Emergency Lower Segment Caesarean Section Research Articles

Association of Maternal Height with Mode of Delivery and Perinatal Outcome

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances.

Placenta Accreta Spectrum in Normal Situated Placenta and Unscarred Uterus

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality.

A Case Report on Monochorionic Diamniotic Twin Gestation with Rh Negative Pregnancy

The terms "monochorionic" and "diamniotic" refer to multiple gestations with just one placental disk (or chorion) and two separate amniotic cavities, respectively. Each fetus in a monochorionic diamniotic twin pregnancy has its own amniotic sac in addition to the common placenta. PPROM is the rupture of membranes before the onset of labor and before 37 weeks of gestation. We present a case of a 33-week-old primigravida female with monochorionic diamniotic twin gestation, Rh negative pregnancy, and PPROM who presented to the labour room with a fully dilated cervix, an emergency lower segment caesarean section was performed with prolonged second stage labour, and twins were delivered.

Application of shock index-based classification in hypovolemic shock due to obstetric hemorrhage and its comparison with conventional vital sign for prediction of adverse maternal outcome

Background: At least, 358,000 women worldwide die annually from pregnancy and childbirth-related problems. Obstetric hemorrhage is the single most significant cause of maternal mortality worldwide accounting for 25–30% of all maternal deaths. Aims and Objectives: The objective of the study is to see the usefulness/importance of shock index (SI) in obstetric hemorrhage (antepartum and post-partum hemorrhage) and to compare the performance of SI with conventional vital signs for prediction of maternal outcome. Materials and Methods: The descriptive study was conducted in 100 cases of hemorrhagic shock patients admitted in obstetrics and gynecology at Baba Raghav Das Medical College, Gorakhpur, between June 2020 and May 2021, on 100 subjects. Results: In our study, there were 100 patients. Patients with SI 0.6 to <1 were included in Group I which comprises 26% patients in which 57.69% patients required only intravenous (IV) fluid, while 30.77% patients needed blood transfusion. Patients with SI>1 were included in Group II which comprises 74% patients in which all patients required initial resuscitation with IV fluid and then blood transfusion, 21.62% patients require inotropic support, and 9.46% patients needed fresh frozen plasma transfusion. Maternal outcome in Group I patients is that only 15.38% patients required emergency lower segment cesarean section (LSCS). While in Group II, 28.95% patients required emergency LSCS, 5.26% patients required intensive care unit (ICU) admission for ventilator support, 3.95% went for cesarean hysterectomy, while 2.63% patients landed in end organ failure and expired. Conclusion: All patients with obstetric hemorrhage with SI>1 should receive immediate intervention such as blood transfusion need of ICU or surgical intervention. This is higher than the upper limit of normality in non-pregnant population. In low-resource settings, this simple parameter could improve outcomes because it has a significant ability to predict adverse maternal outcomes of hemorrhage.

Correlation of Cross-sectional Area of the Umbilical Cord on Antenatal Ultrasound with Neonatal Birth Weight in Pregnant Women with and without Gestational Diabetes Mellitus: A Prospective Cohort Study

Introduction: Many foetal and maternal complications, such as polyhydramnios, macrosomia, birth injuries, and operative interference, are linked with Gestational Diabetes Mellitus (GDM). Among these, macrosomia is particularly significant, as it increases the risk of shoulder dystocia, brachial plexus injury, birth asphyxia, and maternal complications, including emergency Lower Segment Caesarean Section (LSCS), Postpartum Haemorrhage (PPH), and perineal trauma. Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes. Aim: To evaluate whether there is a correlation between the cross-sectional area of the Umbilical Cord (UCA) and the Neonatal Birth Weight (NBW) in pregnant women with GDM. Materials and Methods: A prospective cohort study was conducted in the Departments of Radiology and Obstetrics Bangalore Medical College, Bengaluru, Karnataka, India. A total of 100 pregnant women (50 with GDM and 50 without GDM) were recruited from July 2021 to July 2022. Ultrasound examination (USG) was performed on pregnant women after 36 weeks of gestation. The UCA was measured in a free-floating loop, and the NBW was measured using a digital scale. The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW. Results: The mean age of the subjects was 26.5±3.9 years. The frequency of macrosomia was higher in the GDM group (8%) compared to the control group (4%). A strong positive correlation was observed between UCA and NBW in both diabetics (r=0.819) and control groups (r=0.736). Conclusion: A strong positive correlation exists between UCA and NBW in women with GDM. Therefore, it should be estimated during routine antenatal USG for the prediction of birth weight in such women.

