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Background: Placenta previa is a serious and life-threatening pregnancy complication characterized by bleeding originating from the placental site located in the lower uterine segment. This condition typically occurs during the latter half of pregnancy when the lower uterine segment undergoes stretching.Methods: This study is a retrospective observational study of total 30 cases of placenta previa from October 2022 to February 2024 at the department of obstetrics and gynecology at SVP Hospital, tertiary center, western Ahmedabad. All women with placenta previa included in this study except patients suffering from any other bleeding disorder. These women were analyzed with age, parity, gestational age, past history of bleeding, clinical features at presentation, blood transfusion, period of gestation at time of delivery, mode of delivery and perinatal outcome.Results: In present study 30 cases were taken. Majority were registered 66.7% (20), age group between 21 to 30 year patients 87% (26), multiparous 73.4% (22) patients. Most common risk factor is caesarean section 20% (6) followed by D&E 16.6% (5). Common complications include 33.33% (10) postpartum haemorrhage.Conclusions: Placenta previa is a major risk factor for adverse maternal and perinatal outcome. Good antenatal care, early diagnosis, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and nicu services can improve maternal and neonatal outcome in high risk cases.
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Background: Maternal mortality remains a significant public health challenge globally, particularly in low-resource settings like Bangladesh. This study aims to analyze the incidence and characteristics of maternal mortality at Dhaka Medical College Hospital, a major tertiary care center in Bangladesh.Methods: This retrospective observational study was conducted, reviewing 10,592 birth records from July 2009 to June 2010. The study focused on maternal deaths during this period, identifying 189 cases. Data on age, socioeconomic status, parity, antenatal care practices, and causes of mortality were analyzedResults: The maternal mortality rate was found to be 1.78%. The majority of deaths occurred in younger women, with 25.40% in the 16-20 age group and 36.51% in the 21-25 age group. A significant majority (80.95%) of the deaths occurred among women from low socioeconomic backgrounds. Regarding parity, the highest mortality was observed in women with 1-2 children (39.68%). Antenatal care was notably deficient, with 75.66% of participants not receiving any. The leading causes of maternal mortality were eclampsia (31.75%) and obstetric haemorrhage (30.16%).Conclusions: The study highlights a high incidence of maternal mortality among younger women and those from low socioeconomic backgrounds, with eclampsia and obstetric haemorrhage being the predominant causes. The lack of antenatal care is a critical concern. These findings underscore the need for improved antenatal care services, emergency obstetric care, and targeted interventions to address socioeconomic disparities in maternal health.
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Abusive head trauma, which is a subset of Shaken baby syndrome, refers to a type of brain injury that occurs when the baby's head is subjected to undesirable forces. The characteristic lack of contributory history often leads to misdiagnosis, delayed treatment and suboptimal clinical outcome. We reported a neonatal presentation of abusive head trauma which posed significant diagnostic challenges. This manuscript depicts our journey to the correct diagnosis and also a review of current literature on abusive head trauma.
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Neurofibromatosis 1 (NF1) is an autosomal dominant disease and is usually diagnosed during childhood. Neurofibromatosis are group of genetic disorders that cause tumors to form, which can develop anywhere in the nervous system including brain, spinal cord and nerves. It poses a great challenge to the anaesthesiologist as it may have difficult airway, fibrosis in lungs and neuromas in spinal cord. Due to the involvement of CNS, regional anaesthesia in type 2 neurofibromatosis without careful preoperative examination can be extremely dangerous. Regional anaesthesia on the other hand could be useful in type 1 neurofibromatosis because CNS involvement is rare. This was a case report of management in a 24-year-old pregnant female with undiagnosed neurofibromatosis for an emergency cesarean section for antepartum haemorrhage and IUD under spinal anaesthesia. Although general anaesthesia is the safer option in neurofibromatosis patients, spinal anaesthesia can be a safe procedure in neurofibromatosis patients but special precautions should be taken to avoid neurological injury and uneventful anaesthesia.
