The management of abruptio placentae remains a problem, despite advances in medical science. This study analyses severity of abruption, resultant morbidity, and maternal and fetal mortality in 105 cases. Among the contributory factors, hypertension (44%) and grand multiparity (24%) were common. There was no maternal death among these cases, mainly because of liberal use of blood transfusion, prompt delivery, and careful fetal monitoring, but perinatal mortality remained high (73%). Factors responsible for this high perinatal mortality and its prevention are discussed.
An unusual case of recurrent benign trophoblastic growth occurring for the fourth time in a gravida 4, para 0, 30-year-old woman is reported. Prophylactic chemotherapy was instituted to avert the disaster again, without success. The question of her future obstetric outcome poses a formidable dilemma and no radical measures could be undertaken, as the patient hoped for a normal pregnancy.
A case of leiomyoma of the female urethra is reported. The patient, a perimenopausal, multiparous woman presented with a gradually enlarging mass per vagina for the past 6 months. A provisional diagnosis of carcinoma of skene's duct or vaginal leiomyoma was entertained and an excisional biopsy performed. To our surprise, histopathological examination revealed an urethral cellular leiomyoma.
Cervical incompetency has been recognized as a cause of repeated reproductive loss. Currently many surgeons cast doubt on the existence of cervical insufficiency and the efficiency of encerclage to salvage the situation. Over a period of 3 years we did cervical encerclage for 23 patients with recurrent pregnancy loss in whom all other causes were ruled out. Twenty-one patients benefitted by the procedure, only one ended in missed abortion and one patient had preterm delivery with early neonatal loss. We had a fetal salvage of 91.3%. Birth weights of the babies were above 2500 g in 65.2%. In our experience, with proper selection, patients benefitted from encerclage performed at the appropriate time.
Septic induced abortion is still posing a problem in our community. Out of 14 grade I11 septic induced abortion, 12 required surgical intervention as part of active management for appropriate therapy. Clinical variables like patient characteristics, method of induction, person responsible for induction, the methods, the reason for delay in admission were analysed in detail with a view to obtain a comprehensive idea of this socio-medical problem and its prevention.
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