Ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery: a prospective study from a tertiary care hospital of Rajasthan

Background: Induction of labor (IOL) is one of the most frequent obstetric procedures require for various obstetrics indications in 13-20% of term. Traditionally success of induction has been determined by Bishop score, but this score is observer based and significant inter observer disagreements have been noted. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. So in this study we did ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery.Methods: All eligible women who are planned for induction of labour will undergo ultrasound assessment of foetal head–perineum distance prior to induction of labour. Transvaginal ultrasound will also be performed using ultrasound probe to measure cervical length. After the scans, prevaginal examination will be performed to assess the various components of modified Bishop score (min 0, max 10). If cervix is found unfavourable, induction of labour will be done. If patient did not go into active labour, then induction will be considered unsuccessful) or else oxytocin drip in cases where cervix is found favourable. The patients will be followed up till delivery.Results: Out of 125 patients enrolled for the study, 101 women delivered successfully vaginally and 24 had to undergo caesarean delivery. Of these 24 cases of caesarean delivery, 11 cases were excluded as the operative procedure was performed for indication not related to unsuccessful induction such as occurrence of foetal distress in labour, thick meconium-stained liquor with unfavourable cervix. The final analysis was performed from 114 subjects (101 vaginal births and 13 caesarean births).Conclusions: Transperineal fetal head–perineum distance is less painful as less time consuming and less acceptable by patients compare to Transvaginal measurement of cervical length and painful digital examination for bishop score.

Modified biophysical profile in high-risk pregnancy and its correlation with perinatal outcome

Background: Aim of the present study was to evaluate the perinatal outcome in high-risk pregnancy with modified biophysical profile (MBPP).Methods: The study is observational study,65 high risk pregnant women fulfilling the inclusion criteria participated in the study. The study subjects were subjected to MBPP. Then perinatal outcomes were assessed in view of mode of delivery, maternal and neonatal morbidity and mortality.Results: Out of 65 cases, 78.5% had normal NST, 80% had normal AFI.3 neonates got admitted in NICU. 13 women underwent LSCS, 9 had instrumental delivery and rest delivered vaginally normal.Conclusions: The study showed that HRPs with MBPP abnormal or any of MBPP parameter abnormal have higher chances of perinatal morbidity and mortality.

Neuroimaging in eclamptic patients and its clinical implications

Background: Aim of the study is to assess the utility of neuroimaging (CT/MRI) in eclamptic patients and correlating their clinical implications and to study the role of Injection Mannitol in case of Eclampsia who did not respond to injection magnesium sulphate alone.Methods: This prospective study was conducted in Pannadhay Mahila Chikitsalya Udaipur, RNT Medical College Udaipur, Rajasthan. 50 eclamptic patients fulfilling the inclusion and exclusion criteria were subjected to neuroimaging CT/MRI from August 2021 to August 2022. Injection Mannitol was added in eclamptic patients who did not respond to injection magnesium sulphate alone.Results: In this study neuroimaging were normal in 42% cases while 58% cases had pathological changes; PRES, haemorrhage, infarction, ischemia etc. Out of these PRES was seen in 48% cases. Mannitol was given in 14% patients and only one patient did not respond to mannitol.Conclusions: This study revealed that PRES was the main neurological component among patients. Neuroimaging helps in better management of eclampsia. Mannitol holds utility in managing the patients unresponsive to injection magnesium sulphate.

A rare case of genital myiasis in genital prolapse

Genital myiasis is an infestation by fly larvae in genital organs, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. Commonly cutaneous, ophthalmic, auricular and nasopharyngeal myiasis are seen, with genital myiasis being a rare condition. We reported a case of an 82-year-old postmenopausal female who presented with the complaint of intense pain in genital region. After clinical evaluation she was clinically diagnosed as a case of genital myiasis of prolapsed uterus. Myiasis of the genital organ is a rare clinical entity. Good personal hygiene and proper sanitary conditions are very crucial for prevention of myiasis.