ORIGINAL RESEARCH ARTICLE | Dec. 5, 2020
Factors Predictive of Uterine Rupture after Operative Hysteroscopy
Z.Khallouk, S.Bouhache, K.EL Moussaoui, F.Z.Louzali, S.Badsi, N.Zeraidi, A.Baidada
Page no 241-246
Objectives: To identify factors predictive of obstetric uterine rupture after operative hysteroscopy. When these factors are present, to know if there are means to prevent subsequent uterine rupture. Finally, to specify the criteria for extracting the fetus before rupture. Patients and methods: Description of a case of uterine rupture in a patient with a history of uterine septum rupture treated by operative hysteroscopy and retrospective analysis of the 12 similar observations reported in the literature. Results: Two types of situations are to be differentiated: uncomplicated hysteroscopic ablation of a polyp or submucosal myoma, which does not seem to modify the obstetrical prognosis; metroplasties for uterine malformation, resections of complex synechia, uterine perforations secondary to resection with the use of a monopole section current, constituting situations at high risk of obstetrical rupture. Conclusion: Uterine ruptures secondary to operative hysteroscopy are rare but serious. They may occur before any labour, and involve the vital prognosis of the mother-foetus. Once the risk factors have been identified, there is no way of preventing the progression to obstetric uterine rupture. The vigilance of the obstetrician in this context must be extreme, trying to authenticate the slightest clinical sign in favour of a pre-rupture of the uterus. However, systematic Caesarean section is not justified.
CASE REPORT | Dec. 5, 2020
Post-Caesarean Section Parietal Endometriosis: About A Case
S.Bouhache, Z.khallouk, N.Zerraidi, B.Ghrab, A.Baidada
Page no 247-248
Wall endometriosis is a rare clinical entity whose pathophysiology remains unclearI to ccurs most frequently after gynecologic or obstetric surgery. We report the case of à patient with cyclic pain at the caesarean section scar. Clinical examination showed à 4cm mass in the right iliac fossa. Tomodensitometry revealed a tissue density mass (45mm onthemajor axis). Hence, the decision to performa wide excision of the lesion. Anatomo-pathological examination confirmed the diagnosis of parietal endometriosis. Postoperative sequelae were simple with a follow-up period of 20months with no recurrence of the mass or of the pain. Our study highlights the characteristics of this disease to allow the health practitioner to understand the importance of diagnosis, of early treatment of this disease as well as of the possibility to prevent it during each gynecologic or obstetric surgery.
ORIGINAL RESEARCH ARTICLE | Dec. 10, 2020
The Outcome of Vaginal Birth after One Caesarean Section (VBAC)-A Descriptive Study
Dr. Mst. Jesmin Akter, Dr. Eliza Shirin
Page no 249-257
Background: Caesarean section has become the most performed major operation in obstetrics. The increasing rate of primary caesareans section becomes high worldwide due to early detection of fetal and maternal complications. Repeated caesarean section is one of the major contributory factors for increasing this rate very significantly. Now a day, vaginal delivery of pregnant mothers with the history of previous one caesarean with non-recurrent cause was established. It has been shown that the outcome of trial of labor in past caesarean delivery is acceptable, effective and safe for both mother and fetus, if the women are properly selected. Objective: The objectives of this study was to determine the outcomes of vaginal birth after caesarean section (VBAC) in case of previous one caesarean section to reduce the subsequence cesarean section with its complication. Materials and Methods: It was a cross sectional study carried out in the Maternity Unite-1, Department of Gynecology & Obstetrics, Sir Salimullah Medical College and Mitford hospital, Dhaka, Bangladesh, held on January 2010 to December 2010. Out of total 380 admitted pregnant women who had previous one caesarean section, 50 pregnant women of 37-42 weeks of gestational age with the history of one caesarean delivery with alive baby were selected as study population following consecutive and purposive sampling method. Patients with spontaneous onset labor but preterm pregnancy with any contraindication or prior caesarean section due to recurrent causes, history of classical caesarean section, more than one caesarean section, multiple pregnancy, pregnancy with medical disorder were excluded in the study. Results: Out of total 50 sampled pregnant women, vaginal delivery were done 16(32%) & emergency cesarean section were done 34(68%). According to the age group both vaginal & cesarean section 20-30 years were predominant, which were 8(50%) and 17(50%) respectively. Regarding antenatal care 13(81.25%) of vaginal delivery cases were regular. On the other hand, only 10(29.41%) of cesarean section were regular in care. Fetal survival outcome in vaginal & caesarean which were 14(87.5%) and 33(97.05%) respectively. Comparing the maternal complication maximum number of vaginal delivery group had no complications. Conclusion: In this study 14.5% pregnant women went spontaneous labor. By permitting a trial of labor in our pregnant mother with a previous caesarean section, we will be able to reduce the caesarean delivery rate. Women for VBAC needs regular antenatal checkup, timely admit in hospital and delivery under close supervision. Therefore, all pregnant women with prior delivery by caesarean section need not necessarily be delivered by caesarean section during the next pregnancy of a pregnant women.
