Vineeta Gupta

Displaced intrauterine contraceptive device: a prospective study at tertiary level hospital of Uttarakhand, India

Intrauterine contraceptive devices (IUCD) are safe effective reversible and reliable method of long term contraception. IUCD is the main stay of Contraception especially in developing countries, despite side effect and complication. Uterine perforation is rare but potentially serious complication with an incidence of less than one case per 1000 insertion. The large ongoing international prospective EURAS-IUD study (European Active Surveillance Study for Intrauterine Devices) revealed perforation rates of 0.68/1000 insertions for the LNG-IUS and 0.41/1000 insertions for Cu-IUCDs at 1 year of follow up (Heinmann 2015). The risk factor for uterine perforation by IUCD is type of IUCD, position and size of uterus, congenital anomalies, infection, history of abortion and insertion in postpartum period. A frequent clinical problem is loss of the filament at the external cervical os as the lost tail. This may be due to retracted or torn off tail, misplacement within the cavity, and growing uterus due to pregnancy causing retraction of threads, intramural penetration as extra uterine location. Proposed risk factors of uterine perforation include the immediate post-partum period and breast feeding, regardless of the timing of insertion. Both Andersson and van Haudenhoven have discussed the role of uterine involution and increased uterine contractility as potential contributing factors to IUCD perforation occurring in the postpartum period. Procedure for retrieval of a misplaced device includes Cytobrush, IUCD hook artery forceps, and cylindrical brush. Once a patient comes with missing threads of IUCD, the device is located by X-ray or USG. ABSTRACT

A Rare Case of Perforation Following PPIUCD Insertion

IUCD is a safe and an effective reversible and reliable method of long-term contraception. Uterine perforation is rare but a potentially serious complication with an incidence of less than one case per 1000 insertion and can cause severe morbidity [1]. The risk factors for uterine perforation are the type of IUD used, position and size of the uterus, congenital anomalies, infection, history of abortion, and insertion of IUD in the postpartum period due to the thinness of uterine wall. In recent years, there has been a resurgence of interest in postpartum IUCD. According to the data from country programs, the vast majority of PPIUCD users do not have any complications. There are many case reports of uterine perforation due to postpartum IUCD insertion between 4 and 12 weeks. But we did not come across any case report of uterine perforation after post-placental or postpartum (within 48 h of delivery) IUCD insertion after normal delivery. We present a case report of uterine perforation following postplacental IUCD insertion.

A retrospective study of emergency obstetric hysterectomy in a tertiary care center for a period of 5 years

Background: The study was conducted to determine the frequency, demographic characteristics, indication and fetomaternal outcome associated with emergency obstetric hysterectomy in a tertiary care center. Methods: Thirty cases of emergency obstetric hysterectomy performed during the five-year period from April 2011 to April 2016 were analyzed in the dept. of Gynae and obs. in Shri Guru Ram Rai Institute of Medical Sciences in Dehradun. Results: During the study period there were 30 cases of obstetric hysterectomy out of 8084 deliveries giving an incidence of 0.37%. Majority of the patients (60%) were unbooked and were in the age group of 26-30 (43.3%). Common parity group were 3, 4 and 5. Morbid adherent placenta was the most common indication contributing to 40% of the cases. There were four maternal deaths in the study. All were unbooked and three of them died of hypovolemic shock with cardiopulmonary arrest and one died of septicemia. Whereas there were 60% perinatal mortality and 26.66% NICU admissions. Conclusions: Emergency obstetric hysterectomy is a potentially lifesaving procedure which often puts obstetrician in dilemma at the time of decision making.