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The objective of this study was to decipher the efficacy and safety of the Bakri balloon as a tamponading device for managing secondary postpartum haemorrhage. A 37-year-old lady presented to us with a secondary postpartum haemorrhage after 17 days of vaginal birth. Due to ongoing heavy bleeding per vaginum, she underwent an examination under anaesthesia, and manual removal of placental tissue along with the insertion of a Bakri balloon under ultrasound guidance. However, after 6 hours of the procedure, she deteriorated and the bedside ultrasound showed rupture of the uterus at the fundus with the Bakri balloon in situ. She was resuscitated and had an emergency laparotomy with repair of the uterine perforation following which she recovered completely and was discharged home on day 6. Uterine rupture following balloon tamponade is a rare but life-threatening complication, especially when placed during the management of secondary PPH in a septic postpartum uterus. This occurred despite placing the balloon under ultrasound guidance in an unscarred uterus. Keeping a low threshold of suspicion of uterine rupture and prompt treatment can save the uterus. The safety of the use of the Bakri balloon in secondary PPH needs to be reviewed in a larger population as the uterus is more likely to rupture because of underlying infection.
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Background: Peripartum hysterectomy is a rare condition which is associated with maternal morbidity and mortality, and the last resort to control hemorrhage when all the other methods fail. The main aim of this study was to evaluate the indications, incidence and complications, maternal and perinatal outcome and compare the risk of peripartum hysterectomy in women who underwent LSCS previously with the women who did not have previous LSCS.Methods: A retrospective study was done over one year at a tertiary care teaching hospital in southern Rajasthan. All the women who underwent peripartum hysterectomy were included. Patients were divided into two groups, one who did not have any previous lower segment caesarean section (LSCS) and other who had history of previous LSCS, and their data was compared. The, results were calculated and represented as mean, frequency or median as appropriate.Results: 34 women underwent peripartum hysterectomy yielding the incidence of 2.21/ 1000 deliveries. The main indication of peripartum hysterectomy was abnormally adherent placenta followed by rupture uterus. 73% cases of peripartum hysterectomy were associated was the history of LSCS.Conclusions: The indication of peripartum hysterectomy has changed from atonic PPH to placenta spectrum syndrome. A major change can be brought about by the reduction of index cases of LSCS which has been on the rise in the recent years. Strict protocols should be made. Early transportation facility and institutional deliveries should be promoted to prevent the emergency peripartum hysterectomy.
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Background: Emergency peripartum hysterectomy is a vital surgical procedure performed at the time of vaginal or caesarean delivery or in the immediate postpartum period in cases of intractable postpartum haemorrhage unresponsive to other conservative measures. Such hemorrhage may be due to atonic uterus, uterine trauma, coagulation disorders, abnormal placentation, not treatable by conservative measures.Methods: This study was conducted for a time period of 1.5 years from March 2016 to September 2017, in the department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India. All such patients in our hospital were included in this study. The incidence, risk factors, age, parity, gestational age, indications for performing hystrectomy, pre and post-operative complications were studied.Results: The incidence was 3.2/1000 deliveries. The average age of the patients in our study was 31.18±2.80 years. Most patients were delivered at gestation of 37-38 weeks (61.17%). Among the patients undergoing peripartum hysterectomy 87.38% had caesarean delivery and 12.62% had vaginal delivery. The commonest indication of peripartum hystrectomy in our study was abnormal placentation (67.96%) with accreta accounting for most of these cases (53.40%).Conclusions: The incidence of peripartum hystrectomy in our centre has increased with time, which can be accounted by increase in the rate of caesarean sections over time which has led to the emergence of morbidly adherent placentation as the commonest risk factor for peripartum hysterectomy.
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The liver plays an important regulatory role in maintaining the dynamic balance of coagulation and anticoagulation in the body. Such dynamic balance is fragile in patients with liver cirrhosis， and the risk of bleeding can be increased due to reductions in coagulation factors and platelet count and excessive fibrinolysis； meanwhile， thrombus can be formed due to the increases in von Willebrand factor and coagulation factor Ⅷ， the reductions in anticoagulant protein C and anticoagulant protein S， the increase in thrombin-generating potential， and alterations in antifibrinolytic components. This article reviews the mechanisms of coagulation disorder in liver cirrhosis， so as to help clinicians with the prevention and treatment of bleeding or thrombotic disorders in patients with liver cirrhosis.
