Lower Segment Caesarean Section Research Articles

The Impact of the Association Between Nonalcoholic Fatty Liver Disease and Intrahepatic Cholestasis of Pregnancy on Maternal and Fetal Outcomes.

Backgroundː Intrahepatic cholestasis of pregnancy (ICP), a hepatic condition that causes severe itching in late pregnancy, is linked to nonalcoholic fatty liver disease (NAFLD) due to disrupted bile acid balance. It poses maternal risks such as preterm labor and gestational diabetes and fetal risks such as preterm birth and respiratory distress. The study examined NAFLD's impact on ICP in pregnant women, highlighting management and research implications. Methodsː This retrospective study examined pregnant women (≥18 years) with ICP, assessing fatty liver with follow-up ultrasounds. Participants were divided into ICP only and ICP with fatty liver (FL) groups, excluding heavy alcohol users and incomplete data. Maternal age, medical history, and comorbidities were evaluated alongside abdominal ultrasounds to identify FL. Resultsː In this study of 43 pregnant women, the mean maternal age was 27 years. Patients with ICP and FL had significantly higher bile acid levels than those with ICP alone. However, no significant differences were found between the two groups regarding the history of gestational diabetes mellitus (GDM), dyslipidemia, polycystic ovarian syndrome (PCOS), parity, and hypothyroidism. Among women with ICP and FL, 51.85% underwent lower segment cesarean section (LSCS), while 43.75% with ICP without FL underwent LSCS. Conclusionsː ICP with FL did not show significant adverse effects on maternal and neonatal outcomes, including mode of delivery, gestational age, maternal complications, neonatal intensive care unit (NICU) admissions, and low birth weight (LBW) with asphyxia. However, additional research is required to fully comprehend the relationship between ICP, NAFLD, and their impact on pregnancy outcomes.

Comparison between intravenous carbetocen and rectal misopristole as prophylaxis for postpartum hemorrhage in lower segment caesarean section among low-risk patients.

Comparison between intravenous carbetocen and rectal misopristole as prophylaxis for postpartum hemorrhage in lower segment caesarean section among low-risk patients.

Impact of Primary Cesarean Section on Grand Multiparous Women

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section. Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications. Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017. An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded. Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%. Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%. Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency.

Incisional herniae following lower segment caesarean section: A 20-year chart review

Introduction: The rates of caesarean delivery is increasing worldwide as well as in Sri Lanka. Incisional hernia is a known complication of abdominal surgery. To our knowledge there has been no study to assess the incidence of incisional hernia following caesarean section in Sri Lanka. This study was to assess the incidence of incisional hernia requiring surgical repair after lower segment caesarean section (LSCS) in a cohort during a 20-year period.Methods: This was a chart review based on tertiary care private sector hospital in Sri Lanka. Hernia repairs performed during 2002 to 2022 were identified. The data was retrieved from computer based data base and previous bed head tickets. The main inclusion criterion was a caesarean delivery from the 01st of January 2002 to 31st of December 2022 in women with no history of previous abdominal surgery. The cohort was assessed from their first caesarean delivery until 20 years in the inclusion period for an event of hernia repair. The following exclusion criteria for the hernia repairs were used: Diastasis rectiwithout hernia, hernia not in the caesarean incision, and no hernia. The study was approved by the Research and Ethical Committee of Nawaloka Hospital Sri Lanka. The patient records and the data-set were anonymized before analysis. No conflict of interest.Results: There were 2675 records retrieved. The mean age of the patients was 28±7.5 years. There were 10/2675 (0.37%) patients were found to incisional herniae following LSCS. The majority (7/10) of patients with incisional hernia had lower midline incisions for their LSCS. The average time duration of the occurrence of incisional hernia following a single LSCS was 19.5±2.3 months and it was 14.3±1.6 and 12.3±1.5 months for following second and third LSCS respectively. Majority of the incisional herniae were done as routine cases. Following the incisional hernia repair one patient had a recurrence after year.Conclusion: The overall incidence of having an incisional hernia requiring repair of a caesarean delivery was 0.37%. Most herniae appeared within the first two years and associated with the lower midline incisions.

