Papers by Pratibha Devabhaktuni
The Journal of Obstetrics and Gynecology of India, Feb 1, 2010
International journal of reproduction, contraception, obstetrics and gynecology, Sep 27, 2023
... Pregnancy outcome in chronic rheumatic heart disease Devabhaktuni Pratibha 1, Devineni Kiranm... more ... Pregnancy outcome in chronic rheumatic heart disease Devabhaktuni Pratibha 1, Devineni Kiranmai 2, Vemuri Usha Rani 3, Namani Geeta Vani 4 1 Professor & Superintendent, 2 Asst. ... Am J Obstet Gynecol 1998;179:1643-53. 9. Mishra S, Narang R, Sharma M et al. ...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
A referral case from Kollampally, Narayanpet, primi past EDD by 2 days, thrombocytopenia and elev... more A referral case from Kollampally, Narayanpet, primi past EDD by 2 days, thrombocytopenia and elevated bilirubin levels. EDC-18.09.22, scan EDC- 26.09.22 She had a vaginal septum and a poor Bishop score. During caesarean section, there was atonic post-partum haemorrhage, (PPH). When PPH could not be controlled with medical management, Haymans stitches were applied to control the bleeding. Total she received seventeen units of blood products, (4 FFPS, 1 SDP, 2 PRBC, 10 CRYO). She succumbed on the fourth POD. Fulminant hepatic failure, hepatic encephalopathy, grade 111, oliguric, AKI, thrombocytopenia, coagulopathy, with sepsis. The second case, a 24 years primi, 38 weeks 4 days, jaundice of three days duration, with HELLP? AFLP, thrombocytopenia with poor Bishop score. This case was a referral from SVS medical college, Mahaboob Nagar (MBNR) on 25.10.22, 7.23pm. An emergency LSCS was performed on 26.10. 22, 2.15 am. Blood products 25 units, (1 PRBC, 8 FFP, 6 RDP, 10 Cryo) units transfu...
International journal of reproduction, contraception, obstetrics and gynecology, May 26, 2022
Background: In the recent years, 2021 to 2022, there has been a sudden rise in the number of HELL... more Background: In the recent years, 2021 to 2022, there has been a sudden rise in the number of HELLP syndrome cases admitted to Modern Government Maternity Hospital, (MGMH) / Osmania Medical College. There were maternal deaths due to complications secondary to HELLP syndrome. Complications like placental abruption, DIC, PPH, PRAKI, pulmonary edema, were responsible for maternal deaths. The need for blood products has increased enormously. In our earlier study of eclampsia and imminent eclampsia from the same Institute, during 2004 to 2007, we did not find HELLP syndrome to be a major cause of maternal deaths. Hence, we proceeded with in depth study of the complications, morbidity and mortality and some management issues related to HELLP syndrome. All 70 cases of HELLP in this study had associated Preeclampsia/eclampsia. Methods: This is a prospective analytical observational study of 70 cases of HELLP syndrome. Results: Recurrent preeclampsia was noted in 6÷45=13.33%. Cases of hypothyroidism were observed in 6÷45=13.33%. There were four sets of twins, 8.88%. Placental abruption was noted in 10/70 women with HELLP, 14.28%, DIC occurred in 15÷70=21.42%, PPH occurred in 11÷45 cases, 24.44%, PRAKI was recorded in 16/70 patients, 22.85%, Pulmonary edema occurred in 5/70, 7.14%, PPCM in cases with HELLP syndrome were 2÷70=2.85%, Abdominal delivery was needed in 53÷70=75.71%, Maternal mortality in the present study was10÷70=14.28%, The perinatal mortality was 21.33%. Blood products were needed in 22/45 cases, (9.136) units on the average. Conclusions: Dissemination of knowledge that immediate delivery should be planned in all cases of HELLP, irrespective of gestational age is the need of the hour. Postponing delivery would lead to complications.
