scholarly journals Emergency obstretic hysterectomy: a retrospective study in a tertiary care center

2019 ◽  
Vol 8 (6) ◽  
pp. 2368
Author(s):  
Vaishnavi Sanjay Shivade ◽  
Vaishali S. Vhawal ◽  
Manisha M. Laddad
Keyword(s):  
Maternal Mortality ◽  
Postpartum Hemorrhage ◽  
Early Stage ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Successful Operation ◽  
Management Options ◽  
Primary Indication ◽  
Skilled Operator

Background: Obstetric hysterectomy remains a necessity in preventing maternal mortality in catastrophic rupture of the uterus or intractable postpartum hemorrhage when all the conservative management options fail. Uterine atony followed by abnormal placentation remains the primary indication of emergency obstratic hysterectomy worldwide. In majority of cases, anticipation, prompt resuscitation and earlier surgical intervention by skilled operator will reduce patient’s morbidity and mortality. The first successful operation was performed in 1876. The main objective of the study was to study frequency, indications and fetomaternal outcome of emergency obstetric hysterectomy in tertiary care center.Methods: Observational, retrospective and analytical study was done over 2 years from January 2017 to January 2019. A total of 11 cases of emergency obstretic hysterectomy (EOH) were recorded.Results: The overall incidence was 1.47 per 1000 deliveries. Atonic postpartum hemorrhage (54%) was the most common indication followed by placenta previa (18%) and placenta accreta (9%). Second gravida were mostly involved (45%) with previous LSCS (45%) as a common risk factor in commonest age group of 20-25 years (46%) amongst them. The most frequent squeal was disseminated intravascular coagulation (45%). Maternal mortality was nil while neonatal mortality being 9%. The decision of performing total or subtotal hysterectomy along with bilateral internal iliac ligation was influenced by patient’s condition.Conclusions: Emergency obstretic hysterectomy is the most demanding obstretic surgery performed in circumstances of life threatening hemorrhages where conservative surgical modalities fail and interventional radiology is not immediately available. Antenatal anticipation of the risk factors, involvement of experienced obstetrician at the early stage of management and prompt hystrectomy after adequate rescuitation will reduce fetomaternal mortality and morbidity.

scholarly journals Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years

2020 ◽  
Vol 10 (1) ◽  
pp. 192
Author(s):  
Shikha Madan ◽  
Neetu Sangwan ◽  
Smiti Nanda ◽  
Daya Sirohiwal ◽  
Pushpa Dahiya ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Maternal Mortality ◽  
Postpartum Hemorrhage ◽  
Health Workers ◽  
Care Center ◽  
Tertiary Care ◽  
Normal Delivery ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Common Etiology

Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality.

scholarly journals Caesarean Myomectomy among Patients Undergoing Lower Segment Caesarean Section in a Tertiary Care Center

2021 ◽  
Vol 59 (234) ◽  
Author(s):  
Sapana Amatya Vaidya ◽  
Rijuta Jha
Keyword(s):  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Uterine Fibroids ◽  
Breech Presentation ◽  
Neonatal Morbidity ◽  
Safe Procedure ◽  
Prophylactic Measures ◽  
Cesarean Myomectomy

Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. The most common indications were breech presentation and previous cesarean section. The most common site was anterior, except one which was posterior and the common type is intramural. Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.

scholarly journals Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh

2017 ◽  
Vol 31 (2) ◽  
pp. 86-89
Author(s):  
Farzana Deeba ◽  
Parveen Fatima ◽  
Jesmine Banu ◽  
Shakeela Ishrat ◽  
Nurjahan Begum ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Target Population ◽  
Fertility Treatment ◽  
Tertiary Care Centre ◽  
Infertile Women ◽  
The Mean ◽  
Tsh Levels

Objective(s): Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.Materials and methods: This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT4. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.Results: Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.Conclusion: The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89

scholarly journals Hypertension in Pregnancy Still Remains a Serious Complication Causing Severe Morbidity and Mortality of Mother

2016 ◽  
Vol 30 (2) ◽  
pp. 92-97
Author(s):  
Arife Simsek ◽  
Seyfettin Uludag ◽  
Ali Benian ◽  
Abdullah Tuten
Keyword(s):  
Maternal Mortality ◽  
Care Center ◽  
Tertiary Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Mortality Index ◽  
Retrospective Examination

