Background: Vaginal vault prolapse is a common condition following abdominal or vaginal hysterectomy causing negative impact on women’s quality of life. The study compares the efficacy of abdominal and vaginal route surgery in correcting post-hysterectomy vault prolapse by postoperative assessment and at least twelve months follow up.Methods: A prospective comparative study among post-hysterectomy patients attending the GOPD of Midnapore Medical College diagnosed as vaginal vault prolapse at least stage2 between January 2013 to December 2019. The study population included 31 women divided into two groups-group A included 16 women underwent unilateral sacrospinous ligament fixation (SSF) and group B included 15 women underwent abdominal sacrocolpopexy (ASC).Results: There was no significant difference between the two groups in terms of mean age, mean weight, mean parity and BMI, hence both groups are comparable. The mean operating time was 117±19.68 min in ASC group and 83.25±11.28 min in SSF group (p<0.005); significant mean blood loss was reported in ASC group (373±97.79 ml in ASC group versus 193.125±98.97 ml in SSF group, p<0.005), more hospital stays in ASC group (p<0.005) and more post operative complications in ASC group than SSF group. At follow up, the mean vaginal length showed significantly longer for ASC group than that of SSF group (p<0.005).Conclusions: ASC and SSF, both techniques are effective in management of vault prolapse in hands of an expert though recovery time is much quicker in SSF group.

Background: Pregnancy-induced hypertension (PIH) remains a great challenge to obstetricians. Doppler velocimetry can detect fetal compromise much before other antepartum tests. Aim: The aim of this study is to detect the changes of uterine artery, umbilical artery and middle cerebral artery in PIH by Doppler velocimetry. Subjects and Methods: This prospective study was conducted on hundred subjects with PIH. Doppler studies were carried, and parameters recorded in uterine, umbilical and middle cerebral artery (MCA) were Systolic/Diastolic ratio, Resistance Index, Cerebro-Placental Index (CPI). Fetal outcomes were monitored. Statistical analysis was performed using Epi Info TM software (Version 3.5.1, CDC, Atlanta). Test for significance was done with student's t-test and Chi-square where applicable. A P-value of<0.05 was considered as significant. Results: Among the 100 subjects, 76 (76%) of fetuses had abnormal and 24% normal umbilical artery Doppler velocimetry; 62% had abnormal and 38% normal MCA Doppler velocimetry; 64% fetuses had abnormal and 36% normal CPI. In 95% of subjects having abnormal umbilical Doppler studies, caesarean section had to be done for acute fetal distress. Incidence of caesarean section was 61% in abnormal MCA group and 63% in abnormal CPI group. Among 14 patients who had abnormal uterine artery Doppler, four developed pre-eclampsia, 2 IUGR. In patients with notches in uterine artery Doppler, 38% developed pre-eclampsia, 38% had IUGR, 13% babies were still born and 25% of newborns required NICU admission. In umbilical artery Doppler, when S/D ratio was abnormal, 60% developed pre-eclampsia, 40% had IUGR and 40% of newborns had to be admitted in NICU. Conclusion: Doppler study for fetal surveillance in pregnancy-induced hypertension is a very useful device and abnormal umbilical artery and uterine artery velocimetry seems to have worse pregnancy outcomes in the present study. Notch as a single parameter is the best indicator with highest sensitivity and positive predicative values. However, combination of parameters is the best indicator.

BACKGROUND Pregnancy with one prior Caesarean section (CS) constitutes a high-risk group with associated medical and legal implications. The dictum ‘once a Caesarean always a Caesarean’ has now judiciously been replaced with ‘once a Caesarean, trial of labour after selection’ because low transverse uterine incision has much lesser chance of scar rupture. Though vaginal birth after Caesarean (VBAC) or trial of scar (TOS) brings a significant change in modern obstetric practice in terms of lower maternal and perinatal morbidities, apprehension of accidental scar rupture during trial of labour with its undesirable consequences still prevents a good number of obstetricians adopting this process. The purpose of the study was to determine the outcome of pregnancy in relation to mode of delivery, i.e., either elective repeat Caesarean section (ERCS) or vaginal birth after Caesarean (VBAC) with maternal and perinatal complications in each mode. METHODS A hospital based prospective, longitudinal, and observational study of 300 pregnant women with previous one Caesarean delivery attended labour emergency or out-patient department (OPD) at Midnapore Medical College of West Bengal, was carried out, approved by the institutional ethical committee. Gestational age < 37 weeks and > 42 weeks and h\o previous uterine surgery like myomectomy, hysterotomy, classical CS were excluded from the study. Data collected was analysed using statistical package for the social sciences (SPSS) software version 20. Descriptive statistics were used to analyse the continuous and categorical data and expressed in the form of mean and percentage whereas proportions were analysed using chi-square test. A P - value ≤ 0.05 was considered statistically significant. RESULTS Out of 300 pregnancies, 140 subjects were given trial of labour (TOL). Of which 89 subjects (63.6 %) had successful VBAC and 51 subjects (36.4 %) had repeat Caesarean sections. Among 211 subjects of repeat Caesarean section, 53 subjects (25.12 %) had indicated for scar tenderness and 73 subjects (34.59 %) had elective repeat Caesarean section (ERCS) due to protracted or arrested cervical dilatation. Those having previous vaginal delivery (VD), had more incidences of VBAC in present pregnancy than those who had no previous VD (P ≤ 0.005); Maternal morbidity (33.65 % ERCS versus 10.11 % VD group, P ≤ 0.05) and neonatal morbidity (12.3 % ERCS versus 2.46% VD group, P ≤ 0.05) was significantly higher in ERCS group. CONCLUSIONS Trial of labour (TOL) should be given in well-equipped hospital. In carefully selected cases, it is a safe procedure and often rewarding, thus incidence of repeat CS can be reduced. Those who had a history of vaginal delivery, VBAC often successful. KEYWORDS VBAC, Trial of Scar, Elective Repeat Caesarean Section, Trial of Labour

Background: Ectopic pregnancy (EP) is the single most important cause of maternal morbidity and mortality in the first trimester and its rising trend throws a great challenge to the obstetrician and gynecologist due to its varied presentation. Aim: To study the incidence, clinical trends, risk factors and surgical management of ectopic pregnancy in a tertiary care hospital. Materials and methods: Retrospective study conducted among the diagnosed cases of ectopic pregnancies admitted during a period of 3 years and a total of 474 cases were studied. Data collected from BHT, Labor ward registers, Gynae ward registrars, Operation Theatre registers, Intensive care unit (ICU) and high dependency units (HDU) records. All the parameters were tabulated and analyzed after data entry. Results: Peak age of incidence were among 26-30 years (32.27%), more common in multigravida (74.69%), commonly presented at gestational age between 6-8 weeks (50.42%) risk factors associated with 73.18% of cases. Most commonly presented with lower abdominal pain (75.31%) followed by short h/o amenorrhea (68.35%). Classical triad presents in 37.97% of cases. Clinically extreme pallor and hemodynamically shock stage presented in 26.58% and 33.33% cases respectively. The commonest site of affection was Ampulla of the tube (50.84%) and most common operation done was Salpingectomy (83.54%). There was no mortality. Conclusions: Early diagnosis and proper management becomes the key of success. High degree of suspicion, identification of risk factors, availability of modern investigations and timely intervention will definitely help to reduce the morbidity and mortality associated with EP.

No abstract