Post operative wound gape in obstetric and gynaecological surgeries

Background: Despite advances made in asepsis, post operative wound infection is one of the major causes for increased postoperative morbidity and huge economic burden for patient and healthcare. This study was undertaken to identify risk factors for the post operative wound gaping in obstetrical and gynaecological surgeries.Methods: Retrospective observational study was conducted in the department of obstetrics and gynaecology of Pt. Madan Mohan Malviya Shatabdi hospital, Govandi, Mumbai for the year 2022.Results: 1611 cases were analysed that underwent various obstetrical and gynaecological surgeries. Post operative wound gaping incidence was 1.5 %. Most of the cases were seen in less than 34 years of age. 21% of cases reported with wound gaping and discharge within 5-7 days of surgery while 79% of cases reported gape after 7 days of surgery. 54% cases with wound gape were obstetric. The most commonly known associated risk factor was found to be diabetes mellitus (12.5%) followed by anaemia (8.3%), obesity (4.2%) and hypertension (4.2%). 62.49% of post operative surgical wound gape were multiparous. It is seen that in all these cases of wound gape the subcutaneous tissue was sutured separately as a layer with absorbable suture material- Vicryl no 1-0 or Vicryl no 2-0.Conclusions: Factors affecting post operative wound gaping are diabetes mellitus, anaemia, hypertension, obesity, chemoprophylaxis given prior to surgery, surgical method of wound closure and type of surgery. Standard wound closure techniques, correction of the avoidable known risk factors would provide a better outcome.

Vaginal Delivery through Posterior Cervical Tear without Dilatation of Cervical Os.

A 23-year-old primigravida with no previous history of abortions or miscarriages with spontaneous conception and singleton pregnancy was admitted to the labour ward at 40 weeks 5 days of gestation for induction of labour. She had antenatal workup and immunization as per standard antenatal care (ANC) protocol with regular antenatal visits. She had uneventful antenatal period without any high-risk factors (no hypertension, gestational diabetes or anaemia). There was no history of any medical illness and abdomino-pelvic surgical interventions.On examination, her vital parameters were normal. Uterus full term gestation with fetus in longitudinal lie and cephalic position. Liquor appeared adequate and fetal heart sounds were heard at normal rate in the left lower quadrant. Ultrasonography done prior to admission showed normal findings with estimated baby weight of 2.8 Kg and normal Doppler flows and adequate liquor.Speculum and digital examination was done on admission which revealed the following- No cervical or vaginal injuries or lesions. A long tubular cervix (approx. 2 cm-2.5 cm), midpositioned admitting just tip of a finger. No bleeding or leaking with a BISHOPS score of 4.(1)

Gynaecologic Laparoscopic Surgery Using Spinal Anaesthesia - A Retrospective Observational Study

Laparoscopy is traditionally done under General Anaesthesia (GA) with endotracheal intubation. As the number of cases of laparoscopy increased over the years, regional anaesthesia has been quite frequently used for laparoscopy.METHODSA total of 495 cases of laparoscopic surgeries done in the age group 12 to 47 years during the period August 2015 till September 2019 was considered. Spinal anaesthesia was administered with 25G spinal Needle at L4-L5 intervertebral space with 3-4 ml bupivacaine (0.5%, heavy) and the surgeries were completed. The segmental level achieved was T-6. Intra-abdominal pressure after CO2 insufflation for pneumoperitoneum was maintained at 10-12 mmHg. Post-operative monitoring was done.RESULTSOnly 15 cases (3%) required midazolam. 2 patients stayed for >48 hrs post-surgery (0.4%). 4 GA cases required immediate analgesic infusion. In SA cases, analgesic was required almost 2-3 hours after the surgery was over. Onset of bowel sounds was early with SA cases. In the 4 GA cases (0.8%) PONV was noted. Two patients (0.4%) had spinal headache. 6 patients experienced post laparoscopic shoulder pain (1.21%).CONCLUSIONSSpinal Anaesthesia provides a good field for gynaecologic laparoscopic surgery with excellent muscle relaxation, decreased surgical bed oozing, and a rapid return of gut function, good post-operative analgesia, and decreased incidence of PONV than GA.