Current status of cesarean section myomectomy-prospective ongoing study

Background: The aim of the study was to assess the feasibility, safety and efficacy of performing myomectomy during cesarean section.Methods: It was prospective study conducted in Sri Guru Ram Das University of Health and sciences which is a tertiary care referral centre. Myomectomy was conducted in 34 pregnant women during elective or emergency cesarean section. Analysis was done with reference to age, parity, character of myomas, intraoperative and post-operative morbidity, duration of surgery and duration of stay in hospital.Results: In this study 34-58 fibroid of various size (2-14 cm) were removed in 34 patients during cesarean section. Majority of fibroids were located in body of uterus (65.5%) and in anterior wall (55.2%) and all them were sub serosal. No significant difference was found in mean preoperative hemoglobin (11.8±0.7) and postoperative hemoglobin (10.9±0.8). No patient had postpartum hemorrhage requiring cesarean hysterectomy. Only two patient needed blood transfusion postoperatively. Mean time taken for surgery was 58.4±8.94 minute and average duration of hospital stay was 6.7±1.6.Conclusions: With the advent of better anesthesia, easy availability of blood and blood component, cesarean myomectomy is safe surgical procedure when performed by experienced obstetrician in carefully selected patients.

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A study of various cesarean section techniques at a government tertiary care centre: Misgav Ladach cesarean section versus Pfannenstiel cesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173461 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3449

Author(s):

Medha Kanani

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tertiary Care ◽

Breech Presentation ◽

Care Hospital ◽

Tertiary Care Centre ◽

Pfannenstiel Incision ◽

Emergency Cesarean ◽

Post Operative Pain ◽

Duration Of Surgery

Background: It is important to examine every step in any surgery to identify and evaluate its imortance, necessity and purpose with a view to find its better alternatives if they can be found at all. The most appropriate surgical procedure is the one which takes minimum time to be complete, simplest to perform, causing least damage and least complication for the patient. Present study was undertaken to assess the benefits of the Misgav Ladach cesarean section technique in comparison to the conventional Pfannenstiel technique in the tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative pain and post-operative stay in hospital.Methods: All the women posted for emergency cesarean section in the Obstetrics OT at Sir T Hospital, Bhavnagar, Gujarat were included in this study. Some of the common indications at our hospital for cesarean section were fetal distress, cephalopelvic disproportion, failure of progress of labour, breech presentation, previous cesarean section and failed induction. Informed consent was taken. All the patients were randomly allocated to two groups with 50 women in each group. Group 1 Pfannenstiel incision and Group 2 Misgav Ladach.Results: The duration of surgery, blood loss and post-operative pain were significantly less in the Misgav Ladach group (P<0.001).Conclusions: Misgav Ladach technique of cesarean section has many advantages and should be used routinely.

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ACUTE MYOCARDIAL INFARCTION;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.700 ◽

2013 ◽

Vol 20 (03) ◽

pp. 332-340

Author(s):

ATIF SITWAT HAYAT ◽

MUHAMMAD ADNAN BAWANY ◽

JAWAD AHMED QADRI ◽

Kiran Khalil

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Heart Block ◽

Complete Heart Block ◽

Tertiary Care ◽

Anterior Wall ◽

P Value ◽

Inferior Wall ◽

Care Hospital ◽

Significant Difference

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.

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Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification

Medicina ◽

10.3390/medicina56040180 ◽

2020 ◽

Vol 56 (4) ◽

pp. 180

Author(s):

Noemi Strambi ◽

Flavia Sorbi ◽

Gian Marco Bartolini ◽

Chiara Forconi ◽

Giovanni Sisti ◽

...

Keyword(s):

Cesarean Section ◽

Tertiary Care ◽

Healthcare Setting ◽

Care Hospital ◽

Public Practice ◽

Clinical Variables ◽

Robson Classification ◽

Vaginal Deliveries ◽

Significant Difference ◽

Private And Public

Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.

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Comparing the Effects of Cumin, Peppermint, and Milk of Magnesia on Gastrointestinal Complications after Caesarean Section

Global Journal of Health Science ◽

10.5539/gjhs.v8n12p78 ◽

2016 ◽

Vol 8 (12) ◽

pp. 78 ◽

Cited By ~ 1

Author(s):

Maryam Tofighi Niaki ◽

Zoleykha Atarod ◽

Shabnam Omidvar ◽

Mandana Zafari ◽

Azar Aghamohammadi ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Controlled Trial ◽

Chi Square ◽

Double Blind ◽

Gastrointestinal Complications ◽

Gynecology And Obstetrics ◽

Emergency Cesarean ◽

Gastrointestinal Problems ◽

Significant Difference

CONTEXT: Gastrointestinal problems are common after Cesarean section. During the past three decades, there has been an increasing trend in the use of herbal plants in the treatment of various medical conditions.AIMS: This study aimed to compare the effects of cumin, peppermint with magnesium hydroxide (milk of magnesia; MOM) on gastrointestinal complications of Caesarean section.SETTINGS & DESIGN: This randomized double-blind controlled trial was conducted in the Gynecology and Obstetrics Department of Imam Hospital (affiliated to Mazandaran University of Medical Sciences, Sari, Iran) during November 2013-August 2014. The project was approved by the Research Ethics Committee of Islamic Azad Medical University, Sari Branch (Iran).MATERIAL & METHODS: A total of 83 patients undergoing non-emergency Cesarean delivery in Imam Hospital were randomly selected. Patients with underlying diseases, history of gastrointestinal problems, fever, intestinal adhesion, longer-than-usual Cesarean section, and lack of cooperation were excluded. The subjects were informed about the study objectives and procedure and asked to provide written informed consent. They were then randomly assigned into three groups of cumin, peppermint, MOM. Gastrointestinal complications were assessed 20, 40, 60, and 120 minutes after drug administration.STATISTICAL ANALYSIS USED: The collected data were analyzed using Fisher’s exact and chi-square tests in SPSS for Windows 18.0.RESULTS: There was no significant difference between three groups according to incidence of gastrointestinal side effects after Cesarean section at the mentioned intervals.CONCLUSIONS: Cumin and peppermint were as effective as MOM.