ORIGINAL RESEARCH ARTICLE | Dec. 18, 2020
Breast Cancer and Pregnancy at Sylvanus Olympio Teaching Hospital of Lome -Togo
Ameyo Ayoko Ketevi, Akila Bassowa, Baguilane Douaguibe, Dede Regine Diane Ajavon, Alessi Andele, Togbui Seddoh, Gnama Nawa, Kodjo Fiagnon, Abdoul-Samadou Aboubakari
Page no 258-261
Introduction: The association of breast cancer and pregnancy is a rare event. The aim of our study is to take stock of this association at the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome, Togo. Methodology: This is a descriptive retrospective study that took place at (CHU SO), Lome, Togo; from January 1, 2014 to December 31, 2018. Results: During our study the frequency of breast cancer and pregnancy was 2.1%. The mean age of the patients was 33.3 years. Multiparas represented 69.2% of cases. Breast cancer was found in the second trimester of pregnancy in 45.4%. The invasive ductal carcinoma was found 38.4%. Patients had received palliative treatment in 53.8% of cases. Fifty-three point eight percent (53.8%) of the patients were lost to follow-up. Conclusion: Breast cancer associated with pregnancy is difficult. The ideal would be a nationwide subsidy for this disease.
CASE REPORT | Dec. 24, 2020
Puerperal Hematoma, Rare Postpartum Complication: A Case Report
Fatima Zahra Gounain, N. Mamouni, S. Erraghay, C. Bouchikhi, A. Banani
Page no 262-264
Post-partum hemorrhage is the leading cause of maternal mortality, ranging from 18 to 50% of deaths worldwide. The puerperal hematoma is an unusual cause (also called peri-genital thrombi) with a frequency of 1/1000. They are formed in a paravaginal, paracervical or parametrial connective detachment, after vascular lesions. There are many favorable factors: primiparity, instrumental extraction, macrosomia, multiple pregnancies, vulvovaginalvarices, difficult hemostasis, coagulation anomalies, and prolonged dilation. The “active” treatment of puerperal hematoma is based on surgery and/or arterial embolization.
ORIGINAL RESEARCH ARTICLE | Dec. 30, 2020
Serum Magnesium Levels between Low Dose MgSO4 and Pritchard Regimen in Treatment of Eclampsia: A Comparative study
Dr. Amatunnafe Naseha
Page no 265-269
| DOI: 10.36348/sijog.2020.v03i12.006
Introduction: Eclampsia is an extremely severe form of preeclampsia characterized by sudden onset of generalized tonic-clonic seizures responsible for 17–30% maternal mortality and 22% perinatal mortality. Since then, MgSO4 has been proven to more than halve the risk of occurrence of eclampsia in women with preeclampsia and of recurrence in women with eclampsia. Material and Methods: This is a Prospective study conducted in the Department of Obstetrics and Gynaecology at Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre, Hyderabad over a period of 1 year. Eclamptic patients who got admitted in department of obstetrics and gynecology. Standard principles of management of eclampsia will be followed. Patients are divided into two groups as cases & control alternatively. Groups are chosen based on inclusion & exclusion criteria. Group I Control will follow Pritchard standard regimen. Group II Cases will receive low dose magnesium sulphate regimen. Result: Among low dose and standard regime groups about 11.4% & 17.1% each had previous history of PIH. Among low dose group, 15% were intra uterine deaths, 20% needed NICU admissions, 10% were early neonatal deaths and none were perinatal deaths. Among standard regime group, 20% were intra uterine death, 30% were NICU admissions, 25% were early neonatal deaths &10% were perinatal deaths. The average birth weight among low dose and standard group was 2.18kgs and 2.02kgs respectively. The mean APGAR score at 5 minutes was 7.21 among low dose and 6.4 among standard regimen. There is no major correlation in both groups with respect to fetal outcome. Conclusion: The occurrence of eclampsia in two groups was more common in the age range of 20 to 26 years among the primigravida and with previous history of PIH. There is no major difference in the outcome of maternal and fetal in both groups. Nonetheless the magnesium levels among low dose group are significantly lower in comparison with standard regimen group. In cases and controls the magnesium levels are maintained in normal therapeutic range. Low dose regimen is better alternative to control seizures in eclamptic patients.