A prospective study of effect of delayed cord clamping in term babies as well as in preterm babies

Background: Delayed cord clamping (DCC) is lengthening the time between delivery of newborn and the clamping of their umbilical cord. It is usually performed 25 seconds to 5 minutes after birth, which increases the newborn抯 iron storage, vital for healthy brain development.Methods: This prospective observational study was conducted on 100 late preterm and term newborns delivered in the obstetrics and gynaecology department of Calcutta national medical college and hospital, Kolkata over a period of one and half years (March 2019 to August 2020). The umbilical cord was clamped between 60 to 90 seconds after birth of baby. Babies� weight measurement and blood investigations (Haemoglobin (Hb) level, total serum bilirubin (TSB) and serum ferritin) were performed at birth, after 24 hours of birth and at 6 weeks of age.Results: In this study after DCC, there is significant increase in Serum Ferritin levels after 24 hours and 6 weeks as compared to the birth values. As far as the values of TSB and hemoglobin is concerned, the values first showed increment after 24 hours and then decreased at 6 weeks, which is statistically significant (p=0.001). Birth weight which first decreased after 24 hours, increased at 6 weeks. None of the babies needed blood transfusion during the study period. Out of 100 cases, 9 were admitted in NICU and required phototherapy which was not directly associated with umbilical cord clamping time or bilirubin values at birth.Conclusions: Based on the results of this study, we conclude that newborns with DCC had statistically significant higher levels of Hb and ferritin after birth. This may ensure better iron status throughout infancy along with reduced need of blood transfusion and its related adversities. Delaying cord clamping seems to be beneficial in late preterm and term neonates without causing additional morbidities in the first 6 weeks of life.

A study on role of low dose mifepristone in the management of fibroid in reproductive age group women

Background: Uterine fibroids are the most common benign uterine tumors occurring in 20-50% of women with maximum incidence between 35-45 years of age. Majority of fibroids are asymptomatic. When symptomatic, they present with abnormal menstrual bleeding, dysmenorrhea, chronic pelvic pain, abdominal heaviness, pressure symptoms etc. It is the commonest indication of hysterectomy worldwide. Mifepristone, an antiprogesterone is being widely used as one of the medical managements in potential symptomatic patients (mostly 10-20 mg daily doses).Methods: An institute based prospective study including 100 reproductive aged women with symptomatic single uterine fibroid, was conducted over one-and-a-half-year period. They were administered 10 or 25 mg mifepristone daily for 3 months depending on fibroid size. Clinical parameters were assessed at initiation and at the end of their treatment.Results: Our results showed that mifepristone (both 10 and 25 mg) led to symptomatic relief, with 96% reduction in menstrual blood loss and reversible amenorrhoea in 87% of the patients. Intramural fibroids responded more than submucosal fibroids in terms of relief of menorrhagia and improvement of haemoglobin (Hb) levels, with similar reduction in fibroid volumes of both intramural and submucosal locations.Conclusions: Low dose mifepristone is an effective and safe drug for the medical management of uterine myoma. Due to the benign nature of fibroids, conservative management should be considered wherever feasible. Several clinical trials using 5?50 mg of mifepristone have been conducted over variable durations between 3-12 months but the exact dosage and treatment duration are yet to be decided.

Unusual cases of cervical pregnancy and secondary abdominal pregnancy.

A 22-year-old lady, 3rd gravida presented with discomfort in the lower abdomen and bleeding per vagina following 6 months amenorrhoea. USG of abdomen showed single dead foetus of 21 weeks gestation occupying in the cervical region, endometrial cavity was empty. On laparotomy, cervical region was seen enlarged and distended and over which body of uterus lied. After bilateral internal iliac artery ligation, vertical incision was made over the body of the uterus and cervical region. During the removal of foetal parts and placenta from the cervical region, there was severe haemorrhage for which immediate total hysterectomy was necessitated. In another case, a 28-year-old primigravida was admitted to the hospital with the complaints of abdominal pain at 34 weeks of gestation and she gave history of recurrent pain abdomen throughout pregnancy. USG of abdomen showed a suspected case of secondary abdominal pregnancy. Immediate laparotomy was done and after making a transverse incision over the gestation sac, a live foetus was delivered. A bulky uterus was visible behind the gestation sac and placenta was seen situated,over a part of sigmoid colon and the greatvessels. To see the location of placenta, a part of it got separated spontaneously and severe bleeding started which could not be properly controlled. She received 9 units of blood transfusion but ultimately died. The weight of the baby was 1.9 kg and it had talipes equinovarus. Baby was discharged after 5 days in good condition.

