No abstract

Myocardial infarction (MI) presenting first time in labor is rare with incidence of 3 case per 1,00,000 and its management during labor is rarely seen in literature. In this case, a 29-year-old gravida 2 para 1 with previous caesarean section 1 year back with history of postpartum eclampsia presented with acute breathlessness and lower abdominal pain. She was diagnosed with acute MI. Patient had emergency caesarean section due to scar tenderness. Post operatively patient was managed in ICU with multi-disciplinary team of critical care, cardiologist and obstetrician.

Background: Minimally invasive surgery is the surgical approach of choice for the management of numerous benign and malignant gynaecological conditions of uterus that has come up in the last 2-3 decades. Although their superiority has been assessed objectively over traditional method. To qualitate this Technicity Index (TI) has been introduced which is dened as number of minimally invasive hysterectomies (Vaginal Hysterectomy, Laparoscopic Assisted Vaginal Hysterectomy, Robotic Hysterectomy, Laparoscopic Hysterectomy) divided by total number of hysterectomy cases over a given period of time. Method : Retrospective study of 1411 patients who underwent hysterectomy over a duration of 6 years in a suburban tertiary care centre were included in the study.For the purpose of evaluation of Technicity Index(TI) only 1347 hysterectomies were included excluding 64 hysterectomies which were done for obstetric indications. Data regarding age, parity, indication for hysterectomy and route of hysterectomy was collected and analyzed. Result: Out of 1347 hysterectomies 25 were performed laparoscopically (1.85%), 700 were performed vaginally (51.96%) and 622 were performed by abdominal route (46.17%). The average TI was 55% and it ranged from as low as 46.9% to as high as 64.5% as the trend changed over the years. Conclusion: Quality of care is determined by duration of surgery, length of stay, rate of complications, quality of life. There have been many studies afrming the advantages of vaginal and laparoscopic hysterectomies over the traditional abdominal route. Complications like secondary wound infections are higher and are also associated with poor cosmetic results. Technicity index is a novel method of objective assessment of the difference between various health care indicators and this practice helps as a quality indicator and will improve the health care of the patients.