Shyama Prasad Saha

A randomised comparative study on sublingual versus vaginal administration of misoprostol for termination of pregnancy between 13 to 20 weeks

Background:  Misoprostol is the drug of choice for medical abortion worldwide but consensus is yet to be reached regarding its preferred route of administration.

Consequences of unsafe abortion in India—a case report

Unsafe abortion represents a preventable yet major cause for maternal mortality in India. A majority of these abortions are performed confidentially. Complications occur in a large portion of these cases and ultimately require tertiary care. However, patients and their relatives often fail to disclose the abortion despite the critical state of the patients. This scenario creates considerable confusion for diagnosis and treatment and can lead to further complications. This case report of complications associated with an unsafe abortion in India highlights the need for clinicians to consider the possibility of an undisclosed abortion when treating any morbid woman of reproductive age.

Optimal timing of prophylactic antibiotic for cesarean delivery: a randomized comparative study.

Cesarean delivery is associated with a significantly higher postoperative infection rate than that following vaginal birth and other surgical procedures. This study compared whether antibiotic prophylaxis administered preoperatively was more effective in preventing infectious morbidity following cesarean delivery than administration at cord clamping.

Metastatic vulvo-vaginal choriocarcinoma mimicking a Bartholin cyst and vulvar hematoma-two unusual presentations.

Metastatic choriocarcinoma may present solely as a vulvo-vaginal growth. It may pose initial diagnostic dilemmas and thus treatment delay. Two cases of metastatic choriocarcinoma which presented as vulvo-vaginal swelling are described here. Both the cases were initially misdiagnosed. Later, unresponsiveness to treatment alerted us to the possibility of metastatic choriocarcinoma. Combination chemotherapy was started following diagnosis by serum β-HCG titer. In spite of initial responsiveness in both cases, one could not be saved due to poor compliance. Suspicion of metastatic choriocarcinoma should be kept in mind while dealing with any recent onset vulvovaginal swelling following a pregnancy. It may initially mislead the clinician due to its apparent benign appearance.

Rape among women and girls presenting at a gynecological emergency department, North Bengal Medical College, Darjeeling, India.

doi:10.1016/j.ijgo.2011.12.018 born in 75 different countries, with 466 (46.6%) born in Canada; 415 (41.5%) self-identified their ethnicity as white, 256 (25.6%) as East Asian, 183 (18.3%) as South Asian, and the rest as “other.” Of the total questionnaires distributed, 888 (67.5%) women answered the questions about anal sex and 54 (6.1%) reported they had used anal sex for birth control. Of these 54 women, 41 (75.9%) had been born in Canada and only 5 had lived in Canada for less than 5 years. They were younger and had undergone more previous abortions than the other women (Table 1). Eleven (20.4%) of the 54 reported that they disliked anal sex. Although all women are asked about previous use of contraception when they present to the clinic for abortion, until this specific question was asked, none of the staff was aware of patients who had used anal sex for birth control. The impression that this was a traditional practice used by certain immigrant groups was not confirmed since it was mostly younger, nonimmigrant women who reported that they had used anal sex for birth control. It is possible that these women were more comfortable revealing this information on the questionnaire.

A randomized comparative study on modified Joel-Cohen incision versus Pfannenstiel incision for cesarean section

OBJECTIVE Pfanennstiel incision is the most commonly used incision for cesarean section, but may not be the best. This study compared the modified Joel-Cohen incision with the Pfannenstiel incision to evaluate whether techniques to open the abdomen might influence operative time, and maternal and neonatal outcomes. MATERIAL AND METHODS In a randomized comparative trial, 302 women with gestational age >34 weeks, requiring cesarean section, were randomly assigned to either modified Joel-Cohen incision or Pfannenstiel incision for entry into the peritoneal cavity. The primary outcome measure was total time required for performing operation and secondary outcome measures were baby extraction time, number of haemostatic procedures used in the abdominal wall, postoperative morbidity, postoperative hospital stay and neonatal outcome. RESULTS Mean total operative time was significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group (29.81 vs 32.67 min, p<0.0001, 95%CI=2.253 to 3.467). Time taken to deliver the baby and haemostatic procedures required during operation were also significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group. Requirement of strong analgesics was higher in the Pfannenstiel group (53.64% vs 21.85%, p<0.0001). There was no statically significant difference in the incidence of postoperative wound complications but postoperative stay in hospital was significantly less in the modified Joel-Cohen group (p=0.002). Neonatal outcomes were similar in both groups. CONCLUSION The modified Joel-Cohen incision for entry into peritoneal cavity during cesarean section is associated with reduced mean total operative and baby extraction times with less postoperative pain and shorter hospital stay, which may be beneficial and cost effective.

PREGNANCY IN A WOMAN WITH WILSON'S DISEASE TREATED WITH ZINC: A CASE REPORT

Wilson’s disease is a rare hereditary disorder of copper metabolism affecting 30 per million populations. Copper get deposited in liver, brain and kidney due to decreased hepato-cellular excretion and leading to diverse clinical manifestations. Patient may remain apparently asymptomatic or may present with fulminant liver disease or neuropsychiatric illness. Reproductive outcome in untreated Wilson’s disease is poor. Women remaining untreated either suffer from infertility or experience recurrent pregnancy losses. Invention of copper chelating agents and their usage in these women resulted in successful pregnancy outcome. Penicillamine or zinc salts can be used as copper chelator in pregnancy with Wilson’s disease with equal effectiveness in respect to pregnancy outcome. We report a case of previously undiagnosed Wilson’s disease with three consecutive pregnancy losses who achieved a live birth after successfully treated with zinc salts. The several points regarding antenatal care, drug therapy and optimum time and mode of delivery for the woman with Wilson’s disease are discussed here.