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Background: Antepartum haemorrhage (APH) is one of the most feared complications in obstetrics, contributing to a significant amount of maternal and perinatal morbidity and mortality in our country. An antepartum haemorrhage is defined as bleeding into or from the genital tract from 24 weeks� gestation and onwards, before the delivery of the baby. APH complicates about 2-5% of all the pregnancies with incidence of placenta previa (PP) about 0.33% to 0.55% and incidence of abruptio placenta (AP) about 0.5-1%. The maternal complications seen in patients with APH are malpresentations, premature labour, postpartum haemorrhage (PPH), sepsis, shock and retained placenta and the various foetal complications are preterm baby, low birth weight, intrauterine death, congenital malformation and birth asphyxia.Methods: A 45 patients were included in this descriptive study and detailed history taking and clinical examination was done and the resultant maternal and neonatal outcome was noted.Results: Incidence of APH in current study was calculated to be 0.53%. Out of the 45 patients, 28 (62.3%) were diagnosed with placenta previa and 17 (37.8%) were diagnosed with abruptio placenta. All 45 patients underwent caesarean section. 3 patients (6.6%) underwent obstetric hysterectomy due to diagnosis of placenta accreta spectrum. 35 alive and 8 dead born foetuses were delivered. 40% of new borns were admitted in NICU.Conclusions: Antepartum haemorrhage is a major cause of maternal and perinatal morbidity and mortality which can be prevented by early antenatal registration, regular and frequent antenatal visits, early detection and labelling of high-risk cases, and early referral to higher centre when indicated.
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Background: Anaemia in pregnancy is a globally health-related issue that affects both mothers and their new-born. Hence an observational study to see the effect of anaemia on maternal and foetal outcome was conducted.Methods: 15024 mothers coming in OPD or IPD in past 4 years were recruited and their haemoglobin measured. Descriptive statistics was used for baseline characteristics. This observational study was conducted in department of obs and gynae, GSVM Medical College Kanpur from August 2018 to August 2022. All the data gathered was processed by SPSS version 25.Results: The main outcomes included 4 maternal outcomes (postpartum haemorrhage, shock, ICU admission, and maternal mortality) and 4 neonatal outcomes (foetal growth restriction, birth weight, NICU admission, stillbirth). 60.03% of the mothers were anaemic in our study. Maternal and foetal complications were more in anaemic than non-anaemic mothers with incidence of PPH, shock, ICU admission, and maternal mortality being 14.07%, 11.33% ,4.30 and 1.31% respectively than non-anaemic mothers with incidence of 11.22%, 7.26%, 1.76%, and 7.28% respectively. Foetal outcome was also poorer in anaemic mothers with incidence of FGR, LBW, NICU admission, Still birth being 3.15%, 8.85%, 12.96%, and 1.09% higher than non-anaemic group with incidence being 1.80%, 3.43%, 9.75%, and 0.30 % respectively.Conclusions: This observational study provides valuable insights into the effect of anaemia on both maternal and foetal outcomes. It emphasizes the importance of early detection and management of anaemia to mitigate the risks associated with this condition.
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Background: Anaemia in pregnancy is a globally health-related issue that affects both mothers and their new-born. Hence an observational study to see the effect of anaemia on maternal and foetal outcome was conducted.Methods: 15024 mothers coming in OPD or IPD in past 4 years were recruited and their haemoglobin measured. Descriptive statistics was used for baseline characteristics. This observational study was conducted in department of obs and gynae, GSVM Medical College Kanpur from August 2018 to August 2022. All the data gathered was processed by SPSS version 25.Results: The main outcomes included 4 maternal outcomes (postpartum haemorrhage, shock, ICU admission, and maternal mortality) and 4 neonatal outcomes (foetal growth restriction, birth weight, NICU admission, stillbirth). 60.03% of the mothers were anaemic in our study. Maternal and foetal complications were more in anaemic than non-anaemic mothers with incidence of PPH, shock, ICU admission, and maternal mortality being 14.07%, 11.33% ,4.30 and 1.31% respectively than non-anaemic mothers with incidence of 11.22%, 7.26%, 1.76%, and 7.28% respectively. Foetal outcome was also poorer in anaemic mothers with incidence of FGR, LBW, NICU admission, Still birth being 3.15%, 8.85%, 12.96%, and 1.09% higher than non-anaemic group with incidence being 1.80%, 3.43%, 9.75%, and 0.30 % respectively.Conclusions: This observational study provides valuable insights into the effect of anaemia on both maternal and foetal outcomes. It emphasizes the importance of early detection and management of anaemia to mitigate the risks associated with this condition.
