Introduction: Perineal tear (PT) is the most frequently occurring injury during vaginal birth. Striae gravidarum (SG) is a reflecting marker of connective tissue elasticity. This study aimed to assess SG score and to predict the likelihood of PT during childbirth. Materials & Methods: This was a cross-sectional study done at Sir Salimullah Medical College & Mitford Hospital. Initially, all pregnant women admitted for vaginal delivery were enrolled but who subsequently needed lower segment caesarean section were excluded. Finally, 189 patients who gave vaginal birth were included. SG score was assessed using the Atwal numerical scoring system. The association was examined between PT as the outcome measure, defined by tears or lacerations and the total striae score (TSS) obtained at abdomen, hips, buttocks and breasts. Results: More than half of study patients developed PT. Majority belonged to moderate striae group. Significant correlation was found between PT and TSS. Moderate and severe striae had significantly increased prevalence of PT as compared to mild striae (43.4% vs. 11.6%). Patients who were given episiotomy in moderate and severe striae group had less PT. Weight gain during pregnancy and TSS were significantly associated with a higher incidence of PT. Conclusion: A woman’s SG score in general is a useful clinical predictor of the risk for PT during childbirth. Selective episiotomy in patients with moderate and severe striae can reduce the incidence of PT. SG score can be used as a simple and noninvasive tool by all categories of health personnel to better define women at risk for PT. Medicine Today 2019 Vol.31(2): 64-67

Background: Anesthesia is quite remarkable and attenuation of pressor response is one of the most keenly researched subjects in the field of anaesthesiology, the reason being the non-availability of a ‘procedure/drug of choice’ for the same. Patients with arterial hypertension generally exhibit excessive pressor response to stress such as laryngoscopy, intubation, surgical incision and extubation, which can lead to arrhythmias, myocardial ischemia and cerebrovascular accidents. Exchange extubation with LMA Supreme can be used to overcome or blunt the excessive pressor response following extubation. Objective: To compare the hemodynamic changes during traditional awake extubation and extubation using LMA supreme in controlled hypertensive patients. Methods: The prospective study was carried out in the department of Anaesthesiology, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from January to December-2021. Fifty (50) patients were randomized by permuted blocks into two groups. After complete pre- anesthetic check-up and investigations. Controlled hypertensive patients with ASA (American Society of Anesthesiologists) grade II, between the age of 17 and 65 years, undergoing elective, non-oral surgery were included in the group. Hemodynamic stress response between traditional awake extubation of the endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA Supreme) in terms of Post Extubation Heart Rate (H.R), Systolic Blood Pressure (S.B.P), Diastolic Blood Pressure (D.B.P), Mean Arterial Pressure (MAP), to determine whether this method is easy to perform, the amount of experience needed to perform the exchange well and to calculate the time delay in extubation caused by adopting this method. Results: There was highly significant increase in pulse rate in Group A (ETT Group) as compare to LMA SupremeTM group, which was statistically significant till 15min. of extubation. Statistically ...........

Background & objective: Management of pregnancy with intrauterine fetal death (IUFD) is always puzzling to the obstetricians and mental agony to the patients. Intravenous oxytocin infusion was previously practiced for termination of pregnancy with IUFD. But recently misoprostol is claimed to be better than oxytocin in terms of its efficacy and safety. This prospective study was carried out to find which of these two drugs is suitable for termination of pregnancy with IUFD. Methods: Based on predefined criteria,a total of 100 singleton pregnant women with gestational age more than 22 weeks, ultrasonographically confirmed as having dead fetus in utero were included in the study and were randomly assigned to vaginal Misoprostol and Oxytocin infusion groups. The outcome was evaluated in terms of time required for induction of labor, induction to delivery time and complications encountered by each group. Result: The overall time required for induction to delivery was significantly shorter in Misoprostol group than that in Oxytocin group irrespective of their Bishop’s score (p < 0.001). Even in patients in whom the cervix was unripe (Bishop's score < 6), the mean time required from induction to delivery was much shorter in Misoprostol group (p < 0.001), but in patients in whom the cervix was ripen, the mean time from induction to delivery in Misoprostol group was shorter, but the difference did not turn to significant (p = 0.079). Both nulliparous and multiparous women experienced significantly shorter durations of labor in the Misoprostol group than those in the Oxytocin group (p < 0.001 and p = 0.001 respectively). Complications like hyperstimulation, retained placenta and postpartum hemorrhage all were somewhat higher in Misoprostol group than those in Oxytocin group, but the differences were not statistically significant (p = 0.357, p = 0.500 and p = 0.500 respectively). Conclusion: The use of vaginal misoprostol is more effective than intravenous infusion of oxytocin in induction of labor in patients with IUFD. The time required from induction to delivery is appreciably shorter when Misoprostol is used compared to that needed when oxytocin is used. Ibrahim Card Med J 2019; 9 (1&2): 74-79

