Lower Uterine Segment Caesarean Section Research Articles

Successful Pregnancy Outcome in end-stage Renal Disease (ESRD) Patient : A Case Report

Pregnancy in women with chronic kidney disease (CKD) has always been considered as a challenging event both for the mother and the fetus . Outcomes of pregnancy in patients with End stage renal disease ( ESRD ) have long been considered to be extremely poor and challenges are harder in ESRD patients undergoing maintenance hemodialysis( MHD) . The cases of successful full term pregnancy occurring in an ESRD patient are still very few in whole world even after the evolutionary improvement of medical care. Development of well established multidisciplinary center make it possible to bring a successful pregnancy outcome among ESRD patients who are on going MHD. Patients with CKD are usually amenorrheic and fertility is markedly reduced . Women with chronic kidney disease, who get pregnant have poor pregnancy outcome in term of fetus and mother. Here we report a case of 34 years old lady, mother of two children , housewife presented in Bangladesh Specialized Hospital with a diagnosis 3 rd G 29 weeks of pregnancy with ESRD (on maintenance hemodialysis) with Hypertension. She was treated conservatively with joint consultation with Consultant Obstetrician, Nephrologist and Pediatrician. Her elective Lower uterine segment Cesarean section (LUCS) was done at her 35 weeks of pregnancy due to fetal distress with previous history of 2 LUCS. Both the mother and baby were healthy while discharge from hospital. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 162-164

Acute Lymphoblastic Leukemia in Pregnancy: Pregnant Woman Battled Against Leukemia Until 36 Weeks of Gestation: A Case Report

Leukemia in pregnancy is uncommon and may be a fatal condition. Using chemotherapy treatment during pregnancy gives adversity to the mother and fetus, resulting in a dilemma about the proper management plan. A 33-year-old pregnant woman who is G3P2L2 presented at 22 weeks of gestation with on-and-off back pain and progressive pancytopenia. During this admission, she was suspected to have mild pericarditis, yet the echo report was normal. Clinically, she had small multiple axillary lymph node enlargement, and abdominal ultrasound showed mild hepatosplenomegaly. Diagnosis of pre-B acute lymphoblastic leukemia (pre-B ALL) was confirmed by bone marrow biopsy. She was treated with UK-ALL protocol chemotherapeutic regimen (Table 1), considering some modifications in the standard protocol due to pregnancy. She delivered a healthy boy by loweruterinesegment cesarean section at 36 weeks of gestation. She was encouraged to breastfeed her baby for only 2 weeks in order to pursue chemotherapy treatment afterward. Chemotherapy management during pregnancy carries more risks to both the mother and the fetus and is more challenging to clinicians; therefore, clinicians need to be aware of early diagnosis of leukemia and have high suspicion, especially during pregnancy.

Maternal and Perinatal Outcome in COVID-19: A Hospital based Descriptive Study

Introduction: Since the declaration of the pandemic by World Health Organization (WHO), COVID-19 infection has affected worldwide including vulnerable pregnant women, who are at risk of increased maternal as well as neonatal morbidities and mortality. This study aimed to evaluate the prevalence of COVID-19 as well as maternal and perinatal outcomes in pregnancy with covid infection compared to pregnancy without infection. Methods: This hospital-based descriptive study was conducted in Tribhuvan University Teaching Hospital Obstetrics Department. All pregnant women delivered after the third trimester, positive for COVID-19 during the study period, were compared with age-matched control without infection for maternal outcomes in terms of morbidities, mode of delivery, complications as well as neonatal outcomes such as birth weight, Apgar score, intrauterine fetal demise (IUFD), Neonatal Unit (NNU), Neonatal intensive care unit (NICU) admission and neonatal death. Data were analyzed using Stata 14.1. Results: During the study period, total 59 women with COVID-19 infection (prevalence 2.23%) and 118 women without infection were included. Obstetric complications were seen significantly more in study group than control group (13.55% vs 3.38%; p-value 0.01). Cesarean section and intensive care unit admission were also significantly more in study group than control group (81.35% vs 51.7%; p-value<0.001, 22.03% vs 0.85%, p-value <0.001). Women with COVID-19 infection had significantly more hospital stay than control group (p-value 0.005). but no significant difference was observed in the neonatal outcome. Conclusion: Pregnancy with COVID-19 infection is associated with adverse obstetric complications, lower uterine segment Cesarean section and NICU admission but not with adverse neonatal outcomes compared to women without COVID-19 infection.