A comparative study to evaluate abdominal wall dynamics in patients with incisional hernia compared to healthy controls.

Incisional hernia is a common complication following abdominal surgery. It causes change in function of core abdominal muscles leading to change in abdominal wall dynamics. This study aims to objectively measure and compare preoperative abdominal wall dynamics with surface electromyography (sEMG) in incisional hernia patients with healthy individuals. In this prospective comparative study, two groups of participants as cases and controls were evaluated for their abdominal wall dynamics by using sEMG. Both cases and controls were evenly matched in terms of age and gender. Statistical analysis was done with STATA 14.1 and p value of < 0.05 was considered significant. Demographic profile was comparable between the two groups. Mean BMI of cases was higher than controls. The most common index procedure was lower segment cesarean section. The strength and power of all three abdominal wall muscles (rectus abdominis, external oblique, internal oblique) were significantly diminished among cases compared to controls. Abdominal wall dynamics can be objectively and correctly interpreted from sEMG of abdominal wall core muscles in patients with incisional hernia. This study shows that there is a decrease in abdominal wall strength and power in patients suffering from incisional hernia in comparison with healthy controls.

Rare Case of Systemic Lupus Erythematosus with Multiorgan Involvement in A Young Pregnant Women – A Case Report

Systemic Lupus erythematosus (SLE) is an autoimmune disease that notoriously varies in presentation, course, andoutcome. Active Nephritis, especially if the neuropsychiatry component is involved, is associated with adverse pregnancy outcomessuch as Gestational hypertension, pre-eclampsia, and renal failure. Our aim is to elaborate on the case report of young pregnantwomen diagnosed with SLE with multiorgan involvement about its course and management and the need for a multidisciplinaryapproach. A 20-year-old primigravida at 33 weeks of gestation with no known co-morbidities previously came with a history offever for 2 days, abdominal pain, and bleeding per vagina. Given placental abruption, the patient underwent an emergency lowersegment cesarean section. The patient developed postpartum hemorrhage (PPH), which was managed medically. On POD#8(postoperative day 8), the patient had generalized tonic-clonic seizures (GTCS) and developed hematuria. On evaluation, itrevealed abnormal renal parameters suggestive of Pregnancy-related Acute Kidney Injury (PRAKI). The patient's condition did notimprove with conservative management. After immunological investigations, a renal biopsy was done, and the diagnosis wasconfirmed as SLE-LN III (Systemic lupus erythematosus-Lupus nephritis) with Neuropsychiatry component involvement. Hence,the patient was started on Hydroxychloroquine based on the National Institute of Health protocol, and her condition improved.Hence given the relatively high number of maternal and neonatal deaths, lupus pregnancies should be followed by a multidisciplinaryteam, including nephrologists, rheumatologists, and obstetricians experienced in high-risk pregnancies, and deliveries should beplanned in tertiary-care settings provided with neonatology intensive care units.

Fractionated dose versus bolus dose of isobaric injection ropivacaine (0.75%) for patients undergoing elective caesarean section under spinal anaesthesia: A randomized, double-blind study

