scholarly journals Management Strategies and Maternal Outcome of Placenta Accreta

2016 ◽  
Vol 28 (2) ◽  
pp. 71-75
Author(s):  
Ferdousi Chowdhury ◽  
Mahbuba Akhter ◽  
Rokeya Khatoon ◽  
Morzina Begum ◽  
Mahbuba Siddiqua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Management Strategies ◽  
Maternal Outcome ◽  
Placenta Percreta ◽  
Team Approach ◽  
College Hospital ◽  
Medical College ◽  
Postpartum Hysterectomy

Objectives: To find out the proportion and maternal outcome of placenta accreta.Materials and Methods: Total 10579 deliveries were served during January 2013 to 31st December 2013 in the Department of Obstetrics and Gynecology of Addin Women Medical College Hospital, Dhaka. All patients who needed postpartum or cesarean hysterectomy for postpartum hemorrhage and diagnosed as placenta accreta after postpartum hysterectomy were included for the study. Among them who were antentally diagnosed as placenta previa with having other risk factors of placenta accreta, were evaluated by Doppler Sonography. All these cases such as diagnosed, suspected or only had multiple risk factors of placenta accreta were managed by a team approach and proper counseling of the patient’s guardian about need of massive transfusion, hysterectomy, Intensive Care Unit (ICU) admission .Results: Among the total 10579 deliveries 22 cases were diagnosed as placenta accreta after postpartum hysterectomy. On histopathology 8 of these cases were placenta percreta, 7 cases were placenta increta and 7 cases were placenta accreta vera. Almost ninety one (90.90%) patient had placenta previa and 90.90% patient had past H/O one or two cesarean section. Placenta percreta cases were more common in patients with H/O two previous C/S or one C /S and dilatation & curettage (D&C). In all preoperatively diagnosed cases, Right lower paramedian incision was given and hysterectomy was done leaving the placenta in situ.Conclusion: Placenta accreta is associated with previous two or more cesarean deliveries, or multigravidae with past H/O repeated D&C or M/R or combined. History of of these operations are diagnosed as having anterior or central placenta previa.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(2) : 71-75

scholarly journals Risk factor Analysis and Angiographic Profiles in First 228 Cases Undergone Coronary Angiography in Cardiac Cath Lab of Dhaka Medical College Hospital

1970 ◽  
Vol 3 (2) ◽  
pp. 122-125 ◽  
Author(s):  
AEMM Islam ◽  
M Faruque ◽  
AW Chowdhury ◽  
HIR Khan ◽  
MS Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Coronary Angiography ◽  
Medical Therapy ◽  
Stable Angina ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Single Vessel

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females. Key words: Risk factors; Coronary angiography. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9179 Cardiovasc. J. 2011; 3(2): 122-125

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

Placenta Accreta Spectrum: A preventable nearly iatrogenic disorder.

2021 ◽  
pp. 24-25
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Wall ◽  
Subsequent Pregnancy ◽  
Team Approach ◽  
Fetal Life ◽  
Risk Increase ◽  
History Of ◽  
Placenta Accreta Spectrum ◽  
Threatening Situation

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. PAS disorder is a maternal and fetal life-threatening situation due to the high risk of intrapartum uncontrollable bleeding. The common described risk factors are the placenta previa and history of Caesarean section (CS) [1]. We herein report our experience with five patients referred to our department for suspected PAS. These patient were selected for targeted prepartum ultrasound assessment due to their history of multiple C-sections. PAS risk increase with the number of previous CS and could reach7% [2]. In Nicaragua , the rate of c-section in obstetrical practice is still high and approximating 40% in some centers. Uterine wall dehiscence result in locally defective decidualisation and abnormal placental adherence with important trophoblastic invasion in a subsequent pregnancy [3]. We still believe that this disorder is preventable if we “go back” a little to obstetrical good practices. Dramatic situations can be avoided by selecting suspected PAS on ultrasound or MRI to be referred. PAS is the commonest cause of intrapartum hysterectomy and must be managed always in specialized centers with multidisciplinary team approach.

scholarly journals To estimate the incidence, etiology and risk factors of wound infections in women who undergoes cesarean section at Kilpauk Medical College Hospital: a prospective study

2017 ◽  
Vol 6 (5) ◽  
pp. 1793
Author(s):  
Jayalakshmi Subramani ◽  
Devika Perumal
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Wound Complications ◽  
Wound Infections ◽  
College Hospital ◽  
Obstructed Labour ◽  
Medical College ◽  
Increased Risk ◽  
Significant Extension ◽  
A Prospective Study

