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Background: It has been reported that single intrauterine fetal death in twin pregnancy occurs in 3.7-6.8% all twin pregnancies. The objective of this study was to evaluate the maternal and fetal demographic features and feto-maternal outcomes in twin pregnancies complicated with single intrauterine fetal demise and evaluation of available management guidelines.Methods: This retrospective study was conducted at obstetrics and gynecology department of SGRRIM and HS, Dehradun, Uttarakhand between January 2015 and December 2019. There was a total of 182 twin deliveries at study hospital during this period and 35 of these cases were complicated with single intrauterine fetal demise. Maternal age, parity, chorionicity of twin gestation, gestational age at single intrauterine fetal demise, gestational age at delivery, mode of delivery, birth weight, Apgar Score at birth, neonatal intensive care unit stay of newborn, maternal fibrinogen levels during pregnancy and delivery time and associated obstetric complications were analyzed in these cases of single intrauterine fetal demise with twin gestation. All monochorionic twin pregnancies were included in the study Group A and dichorionic twin in Group B.Results: The mean age of 32 patients included in study was 29.7±4.6 years. Twenty (62.5%) of these patients were dichorionic and 12 (37.5%) of these were monochorionic twin gestation. Single intrauterine fetal demise occurred in first trimester in 8 (25%) patients, during the second trimester 20 (62.5%) and 4 (12.5%) patients had third trimester single intrauterine fetal demise. Preterm deliveries occurred in 18 (56.3%) of patients and 8 (44.4%) of patients were of monochorionic and 10 (55.6%) of dichorionic twin patients. Among thirty-two patients, 11 (34.4%) patients had caesarean delivery and 21 (65.6%) patient had vaginal birth. No maternal or fetal mortality noted and none of the patients had maternal coagulation disorder.Conclusions: This study indicates that in cases of twin pregnancies with single fetal intrauterine demise with individualized management plan at higher centre and close maternal and fetal surveillance live fetus can be saved without any maternal risk.
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Background: Ectopic pregnancy is a condition when a fertilized ovum is implanted outside the uterine cavity. Life threatening risk of rupture of ectopic pregnancy remains one of the important causes of maternal mortality in India. The aim of study is to analyse the clinical profile, associated risk factors, complications, treatment outcomes to improve maternal mortality and morbidity associated with ectopic pregnancy.Methods: It is a retrospective study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences from January 2015 to January 2020. A total of 182 patients diagnosed of Ectopic Pregnancy were analysed for clinical profile, risk factors, serology, ultrasound findings, complications, treatment offered and outcome.Results: During the study period of 5 years there were total 182 patients who were diagnosed of ectopic pregnancy showing the incidence of ectopic pregnancy in our hospital 1.4% of total number of deliveries. Majority of patients were in the age group of 25 to 30 years (43.95%). Mostly multiparous women (80.1%) had ectopic pregnancy. Majority of patients (56.1%) had no associated risk factors for ectopic pregnancy. Main presenting complain was abdominal pain in 58.8% of patients. Majority of patients (63.2%) had surgery as primary care which indicates delay in diagnosis and arrival at hospital especially in hilly region of Uttarakhand.Conclusions: Ectopic pregnancies need to be diagnosed timely to decrease maternal morbidities and mortalities. Clinical signs and symptoms with serology (Serum beta hCG) and radiological findings helps to optimize treatment for potentially life-threatening condition.
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Isolated fallopian tube torsion during pregnancy is a very rare condition. We report a case of twisted left fallopian tube during pregnancy who presented as a case of acute abdomen at 23 weeks and laparotomy was carried out. Subsequently she had a healthy baby by assisted vaginal breech delivery. Isolated fallopian tube torsion should be suspected in case of acute pelvic pain and prompt intervention is necessary as surgical detorsion may prevent irreversible vascular changes.
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Background: In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section. Methods: A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions. Results: In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%. Conclusion: Immediate postpartum IUD insertion is a safe, convenient and effective method.
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The present study was undertaken to evaluate the role of colposcopy as a screening and diagnostic tool for cervical cancer and other cervical lesions in high risk women. Methods: All the women included in the study were subjected to colposcopic examination. Colposcopic findings were compared with cytology and histopathological examination. Accuracy of colposcopic examination was calculated by standard statistical methods. Sensitivity, specificity, Positive Predictive Valve (PPV) and Negative Predictive Valve (NPV) of colposcopic examination was calculated. Results: Three hundred patients underwent colposcopic examination. The overall sensitivity and specificity of colposcopy was 85.85% and 87.65% respectively. Positive predictive value was 75.83% and negative predictive value was 95.38%. The percentage of false negative as well as that of false positive was calculated to be 13.74%. The accuracy of colposcopy was found to be more for high grade lesions as composed to low grade lesions. Conclusions: Colposcopy gives immediate and accurate results and its value as diagnostic modality is undisputed. It should also be considered as a primary screening test for high risk women living in remote areas where women cannot visit the doctor repeatedly as the ideal screening triage cannot be implemented in such situations.