Reduction in the occurrence of uterine rupture in Central India.

This study was carried out in the Department of Obstetrics and Gynaecology of the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. In the 12 years between 1989 and 2000 a total of 16 cases of ruptured uterus were managed, the incidence of rupture of the pregnant uterus being 0.62 per 1000 births. One-quarter of the cases occurred between 1983 and 1988. No teenager or elderly woman (over 40) or grandmultipara sustained a uterine rupture. Four women had a rupture of a previous scar. In five rupture had occurred in association with malpresentations, one was a case of hydrocephalus, two had a morbidly adherent placenta praevia and four had a normal presentation, with lack of progress in labour. Two of these 16 women had twins. One had come with a retained second twin with transverse lie and the other was a booked case with multiple problems, including a previous caesarean section, present twin pregnancy and placenta praevia accreta and she died. This was the only maternal death. Perinatal mortality was 77.77% compared to 5.88% maternal and 100% perinatal mortality in the cases reported previously between 83 and 88, from the same institution. Overall, there is some improvement in perinatal survival and one-quarter incidence of rupture of the pregnant uterus.

Hypertension in the elderly.

OBJECTIVES: To study the clinical profile of hypertension in the elderly, development of end organ complications and the effect of hypertension with other risk factors in producing these complications. METHODS: One hundred and thirty six elderly patients attending the Hypertension Clinic were included in the study. A detailed history was taken that included presenting illness, family history of hypertension, diabetes, coronary artery disease, dyslipidaemia and history of addictions. Physical examination included systemic examination with measurement of waist to hip ratio and fundoscopy for retinopathy. Renal and liver function tests (RFT, LFT), blood sugar, lipid profile, X-ray chest, electrocardiography (ECG), 2-D echocardiography, abdominal ultrasound and computed tomography (CT) scan head (if indicated) were other important investigations done. RESULTS: Seventy-nine patients were in the age group of 60-65 years, of which 42 (30.9%) were males. Headache was the commonest chief complaint in 77.9% patients; whereas 24 patients were asymptomatic. Obesity, diabetes, alcohol, dyslipidaemia and family history were important determinants of hypertension. Lipid profile was abnormal in 55.9% patients. Isolated systolic hypertension (ISH) was found in 56.6% patients. Grade II hypertensive retinopathy was observed in 29.4% patients with uncontrolled blood pressure. Left ventricular hypertrophy (LVH) was the commonest ECG manifestation seen in 36.8% patients of which 26.5% had uncontrolled blood pressure. LVH could be diagnosed in 46.4% patients by 2-D echo. Patients with uncontrolled blood pressure and ISH had increased incidence of cardiovascular and cerebrovascular complications. Cardiovascular complications were seen in 19.1% patients having dyslipidaemia and hypertension. Cerebrovascular complications were seen in 15.4% patients having hypertension with LVH. Treatment included calcium channel blockers and/or other drugs. CONCLUSIONS: The elderly hypertensive patients tend to have ISH. Family history of hypertension is an important determinant of hypertension. Uncontrolled hypertension, ISH, LVH and other associated risk factors are responsible for cardiovascular and cerebrovascular morbidity.