Intrahepatic cholestasis of pregnancy- case series done in a tertiary care hospital

Intrahepatic cholestasis of pregnancy (ICP) also known as obstetric cholestasis is a liver disorder of pregnancy which is characterised by maternal pruritus usually in the third trimester, raised serum bile acids and increased incidence of adverse fetal outcomes and usually complete resolution of symptoms post-delivery. The etiology of ICP is complex and multifactorial as is the mechanism by which fetal complications occur which is yet not completely understood. The introduction of ursodeoxycholic acid in the management of ICP has provided significant improvement in maternal symptoms as well as fetal outcome. We present a case series of 5 cases of obstetric cholestasis which presented in our tertiary care hospital which could possibly help and guide obstetricians in the future who are dealing with dilemma in diagnosis and management of this condition.

Obstetric hysterectomy in a tertiary centre: a 3-year retrospective study

Background: Obstetric hysterectomy (OH) is a life-saving procedure and involves removal of uterus in cases of intractable hemorrhage. This study includes 21 cases of OH in a period of 3 years at a tertiary centre. We sought to understand the prevalence, indications and outcomes of emergency obstetric hysterectomy.Methods: This is a retrospective, observational study, conducted with the means of hospital delivery records in a tertiary care centre in Navi Mumbai. We included all patients who underwent obstetric hysterectomy in a span of 3 years between 1st April 2020 to 31st March 2023, in Dr. D.Y. Patil Hospital, Navi Mumbai, India.Results: Twenty- one OH were done in the period of study. The incidence of obstetric hysterectomy was 0.45% (452 OH per 100,000 deliveries). It was more prevalent in patients with caesarean section compared to vaginal delivery. Women between the age 25-35 years group comprised of 57.15% cases. Out of the 21 women in the study 7 women were primigravida (33.33%). Most common cause for OH was observed to be uterine atony (42.85%) followed by adherent placenta (28.57%). Maternal morbidity like admission to intensive care unit and need for blood and blood product transfusion was noted in most patients, mortality was observed in only 1 case. Neonatal mortality was nil in this study but, admission to neonatal intensive care unit was required in 7 patients.Conclusions: Although, obstetric hysterectomy kills the future reproductive prospect for a woman, it is life saving for her. Timely decision for OH can not only prevent mortality but, also morbidity for the woman. Previous caesarean section and multigravida have higher incidence of OH. Atonicity is the predominant cause for obstetric hysterectomy in this study.

Hysterolaparoscopy as a one-time approach in infertility: a prospective study

Background: The prevalence of infertility ranges from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less developed nations, with an estimated overall median prevalence of 9%. The present study was aimed to evaluate the role of hysterolaparoscopy in the study of primary and secondary infertility, to identify the various pathological conditions in female reproductive tract leading to primary/ secondary infertility, to develop a plan for therapy and management at the same time.Methods: This is a one-year prospective study conducted in obstetrics and gynecology department at D. Y. Patil hospital, Navi Mumbai, Maharashtra, India. All infertility patients seen in outpatient department, who were medically fit, willing for surgery and willing to get enrolled for study were included in this study.Results: Out of total 120 cases for infertility evaluated, tubal factor is the most common cause (28.3%) in both primary (23.3%) and secondary (43.3%) infertility group as seen on laparoscopy. Followed by ovarian factors (28.3%), peritoneal (11.6%) and uterine factors (10.8%). In 27 cases (22%), there were no detectable pathology at laparoscopy. In this study, hysteroscopy findings show 5.8% cases to have submucous fibroid uterus, 3.3% submucous polyp, 1.6% subseptate uterus, 0.8% septate uterus, 0.8% intrauterine adhesions, 0.8% bicornuate uterus and cervical stenosis 1.6% of patients.Conclusions: From this study, it is concluded that the diagnostic hysteroscopy and laparoscopy is an effective and safe tool in evaluation of female infertility. It provides direct and magnified view of all pelvic organs.

Extraperitoneal versus transperitoneal cesarean section: a retrospective analysis

Background: Cesarean section is becoming a more common delivery type worldwide. The objective of this study was to compare surgical morbidity in extraperitoneal versus transperitoneal techniques of cesarean section.Methods: A total of 60 patients was included in this study out of which 30 underwent extraperitoneal cesarean section(ECS) and 30 patients underwent transperitoneal cesarean section (TCS) and compared both the techniques with respect to nausea or vomiting intra-operatively, pain score (as measured by visual analogue scale) post operatively, return of bowel function and blood loss.Results: Intra-operative nausea and vomiting was noted in 33.34% of patients in TCS group while none of the patients in ECS group had any such complaints. No difference was noted in average blood loss between the 2 groups. Post-operative pain in ECS was 4.13 as compared to 6.86 in TCS. Return of bowel sounds in ECS group was much earlier (5.46 hours) as compared to TCS group (11.33 hours).Conclusions: We conclude that extraperitoneal technique is advantageous over transperitoneal approach. Decreased nausea and vomiting, early return of bowel function in the post-operative period, decreased post-operative pain allowing early feeding and mobilization are definite benefits of this technique. This further helps in making a relatively smoother post-operative recovery.

Successful management of a patient with sudden loss of vision and eclampsia complicated by posterior reversible encephalopathy syndrome

Reversible visual disturbances in patients with eclampsia may be due to either retinal detachment or retinal arteriolar vasospasm or thrombosis of the central retinal arteries or PRES (posterior reversible encephalopathy syndrome). Although retinal arteriolar vasospasm is the most common mechanism of visual disturbance, cortical blindness may occur in 1% to 15% of patients with eclampsia. Reporting herewith a case of reversible cortical blindness in the setting of severe preeclampsia complicated with eclampsia.

A clinical study of preterm labour

Background: There has been a rising incidence of preterm labour in India. Preterm labour poses greater risks of morbidity and mortality of the preterm neonates. Various factors contribute towards risk of preterm labour and its outcome. Addressing these factors appropriately improves the outcome in pregnant women.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology from the period of July 2017 to July 2018.Results: The present study was in 98 patients admitted in our hospital with preterm labour. Clinical profile of those patients was studied. Statistically significant association was found between administration of antibiotics and tocolysis in prolongation of pregnancy (p value=0.00). There was an association found between gestational age at birth and immediate neonatal outcome (p value=0.00). Preterm labour was more common in multigravidae (62.4%) and women with cervical length less than 3 cm (85.17%).Conclusions: Preterm labour can be expected more commonly in multigravidae, pregnant women with cervical length less than 3 cm and in presence of high-risk factors. Anticipation of preterm labour, judicious use of antibiotics, tocolytics can improve the outcome of preterm labour.