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A Study Comparing Preoperative Antibiotic Infilteration along the Incision Site and Prophylactic Intravenous Antibiotic Administration for Reducing Surgical Site Infection
No full textA Comparative study on Open Versus Closed Method of Establishment of Pneumoperitoneum in Laparoscopic Surgery
No full textA Cross Sectional study to Determine Association between Body Mass Index and Disease Severity in COVID at a Tertiary Care Hospital in Chennai
No full textAssesment of Endothelial Function in Systemic Lupus Erythematosus Patients Using Flow Mediated Vasodialatation of Brachial Artery and its Relation to HsCRP Levels
No full textNLR (Neutrophil Lymphocyte Ratio) and Spot PCR (Protein Creatinine Ratio) as Early Predictors of AKI in Haemotoxic Snake Bite
No full textComparative Study of Efficacy and Safety of Intravenous Iron Sucrose Versus Ferric Carboxy Maltose in the Treatment of Postpartum Iron Deficiency Anaemia
Full text linkBACKGROUND:
Childbirth should be a joyous event. However, unforeseen medical problems such as postpartum haemorrhage or postpartum anaemia can develop and make this time very difficult. Postpartum anaemia is observed in up to 27% of postpartum women. It is a major contributable factor and indirect cause of maternal death. Iron deficiency is the commonest treatable cause of postpartum anaemia. Parental iron therapy with Ferric carboxy maltose (FCM) which is the third generation compound results in faster and higher replenishment of iron stores with correction of Hb levels and better patient compliance compared to other parenteral compounds and oral drugs.
AIM OF THE STUDY:
To compare the efficacy and safety of intravenous ferric carboxy maltose versus intravenous iron sucrose in the treatment of postpartum iron deficiency anaemia
OBJECTIVES:
1. To compare the efficacy of intravenous ferric carboxy maltose versus intravenous iron sucrose in postpartum anaemia correction.
2. To compare the raise in haemoglobin and other indices such as serum ferritin, MCV, PCV, MCHC and MCH between the two groups.
3. To compare the adverse reactions between the two groups.
MATERIALS AND METHODS:
This was a prospective, randomized comparative study conducted between November 2019 to April 2021 in Department of Obstetrics & Gynaecology, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai.
Postpartum women with Hb – 7 to 9 g/dl detected 24 hours after delivery were included. Total Sample size obtained was 63. Iron Sucrose (IS) group included 21 postpartum women and Ferric Carboxy Maltose (FCM) group included 42 postpartum women in the ratio of 1:2. Randomisation was done by computerized random number generation method. Postpartum women who fulfills the inclusion criteria were included in the study after obtaining their informed consent. The demographic profile and baseline clinical data such as age, parity, SES, educational status, presence of antenatal anaemia and mode of delivery was compared between both the groups. Iron requirement was calculated by GANZONI FORMULA and transfused intravenously. No test dose required in both the drugs. Pretransfusion vitals documented and patients were monitored for any adverse reactions such as pain, itching, rash, headache, dizziness, nausea and vomiting post transfusion. Baseline values of Haemoglobin, ferritin, MCV, MCHC, PCV and MCH were noted and repeated at the end of 4 weeks and 12 weeks of therapy. The observed values were compared and analysed.
RESULT:
The improvement in Haemoglobin, ferritin, MCV, MCHC, PCV and MCH was better and more rapid with ferric carboxy maltose than iron sucrose and it was found to be statistically significant. Also, the use of high single dose of FCM reduced the number of infusions, enabling the possibility of cost reductions compared to multiple administrations. FCM lacks dextran and less immunogenic, so adverse reactions are also low. The occurrence of adverse reactions in FCM group was not significant compared to iron sucrose (p=0.54). The overall satisfaction reported by the postpartum patients was better as they received the drug with minimum hospital stay in a single dose.
CONCLUSION:
The ability to deliver a high dose of iron within a short time, with single prick and less adverse effects make FCM suitable for patients requiring quicker restoration of iron stores in postpartum period and can be recommended for anaemic postpartum women
Prevalence of Thyroid Disorders in Polycystic Ovarian Syndrome Patients
No full textA cross sectional study was conducted in 100 newly diagnosed Polycystic Ovarian Syndrome patients. Among 100 participants, 21 were diagnosed to have hypothyroidism
based on serum TSH (Thyroid Stimulating hormone) level with the cut-off value of 5μU/mL.
