Karthik Chandra Bassetty - Academia.edu (original) (raw)

Papers by Karthik Chandra Bassetty

International journal of reproduction, contraception, obstetrics and gynecology, Jul 26, 2018

Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level ... more Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level of the internal os. Cervical pregnancy is an infrequent form of ectopic gestation both in naturally conceived pregnancies and even after assisted reproductive technology (ART). It accounts for less than 1% of all ectopic pregnancies. The diagnosis can be missed as a case of incomplete abortion unless an experienced sonologist performs a transvaginal ultrasound. Management options vary and depend on the gestational age at diagnosis, general condition of the patient and woman's desire to maintain fertility. Medical treatment with methotrexate is the therapy of choice in early gestation with hemodynamically stable patient. Surgical intervention is indicated in late gestation, unstable cases or failed medical treatment. At times hysterectomy is elected as the final path when bleeding does not subside. We present an unique case of twin cervical ectopic pregnancy managed initially conservatively later surgical management was undertaken in view of bleeding.

International journal of reproduction, contraception, obstetrics and gynecology, Jul 26, 2017

Background: The aim of the study was to evaluate the indications and outcomes of failed induction... more Background: The aim of the study was to evaluate the indications and outcomes of failed induction in primigravidae in a tertiary care hospital located in a health resource poor setting. Methods: We conducted a retrospective cross-sectional study on women admitted in the labor room and planned for induction of labor in Assam Medical College and Hospital, Dibrugarh from 1 st July 2016 to 31 st May 2017. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean section. Results: A total of 201 primigravida patients were selected for the study of which 135 patients delivered by CS and 66 patients by spontaneous vaginal delivery. The average induction-delivery interval was found to be 18.9 hours. Average weight of the babies was 2.9 kg. The following factors are associated with increased rates of failed induction: Bishop's score less than 5, Gestational age >41 weeks, teenage and elderly primi, oligohydramnios, prelabour rupture of membranes (PROM), hypertensive disorders of pregnancy, induction-delivery interval greater than 24 hours, absence of a dating ultrasound done in 1 st trimester, meconium stained liquor, SGA and macrosomia babies. There has been a single maternal death due to rupture of uterus. Conclusions: Most common indication of doing IOL is postdated pregnancy (>40 weeks of gestation). Majority of women (66%) had no dating ultrasound with them hence they were induced based on last menstrual period which is unreliable in most women leading to failed IOL.IOL protocol i.e. when to repeat and how long to wait was purely the duty consultant's opinion in our study rather than following a protocol. IOL is an important obstetric procedure hence there is a dire need to develop a protocol for the same in our setup.

Journal of Cancer Research and Clinical Oncology

Tropical Doctor

Our observational cross-sectional study looked at the risk factors, diagnosis, management and out... more Our observational cross-sectional study looked at the risk factors, diagnosis, management and outcomes of placenta accrete spectrum at the Christian Medical College and Hospital, Vellore, India, between January 2013 and December 2018. A total of 21 cases of placenta accrete spectrum are described among whom a preop diagnosis was available in 14 cases. A previous history of Caesarean section and placenta previa was present in 90%. Caesarean hysterectomy was carried out in 80%, but none of those managed conservatively required interval hysterectomy. Urinary tract injury was the most common surgical complication, seen in over 50%. The mean blood loss was 3.5 l and 14 patients required intensive care unit admission, but no maternal mortality ensued. Thus, we conclude that the conservative management in carefully selected cases is feasible.

The Journal of Obstetrics and Gynecology of India

Vulval Intraepithelial Neoplasia 3 (VIN) is a chronic, premalignant condition affecting the vulva... more Vulval Intraepithelial Neoplasia 3 (VIN) is a chronic, premalignant condition affecting the vulval skin. The age standardised incidence is approximately one per 100,000 women, with a peak at 30–49 years of age, and has risen over recent decades. This study would analyse the pattern of presentation, diagnosis, treatment and follow up of patients diagnosed with VIN 3 over a period of ten years at a tertiary care centre in India. This was a retrospective study conducted on all patients diagnosed to have VIN 3 between 1 January 2010 to 30 November 2019 in the Department of Gynaecologic Oncology, Christian Medical College, Vellore were included in this study. The outpatient records of the patients were obtained from an electronic registry. A total of 18 patients were diagnosed of VIN 3 during this time period. Sixteen patients were older than 50 years. Abnormal PAP was noted in 10 patients (HSIL-7, LSIL-2, ASC-H-1). Four patients had coexisting VAIN 3. About 16 patients underwent primary simple vulvectomy or wide local excision. Two patients were managed conservatively. Nine patients had recurrence with mean disease free interval of 12.5 months (4–36 months). Cryotherapy was used in 2 patients. Imiquimod was used in 3 patients. Surgical margins was achieved in 7 patients out of which 5 patients had recurrence. About 50% of patients with involved margins on biopsy had recurrence. Mean duration of follow up was 17 months (4–105 months). About 8 patients developed squamous cell carcinoma of genital tract on follow up. VIN 3 has a high rate of progression to invasive SCC. Regression of VIN is rare. Proper follow up and treatment of VIN 3 goes a long way in preventing the morbidity associated with vulval cancer.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level ... more Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level of the internal os. Cervical pregnancy is an infrequent form of ectopic gestation both in naturally conceived pregnancies and even after assisted reproductive technology (ART). It accounts for less than 1% of all ectopic pregnancies. The diagnosis can be missed as a case of incomplete abortion unless an experienced sonologist performs a transvaginal ultrasound. Management options vary and depend on the gestational age at diagnosis, general condition of the patient and woman’s desire to maintain fertility. Medical treatment with methotrexate is the therapy of choice in early gestation with hemodynamically stable patient. Surgical intervention is indicated in late gestation, unstable cases or failed medical treatment. At times hysterectomy is elected as the final path when bleeding does not subside. We present an unique case of twin cervical ectopic pregnancy managed initially conservative...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: Puerperal sepsis in developing countries is a major health problem. Antenatal and lab... more Background: Puerperal sepsis in developing countries is a major health problem. Antenatal and labour related risk factors play a huge role in causing puerperal sepsis, many of which are modifiable. The aim of the present study is to study the risk factors, clinical features and outcomes of puerperal sepsis in the mother and determine the causative microorganisms involved.Methods: A prospective observational study was conducted at the department of Obstetrics and Gynaecology, Assam Medical college and Hospital from 1st July 2016 to 30th June 2017.Peurperal sepsis cases were identified based on the WHO clinical definition. A total of 88 patients were identified. Information regarding occupation, antenatal care, delivery related events and outcome were recorded on a predesigned proforma. Mothers were followed up till discharge from the hospital.Results: Out of 88 clinically diagnosed patients with puerperal sepsis, common risk factors associated with mortality were young age(p<0.001...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Gynecology & Obstetrics, 2017