Objective(s): The aim of this study is to evaluate frequency and nature of maternal deaths and maternal near-miss cases in a tertiary care hospital.Materials and Methods: A retrospective examination was conducted on records of the16.612 women who delivered in a tertiary care center, over a ten-year period (1997-2006). The flow chart recommended by Say et al was used in the analysis of the maternal near-miss cases.Results: The ratios of mortality related with pregnancy, maternal mortality and maternal nearmiss were 68.11/100.000, 61.29/100.000 and 17.09/1000, respectively. The ratio of maternal near- miss to maternal mortality was 27.8 and the mortality index was 3.46%. Hypertensive disorders were the leading cause of maternal deaths and maternal near-miss events.Conclusion: Hypertensive disorders were still leading cause of maternal deaths and maternal near-miss events.Absence of antenatal care and disrupted referral chains were major problems.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 92-97

scholarly journals Study of antepartum hemorrhage and its maternal and perinatal outcome at a tertiary care hospital

2021 ◽  
Vol 10 (6) ◽  
pp. 2210
Author(s):  
Amruta R. Kulkarni ◽  
Arti S. Shirsath
Keyword(s):  
Maternal Mortality ◽  
Perinatal Mortality ◽  
Perinatal Outcome ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Antepartum Haemorrhage ◽  
Medical College ◽  
Abruptio Placenta

Background: Antepartum haemorrhages are defined as bleeding from or into the genital tract after the period of viability untill delivery of the fetus. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Objective of this study is to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care hospital.Methods: A retrospective observational study was carried out in the department of obstetrics and gynecology, Smt. Kashibai Navale medical college and general hospital, Pune. Patient information was obtained from the delivery records of 2018, 2019 and 2020. Patients presenting after the gestational age of 28 weeks with antepartum haemorrhage were included in the study.Results: Out of 100 cases of APH, abruptio placenta contributes to 60%, placenta previa to 37% and 3 cases were due to unknown cause. Overall maternal mortality was 3% and perinatal mortality was 23% in abruptio placentas compared to 13% in cases with placenta previa. Main cause of perinatal mortality was prematurity69%.Conclusions: Antepartum haemorrhage is one of the leading cause of perinatal mortality and morbidity. These cases should be deliverd at a centre with transfusion facility, NICU facility and by the obstetrician skilled in controlling intraoperative haemorrhage by stepwise devascularising sutures. Timely decision of uterine tamponade can also save few ceaserean hysterectomies.

scholarly journals Study of fetomaternal outcomes in antepartum haemorrhage at tertiary care centre

2021 ◽  
Vol 10 (4) ◽  
pp. 1509
Author(s):  
Faaizah Husain Ghanchibhai ◽  
Sharda Goyal ◽  
Nalini Sharma ◽  
Ankita Pargee
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Perinatal Mortality ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Maternal Complications ◽  
Mortality And Morbidity ◽  
Antepartum Haemorrhage ◽  
Abruptio Placenta

Background: Antepartum haemorrhage (APH) is a challenge to obstetrician as it involves a question of life and death to mother and fetus. Antepartum hemorrhage is the 2nd most common cause of maternal mortality and morbidity as sepsis and obstructed labour has decreased now. The aim of the study is to find the prevalence of APH. And to study foeto-maternal outcomes in patients with antepartum haemorrhage, association of comorbidities and risk factors.Methods: This study was conducted at Geetanjali Medical College and Hospital, Udaipur after obtaining approval from institutional research ethical board and written informed consent during the period of February 2019 to July 2020. This was prospective observational study, sample size was 60 patients. All the APH patients who were admitted at GMCH Obstetrics and Gynaecology department after 28 weeks of gestation were included in study. Extrauterine or bleeding due to general pathology was excluded. Total number of delivery were 1900 in above duration and number of APH patients were 60, so our incidence is 3.1%.Results: Total number of delivery were 1900 in above duration and number of APH patients were 60, so our incidence is 3.1%. According to maternal complications rate, It was 66.66 % in abruptio placenta, 37.03 % in placenta previa and jointly 53.33%. In placenta previa group 100% patients discharged with good GC, In abruptio placenta group 96.96% patients discharged with good GC and 3.04% patients discharged with poor GC. Perinatal mortality was zero in placenta previa group and in abruptio placenta, it was 27.27% (24.24% IUD, 3.03% neonatal death).Conclusions: The main cause of APH was abruption which was seen in 33 (55%) of patients and placenta previa was seen in 27 (45%) of patients. Maternal and neonatal complications, both were very high in abruption group as compared to placenta previa group. Overall maternal mortality rate was 53.33% and perinatal mortality rate was zero in placenta previa group while in abruption placenta group, it was 27.27%. There was no maternal complications in booked placenta previa cases only there were very few complications in emergency cases. In abruptio placenta group also complications were more in emergency cases, irregular booked and uncontrolled pregnancy pathology cases. 

