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Background: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital.Methods: The study was a retrospective analysis of all obstetric and gynecological surgeries over a period of 6 years from January 2014 to December 2019. Cases with the documented urological injuries during these procedures were analyzed further.Results: Total 8595 patients had undergone different obstetrics and gynecology procedures, out of which 5429 were obstetrics and 3166 were gynecology surgeries. Out of 3166 of gynecology procedures, there were 16 cases (0.5%) of bladder injuries and one case (0.03%) of ureteric injury. Out of 5429 cases of obstetric procedures there were 11 (0.2%) cases of bladder injury and one case (0.01%) of ureteric injury.Conclusions: The incidence urological injuries during obstetrics and gynecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.
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Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome.
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We hereby report the results of a prospective randomized study where we compared efficacy of mifepristone and prostaglandin (PGE2) gel for pre-induction cervical ripening.
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Leiomyomas are most common benign gynaecological tumour. Most of the fibroids are situated in the body of the uterus, but only in 1-2% cases, they are confined to cervix. We report a case of a 48-year old female who presented with gradual abdominal distension for one year. Abdominal examination revealed a huge mass of 28 week size pregnant uterus with well-defined margins except the lower poles which cannot be reached, restricted mobility from above downwards but can be moved from side to side, non-tender and solid in inconsistency. Ultrasound revealed a large abdominopelvic mass with solid and cystic component. On exploratory laparotomy, a huge central cervical fibroid was found and total abdominal hysterectomy with bilateral salpingoophorectomy was done after enucleation of the fibroid by Rutherford Morrison’s technique. Histopathological examination confirmed the diagnosis of cervical fibroid with hyaline and cystic degeneration. The postoperative was uneventful.
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Two pairs of conjoined twins were encountered at the SCB medical college cuttack, Odisha, India during the past 3 years. In the first set the prenatal diagnosis was not established and the case was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Emergency caesarean section done and a pair of thoraco-omphalopagus twins delivered. Both babies died soon after birth. In the second case the conjoined twins were diagnosed prenatally at 20 weeks of gestationon in routine anomaly scan as thoraco-omphalopagus twin with fetuses were positioned face-to-face and fused from sternum to umbilicus. Fetuses were found to have separate hearts, a fused liver and separate upper and lower gastrointestinal tracts. Each twin had two normal appearing kidneys and a urinary bladder. The couples were counselled about the various management options and referred to higher centre. But she was admitted at 34 weeks of gestation with preterm labour and emergency caesarean section done and a pair of male thoraco-omphalopagus twins delivered. Both babies were alive and referred to higher centre for further management. The prenatal identification of conjoined twins is of cardinal importance for the planning of delivery and possible separation.