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 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 Uterine Leiomyoma and Pregnancy Outcome: An Experience at Tertiary Care Setup

2021 ◽  
Vol 15 (6) ◽  
pp. 1682-1684
Author(s):  
Farha Naz Chohan ◽  
Shaista Memon ◽  
Sabreena Abbas ◽  
Syeda Hira Ali Shah ◽  
Aliya Shamim ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Uterine Fibroids ◽  
Breech Presentation ◽  
Study Data ◽  
Health Science ◽  
Increased Risk ◽  
The Impact

Objective: To determine the impact of leiomyoma in pregnant women a tertiary care set up in Hyderabad. Methods: This prospective observational study conducted at OPD of Gynecology unit-III, Liaquat University of Medical and Health Science Hyderabad, from June 2018 to December 2018. A total of 18,402 pregnant women of age 20-45 years were attended, out of which 195 had leiomyoma and they were asked to take part in study. Data regarding demographic characteristics including complications during pregnancy, and indications of caesarean section was collected via study proforma. Results: Total 186 out of 195 females were studied, their mean age was 31.23+3.12 years, average gestational age was 33.12+3.15 weeks and average size of Leiomyoma was 3.12+2.15cm. The most common complications were PPH among 28.49% of cases, blood transfusion was required in 39.25% of the cases, miscarriage occurred in 6.45% of the cases, cord prolapse was seen in 24.3% cases, placental abruption in 5.91% cases, placenta previa in 11.32% cases and retained placenta was observed among 1.61% of the cases. Preterm labour occurred in 5.38% of the cases and IUGR was seen in 10.22% of the cases. Out of all cases, 10 females underwent preterm delivery, while 12 underwent fetus delivery before 24 weeks (miscarriage). Among all term pregnancies, 78.66% underwent C-Section due to failure in progress, cord prolapsed, fibroid in lower segment, breech presentation and low-lying placenta. Conclusion: Fibroid complicates pregnancy itself and also the outcome. Rural area dwelling women are at more risk, which include increase in caesarean section and a multifold increased risk of PPH and associated hysterectomy in these cases. Keywords: Leiomyoma, Uterine Fibroids, Pregnancy, complications.

scholarly journals Maternal and fetal outcome in placenta previa: our experience

2020 ◽  
Vol 9 (8) ◽  
pp. 3253
Author(s):  
G. D. Maiti ◽  
M. Adhikary ◽  
P. R. Lele ◽  
Shilpa Gupta ◽  
M. Saha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fetal Outcome ◽  
Blood Component ◽  
Care Hospital ◽  
Potential Risks ◽  
Risks Factors

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta to mandatory exclude overdiagnosis or migration. All cases of placenta previa need to be managed in a higher centre facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.

scholarly journals Retrospective analysis of breech deliveries in tertiary care center

2020 ◽  
Vol 9 (11) ◽  
pp. 4549
Author(s):  
Suneela Mullakkal Sankaran ◽  
Jayasree Sukumara Sukumara Pillai
Keyword(s):  
Intrauterine Growth Restriction ◽  
Caesarean Delivery ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Growth Restriction ◽  
Cross Sectional ◽  
Intrauterine Growth ◽  
Uterine Anomalies

Background: Breech presentation is the commonest malpresentation accounting for 3-4% of all deliveries at term. The most common cause for breech presentation is preterm delivery. The safest route of delivery for breech had long been a topic of debate and after the results of term breech trial mode of delivery has become abdominal route even in teaching institutions.Methods: This is a retrospective cross sectional study conducted at department of obstetrics and gynaecology, Government medical college, Kozhikode, for a period of 2 years from 01 January 2016 to 31 December 2017. Mothers with gestational age between 28 weeks to 41 weeks with singleton live fetus with breech presentation who had either vaginal or caesarean delivery were included. The case notes were retrieved from the medical records department.Results: A total of 823 breech deliveries occurred during the study period. Of the total mothers 429 were primies and 394 were multies. Common causes identified were prematurity, intrauterine growth restriction, uterine and fetal anomalies. Mode of delivery was caesarean in more than 80% of cases.Conclusions: Incidence of breech presentation was 3.2% during the study period. Increasing incidence of caesarean delivery is seen in breech presentation. Persistent breech presentation at term is most commonly seen in patients with associated oligamnios, intrauterine growth restriction, and uterine anomalies.

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 Emergency obstetric hysterectomy: a two-year observational study at tertiary care center in Berhampur, Odisha, India

2019 ◽  
Vol 8 (12) ◽  
pp. 4695
Author(s):  
Ritanjali Behera ◽  
Bibekananda Rath
Keyword(s):  
Caesarean Section ◽  
Postpartum Hemorrhage ◽  
Care Center ◽  
Tertiary Care ◽  
Medical College ◽  
Balanced Approach ◽  
The Face ◽  
Life Threatening ◽  
Emergency Hysterectomy ◽  
Febrile Morbidity

Background: Emergency obstetric hysterectomy is an unequivocal marker of severe maternal morbidity and, in many respects, the treatment of last resort for rupture uterus, severe postpartum hemorrhage (PPH) and other such life-threatening conditions. In no other gynaecological or obstetrical surgery is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand it is the last resort to save a mother’s life, and on the other hand, the mother’s reproductive capability is sacrificed. This study is conducted with an aim to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency obstetric hysterectomy in a tertiary care centre.Methods: We conducted a prospective, observational, and analytical study over a period of two years, from September 2017 till September 2019. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur.Results: The incidence of EOH in our study was 12 following vaginal delivery and 44 following caesarean section. The overall incidence was 56 per 21,128 deliveries. Uterine rupture (37.5%) was the most common indication followed by atonic postpartum hemorrhage (25%) and placenta accrete spectrum (10.7%). The most frequent sequelae were febrile morbidity (25.7%) and disseminated intravascular coagulation (21.4%). Maternal mortality was 17.1% whereas perinatal mortality was 51.7%.Conclusions: A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of caesarean section and multiple pregnancies particularly in urban settings in developing countries.

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