Background: Wound infections following caesarean section (or) gynaecologic surgery is a common complication that accounts for significant extension of hospital stays.Methods: This is a prospective analytical study, conducted in the department of obstetrics and gynaecology, kilpauk medical college, Chennai from Januray 2013 to November 2013. All cases who underwent ceaserean section were included in the study. Analysis was done in the form of percentages and proportions and represented as tables where necessary.Results: A total of 700 cases were analysed. The incidence of wound infections after caesarean section in this study was 8.14%. Study confirms that risk factors like anemia, chorioamnionitis; PROM, obstructed labour, preeclampsia, increased surgical time, increase BMI poses risk for wound complications. Whereas chorioamnionitis (66%) and obstructed labour (66%) showed increased risk for wound complications.Conclusions: Correcting malnutrion, anemia, stabilizing diabetes and eradicating all infection such as urinary tract infection, proper preparation of skin, proper surgeons scrubbing and using proper surgical technique can decrease the risk of postoperative wound infection.

scholarly journals Risk Factors and Morphological Differences of Ruptured Saccular Aneurysm in Different Sites of Anterior Circulation in Patients Presenting with Subarachnoid Haemorrhage

2018 ◽  
Vol 3 (1) ◽  
pp. 21-28
Author(s):  
Reaz Mahmud ◽  
Mansur Habib ◽  
Sharif Uddin Khan ◽  
Asma Khan
Keyword(s):  
Risk Factors ◽  
Subarachnoid Haemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Aneurysm Rupture ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: All sites of intracranial aneurysms have always been considered together in most of the studies of risk factors of aneurysm rupture. Therefore, it is not known whether some risk factors predispose to aneurysm rupture at a particular location. Morphologies also vary in accordance to different sites of the aneurysm.Objective: The purpose of the present study was to observe the differences in the risk factors, the size, aspect ratio and size ratio among the anterior circulation aneurysms.Methodology: This hospital based cross-sectional study carried out in the Department of Neurology at Dhaka Medical College Hospital (DMCH), Dhaka during July 2013 to June 2015 for a period of two (02) years. Patients with subarachnoid haemorrhage caused by ruptured anterior circulation saccular aneurysms admitted in the Departments of Neurology, Internal Medicine and Neurosurgery Departments at Dhaka Medical College Hospital (DMCH), Dhaka and the Department of Neurointervention at National Institute of Neurosciences and Hospital, Dhaka were enrolled in this study. Patients’ ≥18 years of age with subarachnoid haemorrhage caused by anterior circulation aneurysm which was confirmed by computed tomogram (CT-scan) and/or CSF study and digital subtraction angiography were included in this study. The risk factors were identified by interviewing the patients and the morphology were measured from the digital subtraction angiogram.Results: A total number of 85 patients with ruptured saccular anterior circulation aneurysm were enrolled in this study. In this study anterior communicating artery aneurysm (ACom) was the most frequent site of aneurysm (42%). The mean age of the patients with ACom aneurysm (51.72 ± 9.26 years) was significantly higher than posterior communicating artery (47.5 ± 8.2 years) aneurysm and middle cerebral artery (MCA) (43.41 ± 8.0 years) aneurysm. Above the age of 50 ACom aneurysm was the most frequent aneurysm (OR 5.5, p<0.05). Among the female Posterior communicating artery (PCom) aneurysm (46.7%) was the most frequent aneurysm and among the male ACom aneurysm (37.5%) was the most frequent aneurysm. Family history was exclusive in MCA aneurysm (3.5%). The mean size of MCA (7.79 ± 0.71 cm) was higher than ACom (6.12 ± 2.7cm) aneurysm and PCom (6.5 ± 2.4 cm) aneurysm and proportion of aneurysm >10 mm was also higher among the middle cerebral artery (35.6%) aneurysms. The size ratio was significantly higher in ACom (3.08±1.23) and MCA (3.04±0.97) aneurysm. ACom (76.4%) and MCA (83.3%) had also more frequent high risk size ratio.Conclusion: In conclusion anterior circulation aneurysms differ in respects of risk factors and morphology.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 21-28

scholarly journals Association Between Acute Stroke and Metabolic Syndrome

1970 ◽  
Vol 11 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Md Jabed Iqbal ◽  
Md Mahmudur Rahman Siddiqui ◽  
Quazi Tarikul Islam ◽  
Ahmed Hossain ◽  
Ekramul Mustafa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
National Cholesterol Education Program ◽  
Adult Treatment ◽  
Vascular Risk ◽  
Adult Treatment Panel ◽  
College Hospital ◽  
Medical College ◽  
Study Population ◽  
Definition Of