Background: Spinal anaesthesia (SA) using a bolus dose of Ropivacaine (0.75%) is known for its rapid onset but potential chances of hypotension. Administering Ropivacaine (0.75%) in fractions with intervals between the doses, has shown to establish a dense block, prolong analgesia and maintain better hemodynamic stability. This study aimed to compare the efficacy of fractionated and bolus doses of Ropivacaine (0.75%) in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: In a randomized, double-blinded trial, sixty patients scheduled for elective LSCS were enrolled and assigned to two groups. Group A received a single bolus spinal anaesthesia using Ropivacaine (0.75%) (2.5ml), while Group B received a fractionated dose approach: two-thirds of the total Ropivacaine (0.75%) dose (1.6ml) initially, followed by one-third dose (0.9ml) after 90 seconds. Results: The onset of sensory block (Group A: 3.59±1.31 min, Group B: 4.25±0.63 min) and motor block (Group A: 5.49±2.30 min, Group B: 7.34±11.28 min), as well as the duration of analgesia, were significantly longer in Group B (233.33±16.47 min) compared to Group A (185.17±20.61 min) (P &lt; 0.05). Hemodynamic stability was superior in Group B, with all patients showing better stability than those in Group A. Conclusion: Utilizing a fractionated dose of Ropivacaine (0.75%) in spinal anaesthesia results in an extended duration of analgesia and improved hemodynamic stability compared to a bolus dose approach.

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.

Intraoperative Direct Vision of Transversus Abdominis Plane (TAP) Block versus Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Pain Control after Caesarean Section (CS). A Randomized Controlled Clinical Trial

Background Adequate postoperative analgesia following CS hastens post-operative mobilization, decreases maternal morbidity and facilitates bonding with the newborn. Aim of the Work to assess pain scores at (rest and movement), and need for opioids in women receiving intraoperative direct vision of transversus abdominis plane (TAP) Block versus women receiving ultrasound guided transversus abdominis plane (TAP) Block following cesarean section in first 24H. Study Design Randomized controlled clinical trial was conducted on Patients undergoing lower segment Cesarean section under spinal anesthesia with intra thecal hyper baric bupivacaine 0.5%. Patients were randomized to study group that received intraoperative direct vision transversus abdominis plane (TAP) Block and control group received ultrasound guided transversus abdominis plane (TAP) Block. Postoperative pain score was recorded using visual analog scale (VAS) score and analgesic consumption recorded from patient medication chart. Result A total of 220 eligible women planned to undergo elective lower segment caesarean section were recruited in the current trial, and were randomly allocated into one of the two groups, there were no significant differences between women of both groups regarding age, parity or BMI. No significant differences between the studied group regarding patient pain perception (VAS Score) during rest and movement at different times of follow up (6,8,12,24 H) postoperatively. The dose and the first time of analgesic requirement was non-significantly different among studied groups. Conclusion USG and surgical TAP blocks were safe and had similar efficacy in providing postoperative analgesia in pregnant women following cesarean section under spinal analgesia. Surgical TAP block is an efficacious, safe and rapid technique, particularly in patients in whom USG TAP block is technically challenging (obese women), and where the ultrasound isn’t available in operative theater.

Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache in Patients Undergoing Lower Abdominal Surgeries