Bilateral Renal Cortical Necrosis and Reversible Cerebral Vasoconstriction Syndrome in a Case of Severe Postpartum Haemorrhage

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys’ cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient’s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases.

Emergency Bilateral Internal Iliac Artery Ligation in Antepartum Haemorrhage with Complete Placenta Previa and Placenta Accreta at Previous Caesarean Scar Site: A Case Report

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.

813 Management of Massive Air Leak with Persistent Pneumothorax and Pneumoperitoneum in a 1.2kg Preterm Neonate – a Case Report

Abstract Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birthweight, low APGAR scores and caesarean-section delivery. A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment caesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apnoeic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day-10, gradual removal of five chest drains by day-19 and extubation on day-24. Transillumination and chest radiography were main diagnostic investigations. Laryngotracheobronchoscopy on day-16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis and pulmonary hypertension and was discharged home on day-66. Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Lung ultrasound would improve diagnosis and monitoring. Management is patient-specific and includes needle and tube thoracocentesis and HFOV. Use of blood patch, fibrin glue or chemical agents, selective bronchial ventilation have been reported. Surgery is usually applied in unstable patients where bridging the defect is not feasible. nonsurgical pneumoperitoneum should be considered in ventilated neonates and those with airway injury to avoid exploratory laparotomy. Our case demonstrates challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum with conservative management.

Comparison of Clinical and Radiological Findings for the Prediction of Scar Integrity in Women With Previous Lower Segment Cesarean Sections.

We aimed to compare the clinical and radiological findings to predict scar integrity in term antenatal mothers with a previous lower segment cesarean section (LSCS). This prospective study was conducted in the obstetrics and gynecology department of LN Medical College, Bhopal, India, from August 2020 to August 2021. We included all pregnant women with term gestation (37+0 to 42+0 weeks) who were admitted either for elective repeat LSCS or for emergency LSCS and had a history of a previous LSCS. A detailed history and clinical examinations were performed. We noted the presence of scar tenderness and conducted transabdominal ultrasound (USG) to assess the integrity of the uterine scar in all women. During surgery, the surgeon identified the lower uterine segment scar and graded it as normal, thinned-out, dehiscent, or ruptured. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both clinical findings (scar tenderness) and ultrasound findings as predictors of scar integrity. A total of 60 pregnant women were included in the study. During a repeat cesarean section, we found a thinned-out scar in 26 women out of 60 (43.3%). Out of 60 women, 13 had scar tenderness, and among these 13 women, 12 had thinned-out scars intraoperatively. Forty-seven women had no scar tenderness; 14 had thinned-out scars intraoperatively. The sensitivity of scar tenderness as a predictor of a thinned-out scar was 46.2%, specificity was 97.1%, PPV was 92.3%, and NPV was 70.2%. Whereas the sensitivity of ultrasound scar thickness as a predictor of a thinned-out scar was only 19.2%, with a specificity of 94.1%, a PPV of 71.4%, and an NPVof 60.4%. Thus, we documented a significant correlation between intraoperative and clinical findings (κ = 0.46; p<0.05), but no agreement could be found between ultrasound and intraoperative findings (p>0.05). Clinically evident scar tenderness continues to be a useful parameter to predict intraoperative scar status.

