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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.
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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.
RESUMO
Large population-based studies on stroke report that intracerebral haemorrhage is rare in young women however it is a grave and disturbing complication of pregnancy. Preeclampsia is usually clinically silent, but may cause symptoms of neurological dysfunction such as headache, visual disturbances and impairment of consciousness. Eclampsia is in the occurrence of seizures in the context of preeclampsia and is often, but not always, preceded by the above neurological symptoms. Most published data support the view that preeclampsia and eclampsia are important causative factors for pregnancy related ICH. Sparse data is available with respect to the management of such cases. Identification of near miss cases is an important step in reducing mortality. Herein we report a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy.