Ectopic pregnancy--changing trends.

This study is an attempt to have an overall view of the changing trends in the clinical presentation, diagnostic modalities and management of ectopic pregnancy over a period of three and a half decades. The incidence of ectopic pregnancy was one in 368 during the 15-year period from 1959-1973 (group A) and has increased to one in 160 during the latter part of the study period from 1988-1993 (group B). Medical termination of pregnancy, abortion, intra-uterine contraceptive device and previous tubal ligation were the important risk factors recently (group B). Unruptured tubal pregnancy was diagnosed in 9.8% (group B) as compared to only 3% in group A. However, as most of the patients came to the hospital with disturbed pregnancy, the use of ultrasonography and urine gravindex test was helpful in only 14% in the latter part of the study. The characteristic clinical features like pain abdomen with amenorrhoea, vaginal bleeding and positive culdocentesis were the most reliable diagnostic criteria in both the groups. There is an increasing trend towards conserving the tubes and methotrexate use recently.

Perinatal mortality trends in a referral hospital.

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992-93 (Group B). The perinatal mortality rate (PMR) in Groups A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.

Nerve injuries due to obstetric trauma.

The incidence of nerve injuries among 32,637 deliveries over a period of ten years was 1.81/1000. Brachial plexus injury (1/1000) and facial nerve injury (0.74/1000) accounted for 98% of nerve injuries. Both the right and left side were involved equally. Bilateral nerve injury was not seen. Lack of antenatal care, macrosomia, abnormal presentations, and operative vaginal deliveries significantly increased the risk of nerve injuries. These babies had significantly higher incidence of meconium stained liquor and intrapartum asphyxia. Parity of the mother, gestational age and sex of the baby did not have significant role in the causation of nerve injuries. Injuries to brachial plexus and facial nerve were seen even in babies born by caesarean section, when it was performed for obstructed labour caused by cephalo-pelvic disproportion and abnormal presentations. Three babies with injuries expired and forty-three could be followed up for varying periods. None of the babies had residual defects. Detection of cephalopelvic disproportion and abnormal lie in the third trimester and their appropriate management would decrease the incidence of obstetric palsies to a significant extent.

Bone injuries during delivery.

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.

Perinatal mortality: a hospital based study.

Three thousand seven hundred and two deliveries between January and December, 1990 were the study subjects. The perinatal mortality rate (PNMR), stillbirth rate (SBR) and early neonatal death rates (ENDR) were found to be 57/1000, 35.1/1000 and 22.7/1000, respectively. The preterms had much higher PNMR, SBR and ENDR as compared to term babies. Term babies weighing > or = 2500 g had a PNMR of 18/1000. In preterm and term babies the mortality was reduced considerably with increase in birth weight (BW). The unbooked deliveries had significantly higher PNMR, SBR and ENDR compared to booked deliveries. The fall in PNMR compared to observations of a decade ago was due to a fall primarily in ENDR, with SBR remaining unchanged signifying failure of existing MCH set up. Nearly, 92% of ENDR were in first 72 hours which signifies the need for developing and strengthening the intensive care facilities along with timely referral of high risk mothers.

A comparative evaluation of metoprolol and methyldopa in the management of pregnancy induced hypertension.

Thirty patients matched for age, parity, socioeconomic status and severity of pregnancy induced hypertension (PIH) were randomly allocated to treatment with metoprolol or methyldopa. The average fall in diastolic blood pressure was significant in the group treated with metoprolol as compared with the methyldopa group (p less than 0.01). There were 3 perinatal deaths in the methyldopa group and 1 in the metoprolol group; the mean birth weight of the babies was higher in cases treated with metoprolol. The results suggest metoprolol to be more efficacious with regard to control of hypertension and fetal outcome in cases of pregnancy induced hypertension.

A review of fallopian tube carcinoma over 20 years (1971-90) in Pondicherry.

Nine cases of tubal carcinoma were found in a period of 20 years in JIPMER Hospital among approximately 9,000 gynaecological malignancies. Most patients were diagnosed as malignant ovarian tumour, but two cases presented unusually, one as Meig's syndrome and another as acute hemoperitoneum. This often stressed symptom of amber discharge or hydrops tubae profluens could not be elicited in any patient. All the patients underwent surgical treatment and radiotherapy or chemotherapy. The period of follow up ranged from two months to four and half years.