Abstract Background Postdural puncture headache (PDPH) is a complication of spinal anesthesia or lumbar puncture and is an unpleasant experience for the patient as well as the anesthetist. It is thought to result from meningeal traction related to low cerebrospinal fluid (CSF) pressure or cerebral vasodilation as an indirect effect of decreased CSF pressure. Neostigmine is a reversible inhibitor of the enzyme cholinesterase, which results in an increased concentration of the neurotransmitter acetylcholine. It produces cholinergic-mediated analgesia and has been used as an adjunct analgesic postoperatively. Neostigmine can pass through the choroid plexus but not the blood–brain barrier, the central effect of both neostigmine and atropine influence both CSF secretion and cerebral vascular tone which are the primary pathophysiological changes in PDPH. Objective Assess the effectiveness of postdural anesthesia with addition of Neostigmine and Atropine versus conventional postdural anesthesia. Patients and Methods A 90 patients were included in our prospective randomized controlled double-blind study that was conducted at Ain Shams University Hospitals for 4 months on patients who fulfilled the inclusion criteria: patients with ASA Grade I &amp; II, aged from (18 to 40) years old and scheduled for cesarean section. All patients aged &amp;gt;18 or &amp;lt;40, body weight &amp;gt;50, ASA III, IV, patients with uncontrolled chronic diseases such as hypertension, cardiac, renal, hepatic, cerebral diseases and peripheral vascular diseases, patients with history of PDPH, chronic headache, cluster headache, migraine, convulsions, cerebrovascular accident, signs of meningismus, preeclampsia, eclampsia coagulopathy, and previous neurological diseases and patients with history of bronchial asthma were excluded. Patients were divided into 2 groups: Group I (experimental group): neostigmine and atropine and Group II (placebo group): Saline placebo. Results The results of this study showed that incidence of postoperative headache was significantly lower among the intervention group, furthermore, VAS was significantly lower in the experimental arm versus placebo one. However, there was no significant difference regarding demographic, vital signs, and need for post-operative analgesia. The presented study showed that there is statistically non-significant difference between the studied groups regarding age, weight, and height and body mass index. There is statistically non-significant difference between the studied groups regarding duration of surgery. Conclusion After demonstrating many management options for post dural puncture headache (PDPH), in this study, we tried to prove the value of the use of neostigmine as a new management option that looks promising to alleviate the symptoms of such distressing condition. The current study results proved that the drug reduced the number of cases that experienced (PDPH) after spinal anesthesia for lower segment caesarean section, and how it prevent &amp;control headache. A combination of neostigmine and atropine are effective in managing PDPH by reducing the associated VAS score and preventing persistence of headache.

Effect of Rectus Muscle Re-approximation and Postoperative Pain in Women with Previous Cesarean Delivery: A Randomized Controlled Trial

Background Cesarean section rate has increased dramatically worldwide but there is still debate about the optimum operative technique of cesarean section. Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain. Objective In women with previous cesarean delivery, the aim of this prospective double blind randomized controlled trial is to assess the effect of rectus muscle approximation on postoperative pain. Patients and Methods This study was a prospective, doubleblind, randomized controlled trial. It included 340 women with previous cesarean delivery, with a singleton pregnancy, who underwent elective lower segment cesarean section at term. The patients were randomly allocated into two equal groups; Group I (study group) in which rectus muscle approximation were done (surgeons were instructed to place three vertical midline loose interrupted sutures to re-approximate the rectus muscles by using Vicryl 0 suture) while in Group II (control group) rectus muscle approximation not done. Intra- and postoperative pain management was standardized within the study protocol. Results Both groups were comparable in age, body mass index (BMI), parity, gestational age (GA), sub-rectus hematoma, surgical site infection and subsequent hospital stay. While study group had significantly longer operation duration, significantly higher pain score from first day of operation and up to 6 weeks postoperative and significantly higher NSAID dose and opioid requirements at first and second day postoperative. Conclusion Our results suggest that rectus muscle reapproximation increases operative time &amp; postoperative pain and subsequently associated with higher short-term postoperative opioid use among women undergoing cesarean section (CS). Surgical complications do not appear to be impacted by rectus muscle reapproximation. So, the benefits described with rectus muscle reapproximation such as less adhesions, should be weighed against the potential for a modest increased postoperative pain and corresponding opioid use.

307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report

Abstract Background Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon. Case Summary A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved. Discussion Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system. Conclusion Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.

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.

The Incidence of Obstetrics and Gynecology Cases Returning to Operation Theater due to Postoperative Complications in a Tertiary Care Hospital

