Relaparotomy after Caesarean Section - An Obstetrician’s Ordeal

BACKGROUND The term "Relaparotomy" (RL) refers to operations performed within 60 days in association with the initial surgery. The aim of current study was to investigate the indications, risk factors, procedures undertaken during relaparotomy after caesarean section (CS). METHODS We conducted a retrospective observational study in all patients undergoing relaparotomy after caesarean section, at a tertiary care centre in Odisha over a period of 2 years from January 2017 to December 2018. RESULTS The total incidence of relaparotomies was 0.7 % and the incidence among the sections conducted in our hospital alone was 0.2 %. Obstructed labour (20 %), oligohydramnios with fetal distress (20 %) are major indications of caesarean section. Most of the surgeries (60 %) took place within the first 24 hours of the primary surgery. Most common indication of relaparotomy in our study was postpartum haemorrhage (63.3 %). All women were in the age group of 20 - 35 years and most of them were multiparous (60 %). Pre-existing anaemia is the major (50 %) comorbid factor associated with atonic postpartum haemorrhage which leads to relaparotomy. Major indication of relaparotomy in the present study was haemorrhage (76.5 %). CONCLUSIONS Undertaking proper precautions to ensure proper haemostasis and asepsis, taking calculative decision before embarking a hasty decision is important in decreasing the incidence of relaparotomy. KEYWORDS Relaparotomy, Caesarean Section, Postpartum Haemorrhage, Asepsis

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Assessment of indications of lower section caesarean section at tertiary care centre: a cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20171358 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1253

Author(s):

Vijay L. Badge ◽

Sumit Suresh Aggarwal ◽

Deepti D. Ambalkar ◽

Arun Humne ◽

Neethika Raghuwanshi

Keyword(s):

Caesarean Section ◽

Care Center ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Fetal Distress ◽

Cross Sectional Study ◽

Care Centre ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Medical College

Background: Caesarean section is one of the commonly performed surgical procedures in obstetrics and is certainly one of the oldest operations in surgery. One of the most dramatic features of modern obstetrics is the increase in the caesarean section rate. The present study was conducted to estimate proportion of various indications of LSCS and also to assess socio demographic profile of mothers undergoing caesarean section in a tertiary care centre. Methods: The present cross sectional observational study was conducted at Government Medical College & Hospital, Akola in the post natal ward (PNC). Non probability convenient sampling method was used. All patients admitted to PNC ward after LSCS were included in study. For data collection paper based pre tested, semi –structured questionnaire was used. Results: Previous LSCS was indication for LSCS in 32% cases. Eclampsia, preeclampsia and Anaemia were the indications for LSCS in 19.3%, 8.6% and 5.3% cases respectively. Other common indications includes CPD, meconium stained liquor, fetal distress, breech presentations, twin pregnancy and preterm labour. Conclusions: The proportion of LSCS is more than WHO recommended proportion of LSCS. It may be due to present institute acts as tertiary care center. Still this proportion is high, so encouragement should be given to trial of labour in selected low risk cases and in Primi patients whenever possible.

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Detection and Enumeration of the Commonest Stool Parasites Seen in a Tertiary Care Center in South India

ISRN Tropical Medicine ◽

10.1155/2013/808571 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Vani Chandrashekar

Keyword(s):

Entamoeba Histolytica ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Age Group ◽

Tertiary Care Center ◽

Care Centre ◽

Tertiary Care Centre ◽

Stool Samples

The aim of this study was to identify common stool parasites in patients attending a tertiary care centre in South India. We evaluated 2355 stool samples and parasites were detected in 7.9% of samples. 41.1% of our patients were in the 45–58-year age group. Protozoal infections were the commonest seen in 7.8% of samples. Entamoeba histolytica was the commonest protozoa (4.6%) followed by Entamoeba coli (1.2%) and Giardia (0.8%). Entamoeba histolytica and Entamoeba coli were together seen in 0.63%, and they were the commonest organisms seen in samples with multiple-organism infection. Both were equally detected in diarrheal samples.