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Background: Postpartum Haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage. It is defined by the royal college of obstetrician and gynaecologist as blood loss from the genital tract within the first 24 hours after birth of at least 500ml (minor) and at least 1000ml (major) causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin).Methods: This study aimed to assess the clinical practices used by our hospital in managing major PPH. Observational study of the management of PPH over a period of 2 months from March 2023 to April 2023 was carried out. Criteria examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. Role of blood transfusion, presence of senior faculty, and type of uterotonics used.Results: There were 50 patients diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and history of previous PPH. Uterine atony was commonest cause in 64% of cases.Conclusions: Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH.
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Background: Postpartum Haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage. It is defined by the royal college of obstetrician and gynaecologist as blood loss from the genital tract within the first 24 hours after birth of at least 500ml (minor) and at least 1000ml (major) causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin).Methods: This study aimed to assess the clinical practices used by our hospital in managing major PPH. Observational study of the management of PPH over a period of 2 months from March 2023 to April 2023 was carried out. Criteria examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. Role of blood transfusion, presence of senior faculty, and type of uterotonics used.Results: There were 50 patients diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and history of previous PPH. Uterine atony was commonest cause in 64% of cases.Conclusions: Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH.
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Background: Peripartum hysterectomy is a lifesaving procedure performed for severe obstetric complications such as major obstetric haemorrhage, abnormally invaded placenta, uterine rupture or sepsis. Objectives of the study was to review the epidemiology of peripartum hysterectomies performed over a period of ten years from January 2012 to December2021 and to determine the trends in peripartum hysterectomies by comparing two different time periods.Methods: In this retrospective descriptive study, the case records of peripartum hysterectomies performed at Government Medical College, Kozhikode between January 2012 and December 2021 were analysed. Results for 2012-2014 and 2019-2021 were compared to identify the changing trends.Results: Total number of deliveries for 10 years was 147272, of which 53975 (36.64%) women underwent caesarean section. Total number of peripartum hysterectomies was 312 with incidence of 2.12 per 1000 deliveries. Comparing the data of 2012-14 with 2019-21, incidence was 2.11 and 2.45 per 1000 deliveries respectively. Placenta previa accreta was the commonest indication for peripartum hysterectomies in both periods. Classical caesarean section followed by hysterectomy in 53 cases (61.62%) during 2019-21 whereas only 6 cases (6.06%) during 2012-14. Number of units of blood and blood products received was less during 2019-21 period, 56(65.11%) received only1-3 units whereas 48 (48.48%) received more than 3units during the period 2012-14.Conclusions: Placenta previa accreta was the most common indication for hysterectomy during 2019-21. Classical caesarean section followed by hysterectomy in placenta previa accreta can reduce haemorrhage and need for transfusions.
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Hypertensive disorder in pregnancy is a major source of morbidity and mortality worldwide. This is a disease unique to pregnancy typically characterized by blood pressure ?140/90 mm of Hg after 20 weeks of pregnancy and associated with proteinuria 300 mg/24 hours or 1+ dipstick. If left untreated the disorder often leads to serious maternal and perinatal complications. Here there is a case report of women with undiagnosed hypertension during pregnancy which complicates life of both mother and fetus by complicating labour and birth with precipitate labour and postpartum haemorrhage. This is a preventable complication by educating women about importance of routine antenatal visits.
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Nephrostomy tubes were once the norm following a standard percutaneous nephrolithotomy (PCNL). Nowadays they are a rarity, since most PCNLs are performed without the use of a Nephrostomy tube in the post-operative period (tubeless PCNL). We present the use of a simple irrigation set tubing as a low-cost nephrostomy tube alternative in patients with post-PCNL hemorrhagic complications.
