, and any contraindications to vaginal delivery. Group I received 40 mg HBB as a slow intravenous injection in the active phase of labor while Group II received 2mL normal saline. Pain scores were assessed at baseline and two hours later. Secondary outcome measures compared were progress of labor based on injection delivery interval, mode of delivery and neonatal condition at birth. Statistical Analysis: Statistical significance was assessed by using Student's t-test and Chi-square test. P-value < 0.05 was taken as significant. Results: Pain relief of 35.6% was noted on visual analog score with the use of HBB. Mean duration of labor was 3 hours 46 minutes in Group I compared to 8 hours 16 minutes in Group II (P value: < 0.001). Mode of delivery and neonatal outcome were comparable. No adverse maternal effects were noted. Conclusions: Intravenous Hyoscine N-Butyl Bromide causes pain relief of up to 36% and shortens the duration of active phase without any untoward short term fetal or maternal effects.