Antimicrobial Prophylaxis in Lower Uterine Segment Caesarean Section: A Prospective Observational Data-based Study

Introduction: Any major surgery like lower uterine Caesarean Section (CS) can be hazardous due to postoperative nosocomial infection. Pregnant mothers are at greater risk during such surgical intervention as compared to vaginal delivery. Prophylactic antibiotic administration is a standard practice across the globe to prevent such anticipated postoperative infection. Aim: To evaluate the prophylactic antimicrobial use with regards to the choice of antimicrobials, dose, route, timing and duration, any possible Adverse Drug Reaction (ADR) as well as to assess the frequency of the postoperative morbidity due to infection (if any). Materials and Methods: A prospective observational databased study was conducted in the Department of Pharmacology in collaboration with Department of Obstetrics and Gynaecology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India, from February 2016 to October 2017. Study was conducted on 1944 pregnant women of reproductive age group planned or scheduled for elective/emergency lower segment CS, but otherwise healthy and received prophylactic antimicrobials for the surgery. They were prospectively observed regarding the treatment they received with focus on antimicrobial agents from the period of antimicrobial prophylaxis during their stay at hospital to till their discharge. Demographic data, vital signs, indication of CS, postoperative infections and ADR if any were recorded in predesigned proforma. The study population was divided into two groups: group A included 995 mothers, who received ceftriaxone sodium (1 g intravenously) and metronidazole (15 mg/kg) infusion and group B included 949 mothers, who received ampicillin (2 g intravenously), metronidazole (15 mg/kg) infusion and injection gentamycin (5 mg/kg) for 0.5 hour before initiation of CS. The data were statistically analysed by standard statistical software Microsoft Excel 2010 and Statistical Package for the Social Sciences (SPSS) sotware version 27.0 (SPSS Inc., Chicago, IL, USA) expressed as mean and standard deviation and percentage. Independent t- test and Chi-square test were used for analysis. Results: The mean age of group A was 22.36±3.07 years and group B was 22.76±2.47 years. Endomyometritis was documented in 4 (0.4%) from group A and 2 (0.21%) from the group B. Wound infection was present in 3 (0.3%) for group A and five (0.5%) for the group B. Infection related complications like chest infection seen in 7 (0.7%) for group A and in 3 (0.31%) for group B and urinary tract infection was noticed in 6 (0.6%) for group A and 5 (0.52%) for group B. Any incidence of maternal mortality was not evident among the two study groups and statistically insignificant ADR like vomiting and maculopapular rash (p-value=0.324) was observed in both the study groups with the use of above-mentioned antimicrobial therapy. Conclusion: Prophylactic use of ceftriaxone plus metronidazole and combination of triple antimicrobial therapy of ampicillin, metronidazole, and gentamycin therapy at the usual standard dose were commonly used antimicrobials at the present set up and they are safe and equally effective in decreasing considerably the incidence of post caesarean maternal infection thereby reducing their morbidity and mortality

Evaluation of Intracranial Abnormalities by Transcranial Ultrasound in Neonates- An Observational Study