Open Journal of Obstetrics and Gynecology, 2017
Introduction: The aim of this study was: 1) To study the pattern of menstrual abnormality and sev... more Introduction: The aim of this study was: 1) To study the pattern of menstrual abnormality and severity in women on anticoagulant and antiplatelet drugs. 2) To analyze the correlation of prothrombin time (PT), International Normalised ratio (INR) and the bleeding severity. 3) To discuss the various management options in unexpected emergencies and menstrual complications in this subset of women on anticoagulants. Material & Methods: It is a prospective study, over a period of 18 months from July 2011 to december 2012. We had 44 women on antithrombotic therapy. 32 women were on anticoagulants and 12 were on antiplatelet agents. The severity of bleeding pattern was assessed with pictoral bleeding assessment chart (PBAC). 1) Out of 44 women studied, 32 women were on anticoagulants and 12 were on antiplatelet agents. 26 (81.25%) were on acenocoumarol, 5 (15.62%) on warfarin, 1 (3.12%) on heparin, among the 12 antiplatelet users, 8 (66.66%) were on aspirin and 4 (33.33%) on clopidogrel. 2) The indication for anticoagulants was mitral valve replacement (MVR) in 9, double valve replacement (DVR) in 6, aortic valve replacement (AVR) in 3, severe pulmonary artery hypertension (PAH) in 2, severe mitral stenosis (MS) with atrial thrombus in 2, deep vein thrombosis (DVT) in 5, severe mitral regurgitation (MR) in one, the other indications were subdural hematoma, thromboendarterectomy, chronic kidney disease (CKD) stage V, coarction of aorta, one each. The indication for antiplatelet therapy was percutaneous transluminal coronary angioplasty (PTCA) in 3, Wolf Parkinson White (WPW) syndrome + atrial fibrillation (AF), acute myocardial infarction (AMI), coronary artery bypass graft (CABG), mid basilar artery aneurysm, renal allograft recipient, dialated cardiomyopathy, aortic aneurysm repair, hypertension and unstable angina one each. Results: In women on anticoagulants (32), the main complaint was menorrhagia/heavy menstrual bleeding (HMB) in 20, polymenorrhoea with menorrhagia in 4,
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2022
Background: The aim of the study was to estimate the levels of glycosylated fibronectin (GlyFn) i... more Background: The aim of the study was to estimate the levels of glycosylated fibronectin (GlyFn) in preeclampsia (PE), and hypertensive disorders of pregnancy (HDP) and to correlate with the severity of the disease, adverse outcomes and complications. The study included 77 cases of HDP that were managed in the Institute of Obstetrics and Gynaecology, Modern Government Maternity Hospital (MGMH), Osmania Medical College, Hyderabad.Methods: This study was a prospective non-interventional analytical investigative study. To ascertain the performance of this biomarker, GlyFn, we evaluated the LumellaTM GlyFn POC test.Results: GlyFn positivity percentage was found to be highest in eclampsia (78.57%), next in PE with severe features 74.07%, in HELLP syndrome and gestational hypertension (HTN) (71.42%). In PE without severe features (66.66%) and in chronic HTN with PE superimposed (55.55%). Maternal complications include: abruption 5 (6.57%), thrombocytopenia 3 (3.94%), acute kidney injury (A...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
Mrs. A, 30 years, para 3 with three live children was an unbooked emergency admission on 6 April ... more Mrs. A, 30 years, para 3 with three live children was an unbooked emergency admission on 6 April 2007 with history of severe postpartum haemorrhage (PPH). She was in a state of shock with hypotension, tachycardia, pallor due to anaemia. Examination revealed the uterine inversion, uterus visible as a fleshy red mass protruded outside the vaginal introitus. Puerperal uterine inversion was reduced by vaginal manual reposition under observation through a mini laparotomy incision. She was transfused 4 units of O positive blood. On the second postoperative day she had signs and symptoms of a haemolytic transfusion reaction (HTR). She developed jaundice, haematuria and worsening anaemia. She was later detected to be Bombay Oh phenotype. Total 6 units of Bombay phenotype blood was transfused in a couple of days. Case 2: Mrs. R, 22 years primigravida, term gestation was admitted in labour in government maternity hospital/Osmania medical college, Hyderabad on 26 July 2007. A resident from Mah...
Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and immin... more Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and imminent eclampsia with the management adopted at a tertiary hospital. Methods: During a period of 34 months, from 2003-2007 at Government maternity hospital, Osmania medical college, Hyderabad, 666 women with eclampsia and imminent eclampsia were managed. The number of eclampsia and imminent eclampsia (IE) was 532 and 134, respectively. We have analyzed the clinical profile, parity, age, degree of proteinuria, the period of gestation in weeks, the antenatal care, the number of antenatal visits, referrals from other hospitals, the diastolic B.P. at the time of admission, the recurrence of convulsions and the complications. 1) All the cases of eclampsia and IE were managed with magnesium sulphate as an anticonvulsant. 2) Oral nifedipine, IV labetalol, sublingual nifedipine and nitroglycerine infusion were used to control severe hypertension. 3) Prostaglandin E1 (PGE1) was used for induction of...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Peripartum cardiomyopathy (PPCM) is one of the rare causes of heart failure in pregna... more Background: Peripartum cardiomyopathy (PPCM) is one of the rare causes of heart failure in pregnant women. It occurs in late pregnancy or up to 5 months post-partum. It is associated with high mortality and morbidity but with chances of full recovery. This paper discusses the treatment of peripartum cardiomyopathy, Peripartum cardiomyopathy management -multidisciplinary approach. 2011-2013 at CIMS.Methods: This is an observational study conducted at CARE institute of medical sciences, CIMS, during 2011-2013 years. Women fulfilling the criteria for the diagnosis of PPCM were included in the study. In this study we have analysed the obstetric intervention, the duration of ICU stay, hospital stay, maternal and perinatal outcomes. The cardiac drugs to manage each individual case suited to her condition have been mentioned.Results: Six cases were diagnosed to have PPCM in pregnancy when there was sudden onset of shortness of breath, cough, and palpitations. Four cases had history of PPCM...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disea... more Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically correct...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Between January 2001 to September 2003, 46,171 deliveries were recorded, the number o... more Background: Between January 2001 to September 2003, 46,171 deliveries were recorded, the number of caesarean deliveries during this period of two years and nine months were 16,182 (35.04%). Methods: An Audit from the Institute of obstetrics and gynecology, of uterine ruptures.Results: Total 81 cases of uterine rupture were managed at the Institute. Total number of scar ruptures managed were, 48/81 uterine ruptures. Five women had previous classical upper segment caesarean, and in previous lower segment caesarean section (LSCS), there were 43 cases of rupture uterus. In two cases following forceps delivery, traumatic uterine ruptures were recorded. Spontaneous ruptures were 31 during the study period. Bladder rupture occurred in 13 cases, 16.04% of uterine ruptures. The fetal outcome in uterine ruptures 81 cases, live births were 19-23.45%. The number of vaginal births after caesarean section were 261, 215, 186 in the years 2001, 2002 and 2003 at the Institute of obstetrics and gyn...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: During a period of eight months, 180 cases of abruption that occurred from January 20... more Background: During a period of eight months, 180 cases of abruption that occurred from January 2007 to August 2007 at GMH, Nayapool, Hyderabad were analysed. Total number of deliveries during the study period of eight months were 14004. Incidence of abruption cases delivered was - 1.3%. In this series 88% were unbooked in our hospital, were referrals. Objective of this study was to study maternal fetal outcome of placental abruption.Methods: Initial clinical assessment, investigations for maternal fetal wellbeing, expedite delivery, manage complications as per accepted protocol. In this series of cases, ARM was done in 85 cases (47.22%), ARM was done and oxytocin drip was started in 36 (20%), ARM was done and PGE1 tablet 25 mcg. was inserted in the vagina in 39 (21.66%).Results: The bleeding was revealed in 146-81.1% and concealed in 34-18.88%. The number of cases with hypertension complicating pregnancy were 102-57%, hypotension in 16-8.88%, prolonged clotting time 13-7.22%, the nu...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to d... more Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to discuss the utility of hysteroscopy combined guided endometrial curettage in the diagnosis of uterine cancer and endometrial hyperplasia, and, treat benign lesions, like polyps, synechiae at the same sitting. At MGMH during the years, 2002 to 2006, there were 57 women, and at care, 40 women with PMB during 2011 to 2013, and three in a nursing home, Hyderabad, were investigated.Methods: Evaluation was done in 100 women presenting with PMB by hysteroscopy and curettage to diagnose the cause of PMB and benign lesions like polyps, synechiae were managed by operative hysteroscopy. Bettocchi 5 mm hysteroscope, monopolar instruments and glycine was used for excision of polyps.Results: In one hundred women with PMB, 19% had cancer. Endometrial adenocarcinoma in 14, endocervical carcinoma in 2, uterine carcinosarcoma in 3 cases. All 3 cases of uterine carcinosarcoma on hysteroscopy were large poly...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Most cases of secondary postpartum haemorrhage (PPH) are due to retained placental pr... more Background: Most cases of secondary postpartum haemorrhage (PPH) are due to retained placental products (RPP). This study had a crop of five cases of secondary PPH, referral cases, during a period of six months during 2006. Four cases were following a caesarean delivery and in one, sub mucous and intra mural, uterine fibroids, caused retained placental tissue by distortion of the uterine cavity. Objectives of this study were to evaluate the feasibility of hysteroscopy to identify the retained placental products in cases of secondary postpartum haemorrhage. Verification of complete removal of RPP by reinsertion of hysteroscope, after removal of RPP by using a sponge holder, or curette.Methods: Trans vaginal ultrasonography (TVS) identified echogenic retained products of conception in all cases. Surgical profile investigations were done as per protocol. Transfusion of blood products was needed in some. Bettocchi 5 mm continuous flow hysteroscope (Karl Storz) was used. Storz endomat hy...