From our study, we found that:
1) Mean BMI, Waist / Hip ratio, anti TPO antibody levels among PCOS patients were found to be significantly elevated above the recommended reference range.
2) The prevalence of hypothyroid disorders in PCOS patients was (21%), which is comparatively high than the prevalence of thyroid disorders in general
reproductive age women (2-4%). Thus, similar studies supports early prompt diagnosis and proper treatment.
3) There is a significant relationship between PCOS and AUTOIMMUNE THYROIDITIS (9%) in our study, thus proving that there is a peculiar interplay between thyrocytes, antigen-presenting cells and T cells, irrespective of the
environmental and hormonal factors that are seen in thyroid disorders, causing imbalance between type 1 helper (TH1) and type 2 helper (TH2) lymphocytes leading to a abnormal immune response. TH1-mediated autoimmune disorders causes lysis of thyrocytes and autoimmune hypothyroid disorder (Hashimoto’s
100 thyroiditis), whereas TH2 mediated autoimmune disorders targeted against the TSH receptor will cause Grave’s disease due to hyperthyroidism.
From this study, it is concluded that: Hypothyroidism is remarkably an important causative factor for androgen excess state, hence screening identifying thyroid disorders
along with reproductive hormonal profile study in PCOS / or in patients with infertility work up study for early diagnosis and effective management.
LIMITATIONS OF THE STUDY:
1. This is a cross sectional and observational study carried on a small group consisting of 100 patients diagnosed as PCOS conducted at Coimbatore Medical College Hospital Gynecology outpatient department.
2. Only young reproductive age group women attending this hospital were studied and those attending other peripheral hospitals in the same demographic area were not included in the study.
3. The study was done for a period of one year only and a greater number of patients could not be enrolled due to time limitation and covid crisis.
4. A case-control study could have given more knowledge on the hormonal profile of healthy women in reproductive age group and women(controls) with PCOS individuals (cases), as the study would provide better statistical significance
Assessment of Postpartum Depression and Anxiety among Mothers Delivering at Tertiary Care Hospital in Chengalpattu Medical College and Hospital
No full textThis study has been conducted among postpartum female aged 18 to 35 years, with the benefits of investigating this age group using a standardized questionnaire.
• The mean age of women included in this study 25. 5 with a range of 18 to 35 years. In this study age variance did not significantly affect the development of postpartum depression and anxiety. Chengalpattu medical college is a referral hospital which receives patients from the surrounding rural areas. There is no significant difference in number of cases from rural, semi-urban and urban areas.
• BMI, literacy level, and occupation does not significantly influence the disorder.
• Lower income & lower socio economical people are more prone for post partum disorder. They couldn’t fulfil all their needs in their low income.
• Unmarried, divorced and widow women are more often the victims of postpartum depression and anxiety compared to married women. Degree of consanguinity and type of the marriage do not significantly affect this disorder.
• In our study 49 % women were primigravida . Those who had many abortions and multigravida with no previous live children had a very strong predisposition to the development of postpartum depression and anxiety.
• More spacing between pregnancy increased incidence of this disorder.
• Pregnancy as a result of contraceptive failure were associated with higher rate of postpartum depression and anxiety. It reflect that our health care system should monitor those women using contraception whether they are regularly and properly using or not.
• Nature of the conception and booking also did not significantly affect this disorder.
• The number of health care visit during pregnancy and utilising iron and folic acid also decreased the incidence.
• The pregnancy associated antenatal complication like anemia, heart disease, hypertensive disorder, other infection, sexually transmitted disease etc increased the occurrence of this disorder. This indicate that we need to provide a prophylactic measure to prevent postpartum depression and anxiety in women with significant ante natal problems.
• Mode of deliveries whether normal vaginal, assisted vaginal, elective lscs, and emergency lscs did not significantly affect the incidence of this disorder if their baby was alive healthy.
• But other pregnancy complications like stillborn ,intrauterine death were more significantly causes of these postpartum depression and anxiety.
• In our health system 85% of women did not develop any intra partum complication. It reflect our tamilnadu health care system effectively give better health care service.
• The development of postpartum complications like postpartum haemorrhage, wound infection , and mother admitted in ICU were more significantly affected by this disorder.
• So we have to advise the mother to consume nutritionly rich diet and proper cleanliness and avoid unnecessary visitors during in the period of the hospital admission time These measures will decrease the postpartum complications,
• Hospital stay for more than 7 days has significantly caused higher incidence of postpartum depression and anxiety.
