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Impact of Preoperative Rectal Misoprostol on Blood Loss During and After Caesarean Delivery - Experience in a Government Medical College Hospital
No full textThe above interventional study was initiated to find out the efficacy of preoperatively administered misoprostol through rectal route and its role in minimizing blood loss that occurs during and after surgery, and the following
inferences were made:
● There is significant reduction in the intraoperative and post operative blood loss which occurred with the usage of preoperative rectal misoprostol that is clearly seen in the average blood loss that is compared between the two groups. There is a blood loss of 450 ml in the control group as compared to the test group blood loss of 302 ml which indicates preoperative rectal misoprostol plays role in reducing 148 ml of blood loss in caesarean section.
• There is no difference in the APGAR scores of the newborns at 1 and 5 minutes with the usage of 400 micrograms of preoperative rectal misoprostol when compared with usage of no uterotonics preoperatively.
• The complications with the use of preoperative rectal misoprostol are comparable with the control group. Having declared that, mild complications like chills, vomiting and fever with the usage of 400 micrograms of misoprostol preoperatively were as similar to use of no uterotonic usage preoperatively. Therefore, misoprostol administered
preoperatively does not cause any major complication unlike
misoprostol used post operatively in the treatment of post partum hemorrhage.
• The requirement for additional uterotonics in the scenario of post partum hemorrhage is significantly reduced in cases of misoprostol used preoperatively as the usage of only oxytocin post operatively. Hence, the usage of preoperative rectal misoprostol has a significant role in the prevention of post partum hemorrhage although it also calls for additional uterotonics to be used post operatively.
• In the advent of post partum hemorrhage, the requirement of blood and blood products in the management of intrapartum and post partum hemorrhage is very similar to the group with no preoperative misoprostol usage. Hence, preoperative rectal misoprostol plays little role in the management of post partum hemorrhage once it sets in.
CONCLUSION:
This interventional study on the effect of preoperatively administered rectal misoprostol of 400μg just before the skin incision reduces both intraoperative and post operative blood loss. It causes an average reduction of 150 ml blood loss in caesarean sections with very minimal post operative fetal and maternal complications. However, this cost effective drug used preoperatively does not play a role in the management of post partum hemorrhage in the dose studied
Acceptability and Compliance of Injectable Contraceptive DMPA: A Prospective study
No full textThe summary of this study conducted at Raja Mirasudhar hospital, Thanjavur in women who were willing for DMPA injection is as follows. Eligible women were counselled and recruited on the basis of medical eligibility criteria. Among those who were counselled, 120 women were given DMPA injection after getting written informed consent. A detailed history was elicited and thorough general and systemic examination was done before giving DMPA injection. The results are interpreted by chi - square tests.
● In this study, majority are in age group 26-30 years.
● Majority of the acceptors (40%) were Primiparous women.
●Majority of them are educated and belong to secondary education (33.3%) and graduates (28.3%) and this shows that they accept this method better than those who were not educated.
● Majority of acceptors belongs to post abortal period (65%) followed by interval period (23.3%), postpartum period (11.7%).
● 64.2 % women used no previous contraception, 17.5% used IUCD, 10% used condom, and 8.3% used oral pills as their previous contraception.
● Irregular bleeding occurred in 61.7% women as the most common side effect, 14.2% had amenorrhea, 8.3% had scanty menses, and few others had headache, backache, weight gain, menorrhagia and 2 women had no side effects.
● 72.5% DMPA accepters discontinued after 1st injection, 17.5% after 2nd injection, and 7.5% after 3rd injection.
● The major reason for discontinuation was due to side effects 36.7% (irregular bleeding), 24.2% women lost their follow up, 14.2% due to changed contraception, 10% women discontinued due to planned pregnancy and moved to permanent methods.
● Primiparous women had used no previous contraception; Many multiparous women used copper-T as their previous contraception.
● Most of the graduates discontinued after 4th injection and most Illiterates discontinued after 1st injection. Hence Educational status improves the acceptability and compliance of various methods of contraception.