Introduction: Intracranial abnormalities include hydrocephalus, intracranial haemorrhage and related hypoxic-ischemic damage, for which diagnosis can be confirmed by the transcranial ultrasound. Apart from this, transcranial ultrasound may also be helpful in screening of suspected intracranial infections and tumour. Various studies have demonstrated high sensitivity and specificity of transcranial ultrasound in detecting various intracranial abnormalities. Aim: To evaluate the efficiency of ultrasonography in the diagnosis of intracranial abnormalities in neonates. Materials and Methods: This observational cross-sectional study was conducted in the Department of Radiodiagnosis, SBKS MIRC Sumandeep Vidyapeeth, Piparia, Vadodara from February 2019 to August 2020. Forty neonates with abnormal neurological presentation were included in the study and detailed data regarding prenatal, perinatal and postnatal period was obtained from parents and entered in questionnaire. Length, weight was noted. Further, all the neonates were subjected to relevant blood investigations such as Complete Blood Count (CBC), blood glucose and other investigations depending upon the clinical findings. All the neonates were then subjected to transcranial ultrasonography. Results: In present study, mean gestational age of 40 neonates was 35.38±3.59. Male preponderance was noted in present study with male:female ratio of 2.08:1. Mean birth weight of neonates was 2.11±0.60. Most common mode of delivery was vaginal in 57.5% cases followed by Lower (uterine) Segment Caesarean Section (LSCS) in 27.5% cases. Antenatally, steroids are given in only 25% of the cases in present study. Most common clinical manifestation was seizures and lethargy. Transcranial ultrasound revealed germinal matrix hemorrhage in majority of neonates. Conclusion: Transcranial ultrasound is recommended in every high risk neonate as a first line modality to assess the presence of intracranial abnormalities and for timely referral to higher- centres. It is quick, inexpensive, portable, non invasive and free from ionising radiation.

A Case Report of En Caul Vaginal Delivery of 31 Gestational Weeks Fetus with Podalic Breech Presentation

Delivering fetus completely enclosed in an amniotic sac in caesarean section or in vaginal delivery is called en caul delivery, it mostly occurs before 36 gestational weeks. We report en caul podalic breech vaginal delivery of 31 weeks fetus, but unfortunately the newborn dead 4 days after delivery because of prematurity complications. We discus pro and con for en caul delivery and caesarean section in premature fetuses, concluding that a breech intact membrane vaginal delivery may be a good and safe way to avoid birth trauma and unwanted poorly formed lower uterine segment caesarean section consequences.

A rare case of an incarcerated incisional hernia with gravid uterus

Herniation of a gravid uterus through an abdominal wall incisional hernia with overlying skin necrosis is exceptionally rare. A 29-year-old multiparous K30 + 4/40 pregnant female presented with a 1-month history of worsening abdominal wall skin changes. Magnetic resonance imaging of the abdomen and pelvis confirmed herniation of the gravid uterus into the hernia sac. A lower uterine segment caesarean section and hernia repair were performed by the general surgical and obstetrics team in view of the potential maternofoetal complications. This case highlights the importance of early recognition and the difficulties in managing gravid uterus herniation.

Hepatic cirrhosis with portal hypertension secondary to alpha-1 antitrypsin deficiency and autoimmune hepatitis in pregnancy: A case report

Introduction: Previously, women with cirrhosis rarely became pregnant due to hypothalamic-pituitary dysfunction. However, with advancements in the care of patients with chronic liver disease, pregnancy is becoming more common in this cohort. We will outline the complex, multidisciplinary approach toward managing an obstetrics patient with portal hypertension in the context of previously decompensated liver cirrhosis. Case Report: A 29-year-old primigravida woman was referred to the Obstetric Medicine Clinic with an unplanned pregnancy at 16 weeks’ gestation. This was on a background of previously decompensated liver cirrhosis and portal hypertension, in the context of alpha-1 antitrypsin deficiency and autoimmune hepatitis. The patient had one upper gastrointestinal bleed at 19 weeks’ gestation and underwent three gastroscopies throughout her pregnancy. At 32+6 weeks gestation, she had an elective lower uterine segment Caesarean Section and delivered a healthy liveborn female. Conclusion: Currently, there are no studies that explore pregnancy outcomes in women with cirrhosis secondary to alpha-1 antitrypsin deficiency. This case describes the pregnancy of a woman with previously decompensated liver cirrhosis and portal hypertension, in the context of alpha-1 antitrypsin deficiency and explores the associated management dilemmas.