Total vaginal hysterectomy (TVH): outcome analysis of 108 cases at a tertiary centre -

Background: The aim of this study is to evaluate, analyze the indications of surgery, patients profile with respect to age group, parity, and comorbidities, intraoperative techniques, intra and post-operative complications and post-operative recovery. Methods: A hospital based cross sectional descriptive study of 108 cases was conducted in the department of Obstetrics and Gynecology in a tertiary hospital over a period of one year. All patients admitted with benign gynecological conditions of the uterus were included in study. The patients with uterine prolapse, uterine size >16wks and more than one previous sections were excluded from the study. Results: Among all the indications of TVH, abnormal uterine bleeding was the most common. Mean age group was 44.89 years and the mean parity was 2. Majority of the patients had no intra and post-operative complications. Postoperative recovery was good with shorter hospital stay. Conclusions: TVH should be promoted as the route of choice for all benign gynaecological conditions. It is safe to do TVH in patients who are at poor general anaesthesia risk. In a state like Uttarakhand where medical facilities are hard to avail due to difficult geographic terrain, TVH has a special role .In lack of endoscopic facility, trained medical and paramedical staff and lack of postoperative monitoring instead of; there is a need to promote TVH. To top it all, TVH is the most cost effective route of hysterectomy. It is truly the natural orifice scarless surgery.

Evaluation of risk of malignancy index as a diagnostic tool in cases with adnexal mass

Background: Ovarian tumour usually presents as adnexal mass but often it is difficult to differentiate between benign and malignant tumour. Several diagnostic modalities such as sonography and tumours markers have been evaluated in the past, but none have been established as an ultimate diagnostic tool individually. The development of a mathematical formula using a logistic model, incorporating menopausal status, the serum level of a glycoprotein called CA-125 and USG score has been described in the form of different malignancy indices. The purpose of this study was to evaluate the various risks of malignancy indices (RMI 1, 2, 3, and 4) in the pre-operative evaluation of adnexal masses especially to differentiate between benign and malignant masses. Another objective of the present study was to compare the four RMI with each other in terms of various statistical parameters like specificity and sensitivity. Methods: Women with adnexal masses who underwent surgical treatment were included in this study as histopathological examination was taken as gold standard to calculate the accuracy of RMI. The sensitivity, specificity and positive predictive value and negative predictive value of all the four RMI were calculated and data analyzed. Results: A total of 65 patients were included in the study. RMI 1,2,3,4 was calculated according to their formula. Sensitivity of RMI- 1, 2, 3 and 4 was calculated to be 63.63%, 77.27%, 63.63% and 77.27% respectively. Specificity of RMI- 1, 2, 3 and 4 was calculated to be 69.04%, 64.28%, 64.28% and 62.79% respectively. Conclusions: Risk of malignancy index is a good diagnostic tool to differentiate between benign and malignant pelvic masses. RMI- 2 and RMI-4 had maximum sensitivity while RMI-1 had maximum specificity. Overall RMI-2 appears to be the most accurate of all the four RMI.

A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state

Background: Instrumental vaginal delivery is an age-long obstetric practice used to expedite vaginal delivery or avert recourse to caesarean delivery. Objective of the study is to compare maternal and neonatal outcomes of vacuum and forceps application in instrumental vaginal delivery. Methods: This is a retrospective observational study. Retrospective study of 70 consecutive ventouse and 70 consecutive forceps deliveries was done. Maternal and neonatal morbidity were compared in terms of perineal laceration, episiotomy extension, postpartum hemorrhage, apgar score, neonatal injuries and NICU admissions. Results: Maternal morbidity in terms of periurethral tear, second and third degree perineal tear were significantly more in forceps group (p=0.0332 and p=0.0173 respectively). However neonatal outcomes were found to be similar in both types of instrumental deliveries. Conclusions: Ventouse should be preferred over forceps whenever there is an indication for instrumental delivery (except in fetal distress) as it is associated with less maternal trauma and most of the neonatal morbidities were insignificant in comparison with both instruments.

Comparison between intravenous iron sucrose versus oral iron therapy in pregnant women with nutritional anemia: a prospective study -

Background: In India, the prevalence of anemia during pregnancy may be as high as 80%. The objective of this study was determining the efficacy of intravenous iron sucrose and oral iron in nutritional anemic antenatal patients, presenting at Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun, Uttarakhand, India. Methods: The study was carried out in the department of obstetrics and gynecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India single center study was performed on 400 antenatal patients with nutritional anemia gestational age 14 to 36 weeks. Patients were divided in two groups A and B. Group A was treated with intravenous iron sucrose and group B was treated with oral iron sulfate. Results: There was significant improvement in the various hematological parameters in IV sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in IV sucrose group. Conclusions: This study has shown a significant improvement in the iron sucrose group. Iron sucrose is safe and well tolerated.