Introduction: Unexpected return to operation theater carries high rate of morbidity and mortality for patients, in addition to increased hospital stay. A close look at such cases would help in identifying high-risk patients thus improving outcome. The aim of the study was to evaluate the incidence of Obs/Gyn cases returning to OT due to postoperative complications in a tertiary care hospital. Methods: It was a retrospective observational study done at tertiary care hospital settings affiliated with academic center in the UAE. The records of patients were scrutinized, and all booked and non-booked pregnant patients of any age undergoing emergency or elective obstetrics or gynecological procedure from January 1, 2016 to December 31, 2020 were enrolled in the study. Relaparotomy was defined as cases opened within same admission and causally associated with previous primary obstetrics or gynecological operation. Result: A total of 21,276 operations were performed from 2016 to 2020. In these 4 years, 33 patients had unexpected return to operation theater making the incidence of re-exploration to 0.15% (33/21,276). There were 16 (48.48%) emergency operations and 17 (51.52%) elective operations previously done on these patients. The most common primary procedure for which re-exploration was done was lower segment caesarean section done in 11 (33.3%) of cases followed by laparoscopic adhesiolysis and myomectomy. Hematoma in the pelvic region and ooze from raw area were the most common per-operative finding in 48.48% of cases. There was no mortality in the abovementioned cases; however, 2 (6.06%) had early acute kidney injury and both recovered from it. Discussion: The incidence of relaparotomy in our hospital is comparable to international literature. Most patients returned to OT within 48 h. Bleeding was the most common indication for laparotomy, and lower segment cesarean section was most common primary operation. This study underscores the need for meticulous hemostasis before closing to avoid return to OT. Conclusion: Return to OT for the right indication saves life. Mortality in such cases may be reduced by earlier detection and treatment of postoperative problems, consideration of relaparotomy, active ICU monitoring, and postoperative care.

FETOMATERNAL OUTCOME OF GESTATIONAL DIABETES MELLITUS IN PRIMIGRAVIDA DELIVERED AT TERTIARY CARE HOSPITAL

Objective: To determine the Prevalence of gestational diabetes mellitus (GDM) in primigravida and their feto-maternal outcome who delivered at tertiary care hospital in western Rajasthan. Methods: A retrospective chart review study will be conducted on primigravida delivered at the department of Obstetrics and Gynaecology, MDM Hospital Dr. S. N. Medical College, Jodhpur, Rajasthan, India from May 2022 to December 2022. Results: The prevalence of GDM in primigravida was 6.42%, maximum occurrence between 34 and 36 weeks of gestation (53.3%). 8.8% of GDM patients had a preterm delivery, out of these 8 women polyhydramnios were seen in 4 women. 49% had lower segment cesarean section and 3% had instrument delivery. preeclampsia was seen in 25.56%, urinary tract infection in 10%, preterm labor was seen in 8.89%, premature rupture of membrane was seen in 5.56% of the study population. 10% of babies were low birth weight. The incidence of congenital anomalies was seen in 6.6%. Intrauterine death was seen in 2 babies who had congenital anomalies. Conclusion: GDM is associated with adverse complications in both the mother and fetus.

A comparative study for feto-maternal outcome of trial of labour after caesarean: spontaneous versus induction

Objective The purpose of this study was to compare the foeto-maternal outcome of trial of labour after previous one lower segment caesarean section in spontaneous and induced labour and to ascertain the success rate of VBAC.(Vaginal birth after cesarean section) Methods It was a prospective study conducted from May2019-November2020.The pregnant women admitted in BPSGMC (BPS Government Medical College), labour ward who had previous one caesarean section undergoing trial of labour after either spontaneous onset or induction of labour, were included in the study. Results Total patients were 130, [65 each, in group I(spontaneous) and group II (induced)]. Successful TOLAC (Trial of labour after cesarean section) happened in 80% in spontaneous labour (gp I) patients and 66.2 % women in induced patients (group II), (p value-0.075). There was no significant difference in age, parity and gestational age (p value &gt;0.05), APGAR score and NICU (Neonatal intensive care unit) admissions in both spontaneous labour(gp I) and induced patients (gp II). There incidence of fetal distress was not statistically significant in spontaneous (group I) and induced patients (group II), (p value-0.744). Indication of primary LSCS (Lower segment cesarean section) showed no significant effect on outcome of TOLAC in spontaneous and induced group patients. History of prior vaginal delivery had more chances of VBAC. Hospital stay and PPH was more in induced patients(group II). The dfference of scar dehiscence in group I(spontaneous) and II (induced) were not statistically significant (p value=0.721). There were no cases of scar rupture in both the groups. Conclusion Induction of labour and spontaneous labour both have almost similar VBAC success rates. Also with fewer scar dehiscence and no rupture, IOL (Induction of labour) is a good option in previous one cesarean patients.

