No abstract

We present a rare case of A2+ve blood group with Placenta praevia with Obstetric Haemorrhage in mild hypovolemic shock. An emergency request for blood transfusion confounded the blood bank officer as the patient's blood was seemingly incompatible with all ABO blood groups. Further investigation revealed the patient's blood group to be a rare subtype of the A group known as A2+ve. This article highlights the need to be aware of such rare subgroups, especially in tertiary referral centres like ours, where unbooked Obstetric emergencies are encountered on a regular basis, so life-saving measures can be appropriately taken. CASe RepoRTA 31-year-old unbooked lady presented to the Obstetric emergency ward and a diagnosis of gravida 2, para 1, living 0 with 27 weeks of gestation with central placenta praevia with ante partum haemorrhage was made. She had undergone a previous caesarean section at term for a transverse lie and the baby was still-born. Patient had been treated for secondary infertility and conceived spontaneously ten years later with the present pregnancy. General examination revealed the patient to be in mild hypovolemic shock with a tachycardia of >130 beats/minute. Her blood pressure was 94/60 mmHg. Haemoglobin was 8.4 gm/dL. Blood group was A+ve but when sent for cross matching was found to be incompatible with all ABO groups. Senior blood bank officers were called in and further tests done indicated a rare subgroup of A2+ve. No blood in our bank and two other major blood banks was found compatible. Ultimately, four pints of compatible A2+ve blood was found after screening nearly 600 pints of A+ve blood at the Karnataka Red Cross Blood Bank. At present patient has received 3 pints of blood and antenatal steroids. Since she has no further bleeding we plan to monitor her as an inpatient till she crosses her period of viability or the fetus can sustain in an extra uterine environment, provided she has no further life threatening haemorrhage which would compromise either her or the baby. DiSCuSSionMassive obstetric haemorrhage is a major contributor towards maternal morbidity and mortality. The main causes are abruptio placentae, placenta praevia and postpartum haemorrhage [1]. Clinicians managing pregnant women should be equipped with the knowledge of blood and blood products and skills for managing massive obstetric haemorrhage. We are all familiar with the blood groups O, A, B discovered by K Landsteiner in 1900, by performing a series of mixing experiments with the blood of 22 colleagues in which red cells from each individual was mixed with the serum of each of the others. On the basis of the agglutination pattern that he observed, Landsteiner could establish three groups of individuals (A, B and O). Two years later, Landsteiner recognised a fourth (AB) group when the experiment was repeated on a larger group of subjects. Most clinicians are, however, unfamiliar with the fact that in 1911, Landsteiner detected the presence of subgroups of A, one of which was exhibiting weaker expression of th...

Background: Defensive medicine can be in the form of excessive tests, procedures, surgeries, or visits by the doctors to primarily reduce their exposure to legal liabilities. It also includes avoidance of high risk patients or procedures.  Medical profession has been included under consumer protection act which has led in developing hostile environment for medical practitioners.  This has led to increase in defensive medicine. In obstetrics and gynaecology incorporation of defensive medicine can be scrutinized by observing trends in caesarean section.Methods: It is a retrospective study carried out for 1 year from January 2015 to December 2015. All patients in whom caesarean section was done were included in this study. Indications for which Caesarean section was done were studied and results were compared with similar studies in other hospitals.Results: Overall rate of caesarean section observed in this study was 43.3%. Incidence of caesarean section in primigravidae was 59.5%. Only 2.1% of the patients underwent trial of scar resulting in vaginal birth. Foetal distress was one of the most common indicatorsfor caesarean section and its detection was based on foetal cardiotocograph readings. Out of all patients taken for caesarean section due to foetal distress only 28.5% of the babies required neonatal intensive care admission. Rising trend towards caesarean section on maternal request was also seen.Conclusions: Current climate of high professional liability is detrimental to good patient care as defensive medicine provides less benefit and much harm. Practice of medicine should be safe and hassle free. For this, standard protocols should be made and followed and if practitioners are abiding with standard protocols they should be protected against litigation.

Background: The vagina contains dozens of microbiological species in variable quantities and is, therefore, considered a complex environment. Among the microorganisms, bacteria have important repercussions on women’s health. The present study was conducted to elucidate this type of vaginal isolates and their sensitivity towards currently used antibiotics. Methods: This was a retrospective study conducted at the Department of Obstetrics and Gynaecology, Sapthagiri Hospital, Bangalore, India from January 2012 to December 2013. All symptomatic women who had a high vaginal swab taken for culture and sensitivity testing were included in this study. Antibiotic susceptibility was tested using disc diffusion method (modified Kirby-Bauer’s method). The antibiotic sensitivity patterns of isolated microorganisms were studied. Results: Out of 200 patients, 95% had positive vaginal cultures. Fifteen types of microorganisms were isolated. The highest frequency of infection was seen at the age of 20-30 years, followed by 41-50 years and 31-40 years, and a low frequency of infection was observed above 50 years of age. The most prevalent pathogen was Escherichia coli, followed by Streptococcus agalactiae and diphtheroids with equal incidence. Among the antibiotics tested, isolated pathogens were completely resistant to nalidixic acid and highly sensitive to meropenem and imepenem. Conclusion: The high prevalence of gynaecological infections demands that patients with symptoms undergo thorough investigation with cultures and sensitivity essays. Changes in treatment protocols are required to treat vaginal infections effectively.

No abstract