No abstract

No abstract

BACKGROUND Ultrasound has become the essential tool of modern obstetric practice as it is non-invasive, safe and radiation free. IUGR is defined as the pathologic inhibition of intrauterine foetal growth and the failure of the foetus to achieve its growth potential. Over the last decade, two different patterns of IUGR has been characterised on the basis of gestational age of onset. IUGR has a different phenotypic expression, evolution and outcome when it starts early in gestation called early-onset IUGR and it is different when it starts late in gestation known as late-onset IUGR. Early diagnosis and timely management decisions are the cornerstones for optimum outcome in these cases. MATERIALS AND METHODS This was a cross-sectional study collected from 152 pregnant women with IUGR foetuses, attending/ referred to Maharani Laxmi Bai Medical College and Hospital, Jhansi, Uttar Pradesh. The gray scale and colour Doppler sonography was routinely performed in all these IUGR pregnancies. Subsequently, the results were statistically analysed to find the association between different colour Doppler and gray scale parameters and time of onset of IUGR. RESULTS Abnormality in placenta, increased FL/AC ratio, increased S/D ratio and PI of umbilical artery, decreased S/D ratio and PI of middle cerebral artery and increased mean PI of uterine artery were more strongly associated with early-onset IUGR, while oligohydramnios was more strongly associated with late-onset IUGR. Low lying placenta, increased HC/AC ratio, decreased cerebroplacental ratio (CPR), increased S/D ratio of uterine artery, umbilical vein pulsation and increased PI of ductus venosus were equally associated with both early-and late-onset IUGR. CONCLUSION With the help of non-invasive, single study, sonographic gray scale and colour Doppler parameters, we can diagnose both types of IUGR, but most of the parameters were found to be more commonly associated with early-onset IUGR. So, we can use them to predict IUGR at an early stage and act accordingly for better perinatal outcome.

Placenta percreta is an obstetric emergency often associated with massive hemorrhage, emergency cesarean section, and peripartum hysterectomy. We present a case of a 30-year-old woman, G4P1L1A2 with placenta percreta managed by an alternative approach. The placenta was left in situ along with B/L internal iliac artery ligation during cesarean section and later on delayed subtotal hysterectomy with bladder repair was successfully performed. Placenta percreta spectrum is an obstetricians dilemma associated with massive hemorrhage and is a potential life-threatening condition for both mother and the baby. Cesarean section with B/L internal iliac artery ligation and delayed hysterectomy may be a reasonable strategy in the most severe cases.

Uterine inversion is a rare obstetric emergency that may lead to severe haemorrhage, shock and eventually death. The incidence of uterine inversion varies from one in 2,000-20,000 deliveries. Recurrent uterine inversion is still rare with no exact reported incidence so far. We report a case of a near miss patient, 28 years old primiparous with complete uterine inversion with atonic postpartum haemorrhage and shock, managed by manual repositioning and tamponade insertion which got corrected. Patient had recurrent uterine inversion twice in the puerperal period on 5th and 7th postpartum day. A new approach to management was taken. Rather than going for laparotomy, vaginal manual correction followed by intrauterine tri-way foley catheter insertion was done. Gradual deflation was done leading to final permanent correction. Uterine inversion is a rare but potentially deadly complication post vaginal delivery. Mortality and morbidity can be reduced by rapid recognition and immediate replacement. For recurrent inversion prolonged intrauterine balloon placement may be needed in rare cases.