Background & objective: Among the gynaecological cases admitted in tertiary care hospitals, abortion occupies the highest position. But detailed studies about the pattern of abortion admitted in the hospitals are limited. The present study was intended to find the proportion of abortion cases to total admitted cases and describe the types, clinical presentation and consequences of abortions. Methods: This study was carried out among a cross-section of abortion patients admitted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital. A total of 100 women admitted with a history of abortion between January and June, 2003 were consecutively included in the study. On admission, blood sample was sent for blood grouping & cross-matching and estimation of haemoglobin. Additional investigations like routine blood test, TC, DC, urine for R/E were done in septic abortion cases. High vaginal swab was collected from all cases but only in 5 patients, it was possible to carry out culture and sensitivity test. All cases were admitted and followed up to discharge for studying their consequences. Result: Majority (61%) of the patients was admitted in their third decade of life. The included cases were predominantly poor (68%), Muslim (97%) and urban residents (78%). Over half (54%) of the patients were illiterate. Sixty percent patients were multipara, 21% primipara and 19% nullipara. Two patients were unmarried. One-quarter had previous history of 1-4 abortions. Of the 100 cases of abortions, over three-quarters (77%) were of spontaneous abortions and 23% were of induced abortions. Two-thirds (66%) of the cases presented with incomplete abortions, which among others, included incomplete MR (13%). Septic abortion was 12%; of which 10% were induced and 2% spontaneous abortions, complicated to septic abortions. Missed abortion was 10%, inevitable 10% and threatened 6%. Out of 100 cases, 86% required operative intervention which included dilatation, evacuation and curettage (95.2%), subtotal hysterectomy, repair of perforation, hysterotomy and colpotomy. Two threatened abortions cases continued their pregnancy. One threatened abortion, five missed abortion, one septic abortion and six inevitable abortion cases spontaneously expelled their product of conceptus. Seventy-nine patients received whole blood transfusion to compensate for haemorrhage. Over 80% were discharged from the hospital within 5 days. Complications (except anaemia) of abortion were found in 49% cases. One case of septic abortion with endotoxic shock and severe anemia died of the disease. Conclusion: Complications of abortion are preventable if the patients are made aware about the grave consequences of abortion and appropriate health services are extended at field levels. Ibrahim Card Med J 2020; 10 (1&2): 66-73

This descriptive cross sectional study was carried out to determine the current status of Quality Assurance Scheme in undergraduate medical colleges of Bangladesh. This study was carried out in eight (four Government and four Non- Government) medical colleges in Bangladesh over a period from July 2015 to June 2016. The present study had an interview schedule with open question for college authority and another interview schedule with open question for head of department of medical college. Study revealed that 87.5% of college had Quality Assurance Scheme (QAS) in their college, 75% of college authority had regular meeting of academic coordination committee in their college, 50% of college had active Medical Education Unit in their college, 87.5% of college authority said positively on publication of journal in their college. In the present study researchers interviewed 53 heads of department with open question about distribution, collection of personal review form, submission with recommendation to the academic co-coordinator, and annual review meeting of faculty development. The researchers revealed from the interviews that there is total absence of this practice which is directed in national guidelines and tools for Quality Assurance Scheme (QAS) for medical colleges of Bangladesh. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 33-39