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Nephrostomy tubes were once the norm following a standard percutaneous nephrolithotomy (PCNL). Nowadays they are a rarity, since most PCNLs are performed without the use of a Nephrostomy tube in the post-operative period (tubeless PCNL). We present the use of a simple irrigation set tubing as a low-cost nephrostomy tube alternative in patients with post-PCNL hemorrhagic complications.
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Peripartum hysterectomy is performed in critical conditions like major obstetric haemorrhage, abnormally-invasive placenta, rupture uterus. In developing countries incidence is 0.2�1000 deliveries. It can also be done as non-emergent surgeries for suspected cases by pre-planning. If high-risk patients are identified, timely intervention done, yields better outcome. Data of peripartum hysterectomy patients during last 12 years collected. Demographic details, menstrual-obstetric history, high-risk factors, previous and current delivery details, postpartum haemorrhage, indication, operative details of peripartum-hysterectomy, maternal-perinatal outcome, blood loss, anaesthesia records, length of ICU and hospital stay quantity of blood and products transfused analysed. 18 cases of peripartum hysterectomy with incidence of 2.76 per 1000 deliveries noted. 14-emergency, 4-electively done. In current pregnancy 13 had caesarean deliveries, 5 had vaginal deliveries, all required emergency hysterectomy. Majority were 26-30 years, 83% multiparous. 11 required emergency hysterectomy. 27.77% were due to atonic PPH and 22.22% placenta accreta spectrum. Mean anaesthesia duration, ICU stay, mean blood loss, units of blood and products was more in emergency group. Maternal and perinatal outcomes were favourable in elective group. Keeping high index of suspicion for accrete, identifying risk factors for atonic PPH, managing proactively, results in favourable maternal-perinatal outcome.
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Neonatal adrenal haemorrhage is a relatively uncommon. Most often associated with difficult labour, birth trauma, hypoxia, sepsis. Clinical manifestations may vary from asymptomatic to life threatening Addisonian crisis. We present a case of right subacute adrenal hematoma confirmed on MRI abdomen. Risk factor being birth asphyxia. He presented with neonatal jaundice and was managed successfully by conservative methods. Treatment depends on the clinical features and severity. Most of the cases are asymptomatic and managed conservatively. Infants with acute haemorrhage might need urgent blood transfusion. Laparotomy is indicated when haemorrhage seems to be continuing, especially when the exact site of haemorrhage is in doubt. Adrenal haemorrhage usually takes 3 weeks to 6 months to resolve completely. Our case was clinically and hemodynamically stable, so he was managed conservatively and discharged after a week. This case emphasizes the importance high degree of suspicion in evaluation of neonate presented with late onset jaundice and importance of ultrasonography in diagnosis and conservative management.
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Background: This study was conducted to compare the efficacy and safety of oral misoprostol against intramuscular oxytocin in the active management of the third stage of labour, so that it can be widely used in the areas of limited resources to contribute in preventing post-partum haemorrhage and thus decreasing maternal mortality ratio.Methods: This was a prospective randomised controlled clinical study. Two hundred patients fulfilling inclusion criteria were randomized to receive either oral misoprostol (600 mcg) or intramuscular oxytocin (10 IU) in the active management of third stage of labour. Primary outcome measured was mean blood loss and incidence of primary PPH.Results: The mean blood loss during third stage of labour in oral misoprostol group and oxytocin group was 239.16�.78 ml and 240.19�.70 ml respectively with p value-0.7331 which was insignificant. Similarly mean fall in haemoglobin was also not significant. There was no significant differences between the two groups with regard to the incidence of PPH (3% vs. 2% respectively; p=0.651). Women experiencing side effects like shivering and fever were significantly higher among misoprostol group than in oxytocin group.Conclusions: In this study, oral misoprostol was found to be comparable to intramuscular oxytocin regimen, in terms of amount of blood loss, occurrence of postpartum hemorrhage, duration of third stage of labour, fall in hemoglobin and fall in blood pressure. However, shivering and fever were more common with misoprostol, but no other serious side effects were noted.