Unilateral lower limb oedema in pregnancy.

A 21 years old lady was admitted with severe pain and swelling of left lower limb in a pregnancy of 34 weeks of period of gestation. On examination there was pitting oedema of the whole left lower limb with extreme tenderness. Doppler USG of left femoral vein showed a thrombus in the process of recanalisation and no significant flow was demonstrated inside the lumen and USG for foetoplacental profile showed a single live foetus of gestational age 34 weeks. The case was diagnosed as deep venous thrombosis in pregnancy. She was treated with heparin injection 5000 unit subcutaneously twice daily throughout pregnancy along with antibiotics. In spite of proper management she developed extensive ulceration in left lower limb. She delivered normally a healty male child after induction with oxytocin dirp. The postpartum period was uneventful. Throughout this period heparin was continued and she was referred to surgery department for skin grafting.

A study of prophylactic use of 15-methyl prostalglandin F2alpha in the active management of third stage of labour.

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.

Genital fistula--our experience.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

Myelodysplastic syndrome in pregnancy--a rare cause of severe anaemia in pregnancy.

A 28-year-old woman presented with severe anaemia in pregnancy at a period of gestation of 20 weeks. She was immediately admitted and after proper investigation it was seen that her Hb was 3.5 g/dl and platelet count was 62,000/cmm, RBC showed normocytic, normochromic morphology. There was neither hepatosplenomegaly nor any purpuric spot over the body. Bone marrow showed dyserythropoiesis and its chromosomal study revealed monosomy-7. Her pregnancy was continued till term with repeated packed cell and platelet concentrate transfusions. Normal healthy baby was delivered by caesarean section and she was discharged after 6 days.

Evaluation of women undergoing sterilisation reversal and subsequent pregnancy outcome.

A total of 114 women underwent sterilisation reversal operation by microsurgical technique at Regional Centre of Excellence (RCOE), RG Kar Medical College and Hospital, Kolkata from August, 1998 to July, 2000, and follow-up was done for next two years. The commonest reason for seeking sterilisation reversal was death of male child which was 53.51%. Majority of women (50.88%) were between 25 and 30 years of age and 86.84% of women were of para 2 or less. Most of the women (59.65%) of reversal seeker had undergone prior laparoscopic sterilisation in comparison to sterilisation by minilaparotomy (40.35%). It is also seen that 50% of them had underwent sterilisation less than 3 years back. Commonest type of tubotubal anastomosis performed in this present study was isthmo-isthmic type which was 49.12%. Thirty-one patients were lost in follow-up and out of rest 83 cases, intra-uterine pregnancy was noted in 66.27%. Live birth was 45.78% delivered in the same institution, 8.43% of cases had spontaneous abortion and 3.61% of cases had ectopic pregnancy

Epidemiological study of eclampsia in a referral teaching hospital.

The present study is a retrospective analysis of 864 eclampsia patients managed at RG Kar Medical College and Hospital, Kolkata during the period January 1999 to December 2001. The incidence of eclampsia was seen in about 2.27% cases. Majority (51.97%) of eclampsia patients were between 20 and 29 years though 41.43% were below 20 years of age. They were mostly primigravida (88.19%) and Hindus (69.1%). About 44.56% were antepartum eclampsia patients. All the patients were treated with magnesium sulphate. Caesarean section rate is quite high (46.18%) in this present study. Maternal case fatality rate was 7.29%. Still birth rate was 9.92% with an early neonatal death rate of 14.15% resulting in a perinatal mortality of 24.07%. Ignorance regarding antenatal check-up, lack of transport and lack of early communication with tertiary hospital play an important role for high incidence of eclampsia in our developing country.