Forceps deliveries and fetomaternal outcome in modern obstetrics

Background: In modern obstetrics practice has witnessed an increase in the caesarean section rates everywhere. The incidence of instrumental deliveries varies between 10-12% in UK. The incidence of instrumental deliveries varies between 2.7-5% in India. There is an urgent need to reintroduce instrumental need in the modern obstetrics. Instrumental delivery is one of the basic functions of emergency care according to WHO. This study was done to know the prevalence, indications and fetal outcomes of forceps deliveries.Methods: A retrospective study was conducted at a tertiary teaching hospital, India from January 2014 to December 2018. All cephalic singleton pregnant mothers who underwent forceps delivery after 28 weeks were included. All the forceps delivery done in twins and breech vaginal delivery were excluded. Demographic data, Indication of forceps delivery, maternal complications of forceps delivery like episiotomy extension, cervical tear, vaginal wall tear, PPH and neonatal outcome like low birth weight, NICU admissions, stillbirth, APGAR score at 1 and 5 minutes were recorded. Equal number of mothers of reproductive age group 20-45 ages who underwent normal non breech vaginal deliveries were randomly selected as control.Results: The prevalence of forceps delivery was 5.25%. The most common indication was fetal distress (55%). Most of the mothers were primigravidas in age group 20-30 years (p<0.001). Regarding the neonatal outcome, 72% of the babies were having weight >2.5 kgs.  APGAR <7 at 1 and 5 min was not significant.Conclusions: As fetal distress is the most common indication, every obstetrician should learn the skill of forceps delivery and it should not be a dying art.

Prevalence of teenage pregnancy and pregnancy outcome at a rural teaching hospital in India

Background: Teenage pregnancy accounts for 11% of births worldwide and 95% of these occur in low middle income countries. Pregnancy and its complications are leading cause of death among these girls. This study was done to know the prevalence and to determine whether teenage mothers are at risk of adverse pregnancy outcome.Methods: A retrospective study was conducted at a tertiary teaching hospital, India between July 2015 to Dec, 2017. All teenage mothers delivered after 28 weeks of gestation were included. Women with Diabetes mellitus, renal disease, thyroid disorders were excluded. Demographic data, maternal complications like anaemia, hypertensive disorders of pregnancy, preterm birth, mode of delivery, low birth weight, NICU admissions, stillbirth and early neonatal death were recorded.Results: In the present study, the prevalence was 7% which is less than that of other studies. Incidence of caesarean-Section in the present study was 31%. Amongst the complications oligohydramnious was found to be significantly associated with teenage pregnancy. NICU admissions were needed for 43% of the cases and 31% were LBW.Conclusions: High NICU admission and high LBW in newborns of teenage mothers were noted in the current study. Hence, there is urgent need to focus on the teenage pregnancy.

Insight into evolution of a giant congenital nevomelanocytic nevus over 14 years.

Giant congenital nevomelanocytic nevus (GCNN) is a rare variant of congenital melanocytic nevus measuring >20 cm in size that often has a garment-like distribution. Regular follow up is recommended because of a risk of melanoma transformation of 4.6%. We report a 14-year-old boy with gradual regression of giant congenital melanocytic nevus over the left upper limb, chest, back and axilla, whom we have followed-up since birth. At birth, a hyperpigmented jet-black patch without hair was present over the left side of torso and upper limb including palms and nails. Follow up at the ages of 1, 5, 11 and 14 years showed progressive spontaneous regression of the nevus resulting in shiny atrophic skin, diffuse hypopigmentation, lentigo-like macules, nodules and arthrogryphosis of affected areas. Histopathology of the lesions on follow-up revealed absence of pigmented nevus cells in the regressing areas and thickened sclerotic collagen bundles.

Appraisal of transverse nasal groove: A study.

Background: Transverse nasal groove is a condition of cosmetic concern which awaits due recognition and has been widely described as a shallow groove that extends transversely over the dorsum of nose. However, we observed variations in the clinical presentations of this entity, hitherto undescribed in literature. Aims: We conducted a clinicoepidemiological study of transverse nasal lesions in patients attending our outpatient department. Methods: We conducted a prospective observational study. We screened all patients attending our out-patient department for presence of transverse nasal lesions, signs of any dermatosis and associated other skin conditions. Results: One hundred patients were recruited in the study. Females (80%) predominated over males. Most patients were of 15-45 years age group (70%). Majority of the transverse nasal lesions were classical transverse nasal groove (39%) and others included transverse nasal line (28%), strip (28%), ridge (4%) and loop (1%). Seborrhoeic diathesis was the most common condition associated with transverse nasal lesion. Conclusions: Occurrence of transverse nasal line, strip, ridge and loop, in addition to classical transverse nasal groove implies that latter is actually a subset of transverse nasal lesions. Common association of this entity with seborrheic dermatitis, seborrhea and dandruff raises a possibility of whether transverse nasal lesion is a manifestation of seborrheic diathesis.