Objective: Metabolic syndrome is the cluster of vascular risk factors including insulin resistance, elevated bloodpressure, hyperlipidemia, and obesity. Metabolic syndrome is strongly associated with cardiovascular andcerebrovascular disease. The aim of this study is to find out association between stroke and metabolic syndrome inour population.Methods: In this observational study, a total number of fifty randomly selected patients were studied from July2009 to December 2009 at Medicine ward of Dhaka Medical College Hospital. Definition of metabolic syndromewas taken from the guidelines by the National Cholesterol Education Program Adult Treatment Panel III.Results: Among the study population 46% had metabolic syndrome. This study estimated that Ischaemic stroke ismore common among metabolic syndrome patients (65.2%), but patient without metabolic syndrome had morehaemorrhagic stroke (55.6%).Only 12% patient was found obese. With or without metabolic syndrome most of thepatient had elevated TG (64%) and raised blood pressure (64%).Conclusion: Without obesity, metabolic syndrome is an important risk factor for cerebrovascular disease. Majorityof the patients with metabolic syndrome present as ischemic stroke.Keywords: Stroke; Metabolic syndrome; hypertension; fasting blood sugar; hyperlipidaemia.DOI: 10.3329/jom.v11i2.5453J MEDICINE 2010; 11 : 124-127

scholarly journals Early Puerperal Complications - A Prospective Clinical Study on Caesarean Deliveries

2018 ◽  
Vol 27 (1) ◽  
pp. 68-71
Author(s):  
Tahamina Akhter ◽  
Tabassum Ghani ◽  
Subinoy Krishna Paul ◽  
Noorjahan ◽  
Afrina Begum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Wound Infection ◽  
Fetal Distress ◽  
Medical College Hospital ◽  
Prospective Clinical Study ◽  
Age Group ◽  
College Hospital ◽  
Normal Delivery ◽  
Medical College

Introduction : when a healthy pregnant woman with no obstetric or medical risk factors goes into spontaneous labour, she should anticipate a normal delivery. But still 580, 000 women in the world die from pregnancy and childbirth each year.1 Lack of attention to postpartum care in developing countries is neglected tragedy and requires immediate attention. This study evaluates the incidence of complications of early puerperium and also focuses the specific types of complications and to detect the risk factors associated with these complications. Aims and objectives : Main aim of the study is to evaluate the common complications in early puerperium with special attention to identify the risk factors. Materials and method : This study was carried out in Dhaka Medical College Hospital and Sir Sallimullah Medical College Hospital within the period of March ’2004 to August’ 2004. Two hundred patients were selected for this study who were delivered by caesarean section in these two institutions and complications occurring within 7 days excluding first 24 hours. Patients delivered outside the hospital and with known medical diseases were excluded from this study. Detailed history taking and appropriate clinical examination and specific investigations were done for diagnosis of complications. All relevant informations was noted in prescribed data sheet and results were tabulated and statistical analysis was done. Results : Among 200 cases only 44(22%) cases had early puerperal morbidity.Most of the patients who suffered complications underwent caesarean section for obstructed labour and fetal distress who had trial at home. Many of the patients suffered from wound infection and endometritis (40.9%). Among patients, age group -<20 years suffered from wound infection(53.8%) and endometritis(45.8%) were common in age group 21-30 years. VVF was common in patients in age <20 years.Endometritis (42.2%) was maximum in women with parity 1-3 and wound infection (50%) in women with parity 4-6. Some of the patients had more than one early puerperal morbidity. Maximum number of poor class suffered from wound infection (42.4%).Early puerperal morbidity was more prevalent in women with duration of labour <18 hours and Premature rupture of membrane had relationship with endometritis (15.9%), wound infection (13.6%) and UTI (11.4%). Conclusion : Incidence of early puerperal morbidities is still quite high (22%) and many patients experiences more than one problem at a time.Long term sequelae of early puerperal infectious morbidity should not be neglected as this may interfere quality of life of a woman. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 68-71

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