A COMPARATIVE STUDY OF HYSTEROSCOPIC REPAIR AND TRANSVAGINAL REPAIR IN THE MANAGEMENT OF PATIENTS WITH POST CESAREAN SCAR DEFECT

To compare hysteroscopic repair and transvaginal repair for correcting uterine defect in patients with post cesarean scar defect (PCSD). Patients had a history of transverse lower uterine segment cesarean section, meeting the inclusion criteria and exclusion criteria were enrolled. 79 patients were finally included in the study, of which 39 patients received hysteroscopic repair and 40 patients received transvaginal repair. All patients signed the informed consent and the study was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (trial No 2015-122). Shorter surgery time and less postoperative hospital stay but higher hospitalization expenses were found in patients receiving hysteroscopic repair than those received transvaginal repair. Follow-up data showed that there were significant differences of pre-operative and post-operative menstrual durations between the two groups. 84.6% of patients in hysteroscopic repair group were observed improvement of prolonged menstrual bleeding syndrome while 87.5% found in transvaginal intervention group (p＞0.05). Proportions of patients with disappeared or reduced uterine defect were 84.6% and 85% in operative hysteroscopic repair and transvaginal repair groups, respectively (p＞0.05). Hysteroscopic repair and transvaginal repair can achieve similar short-term results in improving abnormal menstruation and pregnant outcome by resection of PCSD lesions. Shorter operation time and less postoperative hospital stay would make hysteroscopic repair a better choice for PCSD patients who want to get pregnant urgently.

Management of a patient diagnosed with ovarian cancer during pregnancy

Insufficient diagnosis of ovarian tumors during pregnancy and decreased oncological alertness constitute huge problems that can subsequently have an unfavorable outcome for both the pregnant woman and the fetus. The difficulties of diagnosing and treating ovarian cancer during pregnancy were demonstrated on the following clinical case example. In pregnant patient A. at 19-20 weeks of pregnancy, a lesion was found in the area of the right appendages (100.9 55.4 93.4 mm, V = 273 cm3), with many tissue partitions and parietal tissue inclusions. The growth of the neoplasm was noted (CA-125 884 U / ml) and the pain syndrome occurred in the patient at 23-24 weeks of pregnancy. Magnetic resonance imaging revealed a solid-cystic neoplasm of the right ovary (cystadenoma?) and surgery was performed in November 2019. Based on the results of histological examination, a high-grade serous ovarian cancer was diagnosed without signs of microsatellite instability MSI-H/dMMR (in the right ovary, in the biopsy of the left fallopian tube). The patient. received two cycles of polychemotherapy (TC scheme). The treatment was tolerated satisfactorily (CA-125 287.3 U / ml). At a gestational age of 34 6/7 weeks (January 2020), a simultaneous operation was performed, including a lower midline laparotomy, a lower uterine segment caesarean section, extirpation of the uterus with appendages, and an omentectomy. A boy was born (weight 2280 g, height 44 cm) with the Apgar score of 7/7 points, with no complications noticed in the postpartum period. Postoperative histological examination showed metastasis of carcinoma in the left ovary with signs of therapeutic pathomorphosis. The treatment was completed in March 2020 after six cycles of polychemotherapy.