A retrospective analysis of epidemiology and treatment patterns for gastric cancer at a tertiary health care center in India

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4086-4086
Author(s):  
R. Digumarti ◽  
S. J. Rajappa ◽  
S. Uppalapati ◽  
A. Surath
Keyword(s):  
Gastric Cancer ◽  
Retrospective Analysis ◽  
Palliative Chemotherapy ◽  
Early Stage ◽  
Care Center ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Treatment Patterns ◽  
The Body ◽  
Early Stage Disease

4086 Background: Gastric cancer is the second most common gastrointestinal cancer in our hospital based cancer registry. This retrospective analysis aims at studying the epidemiology and treatment patterns for gastric cancer at our hospital, which is a tertiary care cancer center for the state of Andhra Pradesh in south India. Methods: A retrospective analysis of the case records of 125 consecutive patients with gastric cancer who presented to our department between Jan 2004 and Dec 2005 were analysed. Data regarding epidemiology, stages at diagnosis and treatment plans were collected. Patients with early gastric cancer received 5FU based chemoradiation or chemotherapy only. Palliative chemotherapy included 5FU/cisplatin based regimens. Results: A total of 125 patients were analysed. The median age was 61years (range 18–82 years). 71% were males and 29% females. Being a tertiary care center, 92% were referred with a confirmed diagnosis on endoscopic biopsy. 30% were smokers, 11% consumed alcohol, 40% had both habits while 29% had neither. The most common part of the stomach involved was the antro-pyloric region (44%) followed by the body (30%), GE junction/cardia (20%) while 6% had diffuse involvement including linitis plastica. At diagnosis, 35% were early stage, 56% metastatic and 8% locally advanced tumors. 90% patients who had surgery for early stage disease had T2,3 tumors. One third had inadequate nodal staging.70% of patients who had curative resections underwent adjuvant chemoradiation and 30% had chemotherapy only. Of all patients with metastatic disease, 65% palliative chemotherapy while 45% opted for best supportive care. Conclusions: The distribution of tumors within the stomach is similar to Japanese data, which may reflect the common etiological factors like high salt diet. The fact that one third of patients had inadequate nodal dissection stresses the relevance of adjuvant chamoradiotherapy protocols. The high incidence of smoking as a contributory factor in the etiology reflects the need for aggressive anti tobacco legislation. The study reiterates the need for inexpensive and novel therapies for palliation of symptoms in patients with advanced disease and widens the scope for collaborative clinical trials. No significant financial relationships to disclose.

scholarly journals Management of major degree placenta previa during LSCS operation - a new surgical technique (Dutta's)

2013 ◽  
Vol 4 (2) ◽  
pp. 1-7 ◽  
Author(s):  
Dilip Kumar Dutta ◽  
Indranil Dutta
Keyword(s):  
Surgical Technique ◽  
Maternal Mortality ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Polyglycolic Acid ◽  
Care Hospital ◽  
Artery Ligation ◽  
Mortality And Morbidity ◽  
Cesarean Hysterectomy ◽  
New Surgical Technique

Objectives: Evaluation of a new surgical technique (Dutta’s) to prevent postpartum hemorrhage due to major degree placenta previa during cesarean section. Methods:This study was conducted at tertiary care hospital(JNM,& NSGH) at Kalyani, Nadia, West Bengal, India from the period January 2004 to December 2009.Ninty four (94) cases diagnosed to be having major degree placenta previa, undergoing LSCS operation, were selected for this study. New surgical technique(Dutta’s) was adopted in a stepwise manner = delivery of baby > bilateral uterine artery ligation by chromic catgut no-1 suture >injection tranexamic acid (1000mg) IM > injection oxytocin in intravenous infusion(10 units 30 drop /min in 500 ml of 5% dextrose)>delivery of placenta and membranes> checked properly if any tear or laceration in placental site > closure of uterine wound was done after securing bleeding from placental bed >closure of abdomen in layers by polyglycolic acid no 1 suture. Results: It was observed from this study that good effectiveness to control bleeding and intra operative blood loss less than 300cc were seen in 89(94.68%) cases respectively. Six (6.3%) cases required underlying interrupted suture for bleeding from placental bed. Subtotal cesarean hysterectomy was advocated in 3(3.28%) cases due to failure to control uterine atony. Immediate post operative bleeding less than 200c.c was found in 81 (86.16%) cases. Maternal mortality was found to be absent. Maternal morbidity was seen in 12(12.76%) cases. Subsequent menstrual cycles were found to be normal in 80(87.91%) cases and repeated pregnancy was observed in 26(28.57%) cases indicating non effect on gonadal function. Conclusion: Dutta’s new surgical technique during LSCS for major degree placenta previa was found to be simple, safe and quick procedure. It reduces perfusion pressure, permits time for further steps, thereby avoiding unnecessary ligation of bilateral internal iliac arteries and cesarean hysterectomy. Maternal mortality and morbidity were also found to be reduced. This technique is suitable for rural based hospital in absence of adequate blood transfusion facility.DOI: http://dx.doi.org/10.3126/ajms.v4i2.7958 Asian Journal of Medical Sciences 4(2013) 1-7

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