Obstetric practice in recent times has witnessed a steady increase in the rate of primary cesarean sections and thus, the consequences of the same. Managing previous cesarean cases in obstetrics has now become a routine, and the complications which we encounter in these patients. In this case series, we present five different presentations of previous cesareans and their outcomes. Treating the complications in these leads to a lot of diagnostic and management dilemmas as there is no definite prescribed protocol and individualized management strategies need to be adopted. Atypical clinical and radiological signs should be identified in such cases and should be managed in a tertiary care hospital for the best outcome of the patient. How to cite this article: Rao S, Hadi V, Mallapur A, et al. Myriad Obstetric Complications in Patients with Scarred Uterus: A Case Series. J South Asian Feder Obst Gynae 2020;12(6):438–442.

Background: Uterine fibroid are the most common benign tumour of the uterus and is seen in 20% of women in their reproductive age group. The aim of the study was to evaluate effect of Mifepristone on uterine fibroid with reference to reduction in size of fibroid and change in symptomatic profile. Methods: It is a hospital based interventional study conducted at KIMS Hubli hospital. 98 patients with symptomatic fibroid uterus were given 50mg of Mifepristone on alternate day for 3 months. Results: Mifepristone treatment significantly reduced mean PBAC score from baseline score of 212.61 to 20.39 at the end of 3rd month of therapy. Mean fibroid volume also reduced significantly from baseline value of 237.95cm3 to 30.45cm3 after 3 months of treatment. At the end of therapy hemoglobin was raised from 9.57g/dl at baseline to 10.42g/dl after 3 months of treatment. No major side effects were observed, and 7% patients had hysterectomy. Conclusions: Mifepristone is very useful option in perimenopausal women with symptomatic fibroid. It reduces fibroid size and its symptoms without any major side effects. However, future long term RCTs are needed to assess the safety and efficacy of Mifepristone.

BACKGROUND Postpartum haemorrhage is a major cause of mortality and morbidity in pregnant women in developing countries. Caesarean section is associated with increased blood loss. Misoprostol is used as potent uterotonic agent that has been thoroughly studied in the prevention and treatment of PPH after vaginal delivery. However, role of preoperative rectal misoprostol in caesarean section for reducing blood loss is not studied much, hence this study was undertaken. MATERIALS AND METHODS This randomised controlled trial was performed between Jan 2017-July 2017 on 200 high-risk pregnant women coming to labour room of Department of Obstetrics and Gynaecology, Karnataka Institute of Medical Sciences, Hubli, divided into two groups. The Group A (n= 100) received 400 μg of misoprostol. The Group B (n= 100) received 10U IM oxytocin after delivery as per hospital protocol. The primary outcome measures were amount of blood loss and change in haemoglobin level 24 hrs. after surgery. RESULTS The mean intraoperative blood loss was significantly lower in Group A (389 ± 172.56 mL) than Group B (445 ± 180.42 mL). The difference between the preoperative and postoperative haemoglobin value was also significantly lower in the misoprostol group (0.84) than the oxytocin group (1.10) with (p= 0.0300). Admissions to the neonatal intensive care unit were comparable between the two groups. CONCLUSION Preoperative administration of 400 μg rectal misoprostol significantly reduced blood loss compared to oxytocin in caesarean section without significant side effects and it can be used as an alternative to oxytocin.

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