HISTOMORPHOLOGICAL STUDY OF THE UTERUS IN 64 PERIPARTUM HYSTERECTOMY SPECIMENS.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Gayatri Devi Pukhrambam ◽  
O. Okendrajit Singh ◽  
Babina Sarangthem ◽  
Kamal Uddin Gauhar
Keyword(s):  
Caesarean Section ◽  
Cross Sectional Study ◽  
Uterine Atony ◽  
Common Finding ◽  
Prior History ◽  
Histopathological Diagnosis ◽  
Abnormal Placentation ◽  
Cross Sectional ◽  
Peripartum Hysterectomy ◽  
History Of

Background: Peripartum hysterectomy is a life saving procedure performed for intractable obstetric haemorrhage. Uterine atony, rupture, abnormal placentation, retained products etc. are common indications. With the rise of caesarean sections, the incidences of peripartum hysterectomies are increasing worldwide. The aim of the present study is to evaluate the histomorphological findings in peripartum hysterectomy specimens received during a five year period. Material and Method: In this hospital based cross-sectional study during a five year period (Jan 2014 –Dec 2018), 64 peripartum hysterectomy specimens received in the department of Pathology, RIMS, Imphal, Manipur were included. The gross and histomorphological findings were evaluated, studied, statistically analysed and compared with other studies. Results and Observation: The various histomorphological findings were abnormal placentation 28 (43.7%), uterine atony 15 (23.5%), uterine rupture 14 (21.8%), retained placenta/product 6 (9.3%) and subinvolution 1(1.5%).  Abnormal Placentation and Placenta cretas were the most common finding in the present study. The lower uterine segment was the most common abnormal site of placental implantation. The age ranged from 21 to 45 years, with majority of the cases were in the          30-39years age group. History of previous caesarean section was noted in 20 cases (31.2%). The relative risk of abnormal placentation was 2.5 times higher in those cases with prior history of caesarean section. Rupture was most commonly associated with multiparous women. Co-morbid overlapping features were seen in few cases. Conclusion: Histopathological diagnosis not only confirmed the clinico-radiological impression, but also highlighted the other co-morbid associations that caused the intractable haemorrhage which warranted a peripartum hysterectomy.   Keywords: Peripartum Hysterectomy, Abnormal placentation, caesarean section, chorionic villi.

scholarly journals Risk factors for composite adverse outcomes of postpartum haemorrhage in a low-resource setting: a single-centre cross-sectional study in Mpilo Central Hospital, Bulawayo, Zimbabwe

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 211
Author(s):  
Solwayo Ngwenya
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Caesarean Section ◽  
Postpartum Haemorrhage ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Prior History ◽  
Cross Sectional ◽  
History Of ◽  
Independent Risk Factors

Background: Primary postpartum haemorrhage continues to cause considerable global maternal morbidity and mortality. The aim of this study was to determine the risk factors for composite adverse outcomes in postpartum haemorrhage using multivariable logistic regression. The findings could potentially be used to anticipate and prevent composite adverse outcomes in postpartum haemorrhage. Methods: This was a retrospective cross-sectional study carried out at Mpilo Central Hospital, a government tertiary referral centre, covering the period 1 July 2016 to 30 November 2019. Participants were included in the study if they had a diagnosis of postpartum haemorrhage. Those variables that had a p<0.2 from the univariate logistic regression analyses were considered for multivariable logistic regression. The association between independent variables and the dependent variable was assessed using odds ratio with 95% confidence intervals, to identify independent risk factors for composite adverse outcomes in PPH. Results: The independent risk factors for composite adverse outcomes in postpartum haemorrhage were place of dwelling (AOR 4.57, 95% CI 1.87-11.12, p=0.01), prior history of a Caesarean section (AOR 2.57, 95% CI 1.10-6.00, p=0.03), APH (AOR 5.45, 95% CI 2.23-13.27, p<0.0001), antenatal haemoglobin level (AOR 19.64, 95% CI 1.44-268.50, p=0.03), and delivery by Caesarean section (AOR 10.21, 95% CI 4.39-23.74, p<0.0001). Blood loss was also an independent risk factor for composite adverse outcomes in postpartum haemorrhage with the following blood loss; 1001-1500 ml (AOR 9.94, 95% CI 3.68-26.88, p<0.0001), 500-1000 ml (AOR 41.27, 95% CI 11.32-150.54, p<0.0001), and 2001 ml (AOR 164.77, 95% CI 31.06-874.25, p<0.0001). Conclusions: This study found that the independent predictors for composite adverse outcomes in PPH were rural dwelling, prior history of a Caesarean section, antenatal haemoglobin level, delivery by Caesarean section, and blood. In low- and middle-income countries, such information should help in increasing clinical vigilance and preventing maternal deaths.