English

BACKGROUND Retinopathy of prematurity (ROP) is one of the leading causes of ocular morbidity and mortality throughout the world. Prematurity, low–birth, and oxygen therapy are considered to be the common risk factors. The maldeveloped retina in those affected are very much prone to develop refractive error, neo-vasculopathy, and neurosensory detachment. The purpose of our study was to find out the incidence and ascertain the risk factors of retinopathy of prematurity among the neonates attending the sick neonatal care unit and OPD of Calcutta National Medical College & Hospital. METHODS This is an institution based cross-sectional observational study conducted in the sick newborn care unit of a tertiary care hospital. Informed consent was obtained from the parents along with proper birth history. Indirect ophthalmoscopy with a + 20 dioptre (+ 20 D) lens with a paediatric scleral depressor was performed in each eye under the guidance of the neonatologist after pupillary dilatation. If either eye was found to have ROP, the baby was considered as an ROP case in the study and each eye was considered as a single case. RESULTS 50.27 % babies (N = 91) were delivered by Lower Uterine Segment Caesarean Section (LSCS) and 55. 24 % babies were < 32 weeks of gestational age whereas 21.45 % (N = 39) babies were having < 1500 gm birth weight. Phototherapy was needed in 50 % of the babies (N = 92) whereas hyperbilirubinemia was present in 59.66 % of total babies. Bradycardia, apnoea, and sepsis were present in 29.83 % (N = 54), 25.41 % (N = 46), 41.98 % (N = 76) of the babies respectively. When compared in the two independent groups (ROP present and absent), low gestational age and low birth weight of the babies were found to be statistically significant (P < 0.05) for the development of ROP. After adjusting with different factors in the regression model we have found that low birth weight and oxygen therapy after birth were statistically significant with the development of ROP (P < 0.05). CONCLUSIONS ROP screening, specifically for those babies with low-birthweight, low gestational age, and those who received oxygen therapy for other systemic reasons, is mandatory to have an early diagnosis and treatment done. KEYWORDS ROP, Low-Birthweight, Gestational Age, Oxygen Therapy

A comparison between intravenous ondansetron and granisetron in the preventive management of postoperative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia

Background: Efforts are still conducted to reduce side effects of anesthesia, such as postoperative nausea and vomiting (PONV). This study was performed to compare the effectiveness of prophylactic use of intravenous Ondansetron (4 mg) and Granisetron (2 mg) in the preventive management of postoperative nausea and vomiting in women undergoing elective lower (uterine) segment cesarean section (LSCS). Patients and Methods: A total of 100 patients belonging to the American Society of Anesthesiologists (ASA) Grade I and II posted for elective LSCS were included in the study. 100 patients were further divided into two groups (n = 50), i.e., Group O (ondansetron) and Group G (granisetron). This study was conducted from November 2017 to August 2019 on 100 ASA I and ASA II patients, aged from 18 to 35 years who underwent elective LSCS under the subarachnoid block. Results: Both drugs Ondansetron and Granisetron showed prevention of PONV (Granisetron showed 80% response and Ondansetron showed 44% response). Both drugs have shown promising results for a shorter duration in postoperative care but Ondansetron showed a higher number of PONV incidences than Granisetron in long duration. Conclusion: Granisetron is effective than Ondansetron in preventing nausea and vomiting in the late postoperative period with fewer side effects.

Pregnant woman with circumvallate placenta and suspected fetal hypotrophy caused by placental insufficiency: a case report

Background: The circumvallate placenta is a rare pathology of the human placenta that occurs in 1–2% of pregnancies. It is characterized by extrachorial placental development, resulting in a ring formation along the edges of the placenta, which leads to efficiency impairment. As a consequence, it causes an intrauterine fetal hypotrophy. The fetal hypotrophic pregnancies are classified as high-risk pregnancies, requiring not only intensive monitoring of fetal development but also maternal and fetal care by the highest reference clinical center. Aim of the study: The aim of this study was to analyze the case of a patient with circumvallate placenta and fetal hypotrophy suspicion. Material and methods: The study was based on the case study method. The data was obtained by analyzing medical documentation collected during hospitalization. The patient was interviewed and observed. All of the selected parameters were measured and scaled. Case study: A 30-year-old primiparous woman at 38+1 weeks gestation, with diagnosed circumvallate placenta and suspected fetal hypotrophy. The pregnancy had several complications, including gestational hypothyroidism. There was spotting and imminent abortion in the first trimester and in the second and third trimester, the patient was treated for vaginal mycosis. There was a risk of preterm labor in the third trimester. The patient was admitted to the delivery room in the first stage of labor. The course of first stage of labor was normal however the second stage of labor was complicated. Obstructed labor with ace presentation, mentoposterior position. A lower uterine segment cesarean section (LUSCS) was performed and a live full-term female infant was delivered, which was found to be small for gestational age (SGA). The course of the early puerperium was uncomplicated with an expected duration of stay in the neonatology department. Both mother and baby were discharged from hospital on postpartum day 3. Conclusions: Circumvallate placenta is not a contraindication to natural delivery however is associated with an increased risk of many perinatal complications. Holistic care during delivery and the early puerperium requires specialized knowledge and skills of medical staff in taking care of both of the mother and the child.