Maternal and Fetal Outcome Following Post In vitro Fertilization and Embryo Transfer Pregnancy: A Prospective Observational Study

Abstract Background: While the majority of in vitro fertilization (IVF)-conceived children are healthy, IVF has been associated with an increased risk of adverse obstetric and perinatal outcomes including hypertensive disorders of pregnancy, preterm labor and preterm delivery, and low birth weight (LBW). Objective: The objective of the study is to assess pregnancy, maternal, and perinatal outcomes in patients undergoing IVF embryo transfer (IVF-ET) at tertiary care center in North India. Methodology: It was a prospective observational study carried out for duration of 20 months among women who conceived following an IVF-ET. The sample size was 107 consecutive mothers and data were collected using a predesigned semi-structured study pro forma. Detailed menstrual, obstetric, and medical histories of each patient were noted. Findings of the general, physical, systemic, and obstetrical and gynecological examination were noted for all patients. Results: One hundred and seven mothers who fulfilled the study criteria were included. Of these, 4 had an abortion. Rest of the 103 mothers were included in the final analysis. The mean age of the mothers was 30.39 ± 4.7, ranging from 22 to 50 years. Twin pregnancy rate was 45.7%. All were dichorionic-diamniotic twins. Based on gestational age, 5% were extreme preterm births, 14% were very preterm births, 32% were late preterm births, and 48% were early-term births. Normal vaginal delivery (NVD) occurred in 26.2% of the mothers, elective lower-segment cesarean section (LSCS) in 21.4%, emergency LSCS in 51.4%, and one case had vacuum delivery. Hence, NVD occurred in 27% and 73% had LSCS. With respect to neonates born to study participants, 8% were extremely LBW, 7.3% were very LBW, 46% were LBW, and the rest 38.7% weighed 2.5 kg or more at birth. Conclusion: IVF-ET is a safe and highly successful treatment for infertility. Many of adverse outcomes are largely due to an increased risk of multiple gestations in IVF. Patients with infertility are likely to be older and have preexisting comorbid conditions such as hypertension, diabetes, insulin resistance, or other endocrinopathies which may predispose them to adverse obstetric and perinatal outcomes. It is also recommended that patients should be given adequate preconception counseling regarding increased maternal as well as neonatal risk.

Study of maternal and neonatal outcome in women with one previous lower segment caesarean scar in Raja Isteri Pengiran Anak Saleha Hospital (RIPAS)

Background: The rate of primary caesarean section (CS) is on the rise; it was 30.8% for primiparous women and 11.5% for multiparous women. A trial of vaginal delivery can prevent the risk of repeat CS. Aim: The study was to determine the success rate, and also maternal and neonatal implications of VBAC (Vaginal Birth after Caesarean), attempted in women with one previous lower segment caesarean section (LSCS). Materials and Methods: The retrospective and descriptive study was carried out in a tertiary care hospital, RIPAS Hospital, Brunei Darussalam, over a period of three months (from February 2010 to May 2010). All women with prior LSCS who are suitable for a trial of labour after the previous caesarean (TOLAC) were included in our study. Sixty-one pregnant women with a history of one previous LSCS were enrolled in the study. Results: In our study (38/61) 62.3% of patients had a successful VBAC, and (23/61) 37.7% had undergone a repeat emergency LSCS. In those who had the previous VBAC, cervical dilatation of &gt;4 cm at the time of admission and those who had the previous VBAC are significant factors for a successful VBAC. Conclusion: The trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS, as it has a considerable success rate and is not associated with serious maternal and foetal morbidity and mortality.

A RARE CASE OF TRIPLET EXTRACTION

The incidence of triplet is raising several hundred percent due to wide availability of fertility therapies which is around 24%. It is associated with diferent perinatal and maternal complications. At present incidence of twins in 1in 250 pregnancy and triplets being 1 in 10,000 pregnancy. In present case report a 22 year old female with gravid 2 para 1 with trichorionic and triamniotic triplet gestation conceived spontaneously had regular ANC visits with all ANC prole. At 32 weeks of period of gestation, she went into labour and emergency lower segment Caesarean section was done extracted three preterm babies , triplet 1 female weighing 1758 grams, triplet 2 male of 1.33gms and triplet 3 female of 1.104gms and PPH drugs were kept before hand. Three resuscitation teams were kept ready to receive the babies. Babies were asphyxiated at birth and were successfully resuscitated. There was no evidence of foetofoetal or foeto-maternal transfusion and no external congenital anomaly was found in them