scholarly journals An Audit of Indications for Hysterectomy in a District Hospital, Madikeri

2020 ◽  
Author(s):  
Sumanashree Mallappa ◽  
Aishwarya Ramanujam ◽  
Priyadarshini Monnappa ◽  
Padmaja Kulkarni
Keyword(s):  
District Hospital ◽  
Cross Sectional Study ◽  
Common Type ◽  
Common Finding ◽  
Histopathological Diagnosis ◽  
Fallopian Tubes ◽  
Cross Sectional ◽  
Histopathological Findings ◽  
Abdominal Approach ◽  
Nonsurgical Management

Introduction: Hysterectomy is the removal of the uterus and is the most common gynaecological operation done in females worldwide. In the early 20th century, hysterectomies were done for many conditions like leiomyoma, Dysfunctional Uterine Bleeding (DUB), chronic pelvic pain, endometriosis, adenomyosis, prolapse, and malignancies. Considering that the procedure has a 20-35% life risk, it calls for a thorough justification before consideration. A hysterectomy has mental, physical, social, economic and psychosexual impact, apart from intraoperative and postoperative complications. Thus, an audit on hysterectomies was done to help students, medical fraternity, and the women of Kodagu in having a better understanding of hysterectomies. Aim: To conduct an audit on hysterectomies performed for gynaecological indications to correlate pre-operative diagnosis with the histopathological diagnosis. Materials and Methods: This was a cross-sectional study which included all elective hysterectomies performed for gynaecological indications conducted at the District Hospital of Kodagu Institute of Medical Sciences, Madikeri from January 2018-June 2019. All cases of hysterectomies were considered except Caesarean peripartal hysterectomies. The histopathological findings of the endometrium, myometrium, cervix, ovaries and fallopian tubes were recorded. Findings were tabulated as frequency and percentage. Then, using the data, preoperative indications were compared with postoperative histopathological findings to know if hysterectomy was justified. Results: A total of 238 hysterectomies were performed during 18 months in the District Hospital. Abdominal and vaginal approaches were used. Panhysterectomy via abdominal approach was the most common type of hysterectomy. The most common age group where hysterectomy occurred was 41-60 years. The most common indication for hysterectomy was found to be Fibroid uterus. Analysis of the myometrial findings revealed that the most common finding was leiomyoma. Majority of ovaries and fallopian tubes did not show significant pathology. Conclusion: Panhysterectomy was the most common type of hysterectomy. Fibroid were the most common histopathological findings and medium and small sized fibroids can be given a trial of nonsurgical management. Injudicious use of hysterectomy procedure has multiple loop holes involving medical fraternity, socioeconomic conditions of women and attitude of society towards female reproductive health.

scholarly journals Caesarean section at Koudougou regional hospital centre: indications and prognosis

2020 ◽  
Vol 9 (12) ◽  
pp. 4792
Author(s):  
Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽  
Lankaonde Martin ◽  
Savadogo-Komboigo B. Eveline ◽  
S. I. B. Sansan Rodrigue ◽  
Ouedraogo Wendlassida Estelle ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Caesarean Section Rate ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Important Place ◽  
History Of ◽  
Group 3 ◽  
Group 5 ◽  
Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

scholarly journals Hepatitis C in pregnancy: an observational study highlighting its association with maternal parameters

