Maternal and perinatal outcomes of induction of labor in oligohydramnios at term-a retrospective cohort study.

Objective: To evaluate the maternal and perinatal outcomes of labor induction in women at term with oligohydramnios.Methods: A retrospective cohort of women with a singleton pregnancy, who had oligohydramnios at or beyond term (37-42 weeks) and underwent induction of labor for oligohydramnios were studied. Antenatally diagnosed fetal anomalies and intrauterine fetal demise were excluded. The women were categorized into two groups: 1) women with isolated oligohydramnios (n = 166) and 2) women with oligohydramnios associated with other maternal or fetal complications (n = 43). Maternal and perinatal outcomes were collected from the records of all deliveries, data compiled, and appropriate statistical tests were applied.Results: The study included 209 women with mean gestational age of 38.76 ± 1.00 weeks and mean induction-delivery interval of 17.45 ± 8.70 hours (16.98 hours in group 1 versus 19.23 hours in group 2). Most (75%) women delivered vaginally. Only one of the neonates had an Apgar score of less than 7 at 5 min. Average neonatal ICU length of stay was 5.52 days (5.27 days in group 1 versus 6.17 days in group 2). Among all the maternal and neonatal outcomes studied, only the mean birth weights among the two groups was found to be statistically significant (p = 0.0017).Conclusions: Women with isolated oligohydramnios and their neonates were not found to suffer any additional harm due to labor induction at term than women who had oligohydramnios associated with other complications.

Molecular characterization of chikungunya virus causing the 2017 outbreak in Dhaka, Bangladesh.

Chikungunya viruses from the 2017 outbreak in Dhaka, Bangladesh, were analysed phylogenetically. E1 sequences from 21 strains belonged to the Indian Ocean clade of the East/Central/South African (ECSA) genotype, forming a novel cluster with latest South Asian strains. They lacked the A226V substitution.

Emergency Peripartum Hysterectomy: A 14-Year Experience at a Tertiary Care Centre in India.

INTRODUCTION: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum haemorrhage. AIM: To assess incidence, risk factors, indications and complications of peripartum hysterectomies at a tertiary care teaching hospital in India. MATERIALS AND METHODS: A retrospective study was conducted at 650-bedded tertiary care medical teaching hospital in Southern India. All emergency peripartum hysterectomies performed between February 2002 and December 2015 at a tertiary care teaching hospital, were included in the study. Demographic characteristics, risk factors, antepartum, intrapartum and post-partum events, need for blood transfusion, length of stay in intensive care unit and postoperative complications were noted. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 22.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean±SD. RESULTS: Among 16,473 deliveries in the study period, 12 emergency peripartum hysterectomies were undertaken, the incidence being 0.073%. Women were aged 20 to 40 years (mean 30.25 years). Majority (83%) were multiparous women. Atonic postpartum haemorrhage was the most common (58%) indication for hysterectomy. About 67% of hysterectomies performed were subtotal hysterectomies. One half of them had a previous caesarean section. Two patients had bilateral internal iliac artery embolization for ongoing haemorrhage. All patients required intensive care and blood transfusion. Two patients did not survive even after hysterectomy. CONCLUSION: Atonic postpartum haemorrhage was the most common reason for performing an emergency peripartum hysterectomy. Women with previous caesarean section are at increased risk, both due to atonic and traumatic postpartum haemorrhage. Regular departmental audits are needed to formulate appropriate protocols to decrease mortality and near-miss events like EPH. Stringent protocols should be instituted for managing obstetric haemorrhage. Although EPH is life-saving, early intervention by a senior obstetrician well versed with conservative procedures may avoid morbidity associated with EPH.

Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study.

INTRODUCTION: Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. AIM: To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. MATERIALS AND METHODS: This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. STATISTICAL ANALYSIS: Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. RESULTS: Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted. CONCLUSION: Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.

Seropositivity of Helicobacter Pylori among the fish handlers.

This case control study was done to study the seropositivity of helicobacter pylori among the fish handlers and to find out rapid urease test (RUT) & haematoxillin and eosin staining report correlation of seropositive cases. It was performed among fish handlers in the period of July 2005 to June 2006. Blood samples were collected from fish handlers (Group I) and some non-fish handler control subjects (Group II) to perform Anti-H. Pylori IgG test by ELISA method. Samples were collected from both the sea water area (Paikgacha, Khulna) and fresh water area (Derai, Sunamgonj and Dhaka). Seropositive cases having complaints and treatment history of peptic ulcer diseases were motivated for endoscopic examination to collect biopsy from upper GIT and rapid urease test (RUT) hematoxillin & eosin (H & E) staining were performed. A total of 235 respondents were included in this study, among them 163 were fish handlers (80 sea water and 83 fresh water) and 72 were non fish handler control (25 sea water, 22 fresh water from Sunamgonj, 25 fresh water from Dhaka city). Serum anti- H. pylori test was positive in 126(77.30%) cases in fish handler group (a) and 27(37.5%) cases in the control group (b). Seropositive cases were observed more among the higher age group (>40 years) than in lower age group (<40 years) which was 86% and 67% respectively. Endoscopic examination was done among the seropositive cases having positive PUD features. Total seropositive cases were 153 and among them 81 have positive PUD features, among them 48 cases were selected for endoscopic examination. Among the fish handlers out of 34 cases, 31(91.17%) were RUT positive and out of 14 non-fish handlers 6(42.85%) were RUT positive. Among the fish handlers, 28(82.35%) of the 34-biopsy specimens were H & E positive and among the non-fish handlers, out of 14 samples, 5(35.71%) were H & E positive. Fish handlers have more association of H. Pylori infection than non fish handlers and higher age group persons are more prone to H. Pylori infection. A significant number of seropositive persons have association with positive RUT and H & E staining report.