Two-Dimensional versus Three-Dimensional Transabdominal Sonography for Measurement of Lower Uterine Segment Thickness in Women at Term Pregnancies with Previous Caesarean Sections

Abstract Background: Caesarean section is the commonest opera-tion performed by the gynecologists and due to the risks and benefits of ERC and VBAC, cases selection and counseling are of out most importance. Aim of Study: To evaluate inter method and inter observer reliability of 2D versus 3D trans abdominal sonography for lower uterine segment measurement. Method: The study enrolled 100 pregnant women under going elective lower uterine segment caesarean section, all sonographic examination was performed by an ultrasound Voluson E6 BT16 Transducer for 2D and 3D trans abdominal sonography, inner myometrial thickness and full thickness will be measured at the thinnest portion and perpendicular to the contour of the lower uterine segment, then measurement intra operatively using graduated sound. Results: Lower uterine segment inner and full diameter measurements were strongly and directly correlated by both 2D and 3D ultrasonography which means the 3D method of assessment added no more value. Both 2D and 3D method of assessment were correlated to a lower uterine segment meas-urement intra operatively with a comparable correlation factor. Conclusion: Multiple caesarean section patients had a significant lower value of lower uterine segment thickness by all means of measurements.

Body stalk anomaly presenting as an emergency in Ethiopia: a case report

BackgroundBody stalk anomaly is a generally lethal malformation of the thorax and/or abdomen. It is often associated with limb defects. The intrathoracic and abdominal organs lie outside the abdominal cavity. These are contained within a sac composed of amnioperitoneal membrane attached directly to the placenta. The umbilical cord may be totally absent or extremely shortened. Severe kyphoscoliosis is often present. This case is reported to highlight this rare malformation and its clinical presentation.Case presentationWe present a case of a 27-year-old primigravida Oromo woman who had been amenorrheic for 9 months. She presented with an urge to bear down of 10 hours and passage of liquor of the same duration. The patient was referred from a district primary hospital with a diagnosis of preterm labor and hand prolapse. A lower uterine segment cesarean section was performed at Jimma University Medical Center for an indication of active first stage of labor with nonreassuring fetal heart rate pattern (fetal bradycardia) and hand prolapse to effect an anomalous fetus that had only a rudimentary right lower extremity and liver and intestine found outside the abdominal cavity contained within a sac composed of transparent membrane attached directly to the placenta. The umbilical cord was very short, measuring about 7 cm. The fetus had severe scoliosis. It also had a heartbeat upon extraction, which stopped after 5 minutes of delivery. The placenta and fetal body parts together weighed 2400 g.ConclusionTermination of pregnancy is usually offered because this abnormality is generally considered lethal. If the pregnancy is continued undetected as in our patient’s case, vaginal delivery is recommended, given the highly lethal nature of this anomaly. Good prenatal screening and counseling are recommended for early detection and management.

Comparison of the Genital Microbiomes of Pregnant Aboriginal and Non-aboriginal Women.

The genital microbiomes of women varies with racial background. Preterm birth and early-onset neonatal sepsis are two outcomes associated with genital infections during pregnancy. The rate of preterm birth in Aboriginal Australian mothers is high, as is the rate of early-onset sepsis in their infants. To date, no studies have been conducted to investigate genital microbiome taxa associated infection in this group of women. A prospective cohort study to characterize the vaginal and placental microbiomes of a group of these women from the Pilbara region was conducted at the Hedland Health Campus in Western Australia. Included in the study were gravidae Aboriginal (n = 23) and Non-aboriginal (n = 27) women in labor or for planned lower uterine segment Caesarean section. Employing sterile swabs, vaginal samples were obtained under sterile conditions immediately prior to vaginal delivery or planned Caesarean section; and placental samples were obtained under the same conditions during labor. Taxa present in the samples were identified by 16S rRNA amplicon sequencing (V4 region, 515F-806R). Taxon identity and abundance were established from Operational Taxonomic Unit (OTU) counts. Statistical analyses combining clinical metadata and sequencing results were employed to determine associations of taxa with racial background. The findings of this work served to enhance the current understanding of microbiota associated with health and disease in Aboriginal and Non-Aboriginal women. Differences were found between the vaginal and placental microbiomes of Aboriginal and Non-aboriginal women during pregnancy, as well as notable differences between the abundance of specific taxa in each racial group. The relative abundances of specific taxa were significantly different between participants with clinical signs of infection and those with healthy pregnancies. This work will contribute to understanding the causes of differences in rates of infection-driven preterm birth in various racial populations.