2019 ◽  
Vol 8 (1) ◽  
pp. 344
Author(s):  
Bushra . ◽  
Ambreen Ghori ◽  
Azra Ahmed ◽  
Najma Dalwani ◽  
Mushtaque Ali Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Previous History ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Prior History ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
History Of

Background: Pregnancy is a very crucial time in a woman’s life. In this period of time, not only multiple physiological alterations effect the usual health status but also makes women more vulnerable to contract infection and face negative sequalae. Hepatitis C, a blood borne viral infection serve the similar fate when encountered by pregnant ladies. This study is based on exploring the prevalence of the Hepatitis C virus seropositivity among pregnant population. Moreover, we also evaluated the major risk factors leading to the infection in these mothers. Besides this, infected mothers were studied for their pregnancy outcomes.Methods: In this study 114 pregnant females were observed for this cross-sectional study. It was conducted in Gynecology Unit- 1, Liaquat University Hospital Hyderabad, for the period of January 2017 to July 2017. Chi square test was applied for statistical analysis on SPSS version 16. The criteria for enrollment in the study was set to be a pregnant lady belonging to age group 20-35 years; having singleton pregnancy; was a booked case at the hospital with compliant to antenatal follow ups; admitted to the labor room for delivery. All the non-pregnant ladies, whom had co morbid conditions such as hypertension or diabetes or had infected with hepatitis B or D were excluded from the study. Furthermore, pregnant ladies with multiple gestion or those who were either diagnosed of hepatitis C prior to conceive or had a previous history of hepatitis C were also excluded.Results: Present study revealed that out of 114, 10(8.8%) pregnant ladies were found seropositive for Hepatitis C virus. Prior history for transfusion of blood was the Foremost risk factor discovered, with 60.5% women reported this. History of surgery was the 2nd commonest factor and 43.9% had this in their medical records. On the other hand, only 8.8% women gave the history for previous evacuation. While observing pregnancy outcomes, we found 48.2% neonates had low birth weight, 41.2% were born preterm and 21.1% had low APGAR score.Conclusions: In a nutshell hepatitis c is prevalent in the pregnant population of this region and showing its effects in the form of compromised pregnancies. History of blood transfusion and previous surgery were found to be chief risk factors in the study.

Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags

Cephalalgia ◽  
2018 ◽  
Vol 38 (12) ◽  
pp. 1841-1848 ◽  
Author(s):  
Nathan P Young ◽  
Muhamad Y Elrashidi ◽  
Paul M McKie ◽  
Jon O Ebbert
Keyword(s):  
Imaging Study ◽  
Cross Sectional Study ◽  
Prior History ◽  
Community Practice ◽  
Red Flags ◽  
Cross Sectional ◽  
History Of ◽  
Red Flag ◽  
Neuroimaging Study ◽  
Yellow Flags

Background Neuroimaging for headache commonly exceeds published guideline recommendations and may be overutilized. Methods We conducted a retrospective cross-sectional study of all outpatient community patients at Mayo Clinic Rochester who underwent a neuroimaging study for a headache indication in 2015. We assessed the neuroimaging utilization pattern, clinical application of red flags, and concordance with neuroimaging guidelines. Results We identified 190 outpatients who underwent 304 neuroimaging studies for headache. The median age was 46.5 years (range 18–91 years), 65% were female, and most reported no prior history of headache (n = 97, 51%). A minority of patients had prior brain imaging studies (n = 44, 23%) and neurological consultations for headache (n = 29, 15%). Few studies were ordered after consultation with a neurologist (n = 14, 7%). Seventy-seven percent of patients were documented to have a “red flag” justifying the imaging study. Abnormal neuroimaging findings were found in 3.1% of patients with warning flags (5/161); carotid dissection (n = 3) and reversible cerebral vasoconstrictive syndrome (n = 2). An estimated 35% of patients were imaged against guidelines. Conclusions The prevalence of serious causes of headache in a community practice was low despite the presence of a documented red flag symptom. Inadequate understanding or application of red flags may be contributing to recommendations to image patients against current guidelines. Interventions to reduce unnecessary neuroimaging of patients with headache need to be designed and implemented.