Background: Intrauterine growth restriction (IUGR) in developing countries is a major health prob... more Background: Intrauterine growth restriction (IUGR) in developing countries is a major health problem. Maternal risk factors play a huge role in causing IUGR, many of which are preventable or modifiable. Aim: To find out the risk factors and outcomes of IUGR infants in pregnant women coming for delivery in a developing country. Method: A cross sectional observational study was conducted at the department of Obstetrics and Gynaecology, Assam Medical College and hospital from July 2016 to December 2016. IUGR was diagnosed clinically by a lag of 4 weeks between actual gestational age and uterine fundal height. Total of 200 pregnant women with IUGR coming for delivery were included. Information regarding occupation, gestational age, maternal risk factors, mode of delivery and neonatal outcome were recorded on predesigned proforma. Mothers were followed up till delivery and neonates were followed up till discharge or death. Results: Out of 200 clinically diagnosed pregnancies with IUGR, 148 neonates were IUGR as per Fenton's Growth Chart, significant risk factors for IUGR were gestational hypertension (p=0.0001), anaemia (p=0.0001), ethnicity (p<0.05). Our method of clinically selecting patients was highly accurate (p<0.05) when compared with birth weight as per Fenton's chart. Of 143 IUGR neonates, 6(4%) were still born, 10(6.7%) had died at birth due to resuscitation failure, 45(30%) had sepsis while 70(47%) needed NICU admission for some morbidity. Conclusion: As anaemia and gestational hypertension being the prime and treatable causes of IUGR, proper antenatal care would be the key to reducing the IUGR burden in our setup.

The Journal of Obstetrics and Gynecology of India

Enhanced recovery after surgery (ERAS) is a set of multidisciplinary, evidence proven guidelines ... more Enhanced recovery after surgery (ERAS) is a set of multidisciplinary, evidence proven guidelines which enhance perioperative recovery in various surgical branches. This study was planned as a pilot effort with the aim of evaluating the surgical team’s compliance to ERAS, in the absence of a structured programme, in the department of gynaecologic oncology of a tertiary care hospital in India. This is a retrospective audit of patients who underwent elective surgery, in the department of gynaecologic oncology, in a tertiary care centre in India, between 15th August 2019 to 15th October 2019. Emergency operations and those surgeries with palliative intent were excluded from the study. Electronic outpatient and inpatient records of patients chosen by convenient sampling were examined. Adherence to 18 components (pre-operative, intra-operative and post-operative) from the ERAS guidelines pertaining to surgical care were analysed. A total of 50 patients were included. Mean age group was 50 years (22–76 years). Majority of patients (60%) had a Charlson Deyo score of 0. Excellent compliance was noted with respect to preoperative counselling (94%), intraoperative management (86%) and post-operative factors such as early ambulation, thromboprophylaxis and early discharge. Practices which required improvement included reduction of period of pre-operative fasting, prehabilitation, carbohydrate loading, gum chewing and coffee consumption and early initiation of feeding in post-operative period. Dedicated and co-ordinated team effort will ensure that an ERAS protocol is enforced. Periodic auditing will reveal inconsistencies in compliance and guarantee benefit to patients.

International journal of reproduction, contraception, obstetrics and gynecology, Jul 26, 2018

International journal of reproduction, contraception, obstetrics and gynecology, Jul 26, 2017

Journal of Cancer Research and Clinical Oncology

Tropical Doctor

The Journal of Obstetrics and Gynecology of India

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level ... more Cervical ectopic pregnancy is implantation of an embryo into the cervical mucosa below the level of the internal os. Cervical pregnancy is an infrequent form of ectopic gestation both in naturally conceived pregnancies and even after assisted reproductive technology (ART). It accounts for less than 1% of all ectopic pregnancies. The diagnosis can be missed as a case of incomplete abortion unless an experienced sonologist performs a transvaginal ultrasound. Management options vary and depend on the gestational age at diagnosis, general condition of the patient and woman’s desire to maintain fertility. Medical treatment with methotrexate is the therapy of choice in early gestation with hemodynamically stable patient. Surgical intervention is indicated in late gestation, unstable cases or failed medical treatment. At times hysterectomy is elected as the final path when bleeding does not subside. We present an unique case of twin cervical ectopic pregnancy managed initially conservative...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Gynecology & Obstetrics, 2017

The Journal of Obstetrics and Gynecology of India