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O164 PLACENTA PERCRETA: RETROSPECTIVE ANALYSIS OF 12 CASES OVER LAST 11 YEARS
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
but 10–30% of these pregnancies may present with complications like red degeneration, pressure symptoms, torsion of pedunculated fibroid, PROM, preterm labor. Intrapartum complications include dysfunctional labor, difficult delivery, PPH. Myomectomy at the time of CS has been discouraged traditionally due to risk of hemorrhage and sometimes due to fear of litigation. Obstetrician is usually in dilemma when confronted with fibroids during CS. But if left alone fibroid may undergo degeneration and infection and will require another major surgery. Till recent past Intracesarean Myomectomy was done in cases with subserosal, pedunculated and if fibroids are located in lower segment in the caesarean incision line. Considering all these it is desirable to get the fibroids of any sort removed during CS in selective cases. Materials: During the period of January 2010 to December 2011, there were 25780 number of deliveries in the Department of Obstetrics & Gynaecology, Gauhati Medical College and Hospital, Assam, India. There were 65 (0.25%) antenatal cases who were diagnosed with fibroid uterus. Methods: Mapping of the fibroids in gravid uterus was confirmed by USG. Patients were counseled regarding the feasibility of myomectomy if they had to undergo CS. Results: Out of 65 cases, 55 (84.6%) of them underwent elective CS due to elderly primigravida, history of infertility and for IUGR etc. Among these 55 cases, 40 (72.7%) of them underwent Intracaesarean Myomectomy. During this process, Assistant Surgeon was asked to make a tight finger grip at the isthmic region to act as a tourniquet. 10 patients (28.57%) required blood transfusion because of pre-existing anaemia in pregnancy. Conclusions: Intracaesarean Myomectomy is possible routinely without additional hazards to the patients in an experienced hand and in a tertiary care centre.
had earlier 3 surgical MTP. Confirmed diagnosis was done antenatally with sonography and MRI only in 3 cases. LSCS followed by hysterectomy 6 cases, Of them 4 for atonic uterus [ 2 were post C.S & 2 were multipara with earlier vaginal deliveries], remaining 2 multipara with previous vaginal deliveries had posterior wall perforation and haemo-peritoneum. Upper segment CS done in 6 post C.S cases because of highly vascular lower segment. All of them had severe bleeding requiring hysterectomy and bilateral internal iliac artery ligation. In five cases placenta infiltrated upto urinary bladder wall, separation was difficult, all of them developed urinary fistula inspite of urologist performing the job and they required repair of fistula after puerperium. One had ureteric implantation because of transection of ureter during hysterectomy. All patients required multiple blood transfusions. Average hospital stay with bladder injury 6 weeks. No mortality in the present series. Conclusions: Placenta percreta is a life threatening situation in pregnancy. Because of rising trend of caesarean section, incidence of morbidly adherent placenta is increasing. High degree of suspicion in post caesarean placenta praevia cases is helpful to diagnose placenta percreta. Meticulous sonography & MRI are essential for antenatal diagnosis. Multidisciplinary approach of skilled obstetrician, urologist, surgeon, anaesthetist and availability of blood and its products are needed to reduce mortality and morbidity.
Figure: Fibroid. O164 PLACENTA PERCRETA: RETROSPECTIVE ANALYSIS OF 12 CASES OVER LAST 11 YEARS P. Das1 , C. Das1 . 1 Dept of O & G, Gauhati Medical College & Hospital, Guwahati, ASSAM, India
O165 BEYOND TRAINING: KEY INTERVENTIONS IN SCALING UP POSTPARTUM IUD SERVICES IN INDIA S. Das1 , B. Sood1 , R. Asif1 , S. Kumar1 , V. Yadav1 , S. Saha1 . 1 Jhpiego -An affiliate of Johns Hopkins University, New Delhi, India
Objectives: Placenta percreta is a rare but critical situation in pregnancy. Present study was done to assess magnitude of the problem, to analyse presenting symptoms, diagnostic aids, management, operative findings, mortality and morbidity. Materials: Over the last 11 years, w.e.f. 1st January 2001 to 31st December 2011, at GMCH, Guwahati, Assam, India, out of 1,05.886 no of deliveries placenta percreta was diagnosed in 12 cases. Methods: All the relevant documents of these cases were systematically analysed. Cases with visible placenta over the peritoneal surface of uterus were included. HPE of uterus was done in all cases. Results: Presenting symptoms: APH 66%, Haemo-peritoneum with shock 16.6%, foetal distress 16.6%. Associated risk factors: Previous caesarean section 66%, 3 of them were twice post C.S. and 5 were once post C.S. Of the multipara cases with no history of C.S, 2 had history of surgical MTP done twice and remaining two cases
Objectives: Given high unmet need for family planning, postpartum period is an opportune time for IUD placement, especially with government’s financial incentives fuelling a tenfold increase in institutional deliveries. The presentation focuses on key interventions for scaling up PPIUD services, going beyond competency based training. Materials: Government focuses on strengthening PPIUD services in selected hospitals of 19 states, with Jhpiego’s technical assistance. In March 2010, 2–4 providers per facility were given 3-day competency based training and expected to offer PPIUD services at their sites. Methods: Assessment findings of 31 facilities conducted a year later, service statistics and program implementation information were sources of data utilized. Results: From 31 sites which had sent providers for training, a year later only 18 facilities (58%) had trained PPIUD providers in place
