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Background: With the increasing caesarean section rates a new challenging evil of caesarean scar pregnancy (CSPs) has emerged. As a variant of ectopic pregnancy caesarean scar pregnancy is the rarest of all. Diagnosis and management of CSP can be challenging especially when there are no early symptoms and even lessor index of suspicion. Objective of this endeavour was to present one institute experience of management of caesarean scar pregnancies.Methods: This are a retrospective analysis of women admitted with CSP. Detailed history, investigation, management protocols and complications were noted.Results: Of the total cases maximum women (60%) had history of previous two caesarean section. 90 % of cases were managed successfully with intra-sac or systemic methotrexate, and surgical evacuation with Foley’s catheter tamponade, only two women needed hysterectomy for uncontrolled bleeding.Conclusions: Caesarean scar pregnancy is a diagnostic and management challenge in modern obstetrics. Early ultrasound diagnosis helps in planning a successful medical treatment and serves to preserve uterus and fertility. Treatment with transabdominal intra-sac methotrexate and Foley’s catheter for tamponade is safe and effective method of treating CSPs.
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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: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security.
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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.