CONCLUSION:
DMPA is an effective and reversible method of contraception and is easily available to those who desire Family Planning. Pre-administration counseling is an important tool to minimize discontinuation because of the menstrual changes
which occur in most of the patients. This can be decreased by effective counseling at the start of DMPA injection which should include the contraceptive and noncontraceptive
benefits of DMPA; specific side effects such as bleeding
disturbances, weight changes, and fertility changes. Awareness of the patients about the benefits of DMPA over progesterone only pills and latest IUCDs. Apart from menstrual troubles there are no major side effects related to its use. Injectable DMPA use as a contraceptive in the postpartum period was found to be a safe and effective alternative method with no deleterious effect on mother's milk secretion and infant growth. In a developing country like India where infant and perinatal mortality is high it is better to use temporary methods rather than permanent methods, until the baby becomes older as well as good for spacing also. In such cases DMPA appears to be the best option. Women need to be educated and empowered so that they can control their fertility rates and avail access to wide range of contraceptives which suites their age and reproductive life. The study concludes that DMPA is a very effective contraceptive. However side effect decreases compliance. DMPA should be considered a highly effective, safe, convenient contraceptive option for appropriately selected patients. If women are given reminders for their follow-up injections, it could increase regular and uninterrupted use of the injection. DMPA when given every 3 months is a highly effective hormonal contraceptive with a very low failure rate. It should be available as a first line contraceptive to all those who wish to opt for reversible methods of contraception
A Cross Sectional study on Knowledge, Attitude and Practice of Contraception in Tertiary Care Hospital
No full text● In the present study majority of the participants belongs to 22-24 years.
● Most of them completed their school education 38.3%.
● Most of them have one live child 47.6%.
● Majority of the participant had no previous abortions
● Most of them accepted that knowledge about her contraception is necessary.
● Half of the study population knows about all contraception.
● Half of the study population only got PPIUCD counselling 53.6%.
● Only 34.4% of participants knows about emergency contraception.
● Most commonly used contraceptive method practiced is IUCD 48.3%.
● Nearly one fourth of the population 20.3% never used any contraceptives.
● Ignorance of the contraception and contraceptive methods is the main reason for not using contraception.
● Nearly half of the population 40.4% had unintended pregnancy in their life in that half of them not used any contraception.
● Main source of information is from Medical professional 52.4 %.
● More than half of the study population accept that they will adopt permanent sterilization in future. (73.6%)
● Majority prefer IUCD 42.8%.
● Knowledge about vasectomy and its preference is very poor in the population.
● The main reason for avoiding vasectomy is loss of work efficiency.
● Only one fourth among the illiterate knows about all contraceptives 28.6%.
● Among degree holders 65.6% knows about all contraception.
● Knowledge about vasectomy, laparoscopic sterilization, withdrawal technic, OCP is poor in all population.
● Education improves the knowledge about contraception.
● Among the highly qualified persons the practice of contraceptives is reduced compared to illiterates.
● The knowledge about contraception is less in lower class compared to the upper class.
CONCLUSION:
The present study brings about good knowledge and positive attitude towards contraception. Overall acceptance of contraception has increased with the more usage of IUCD. Collective efforts from the Government, Health care providers and Society has improved the acceptance and uses of contraceptives. Due to the implementation of many welfare schemes by government the attitude and practice towards female sterilization increased.The main reason for non
utilisation of Contraception is ignorance and fear of its side effects. Educational programs towards emergency contraception, vasectomy to be improved
Prospective study to Compare the Effectiveness of Wound Healing by Platelet Rich Plasma Versus Conventional Dressing in Chronic Diabetic Non Healing Ulcers
No full textBeta Catenin Expression in Colorectal Neoplasm and Its Prognostic Significance: An Observational study
No full textA Study on Functional and Radiological Outcome of Subtrochanteric Fractures Treated by Long Proximal Femoral Nailing
No full textA Cross Sectional study on Factors Associated with Photoreceptor Ellipsoid Zone Disruption in Diabetic Retinopathy
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