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Pattern of Ear Diseases among Paediatric ENT Patient: An Experience from Tertiary Care Centre, Pokhara, Nepal

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i2.5673 ◽

2012 ◽

Vol 32 (2) ◽

pp. 142-145 ◽

Cited By ~ 2

Author(s):

B Sigdel ◽

R Nepali

Keyword(s):

Tertiary Care ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Suppurative Otitis Media ◽

Ear Diseases ◽

Paediatric Age ◽

One Year ◽

A Prospective Study ◽

Nose And Throat

Introduction: Ear diseases are common in children mainly due to altered anatomy of Eustachian tube which is straighter in children as compared to that in adults. However, the cause of hearing loss in children is more varied, including the etiologies. This study was done to find out the pattern of ear diseases in paediatric age group attending ear, nose and throat OPD in a tertiary care centre in Pokhara, Nepal. Materials and Methods: This is a prospective study done in paediatric patients attending ENT OPD over a period of one year from January 2010 to January 2011. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 1632 Pediatric ENT patients, 944 had ear diseases, 59.2% were males and 40.8% females. Wax (33.4%) was the commonest diagnosis followed by Chronic suppurative otitis media (24.3%) and Acute ottitis media (13%). Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases. J. Nepal Paediatr. Soc. 32(2) 2012 142-145 doi: http://dx.doi.org/10.3126/jnps.v32i2.5673

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TO DETERMINE THE PREVALENCE AND OCCURANCE OF VISUAL MORBIDITY IN PATIENTS OF PTERYGIUM ATTENDING EYE OPD IN A TERTIARY CARE CENTRE OF EASTERN INDIA

10.36106/ijsr/6908440 ◽

2021 ◽

pp. 80-81

Author(s):

Vandana Parasar ◽

Vidyabhushan Kumar ◽

Ankita Singh ◽

Nilesh Mohan

Keyword(s):

Socioeconomic Status ◽

Tertiary Care ◽

Living Condition ◽

Age Group ◽

Care Centre ◽

Eastern India ◽

Tertiary Care Centre ◽

Male Preponderance ◽

Uvb Exposure ◽

Epidemiological Trends

To determine the prevalence and occurrence of visual morbidity in patients of pterygium attending eye opd in a tertiary care centre of Bihar. Methods: In this observational study a total of 193 patients, diagnosed with pterygium, underwent complete ocular examination by an ophthalmologist. Epidemiological trends including age, sex, occupation, effect of living condition and socioeconomic status were analyzed. Results: There is a male preponderance of 58.03%. The age incidence of the group showed that the incidence of pterygium was 10.36% in the age group of less than 30 years. It rises to a maximum of 29.53% in the age of 41-50 years and then gradually declines.. The incidence was found to be maximum among farmers(39.86%) followed by miners(31%). Conclusion: People who work outdoors are at a greater risk because they are subjected to involuntary UVB exposure. The highest exposure occurs during the two hours on either side of noon. Workers must be aware and should take appropriate measures like wearing protective glasses, caps, etc

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CLINICAL PROFILE OF INTUSSUSCEPTION IN CHILDREN ADMITTED TO A TERTIARY CARE CENTRE IN KERALA

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v4i12.726 ◽

2020 ◽

Vol 4 (12) ◽

Author(s):

Neethu Jose ◽

Aparna Namboodiripad ◽

Regi George A N

Keyword(s):

Tertiary Care ◽

Spontaneous Resolution ◽

Reduction Technique ◽

Clinical Profile ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Hydrostatic Reduction ◽

Duration Of Hospital Stay ◽

Study Population

Background and objectives: Intussusception is the commonest cause of bowel obstruction and is one of the common abdominal emergencies in children younger than 2 years of age.The objective of the study was to assess the clinical profile of intussusception in children and the management and the outcome and to assess whether the characteristics mentioned in clinical profile are predictive of subsequent management and outcome of the disease. Methods: A hospital based descriptive study conducted in a tertiary care centre in Kerala, using purposive sampling technique. 120 children admitted with diagnosis of intussusception fulfilling inclusion criteria and whose parents consented for study were included in the study population, during the study period from November 2018 to June 2020. Detailed history, clinical examination including per rectal examination and USG was done to make diagnosis of intussusception in suspected cases. Follow up is done at 72 hours,1 week after the admission and 1month later. To assess the clinical profile and outcome of patients, frequency and percentage is used. To obtain the association of clinical profile with outcome chi square test is applied. Results: Outcome of the problem was correlated with age, sex, symptoms, risk factors sonological findings treatment protocol and duration of hospital stay. Out of the 120 children in study population, majority were males(65.8%) with male to female ratio 1.9:1 and majority was in the age group 7- 12 months, which is similar to many other similar studies. Maximum number of cases were in the month of February(14.2%) and November(15%). Majority of the patients(57.5%) presented to healthcare facility within 24 hours of onset of first symptom.Irritability was the most common clinical symptom(62.5%) followed by vomiting(58.3%) and abdominal pain(49.2%). Ileocolic intussusception (96.7%) was the commonest type. Majority of the cases could be managed with hydrostatic saline reduction(73.3%) and significantly lesser number of patient went for surgical intervention(7.5%) and spontaneous resolution(19.2%). Conclusions: Incidence of intussusception is more common among males and more in the 7-12 month age group. Majority of the cases presented to health care facility within 24 hours of onset of symptom and could be managed with hydrostatic reduction technique and had a shorter duration of hospital stay compared to surgical reduction technique. Even recurrent cases could be managed with hydrostatic saline reduction. Keywords: Intussusception; Intestinal obstruction; Hydrostatic reduction; Spontaneous resolution

