Ectopic pregnancy: an observational study in a tertiary care centre of Southern Rajasthan, India

Background: One among the three chief obstetric causes of bleeding in first trimester, ectopic pregnancy is the first thing to rule out as a gestation is suspected. The present study observes and analyses sociodemographic distribution, risk factors, presentation, diagnosis and treatment modalities in a tertiary care centre.Methods: An observational cross-sectional study, conducted among patients who were diagnosed and managed in department of obstetrics and gynaecology of a tertiary care centre. Data analyzed and explained as frequency, percentage, mean and standard deviation.Results: Age group between 21 to 30 years (69.9%) and multigravida (68.5%) are high risk for ectopic pregnancy (EP). Menstrual history was regular in 86.3%. Risk factors identified were previous abortion (30%) and history of pelvic inflammatory disease (30%). In 80.9% pain in abdomen was presenting complaints followed by bleeding per vaginum (60%), amenorrhoea (60%) and nausea and vomiting (32.9%). Right salpingectomy was most common in 43.8%, followed by left salpingectomy in 28.8%, methotrexate in 15.1%, left salpingo-ophorectomy in 5.5%, right salpingo-opherectomy in 5.5% and removal of tubal abortion in 1.3% patients. Laparoscopy was chosen route in majority 64.4% patients.Conclusions: Ectopic pregnancy - a gynecological catastrophe as well as a major challenge to the reproductive performance of women worldwide, should be considered a relevant public health issue. By providing adequate materials, manpower, well-equipped health facilities as well as a prompt and efficient referral system, good access roads and efficient transportation, will ensure early presentation in hospitals and prompt management of cases.

Misdiagnosis of interstitial pregnancy followed by circlage operation and failed induced midtrimester abortion: a case report

Interstitial pregnancy is rare form of ectopic pregnancy that can expand up to 18 weeks leads to massive haemoperitoneum hence early diagnosis is imperative to decrease mortality and morbidity. Present case diagnosed as interstitial pregnancy at laparotomy when she had taken for hysterotomy after two failed courses of medical abortion. Clinicians should bear in mind the limitations of various investigations and should have a higher degree of suspicion for interstitial pregnancy Any deviation from normal response to administration of medical abortificient, such as failure to abort, should instigate the diagnosis of ectopic (interstitial) pregnancy by expert radiologist.

A study of fetomaternal outcome in induction of labour in third trimester oligohydramnios

Background: The Induction of labor in oligohydramnios poses a dilemma for obstetrician. Studies are limited with variable results. This study aims at finding whether isolated oligohydramnios is an indication for operative delivery or labor induction followed by vaginal delivery is possible.Methods: A prospective study carried out on females delivered in study duration in Umaid Hospital, Jodhpur, Rajasthan. Outcomes studied were gestational age at delivery, colour of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery, Apgar score at one minute and five minutes, birth weight, admission to Neonatal Intensive Care Unit (NICU), perinatal morbidity and perinatal mortality. Descriptive statistics were applied and data was represented on frequency tables, graphs and diagrams.Results: 40% of subjects had amniotic fluid index (AFI) <5 cm and 60% demonstrated AFI between 5-7 cm. 60% of patients induced delivered vaginally with (38.33%) having AFI <5 cm. Operative delivery was resorted to in 40% of patients. Perinatal outcomes resulted in total 97% of babies discharged in healthy condition.Conclusions: Labor induction is feasible in idiopathic oligohydramnios. Fetal distress is the most feared and predicted outcome with labor induction in oligohydramnios. This study deduced that in majority- reason for c-sections was failed labor induction due the poor Bishop's score, not fetal reasons. We hope by putting at rest apprehensions of obstetrician regarding this notion rate of c-sections could be reduced.

A Rare Case Of Term Viable Abdominal Pregnancy With Review Of Literature

Abdominal pregnancies are rare types of ectopic pregnancies with high rates of maternal and perinatal morbidity and mortality. Abdominal pregnancy accounts for up to 1.4% of ectopic pregnancies. We report a case of term live abdominal pregnancy without malformation with implantation of the placenta into the uterus and anterior abdominal wall, discovered during a planned obstetric hysterectomy indicated for placenta accreta. Abdominal pregnancy is a serious and potential life-threatening condition. Diagnosis and management can be difficult especially in developing countries. A high index of suspicion is key for timely diagnosis and intervention to prevent life-threatening complications

Repeated broad ligament hematomas managed by uterine artery embolization: time to execute

Selective arterial embolization (SAE) of the uterine arteries is an alternative to surgery when medical management fails in cases of intractable posrtpartum haemorrhage. It is highly efficacious with low complication rate. Here we report a case of repeated broad ligament haematoma managed by selective uterine artery embolization. Present case 28year old P4L4 was referred from a district hospital as post LSCS case with broad ligament haematoma. Patients general condition was very poor at the time of admission. She underwent laparotomy twice and finally uterine artery embolization for repeated broad ligament haematoma and responded. Massive obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. The threshold for uterine artery embolization (UAE) in women with obstetric haemorrhage should be low, as it is coupled with a high clinical effectiveness rate, low complication rate and preservation of fertility. However, it requires an infrastructure, multidisciplinary approach, as well as speedy and effective interaction between various specialties.

Randomized Controlled Study Comparing Sublingual to Vaginal Misoprostol for Cervical Priming Prior to Surgical Termination of Pregnancy in First Trimester.

Background: To compares the effectiveness and acceptability of sublingual versus vaginal route of misoprostol for cervical priming prior to vacuum aspiration. Material and methods: In this prospective clinical study, a total of 70 women with period of gestation between 6 and 12 weeks selected randomly for day surgery abortion were sequentially allocated into two groups of 36 and 34. All selected women received 400 mg of misoprostol 3 hours prior to vacuum aspiration either by sublingual or by vaginal route in the hospital. Results: For all periods of gestation, sublingual misoprostol significantly improved cervical dilatation. Duration of the procedure and amount of blood loss were comparable in both the groups. Patient acceptability was higher in the sublingual group. Conclusion: Cervical priming with sublingual misoprostol is effective and convenient route with high patient acceptability rate.

Bilateral acquired ptosis, an unusual presentation of a cerebral arteriovenous malformation

Arteriovenous malformations (AVM) of the brain are uncommon congenital lesions with a complex array of arterial to venous shunts. The common clinical manifestations include haemorrhage, seizures, headache, progressive neurologic defi cits and congestive cardiac failure. We report a child who presented with bilateral acquired ptosis, a very rare presentation of AVM which has not been previously reported.