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
but 10–30% of these pregnancies may present with complications like red degeneration, pressure symptoms, torsion of pedunculated fibroid, PROM, preterm labor. Intrapartum complications include dysfunctional labor, difficult delivery, PPH. Myomectomy at the time of CS has been discouraged traditionally due to risk of hemorrhage and sometimes due to fear of litigation. Obstetrician is usually in dilemma when confronted with fibroids during CS. But if left alone fibroid may undergo degeneration and infection and will require another major surgery. Till recent past Intracesarean Myomectomy was done in cases with subserosal, pedunculated and if fibroids are located in lower segment in the caesarean incision line. Considering all these it is desirable to get the fibroids of any sort removed during CS in selective cases. Materials: During the period of January 2010 to December 2011, there were 25780 number of deliveries in the Department of Obstetrics & Gynaecology, Gauhati Medical College and Hospital, Assam, India. There were 65 (0.25%) antenatal cases who were diagnosed with fibroid uterus. Methods: Mapping of the fibroids in gravid uterus was confirmed by USG. Patients were counseled regarding the feasibility of myomectomy if they had to undergo CS. Results: Out of 65 cases, 55 (84.6%) of them underwent elective CS due to elderly primigravida, history of infertility and for IUGR etc. Among these 55 cases, 40 (72.7%) of them underwent Intracaesarean Myomectomy. During this process, Assistant Surgeon was asked to make a tight finger grip at the isthmic region to act as a tourniquet. 10 patients (28.57%) required blood transfusion because of pre-existing anaemia in pregnancy. Conclusions: Intracaesarean Myomectomy is possible routinely without additional hazards to the patients in an experienced hand and in a tertiary care centre.
had earlier 3 surgical MTP. Confirmed diagnosis was done antenatally with sonography and MRI only in 3 cases. LSCS followed by hysterectomy 6 cases, Of them 4 for atonic uterus [ 2 were post C.S & 2 were multipara with earlier vaginal deliveries], remaining 2 multipara with previous vaginal deliveries had posterior wall perforation and haemo-peritoneum. Upper segment CS done in 6 post C.S cases because of highly vascular lower segment. All of them had severe bleeding requiring hysterectomy and bilateral internal iliac artery ligation. In five cases placenta infiltrated upto urinary bladder wall, separation was difficult, all of them developed urinary fistula inspite of urologist performing the job and they required repair of fistula after puerperium. One had ureteric implantation because of transection of ureter during hysterectomy. All patients required multiple blood transfusions. Average hospital stay with bladder injury 6 weeks. No mortality in the present series. Conclusions: Placenta percreta is a life threatening situation in pregnancy. Because of rising trend of caesarean section, incidence of morbidly adherent placenta is increasing. High degree of suspicion in post caesarean placenta praevia cases is helpful to diagnose placenta percreta. Meticulous sonography & MRI are essential for antenatal diagnosis. Multidisciplinary approach of skilled obstetrician, urologist, surgeon, anaesthetist and availability of blood and its products are needed to reduce mortality and morbidity.
Figure: Fibroid. O164 PLACENTA PERCRETA: RETROSPECTIVE ANALYSIS OF 12 CASES OVER LAST 11 YEARS P. Das1 , C. Das1 . 1 Dept of O & G, Gauhati Medical College & Hospital, Guwahati, ASSAM, India
O165 BEYOND TRAINING: KEY INTERVENTIONS IN SCALING UP POSTPARTUM IUD SERVICES IN INDIA S. Das1 , B. Sood1 , R. Asif1 , S. Kumar1 , V. Yadav1 , S. Saha1 . 1 Jhpiego -An affiliate of Johns Hopkins University, New Delhi, India
Objectives: Placenta percreta is a rare but critical situation in pregnancy. Present study was done to assess magnitude of the problem, to analyse presenting symptoms, diagnostic aids, management, operative findings, mortality and morbidity. Materials: Over the last 11 years, w.e.f. 1st January 2001 to 31st December 2011, at GMCH, Guwahati, Assam, India, out of 1,05.886 no of deliveries placenta percreta was diagnosed in 12 cases. Methods: All the relevant documents of these cases were systematically analysed. Cases with visible placenta over the peritoneal surface of uterus were included. HPE of uterus was done in all cases. Results: Presenting symptoms: APH 66%, Haemo-peritoneum with shock 16.6%, foetal distress 16.6%. Associated risk factors: Previous caesarean section 66%, 3 of them were twice post C.S. and 5 were once post C.S. Of the multipara cases with no history of C.S, 2 had history of surgical MTP done twice and remaining two cases
Objectives: Given high unmet need for family planning, postpartum period is an opportune time for IUD placement, especially with government’s financial incentives fuelling a tenfold increase in institutional deliveries. The presentation focuses on key interventions for scaling up PPIUD services, going beyond competency based training. Materials: Government focuses on strengthening PPIUD services in selected hospitals of 19 states, with Jhpiego’s technical assistance. In March 2010, 2–4 providers per facility were given 3-day competency based training and expected to offer PPIUD services at their sites. Methods: Assessment findings of 31 facilities conducted a year later, service statistics and program implementation information were sources of data utilized. Results: From 31 sites which had sent providers for training, a year later only 18 facilities (58%) had trained PPIUD providers in place