Open Journal of Obstetrics and Gynecology
Open Journal of Obstetrics and Gynecology
OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is ... more OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of prostaglandins for labor induction, it was a routine practice to do amniotomy and use oxytocin drip to accelerate labor when vaginal delivery was contemplated. We present 116 cases of placental abruption, including the severe cases, managed in the year 2006 during a period of 8 months, at Modern Government Maternity Hospital, which was the biggest maternity hospital in the combined state of Andhra Pradesh, and is the biggest in the state of Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for cervical ripening and labor induction/augmentation has been analyzed in this observational study. A variety of variables including age, parity, gestational age, severity of abruption and maternal and fetal status, associated preeclampsia, Bishop score, availability of blood and blood products, associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been studied in terms of efficacy, the total number of doses of vaginal PGE1 in relation to parity, induction delivery interval, successful vaginal delivery rate, the indications for caesarean delivery, perinatal outcome and complications. A decision was made for either abdominal delivery or vaginal delivery on a case to case basis. A routine amniotomy was performed when the cervical os was open, both for confirmation of diagnosis and to release intra uterine pressure, and also it would help in the acceleration of labor. When the Bishop score was more than six, amniotomy was performed and an oxytocin intravenous drip was started. If the Bishop score was less than six, 25/50 mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS: Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In our study 68/116, (58.
Open Journal of Obstetrics and Gynecology
Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and immin... more Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and imminent eclampsia with the management adopted at a tertiary hospital. Methods: During a period of 34 months, from 2003-2007 at Government maternity hospital, Osmania medical college, Hyderabad, 666 women with eclampsia and imminent eclampsia were managed. The number of eclampsia and imminent eclampsia (IE) was 532 and 134, respectively. We have analyzed the clinical profile, parity, age, degree of proteinuria, the period of gestation in weeks, the antenatal care, the number of antenatal visits, referrals from other hospitals, the diastolic B.P. at the time of admission, the recurrence of convulsions and the complications. 1) All the cases of eclampsia and IE were managed with magnesium sulphate as an anticonvulsant. 2) Oral nifedipine, IV labetalol, sublingual nifedipine and nitroglycerine infusion were used to control severe hypertension. 3) Prostaglandin E1 (PGE1) was used for induction of labour (IOL), 25 mcg × 4 th hrly, vaginal route and 50 mcg for less than 28 weeks gestation, in 290/424 cases of IOL. Other methods of IOL were employed in 134 cases. Results: Eclampsia (n = 532) occurred antepartum in 407 (75.56%), intrapartum in 76 (14.28%), post partum in 46 (8.64%) and intercurrent in 3 (0.5%) patients. The period of gestation was <28 weeks in 86, 28-34 weeks in 228, >34 weeks in 340 patients. Induction of labour with misoprostol was done in 290 with vaginal delivery in 235 (81%) and lower segment caesarean section (LSCS) for failed IOL in 55 (19%) and other methods of IOL were used in 134. The total number of deliveries was 656, with vaginal deliveries in 336 (66.46%) patients, ceasarean deliveries in 220 (33.54%) patients. Ten patients died undelivered. Maternal mortality was 17/666-2.55%. Cerebrovascular events were responsible in 13/17 (76.46%) patients, pulmo
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Papers by Pratibha Devabhaktuni