Preoperative Diagnostic Dilemma of Diaphragmatic Eventration

Background: Diaphragmatic eventration is an abnormal elevation of the dome of the diaphragm into the thoracic cavity. Neonatal respiratory distress is the most common clinical presentation of diaphragmatic eventration. Direct abdominal organ compression on the lung or lung hypoplasia is the cause of this symptom. Preoperative radiological imaging is important to diagnose diaphragmatic eventration. Chest radiographs, ultrasound, CT scans and MRI can be used to evaluate the anatomy of the diaphragm. In complicated condition, video-assisted thoracoscopy (VATS) play a role as a diagnostic and therapeutic tool to diagnose and manage diaphragmatic eventration. Case presentation: We presented a case of a full-term unfortunate baby delivered via emergency lower segment caesarean section due to bleeding of the placenta previa type III. Immediately post-delivery, the patient had respiratory distress with an episode of desaturation. CT scan showed a focal right hemi-diaphragmatic bulge with liver tissue within. Video-assisted thoracoscopy (VATS) was performed and the diagnosis of right diaphragmatic eventration had been established. Diaphragmatic plication was done via a VATS-assisted thoracotomy approach. Conclusion: Video-assisted thoracoscopy (VATS) plays a role as a diagnostic tool and even as a therapeutic tool to diagnose and manage diaphragmatic eventration. The capability of VATS to provide direct visualization intrathoracically has a great advantage in managing a such case.

A Longitudinal Analytical Study on Umbilical Cord Coiling Index as a Predictor of Pregnancy Outcome.

Background The umbilical cord coiling index (UCI) is usually measured sonographically during antenatal follow-up and can be used to determine the fetuses at risk of adverse outcomes. Methodology UCI measured antenatally and postnatally whose correlation is studied along with the association of abnormal UCI with the adverse outcomes in terms of gestational age, intrauterine growth restriction (IUGR), intra-uterine death, birth weight, sex, neonatal intensive care unit (NICU) admission, the color of the liquor, Amniotic Fluid Index (AFI), Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at one min and five mins and mode of delivery. All parameters are tested for significant differences among UCI and a p-value < 0.05 is considered significant. The correlation of UCI measured antenatally and postnatally is tested using the spearman correlation coefficient. Results A strong correlation is found between antenatal UCI and postnatal UCI with rs 0.9. The majority of the population had normo coiling. Hyper and hypo coiling are associated risks of emergency lower segment cesarean section (LSCS). Low birth weight is seen in 88.89% of hypo coiled patients with a p-value < 0.01. The coiling index among sex is found to be insignificant with a p-value of 0.81. Meconium-Stained Liquor (MSL) is seen in 78.5% of hyper coiled patients. IUGR is found to be associated with hypo coiling as seen in 59.2% of patients with significant p-value (< 0.01). Age, gestational age, and birth weight are found to be statistically significant between various coiling indexes with p-value < 0.05. Conclusion Antenatal UCI correlates with postnatal UCI and any abnormal index found can be used as a predictor of adverse perinatal outcomes and help obstetricians to monitor continuously and put the patients at risk on prophylactic measures.

Oxytocin induced itching in a 37 week primigravida with meconium stained liquor

Introduction: Oxytocin is the most frequently used medication for labour augmentation in obstetrics. One of the known benefits of its use is the improvement of uterine contractions. An injectable form of oxytocin is administered intravenously as an infusion. Adverse drug reactions at this stage may distress the baby and worsen the outcome of the pregnancy.&#x0D; Case details: A 19-year-old female with a history of nine months gestation presented in labour. She was administered oxytocin infusion in ringer lactate to augment labor. She developed itching all over her body and was immediately administered Inj. hydrocortisone intravenously. As the foetus was in distress, she was taken for an emergency lower segment cesarean section (LSCS).&#x0D; Conclusion: The administration of IV oxytocin was considered the possible cause of the development of rashes in this case. We suggest adopting preventive strategies to avoid ADRs in emergencies to avoid deleterious consequences. The preventive strategies may include screening in the antenatal period for previous history of sensitivity to oxytocin, latex, etc. In addition, other strategies are discussed in this article.

