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Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

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Background: Various caesarean delivery techniques have been compared in the past to assess the associated short-term and long-term advantages and disadvantages. Although uterine exteriorization at caesarean section is popular among obstetricians, safety of this technique remains a disputed matter. The aim of the present study was to compare the influence of uterine exteriorization or in situ repair on caesarean section morbidity.Methods: In this prospective, randomized, controlled study, 200 pregnant women with indication for caesarean delivery were randomized as 100 patients each in the exteriorization group and in the in-situ group. Data on mean time taken for uterine incision closure, intra-operative blood loss and post-operative morbidities were collected and compared between the two groups for statistical analysis.Results: A statistically significant trend towards lesser mean time taken for the uterine wound repair was observed in the exteriorization group. However significantly more number of patients had increased post-operative pain and need for additional analgesia in exteriorization group. There was no significant difference with respect to intra-operative blood loss and incidence of nausea and vomiting; incidence of post-operative endomyometritis, febrile morbidity, wound infection, time taken for return of bowel function and length of hospital stay among the two groups.Conclusions: We concluded that uterine exteriorization and in situ repair have similar post-operative caesarean section morbidity outcomes. However, in situ repair of uterus was associated with lesser post-operative pain, and exteriorization of uterus was associated with lesser operating time.

Background: The aim of this study is to compare the accuracy and adequacy of endometrial sampling using pipelle biopsy with dilatation and uterine curettage (D and C) and hysterectomy specimen in the assessment of endometrium in patients of perimenopausal and postmenopausal age.Methods: One hundred fifty patients of perimenopausal and postmenopausal age who attended the Gynecology OPD of KIMS Hospital from June 2012 to May 2014 with complaints of abnormal uterine bleeding or who were found to have abnormally thickened endometrium by ultrasonography were included in the study.Results: Adequate specimen could be obtained through pipelle biopsy in 86.7% of the patients, compared to 76% with adequate sample in case of D and C. Comparing histopathology reports between Pipelle and DandC specimens, the confidence interval was 92.7%, 95% lying in the range between 86.54% to 96.53%. 68 of the 150 patients had undergone hysterectomy for various reasons. Comparing histopathology reports between Pipelle and hysterectomy specimens, the confidence interval was 94.2%; 95% of study population lies within the C.I range of 84.05 %-98.79% while accounting for the whole population, which shows that Pipelle endometrial sampling can be considered to be almost accurate as HPE by hysterectomy specimen. Comparing the difficulty of the procedure, Pipelle biopsy was found to be easier in perimenopausal patients when compared to post-menopausal patients and the difference was statistically significant. Mode of delivery did not seem to affect the ease of Pipelle endometrial sampling as per present observations.Conclusions: Endometrial tissue sampling using Pipelle was found to be as reliable as D and C and hysterectomy specimen on histopathologic examination for the assessment of endometrium in perimenopausal and post-menopausal age group. Pipelle endometrial sampling was found to be yield adequate specimen when compared with D and C.