An extremely rare case of hand prolapse with preterm premature rupture in the membrane of one twin

The latency in preterm premature rupture of membranes (PPROM) can last for weeks. We describe an extremely rare case of hand prolapse with PPROM that was exposed for 23 days before delivery. The patient had spontaneous PPROM of twin A at 21.4 weeks of gestation with shoulder presentation. The right arm of the fetus eventually protruded out the vagina and the hand was exposed for extended period of time of 23 days until delivery. Daily dressing by applying collagen to dry skin and silicone to keep moisture was done to the protruding hand to prevent dehydration and desquamation of the skin. Prophylactic antibiotics were used and the patient underwent emergent cesarean section due to uncontrolled preterm labor at 25.2 weeks. To the best of our knowledge, this is the first case of hand prolapse of one twin with extended period of latency before delivery.

Pattern of Obstetrical Emergencies and Fetal Outcomes in a Tertiary Care Center.

Introduction: Th ere is increasing awareness and facilities provided by various government and non government organizations regarding antenatal care and safe delivery practices but it is still a public health concern due to high maternal and perinatal mortality. Th e aims of present study is to assess the availability of manpower which provided services to the mothers in the peripheries, role of demographic characteristics, educational status, common pregnancy complications and there maternal and fetal outcome along with the hospital stay. Material and Methods: It was a retrospective study carried out in the Teerthanker Mahaveer Medical College. All the patients who were admitted through casualty were analysed with respect to Age, parity, Socioeconomic status, antenatal check-up, reason for referral from periphery, maternal and fetal condition at the time of admission, mode of delivery, maternal and fetal outcome along with NICU admission & hospital stay. Result: It has been observed that most of the patients with poor obstetrical outcome are multiparous or grand multiparous with low socio economic status not receiving any antenatal care. Th e common obstetrical emergencies came out were PIH (18%), obstructed labor (10.3%) followed by APH (8.2%), fetal mal-presentation (7.5%) and anemia (7.2%). Conclusion: Illiteracy and ignorance of female regarding healthcare requirements came out to be a major contributor of poor pregnancy outcome. Early diagnosis and management of high risk pregnancies is one of the measures which can reduce poor pregnancy outcomes. It is to be emphasized that majority of the maternal death from pregnancy are preventable by sample priority intervention. Co-ordination between healthcare providers at gross root level to tertiary care centre is the need of time. Health care providers at PHC and CHC levels should have adequate knowledge of antenatal requirements and importance of immunization. Th ere must be referral of high risk cases for their early and timely management. Th ere must be adequate transport facility and systematic referral system as well as provision of immediate management of referred cases at tertiary care centre. So it is high time for urgent strategic planning and investment for upgrading eff ective obstetric and neonatal care.