Comparative Study on Fetomaternal Outcome after Lower Uterine Segment Caesarean Section and Vaginal Delivery in Eclamptic Patient

Eclampsia has a high prevalence in our country with a high mortality rate. Eclampsia is uniquely a disease of pregnancy and regardless of gestational age. It is recognized that termination of pregnancy is the only definitive care of pathophysiological event in eclampsia. This study was done to observe fetomaternal outcome in Lower Uterine Segment Caesarean Section (LUCS) and vaginal delivery in eclamptic patient. This cross sectional analytical study was carried out in eclampsia department of Obst and Gyane in Dhaka Medical College Hospital from July 2016 to June 2018. A uniform protocol was followed in all cases to have appropriate history, physical findings and laboratory investigations. In this study 98.0% patients were conscious on admission in group I and 96.0% in group II. This study showed significant difference in recurrence of convulsion after delivery between two groups. Recurrence of convulsion was 30% in vaginal delivery group and 6% in the cesarean section group. Total complications were found in 46.0% and 16.0% patients in group I and group II respectively in this study. The difference was statistically significant (p<0.05) between two groups. In this study PPH was the most common complication in both the groups. Abruptio placenta was found more common among the vaginal delivery group. On the other hand, electrolyte imbalance was found more in cesarean section group. Maternal death was only 2% and 1% in group I and group II respectively. In this study live birth was found 64.0% and 79% in group I and group II respectively. Asphyxia was more in neonates in group I than group II which was statistically significant. Referral of asphyxiated babies to NICU was found 63.0% and 56.0% in group I and II respectively. The difference was statistically not significant between two groups.
 Faridpur Med. Coll. J. Jan 2020;15(1): 16-20