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.

The Correlation between Maternal Factors and Infants Lower Birth Weight

Background: Low birth weight (LBW) continues to remain a major public health problem worldwide. There are numerous factors contributing to LBW both maternal and fetal. The mortality of low birth weight can be reduced if the risk factors are detected early and managed by simple techniques. Objective: In this study our main goal is to assess the correlation between maternal factors and infants lower birth weight. Method: This research was conducted as a cross- sectional analysis at a tertiary care medical facility between January 2022 and January 2023. Where a convenience sample of 100 moms aged 11–19 who were hospitalized throughout the research period was chosen. Ultrasound and other diagnostic procedures verified the pregnancy. Results: During the study, the average age of the participants in the study group was 18.02±05 years, and only 19% of the patients visited the antenatal care facility more than four times. Among the study group, 34% of the participants had anemia, followed by 20% with premature rupture of membranes (PROM), 6% with preterm premature rupture of membranes (PPROM), 11% with mild eclampsia, 7% with severe eclampsia, 5% with gestational hypertension, and 6% with gestational diabetes. In terms of delivery methods, 40% had normal spontaneous vaginal delivery (NSVD), 28% had emergency lower segment cesarean section (LSCS), 17% had planned LSCS, and 13% underwent instrumental delivery. Regarding postpartum complications, 5% of the study group experienced postpartum hemorrhage (PPH), 2% had uterine atony, 3% had wound disruption, 1% had perineal tear, and 1% of the cases resulted in maternal death. Adverse neonatal outcomes were also observed, with 15% of the newborns having a body weight of less than 2500 grams, 11% having low APGAR scores, 12% developing neonatal jaundice, 2% experiencing intrauterine growth restriction (IUGR), 2% being stillborn, 1% having congenital anomalies, and 1% suffering from respiratory distress syndrome. ...

Pregnancy and assisted reproductive technology use in Australian female transfusion-dependent haemoglobinopathy patients: a 20-year retrospective analysis.

In the last few decades, the life expectancy of patients with transfusion-dependent thalassaemia (TDT) and sickle cell disease (SCD) has improved significantly, in part because of improved iron chelation. Fertility challenges and pregnancy complications have historically limited reproductive options in this group; however, improved multi-disciplinary care has made infertility a chronic disease complication requiring attention. Despite this, there are very few reports and no Australian data describing fertility and pregnancy outcomes in this population. To identify the rate of assisted reproductive technologies (ART) utilisation in our female transfusion-dependent haemoglobinopathy patients and to establish the nature of maternal and neonatal complications in this cohort. A 20-year retrospective analysis (1997-2017) at an Australian centre captured data on conception rates, use of assisted reproductive techniques (ART), and pregnancy and neonatal outcomes in female transfusion-dependent haemoglobinopathy patients. Conception was attempted in 14 women (11 TDT and three SCD) during the study period. A total of 28 pregnancies resulting in 25 live births were recorded. ART supported 13 conceptions. A positive association was not identified between elevated mean serum ferritin and ART use; however, all patients with an established diagnosis of hypogonadotropic hypogonadism (HH) required ART. Maternal complications included gestational diabetes mellitus and post-partum haemorrhage. There were no cardiac complications. Two-thirds of women underwent lower segment caesarean section, with prematurity complicating 20% of births. There were no neonatal or maternal deaths. Pregnancy is an achievable goal for women with transfusion-dependent haemoglobinopathies, although the support of ART may be required in a subset of patients.