A prospective study of a new prediction model of vaginal birth after cesarean section at a tertiary care centre.

OBJECTIVE: To create a new and simple model for predicting the likelihood of vaginal birth after cesarean (VBAC) section using variables available at the time of admission. MATERIALS AND METHODS: A prospective observational study was performed at a tertiary care centre in Haryana over a period of 12 months (January 2018 - December 2018) in pregnant women attending the labour room with one previous cesarean section fulfilling the criteria for undergoing trial of labour after cesarean (TOLAC). The sample size was 150. A VBAC score was calculated for each patient using a new prediction model that included variables available at the time of admission such as maternal age, gestational age, Bishop's score, body mass index, indication for primary cesarean section, and clinically estimated fetal weight. The results of the VBAC scores were correlated with outcomes i.e. successful VBAC or failed VBAC. The chi-square test and Student's t-test was used for comparison among the groups. Descriptive and regression analysis was performed for the study variables. RESULTS: Out of 150 TOLAC cases, 78% had successful VBAC and the remainder (22%) had failed VBAC. The observed probability of having a successful VBAC for a VBAC score of 0-3 was 34%, 4-6 was 68%, 7-9 was 90%, and ≥10 was 97%. The prediction model performed well with an area under the curve of 0.77 (95% CI: 0.68 to 0.85) of the receiver operating characteristics receiver operating characteristic curve. CONCLUSION: The present study shows that the proposed VBAC prediction model is a good tool to predict the outcome of TOLAC and can be used to counsel women regarding the mode of delivery in the current and subsequent pregnancies. Further studies of this model and other such models with different permutations and combinations of variables are required.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section.

OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

Ileosigmoid knotting: a rare case report with review of literature†.

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction in which loops of ileum and sigmoid colon wrap around each other. It is very uncommon in western world when compared with the African and Asian region. It is rapidly a progressive, fatal disease. Early diagnosis and intervention is the key of better outcome. We are reporting a case of 51-year-old male who presented with shock within 24 h of onset of symptoms. Exploratory laparotomy revealed ISK causing gangrene of ileum and sigmoid colon. In view of haemodynamic unstability, end ileostomy was done after excising gangrenous segments. The patient expired after 2 weeks due to complications of short bowl syndrome. We are also tabulating all cases of ISK reported in the literature till date.

Assessment of maternal vascular stiffness indices in three trimesters of normal pregnancy.

Normal pregnancy is associated with intense alterations in the maternal cardiovascular system. The aim of the present study was, to assess the influence of normal pregnancy on maternal central aortic pressures, arterial stiffness, and arterial wave reflection using non-invasive PC based cardiovascular risk analysis system (Periscope). The current study was conducted on 137 women with, normotensive, healthy, singleton pregnancies at first trimester (n = 42), second trimester (n = 48), third trimester (n = 47) of pregnancy and 35 age matched non-pregnant controls. There was no significant correlation between the estimated means for age and systolic and diastolic blood pressure. There was progressive and significant increase in BMI as pregnancy progresses (p = 0.0001). Heart rate rose significantly from Pre-pregnant to second and second to third trimesters (P < 0.003). There were no significant changes observed in central aortic diastolic pressure (AoDiaBP) as pregnancy progressed (p = 0.235) however Post Hoc comparisons showed a significant increase in central aortic systolic blood pressure (AoSysBP) and central aortic pulse pressure (AoPP) during first trimester when compared with non pregnant control group (p = 0.039 and 0.048 respectively). There was significant increase in central aortic augmentation pressure (AoAugP) in first trimester compared to non pregnant control group (p = 0.024). All the parameters of central aortic pressures were increased in the first trimester but decreased in the second trimester and again increased in the third trimester of pregnancy. There was a significant drop in Brachial-Ankle Pulse wave Velocity (baPWV) during first trimester of pregnancy compared to non-pregnant control group (p = 0.0001) after that there is a progressive increase in baPWV in second and third trimester of pregnancy. In the third trimester baPWV is increased to more than non-pregnant control group but it was non significant (p = 0.562) however it was significantly higher than first trimester (p = 0.0001). Carotid-femoral Pulse wave velocity (cfPWV) also followed the same sequence as BaPWV but the drop in cfPWV during first trimester was not significant (P = 0.135). All of the variables of hemodynamic and arterial compliance differed between participants with various trimester of pregnancy and non-pregnant control group. A significant up and down changes in Augmentation index (Aix) was observed from control to first, second and third trimester of pregnancy (3.14 to 6.74 to 2.63 to 10.51 respectively, P < 0.0001). To summarize our report show that normal pregnancy is associated with a significant cardiovascular adaptation indicated by alteration in central aortic blood pressure, augmentation index and pulse wave velocity.