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The ten group Robson classification: an institutional study to analyse the caesarean section rates

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213220 ◽

2021 ◽

Author(s):

Lekshminath Gopinath ◽

Rajani Vaidya

Keyword(s):

Caesarean Section ◽

Policy Making ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Robson Classification ◽

Relative Contribution ◽

Obstetrics And Gynaecology ◽

Vaginal Deliveries ◽

Group 5

Background: Over the last few decades, there has been an alarming increase in the rate of deliveries by caesarean section (CS) in most of the countries, though the drivers of this trend are not completely understood. In 1985, WHO had proposed that ideal rate for regional CS rates should not exceed 10-15%. The Robson’s classification system is simple, robust and flexible. The study was done as it was important to have a tool to monitor, compare the CS rates in a same setting and between different settings over a period of time and to optimise the CS rates.Methods: It was a retrospective study conducted in the department of obstetrics and gynaecology in a tertiary care centre. The hospital delivery records were reviewed for a period of 15 months from April 2020 to June 2021.Results: The total number of deliveries during the study period was 1016. The total number of CSs was 441 and the total number of vaginal deliveries was 575.The CS rate was 43.4%. The relative contribution from groups 1, 2 and 5 in our study accounted for 76.36% and group 5 accounted for 44.4% of the total CSs. These 3 groups should be the focus of attention to reduce the overall CS rates.Conclusions: It is advisable that all institutions can use the Robson’s report table to analyse the population catered by them and to make institutional specific policies. This will allow comparing the data amongst the different institutions and countries which can help in policy making.

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Study of caesarean section at tertiary care centre: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201819 ◽

2020 ◽

Vol 9 (5) ◽

pp. 2138

Author(s):

Varsha Kose ◽

Kumari Sadhvi

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Tertiary Care ◽

Fetal Distress ◽

High Rate ◽

Audit And Feedback ◽

Research Centre ◽

Medical Sciences ◽

Tertiary Care Centre ◽

Failure Of Induction

Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%, and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.

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Epidemiological study, clinical spectrum and associations of childhood vitiligo in a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20163976 ◽

2016 ◽

Vol 2 (4) ◽

pp. 86

Author(s):

Rangaraj Murugaiyan

Keyword(s):

Tertiary Care ◽

Significant Proportion ◽

Clinical Spectrum ◽

Age Group ◽

Care Centre ◽

Inclusion Criteria ◽

Common Site ◽

Tertiary Care Centre ◽

Exclusion Criteria ◽

The Past

Background: Childhood vitiligo is a special subtype and is seen in significant proportion of vitiligo patients. There are only a few clinical studies in the past which address the clinical spectrum of vitiligo in children. This study on eighty cases of childhood vitiligo will cover the epidemiology and clinical spectrum.Methods: To study the epidemiology, clinical spectrum and associations in childhood vitiligo. Inclusion criteria: all new cases of vitiligo in children under 12 years attending the outpatient department of Dermatology, exclusion criteria: old treated cases of vitiligo and age more than 12 years. Statistical analysis was done using mean and percentage of means.Results: Most common age group affected includes 4-6 years. Most common site of initial lesion was head and neck followed by upper limb, lower limb and trunk. Most common clinical type was vitiligo vulgaris followed by focal type then segmental. Lip tip type was least common type. Conclusions: Childhood vitiligo is a serious issue and the knowledge of its various patterns and associations needs to be updated at regular intervals.

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Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3056 ◽

2017 ◽

Vol 56 (205) ◽

pp. 137-140

Author(s):

Anil Kumar Adhikari ◽

Mahuya Dutta ◽

Chittra Ranjan Das

Keyword(s):

Genital Tract ◽

Surgical Intervention ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Age Group ◽

Care Centre ◽

Tertiary Care Centre ◽

Lower Genital Tract ◽

Clinical Presentations ◽

Fall From Height

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Conclusions: Appropriate surgical intervention can avert morbidity and mortality. Keywords: accident; lower genital tract; Nepal; trauma.

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