ABSTRACT
Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality.
ABSTRACT
Background: Ultrasound helps in assessing the type of abortion. Life threatening emergency like ectopic pregnancy, when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status. The objective of this study was to compare the utility of ultrasound with clinical examination findings in pregnant females having vaginal bleeding.Methods: A hospital-based prospective study was conducted among 100 pregnant patients who have the problem of bleeding. A complete general physical and pelvic examination was done, and patients were then subjected to ultrasound examination. Epi info 7 software was used for statistical analysis. Chi- square test was used as the test of significance and correlation in terms of sensitivity, specificity was seen. P<0.05 is considered statistically significant.Results: 72 cases were diagnosed by ultrasonography as viable pregnancies with sensitivity, specificity negative predictive value (NPV), and positive predictive value (PPV) of 82% and 28 cases were diagnosed as non-viable pregnancies by ultrasonography with sensitivity of 52%, specificity of 81%, and NPV of 72%. The clinical diagnosis had sensitivity of 82%, specificity of 52%, and PPV of 40% in diagnosing viable pregnancies. In diagnosing non-viable pregnancies, clinical diagnosis had a very poor statistical correlation with sensitivity of 52%, specificity of 81%, PPV of 64%, and NPV of 72%.Conclusions: Judicious utilization of ultrasonography and a close connection with the sonologist is necessary. However, it should be realised that ultrasound is complementary in the pelvic examination and cannot substitute obstetric history and clinical examination.
ABSTRACT
Background: The incidence of placenta previa ranges from 0.5-1% amongst hospital deliveries. Placenta previa is major cause of antepartum haemorrhage and is potentially devastating complication. Obstetric haemorrhage is most common cause for maternal and perinatal morbidity and mortality in India. This study aimed to determine frequency, type of placenta previa, risk factors and adverse fetomaternal outcomes of placenta previa.Methods: This was a prospective study carried out in Department of Obstetrics and Gynaecology, Government Medical College and Sir-T hospital, Bhavnagar from July 2007 to July 2009 to analyze fetomaternal outcome in cases of placenta previa. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by Ultrasound examination. All cases were carefully analyzed to find out the incidence, type of placenta previa, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity.Results: There was total 50 cases of placenta previa out of 5636 deliveries. The prevalence of placenta previa was 0.88% and was more commonly present among multiparous women (82%). Most common type was type IV placenta previa in 23 (46%) cases followed by type III in 11 (22%) cases. Out of 50 cases, 06 (12%) cases had atonic PPH and 02 (04%) cases underwent peripartum hysterectomy. Most common predisposing factors were age >35 years (04%), multiparity (50%), previous cesarean section (16%) and previous history of abortion (12%). All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.5 kg. There was no maternal mortality in this study.Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due to its increased risk of maternal and perinatal complications.