Uterine Defect after Open Maternal-fetal Surgery

A 36-year-old gravida 5, para 3 woman presented with persistent dysmenorrhea, dyspareunia, and abnormal uterine bleeding (AUB) for 4 years following an open maternal-fetal surgery (OMFS) for fetal myelomeningocele repair. Surgery was performed at 23-week gestation and involved a full-thickness hysterotomy at the posterofundal aspect of the uterus, followed by placement of an omental patch over the hysterotomy site. A cesarean section was ultimately performed at 31-week gestation because of preterm labor. Attempts at uterine exteriorization were unsuccessful because of omental adhesions. The postpartum course was uncomplicated. In the workup of her gynecologic symptoms, a transvaginal ultrasound was performed. A fundal defect in the uterine myometrium was seen [Fig. 1]. The patient ultimately underwent a total laparoscopic hysterectomy, lysis of omental adhesions [Fig. 2], and bilateral salpingectomy after failing medical management. A fundal uterine defect was again noted in the pathologic assessment [Fig. 3]. The postoperative course was uncomplicated, and her pelvic pain resolved.Fig. 2(A) Uterus with omental adhesions to posterior fundus. (B) Otherwise normal appearing posterior cul-de-sac.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Fundal uterine defect noted during pathologic assessment following total laparoscopic hysterectomy. Omentum was adhered to the uterine serosa overlying the defect. C = cervix E = endometrium and cavity; M = myometrium.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This case highlights potential gynecologic complications following OMFS that may be overlooked. New onset gynecologic symptoms including chronic abdominal/pelvic pain, and AUB have been reported following both OMFS [1Wilson RD Lemerand K Johnson MP et al.Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal-fetal surgery (1996–2007).Am J Obstet Gynecol. 2010; 203: 209.e1-209.e6Abstract Full Text Full Text PDF Scopus (82) Google Scholar] and fetoscopic surgery [2Sacco A Van der Veeken L Bagshaw E et al.Maternal complications following open and fetoscopic fetal surgery: a systematic review and meta-analysis.Prenat Diagn. 2019; 39: 251-268Crossref PubMed Scopus (49) Google Scholar]. Neither OMFS nor fetoscopic surgery has been associated with infertility [1Wilson RD Lemerand K Johnson MP et al.Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal-fetal surgery (1996–2007).Am J Obstet Gynecol. 2010; 203: 209.e1-209.e6Abstract Full Text Full Text PDF Scopus (82) Google Scholar,2Sacco A Van der Veeken L Bagshaw E et al.Maternal complications following open and fetoscopic fetal surgery: a systematic review and meta-analysis.Prenat Diagn. 2019; 39: 251-268Crossref PubMed Scopus (49) Google Scholar]. In this case, new onset of pelvic pain, dysmenorrhea, and AUB were associated with a posterofundal uterine defect, complicated by prior OMFS. These symptoms mimic those that can arise following cesarean sections, complicated by postoperative cesarean scar isthmocele formation [3Morris H Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms?.Int J Gynecol Pathol. 1995; 14: 16-20Crossref PubMed Scopus (135) Google Scholar]. Symptom etiology in the setting of an isthmocele may be related to underlying lymphocytic infiltration, abnormal vascularity, and iatrogenic adenomyosis [3Morris H Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms?.Int J Gynecol Pathol. 1995; 14: 16-20Crossref PubMed Scopus (135) Google Scholar]. This case raises the question as to whether a similar underlying pathophysiologic process accounts for the symptoms, as focal adenomyosis was found around the defect but lymphocytic infiltration or abnormal vascularity was not distinctly commented on. With the increasing prevalence of intrauterine maternal-fetal surgery, more long-term follow-up studies are required to better understand both the reproductive outcomes and gynecologic implications of these procedures.

Are the changes in diagnostic criteria for gestational diabetes mellitus reflected in perinatal outcomes? A retrospective assessment

Gestational diabetes mellitus (GDM) is glucose intolerance first diagnosed during pregnancy not due to overt diabetes. Recent changes to the diagnostic guidelines have been shown to increase the apparent occurrence of GDM. The aim of this study was to compare retrospectively the neonatal outcomes between groups defined using the new and old criteria to assess the impact of guideline changes on pregnancy outcomes. The study was of singleton babies delivered of 641 women, who had oral glucose tolerance testing and pregnancy care at a single tertiary centre between 2011 and 2015. Compared to the population of women not now considered to have GDM by International Association of Diabetes and Pregnancy Study Groups criteria (two-hour glucose concentration ≤8.4mmol/L), neonates born to women with the new lower fasting criterion (5.1-5.4mmol/L) and/or the new 60-min group (glucose ≥10mmol/L) combined were significantly more likely to have birthweight ≥90th percentile (22% vs 5%, P<0.0001). In contradistinction, there was a significant excess number of small-for-dates babies (birthweight ≤10th percentile) in all subgroups previously diagnosed and treated for GDM by the Australian Diabetes in Pregnancy Society criteria (17% vs 7%, P=0.001). Rates for lower uterine segment caesarean section, admission to the neonatal intensive care unit / special care nursery and Apgar scores at one and fiveminutes were not statistically different across all groups. Outcomes support the lowering of the fasting criterion to extend management of GDM to limit growth of large birthweight neonates. An unexpected outcome was that in women previously treated for GDM, there were increased numbers of low-birthweight neonates.

Comparison of Incidence of Post-Dural Puncture Headache (PDPH) in Patients Undergoing Lower Uterine Segment Caesarean Section (LSCS) among Different Batches of Residents

Comparison of Incidence of Post-Dural Puncture Headache (PDPH) in Patients Undergoing Lower Uterine Segment Caesarean Section (LSCS) among Different Batches of Residents