A rare case report of uterine rupture in a case of suspected septic abortion

There was a progressive rise in the rate of caesarean sections globally from 17.2% to 21.5% from 2017 to 2021. Caesarean sections have an improved feto-maternal outcome but come with a set of challenges. A second-trimester abortion in a previously scarred uterus is one of them. The incidence of uterine rupture is about 3.8�3% in a scarred uterus, which is much higher than in an unscarred uterus. Mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally within 24� hours has been proven to be an effective method for medical abortion, but its safety in a previously scarred uterus has not been fully established. A 27-year-old P2L2A1 with two previous caesarean sections at 19 weeks of gestation was referred to our tertiary care center with bleeding per vagina following consumption of medical termination of pregnancy (MTP) pills, followed by dilatation and curettage outside. She was pale, and tachycardia was noted. Septic abortion was suspected due to repeated bouts of fever, raised total counts, and starting on higher antibiotics. Due to persistent tachycardia and computed tomography (CT) findings, she was subjected to exploratory laparotomy, and a uterine rupture was confirmed. She underwent an obstetric hysterectomy as a lifesaving procedure. Second-trimester abortions with misoprostol in a previously scarred uterus require a high index of suspicion and close monitoring. Detecting life-threatening complications early in at-risk patients plays a crucial role in uterine preservation. There is scope for research to incorporate methods like Foley's induction in these cases. The clinical picture of a ruptured uterus can be initially non-specific, delaying the diagnosis. Surgery depends on the extent of the rupture, maternal hemodynamic status, and family completion. It is challenging to rule out uterine rupture when there is a similar presentation as septic abortion, so ultrasound is the first investigation of choice in the diagnosis of uterine rupture, whereas CT abdomen and pelvis are confirmatory.

Constraints to Integrated Farming System in Hadoti Region of Rajasthan, India

The study's major goal was to find out the challenges (high cost of input, pest attack, marketing problems, high transportation cost etc.,) that farmers face in the integrated farming system. Farmers' constraints in different enterprises of the integrated farming system were recorded through a well-structured and pretested survey schedule. To confirm their validity and determine the extent to which the identified constraints were seen in crop production as well as in cattle production, goat rearing, backyard poultry production and orange cultivation, the severity of the indicated constraints in the real field condition was measured. The fieldwork was carried out in sixteen villages of the Hadoti region out of which Kota, Bundi, Baran, and Jhalawar were selected randomly. A total of 112 farmers were interviewed and data was gathered through group discussions and personal interviews. The data were quantified by ranking the limitations based on the responses of the respondents.

Urinary Tract Infection in Elderly Women Patients Admitted in a Tertiary care hospital -A Case Series Study

Background: Urinary tract infection is a common infection among both genders there was higher prevalence among women probably due to the physiology of urinary tract in women. In addition, age is an important factor where elderly people with urinary devices like catheters are prone to the infection. Aims and Objectives: Study conducted to assess the clinical profile, predisposing factors, uropathogen profile causing Urinary tract infection in elderly women and to identify associated factors responsible for it. Methods: The study was conducted in, S Nijalingappa Medical College and HSK Hospital, Bagalkot, Karnataka and was conducted in the Department of Internal Medicine. Study period extended from December 2018 to May 2020. It was a study on elderly women patients (age>60 yr) with symptoms of UTI admitted in HSK hospital. Patients were selected based on inclusion and exclusion criteria. Total number of 65 patients were taken for the study. Results: In our study, UTI commonly witnessed in the age group was 60-69 years. Most common causative organism is E. Coli isolated in 47.7% cases. The average length of hospitalization was 8.65 ± 8.94 days. Most organisms are sensitive to Nitrofurantoin (43%). Conclusion: 1. Urinary tract infection is common infection among both genders there was higher prevalence among women, age is an important factor where elderly people with urinary devices like catheters are prone to the infection. 2. Diabetes enhances the incidence due to elevated blood sugar levels and has a significant role in the incidence of the infection. 3. As gram negative isolates shows drug resistance, prompt diagnosis and the right choice of antimicrobials can play a key role in reducing mortality in elderly UTI patients.

A Clinical Audit: Intrapartum Care in Third Stage of Labor

Introduction: The third stage of labor is the time from the birth of the baby to the expulsion of the placenta and membranes.Management is normally categorized into two types; active management and physiological management. Active managementof the third stage involves a package of care comprising the following components: Routine use of uterotonic drugs, deferredclamping, and cutting of the cord controlled cord traction after signs of separation of the placenta. Most common complicationsof the third stage of labor are postpartum hemorrhage and retained placenta.Aims and Objectives: The present clinical audit aims to improve the care of healthy women and their babies during the thirdstage of child and to review the practices regarding the third stage of labor and to develop and implement action plan regardingmanagement strategies.Materials And Methodology: The audit was carried out on 218 pregnant women admitted in Rajarajeswari Medical Collegeand Hospital from April 2018 to September 2018. The inclusion criteria, exclusion criteria, and data collection on the excel sheetwere based on the National Institute for Health and Care Excellence (NICE) guidelines.Results: Among 218 cases, vaginal blood loss was recorded in 181 (83%) cases whereas the color, respiration, and generalcondition were recorded in all 218 cases. In all 218 cases, active management of the third stage was carried out, and decisionregarding the same was recorded. The time of cord clamping was recorded in only 6% of the cases. The management ofpostpartum hemorrhage and retained placenta met audit standard in all 218 cases.Conclusion and Recommendations: The present clinical audit suggests that there is a need to follow specific guidelines andtreatment strategies to avert the complications. Recording of vaginal blood loss in all cases, instructions for the compulsoryrecording of the cord clamping time following the birth of a baby and continue to follow the remaining steps according to theNICE guidelines to reduce the complications of the third stage of labor.