PARTIAL LONGITUDINAL VAGINAL SEPTUM WITH A PELVIC MASS IN LABOUR: A CASE REPORT AND A SHORT REVIEW OF LITERATURE

Introduction Mullerian anomalies arise because of aberrant embryogenesis and a longitudinal vaginal septum (LVS) is a failure of resorption of the distal Mullerian canal. Material and methods A 26-year-old pregnant lady with full-term gestation presented to our rural hospital in labour. Her physical examination was normal except for a partial longitudinal vaginal septum that she had in the proximal vagina distinct from the cervix extending from the 12 O clock position of the anterior vaginal wall to 6 O clock of the posterior vaginal wall along with a bulge felt in the posterior fornix. An emergency lower segment caesarean section was performed for possible fetal distress and a right ovarian mass was encountered which was removed along with the resection of the partial longitudinal vaginal septum. Her postoperative period was uneventful and the histopathology report of the ovarian mass turned out as a mature cystic teratoma. Conclusion A partial longitudinal vaginal septum can be easily resected during labour if it hasn't been diagnosed before. This is one of the rst cases reported where a partial LVS along with an ovarian mass was reported and managed successfully by resection.

The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre.

Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications weresickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCDvigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.

Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report

Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery. Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66. Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.

Impact of Maternal Obesity on Obstetric Outcome: A Prospective Study in a District Hospital of West Bengal

Introduction: The prevalence of obesity among women is an increasing problem, especially in urban population due to sedentary lifestyles and altered dietary habits. Maternal obesity has consequences on pregnancy and perinatal outcome. The present study was conducted to determine the impact of maternal obesity on maternal and perinatal outcome. Materials and Methods: A prospective hospital-based study was conducted on 176 pregnant women with body mass index (BMI) &lt;25 kg/m2 and 166 pregnant women with BMI ≥25 kg/m2. Data on maternal outcomes and perinatal outcomes were collected by following up on antenatal women till the end of the pregnancy and results were analyzed among the two groups using SPSS version 27. Results: Around 31.3% of pregnant women with BMI ≥25 kg/m2 had developed gestational hypertension, 22.9% had gestational diabetes mellitus (GDM), 7.8% had preeclampsia/eclampsia, 9.6% had prolonged labor, and more than half (53%) of them had emergency lower segment cesarean section (LSCS). Less than 1/3rd of pregnant women with BMI ≥25 kg/m2 had induction of labor and perineal injuries. Association of gestational hypertension, GDM, preeclampsia/eclampsia, prolonged labor, and mode of delivery (emergency LSCS) was found to be significant with maternal obesity. About 16.9% and 7.2% of pregnant women with BMI ≥25 kg/m2 had preterm and postterm delivery, respectively. Only 0.6% of pregnant women with BMI ≥25 kg/m2 had weight of newborn &gt;4 kg. Conclusions: Maternal obesity leads to adverse maternal and perinatal outcomes and is an important contributor to the burden of obstetric care. Thus, effective intervention is required in preconception period to reduce the obstetric complications.

Multifactorial Intraoperative Uterine Scar Dehiscence: A Case Report

Now-a-days, the number of Caesarean section (c-section) has increased, also the complications of c-section has increased. Obstetricians often encounter uterine scar dehiscence during delivery by c-section. However, it is rare to find a uterine scar dehiscence which is extending over one-third of the anterior uterine wall and it is yet to build the best surgical approach for repairing this rare complication of c-section or a torn anterior wall during delivery. Herein, a 23-year-old female who is Rhesus factor (Rh) negative G2P1L1 with seven months of amenorrhea came with chief complaints of pain in the abdomen since morning. On ultrasonography, severe oligohydramnios was diagnosed as Amniotic Fluid Index (AFI) was &gt;5 cm. Hence, the patient was taken for emergency Lower Segment Caesarean Section (LSCS), Lower Uterine Section (LUS) was papery thin, uterovaginal fold of peritoneum was opened and the bladder was pushed down. One-third of the anterior uterine wall was involved. LUS was sutured using vicryl No. 1 and complete haemostasis was achieved. As uterine scar dehiscence is not preventable, efforts should be made to manage it efficiently and repair the myometrium safely.