scholarly journals Factors affecting the fetal & maternal outcome in a trial of labour after previous one caesarean section

2019 ◽  
Vol 10 (2) ◽  
pp. 1110-1117
Author(s):  
Aseel Ghazi Rifat
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Safe Alternative ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Fetal Complications ◽  
History Of ◽  
Maternal Bmi

This study was designed to evaluate maternal and obstetrical factors associated with a successful trial of labour after one caesarean section (TOLAC) as well as evaluating the associated fetal and maternal outcomes and to determine the rate of vaginal delivery and repeated C/S. A prospective cross-sectional study was done on 237 women with previous one C/S then patients were selected for the trial of labour based on the department protocol. Those who were chosen for TOL were strictly monitored & observed for the progress of labour and the outcomes were recorded in terms of mode of delivery, maternal & fetal complications and were analysed and compared with those who had repeated C/S. Seventy-three (30.8%) patient was delivered by elective C/S without trial, 109 (46%) of the patients who were admitted to labour room delivered vaginally while 55 (23.2%) delivered by emergency C/S. It has been found that maternal BMI of (<25), history of vaginal birth after C/S (VBAC) and smaller gestational age were significantly associated with the success of TOL and can predict the outcome. Higher maternal & fetal complications rates were reported in cases delivered by emergency C/S compared to those who delivered vaginally or through elective C/S. The trial of labour after one caesarean section is a safe alternative to repeated C/S and decreases the associated morbidities with repeated C/S. The success rate of TOLAC reported in this study was (66.5%). A successful TOLAC is associated with normal maternal BMI, smaller gestational age and history of the previous VBAC.

scholarly journals Clinical analysis of cardiac failure in post-myocardial infarction patients

2018 ◽  
Vol 5 (3) ◽  
pp. 587
Author(s):  
R. Jaya Prakash Reddy ◽  
P. Vijaya Narasimha Reddy
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Failure ◽  
Clinical Analysis ◽  
Cross Sectional Study ◽  
Anterior Wall ◽  
Prior History ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Number Of Patients ◽  
History Of

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

scholarly journals A study on peripartum hysterectomy in a tertiary referral government hospital

2019 ◽  
Vol 8 (12) ◽  
pp. 4971
Author(s):  
Chaithra M. ◽  
Tejeswini K. K. ◽  
Savitha C.
Keyword(s):  
Caesarean Section ◽  
Postpartum Haemorrhage ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Peripartum Hysterectomy ◽  
Obstetrics And Gynaecology ◽  
Vaginal Deliveries ◽  
Life Threatening ◽  
Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a major surgical venture invariably performed in the setting of life-threatening haemorrhage during or immediately after abdominal and vaginal deliveries. Aim of the study was to study the frequency and indications for peripartum hysterectomy and to assess the maternal outcome of peripartum hysterectomy.Methods: Cross sectional study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from September 2018 to august 2019. This study consists of 24 cases of emergency peripartum hysterectomy within 24 hours of delivery, operated at Vanivilas hospital.Results: The frequency of peripartum hysterectomy was 1.102/1000 deliveries and following caesarean section and vaginal deliveries are 3.544/1000 deliveries and 0.248/1000 deliveries respectively. Among 24 cases who had peripartum hysterectomy, 16 cases were delivered by caesarean section and 4 cases delivered by vaginal route while another 4 cases delivered by laparotomy for rupture uterus. 22 cases (91.67%) survived with major number of cases having morbidities and there were 2 (8.33%) maternal death.Conclusions: The most common mode of delivery before peripartum hysterectomy was Caesarean section. The most common indication was atonic postpartum haemorrhage. Better protocols for induction and augmentation of labour will decrease the necessity of peripartum hysterectomies.