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Inguinal hernia repair – TEP or TAPP?? A comparative analysis between both the laparoscopic procedures in a tertiary care center

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i6.30776 ◽

2020 ◽

Vol 11 (6) ◽

pp. 84-88

Author(s):

Atia Zaka Ur Rab ◽

Sheikh Saif Alim ◽

Wasif Mohammad Ali ◽

Syed Amjad Ali Rizvi

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Prospective Study ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Tertiary Care ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery ◽

Normal Work

Background: Inguinal hernia surgery is one of the most common elective procedures performed by the surgeons and has evolved from open to the laparoscopic technique. Aims and Objectives: This prospective study was conducted to find out intra-operative and post-operative outcomes in patients undergoing TEP and TAPP for inguinal hernia repair. Materials and Methods: A prospective study was conducted on 50 adult patients who underwent laparoscopic inguinal hernia repair between November 2017 to November 2018. It was a randomized study and equal number of patients were allocated to TAPP and TEP group based on the surgeon’s preference. Results: Operative time [p<0.0001], intensity of pain (VAS) was significantly higher in TAPP compared to TEP in the immediate post-operative period (6 hours) and during hospital stay [p=0.0299]. No significant difference observed in VAS between TEP and TAPP during follow up [after 1 week (p=0.2298), 2 weeks (p=0.2337), and 4 weeks (p=0.3944)]. Both TEP and TAPP were comparable in terms of Intra-operative and Post-operative complications {seroma [during hospital stay (p=0.1573), after 1 week (p=0.6375), after 2 weeks (p=0.5513)]; haematoma [during hospital stay (p=0.1492), after 1 week (p=0.3125)]} and Conversion (p=0.3125), and Length of hospital stay (p=0.3960). Time to resume normal work [p<0.0001] was significantly more in TAPP than TEP. Conclusion: TEP has a definite edge over TAPP taking into consideration the lesser intensity of post-operative pain during hospital stay, shorter duration of surgery and relatively early return to normal work associated with the former procedure. TEP should therefore be regarded as the procedure of choice for inguinal hernia repair.

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Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis

Obstetrics and Gynecology International ◽

10.1155/2020/4039140 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Tulasa Basnet ◽

Baburam Dixit Thapa ◽

Dipti Das ◽

Ramesh Shrestha ◽

Sarita Sitaula ◽

...

Keyword(s):

Cesarean Section ◽

Perinatal Mortality ◽

Vaginal Delivery ◽

Tertiary Care ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Care Hospital ◽

Breech Delivery ◽

Vaginal Breech Delivery ◽

Emergency Cesarean

Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

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Comparison of prophylactic versus regular use of antibiotics in elective major obstetrical and gynecological surgeries

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190288 ◽

2019 ◽

Vol 8 (2) ◽

pp. 580

Author(s):

Ramya Sreevarshni Shunmugha Sundharam ◽

Hiremath P. B. ◽

Sankareswari R.

Keyword(s):

Tertiary Care ◽

Prophylactic Antibiotic ◽

Mean Value ◽

Controlled Study ◽

Therapeutic Drug ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

The Mean ◽

Group B

Background: Surgical site infections better prevented by parenteral antibiotic in sufficient doses generally should be given before the operation which helps to achieve the therapeutic drug level both in the blood and related tissue during the operation. Ceftriaxone, when administered together as a prophylaxis can fulfil the above criteria of a good antibiotic. Thus, this study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries.Methods: This randomized controlled study was conducted in a tertiary care teaching hospital during the study period of June 2017 to April 2018 with 140 cases. Group A received a single dose of Injection Ceftriaxone 1g. Group B, received Injection Ceftriaxone 1 gm and Injection Metronidazole 500 mg for five days. The data was entered in excel sheet and analyzed using SPSS (Version 16).Results: The mean age group in Group A and Group B was found to be 34.24±10.5 and 35.97±11.89, respectively. There was no statistical significance between group A and B for incidence of infection in the post-operative period and duration of hospital stay. The mean value in group A for duration of surgery was found to be 67.5±13.5 and in group B mean value was 72.1±14.9. (p value <0.05).Conclusions: This study demonstrated that administration of prophylactic antibiotic rather than conventional antibiotic at caesarean and gynecological surgeries are not associated with significant difference in post-operative morbidities.

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Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i4.21687 ◽

2016 ◽

Vol 15 (4) ◽

pp. 546-550 ◽

Cited By ~ 1

Author(s):

Huma Tasleem ◽

Haider Ghazanfar

Keyword(s):

Cesarean Section ◽

Success Rate ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Health Centre ◽

Tertiary Care ◽

Vaginal Birth ◽

Trial Of Labor ◽

Emergency Cesarean ◽

Previous Cesarean

Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p<0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p <0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550

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Postpartum Depression: Is Mode of Delivery a Risk Factor?

ISRN Obstetrics and Gynecology ◽

10.5402/2012/616759 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 39

Author(s):

Asli Goker ◽

Emre Yanikkerem ◽

M. Murat Demet ◽

Serife Dikayak ◽

Yasemin Yildirim ◽

...

Keyword(s):

Postpartum Depression ◽

Cesarean Section ◽

Mode Of Delivery ◽

Healthcare Providers ◽

Depression Scale ◽

Family Type ◽

Elective Cesarean Section ◽

Emergency Cesarean ◽

Significant Difference ◽

History Of

There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression.

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