• Depressive symptoms and suicidal thoughts during pregnancy were associated with significantly increased psychiatric morbidity.
• Mother those who are breast feeding were protective to the development of postpartum depression and anxiety.
• The reason could be the bonding of the mother and child during feeding and the feeling of satisfaction upon breast feeding the child.
• In our study the women who lacked family support structure were at a higher risk of developing postpartum depression and anxiety.
• The outcome of current children like Birth asphyxia ,congenital disease and dead born significantly increased postpartum depression and anxiety.
• Higher rate of development of postpartum depression and anxiety in women who gave birth to female baby. There is a prevalent opinion in the society that male children are better than female children because of decreased expenditure and more income and the notion that male children take care of the parents during old age .this has also reflected in the higher rates of development of postpartum disorder in women who gave birth to female baby.
• If the baby admitted in NICU due to birth asphyxia, hypoxic ischemic encephalopathy, Respiratory distress syndrome those mother are naturally prone for psychiatric disorder.
• Women who were associated with psychiatric illness had increased rate of postpartum depression and anxiety.
• Since HDRS, HARS scale were screening tools we have used in this study to analyse the postpartum depression and anxiety. women who scored more value were diagnosed to have postpartum depression and anxiety. They were referred to the department of psychiatrics or call over given to psychiatric department for more tests and better and proper mode of treatment.
CONCLUSION:
❖ People in our country are still considering that visiting a Psychiatrist and having a Psychiatric illness as a taboo. This also relates with the very little content about Post partum Depression and Anxiety in the Indian Books. In Postpartum Disorder, the Baby is affected more as the mother suffers from depression and Anxiety This indicates the significance to take the necessary action as a Healthcare provider towards Post Partum Disorder.
❖ The initial steps which needs to be done is to identify the mothers who are at risk of developing depression and Anxiety to provide appropriate treatment. This is achieved only by a team of specialists which include an Obstetrician, Clinical Psychologists, Pediatric Psychiatrist and the paramedical workers.
❖ This can be done if the Health care providers first increase their knowledge about the disease and the various problems which the mother, the baby and the family members had to face.
❖ The society should be educated about the manifestations of Postpartum blues, Postpartum Depression and Anxiety, Post Partum psychosis and the need to contact a health care provider when the symptoms occur.
❖ The pharmacokinetics and dynamics of the Antidepressants and Antianxiety and their interaction in breastfeeding the baby are to be considered as the Breast milk is important in the Growth and development of the Baby
Quantification of Blood Loss Improves Detection of Postpartum Hemorrhage and Accuracy of Postpartum Hemorrhage Rates
No full textOBJECTIVES:
1. To accurately estimate the amount of blood loss following a natural labour
2. To compare the efficacy of visual estimation and objective measurement using a sterile under buttock drape to determine the volume of postpartum blood loss.
MATERIALS AND METHODS:
STUDY DESIGN – observational study.
STUDY PERIOD – MAY 2021 to OCTOBER 2021.
STUDY DURATION – 6 months.
STUDY SETTING – hospital based.
SAMPLE SIZE – 200.
STUDY SUBJECTS:
Normal deliveries held in Kilpauk Medical College Hospital during the period of May 2021 - Octorber 2021.
INCLUSION CRITERIA:
Gestational age >3 4 weeks
Age >18 years, Past history of hypothyroid, anaemia treated, diabetic, asthmatic, epileptic, Twin pregnancies,
Anemic patients, Polyhydramios.
EXCLUSION CRITERIA:
Gestational age < 3 4 weeks, Age < 18 years, Known case of Preeclampsia and eclampsia.
CONCLUSION:
Although visual estimation of blood loss remains more
economical, easier and practical, it is highly underestimating and identification of postpartum haemorrhage has been missed.
Thus quantification of blood loss by drape method remains a
superior method for identifying and treating PPH and thereby
saving the country’s MMR.
When quantitative blood loss is included as a component of
a bundle of practices that focus on prevention and early diagnosis of excessive blood loss, it may improve haemorrhage diagnosis and response time.
Hospitals that participate in quality improvement activities
can improve haemorrhage outcomes by effectively utilising this strategy.
LIMITATIONS:
Blood loss up to 1000 ml can only be estimated. Beyond that
the above drape doesn’t support.
The soaked cotton rolls and gauze pieces contribute to a
minor changes in estimating blood loss