scholarly journals Epidemiology of Sports Related Concussion in Brazilian Jiu-Jitsu: A Cross-Sectional Study

Sports ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 53 ◽  
Author(s):  
Matthew Spano ◽  
Donald Risucci ◽  
Mill Etienne ◽  
Kristina Petersen
Keyword(s):  
Wide Spectrum ◽  
Female Gender ◽  
The United States ◽  
Cross Sectional Study ◽  
Lifetime Prevalence ◽  
Prior History ◽  
Return To Sports ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of

Brazilian Jiu-Jitsu (BJJ) is a rapidly growing grappling sport with a wide spectrum of participants. This cross-sectional study examined the lifetime prevalence of concussion in adult BJJ practitioners in the United States using a 17-item survey. A total of 778 (11.4% female) BJJ practitioners with a median age of 31 years completed the survey. Overall, the lifetime prevalence of the self-reported BJJ-related concussion was 25.2%. However, the prevalence was higher among females than males (43.0% versus 22.9%; X2(1,740) = 15.129; p < 0.001). Factors independently associated with significantly increased odds of having sustained a BJJ-related concussion included a prior history of concussion (OR 1.76, 95% CI 1.14–2.74; p = 0.011) and female gender (OR 1.95, 95% CI 1.04–3.65; p = 0.037). The median return to sports time was three days, with 30.3% of participants returning on the same day as being concussed. The present study represents the first epidemiological research examining the concussions in BJJ. The results underscore the need for increased education on concussions and return to sports guidelines among BJJ coaches and practitioners.

scholarly journals Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Ayenew Mose ◽  
Haimanot Abebe
Keyword(s):  
Caesarean Section ◽  
Urban Area ◽  
Previous History ◽  
Cross Sectional Study ◽  
Multiple Pregnancies ◽  
Sectional Study ◽  
Cross Sectional ◽  
Southwest Ethiopia ◽  
Factors Associated ◽  
History Of

Abstract Background Caesarean section is a life-saving comprehensive obstetric procedure of women and newborn performed during childbirth-related complications and should be universally accessible for all pregnant mothers globally. Appropriate use of caesarean section can reduce maternal and perinatal mortality. However, inappropriate use of caesarean section can negatively affect infant health, women health, and future pregnancies. The magnitude and factors associated with caesarean section delivery were not consistent and will vary between different hospitals of Ethiopia. Hence, this study aimed at assessing the magnitude and factors associated with caesarean section deliveries in Southwest Ethiopia. Methods and Materials An institutional-based cross-sectional study was conducted from January 1 to February 29, 2020. A systematic random sampling technique was used to select 551 study participants. A pretested, structured, and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with caesarean section deliveries. P values < 0.05 result were considered as a statistically significant association. Results The magnitude of caesarean section deliveries was found to be 32.5 % (95 % CI; 28.6%-36.7 %). Mothers resided in an urban area [AOR = 2.58, (95% CI; 1.66–4.01)], multiple pregnancies [AOR = 3.15, (95% CI; 1.89–5.23), malpresentation [AOR = 3.05, (95% CI; 1.77–5.24)], and previous history of caesarean section [AOR = 3.55, (95% CI; 2.23–5.64) were factors associated with caesarean section deliveries. Conclusions Caesarean section deliveries were found high in the study area. Mothers resided in an urban area, multiple pregnancies, malpresentation, and previous history of caesarean section were factors associated with caesarean section deliveries. Therefore, counselling of mothers on the risk of giving birth through elective caesarean section without absolute and relative medical indications and giving enough time for the trial of vaginal birth after caesarean section are recommended.

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