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A Cross Section Study to Assess the Prevalence of Thyroid Autoantibodies in Type 1 Diabetes Mellitus
No full textA Study on Elevated Pulse Pressure Index as an Indicator of Left Ventricular Diastolic Dysfunction
No full textThe Impact of Helicobacter Pylori Eradication on Platelet Counts of Adult Patients with Idiopathic Thrombocytopenic Purpura
No full textTo Study the Maternal and Neonatal Outcomes with Prophylactic and Regular Antibiotic Usage in C-Section
Get PDFSUMMARY:
1) 216 cases of elective caesarean were included in this study. These 216 patients were randomized into two groups,based on the seniority in admission. First admitted 108 patients were allocated to prophylactic group and next 108 to regular regimen group.
❖ In group 1-prophylactic group : 2 dose regimen was administered. Inj. Ceftriaxone 1 gm I.V. within one hour before commencement of surgery, and Another dose is given 6 hours after the 1st dose in same patient.
❖ In group 2, Regular course of antibiotic regimen was administered. inj. Ceftriaxone 1 gm I.V. twice a day for 3 days.
❖ Incidence of febrile morbidity in prophylactic antibiotic group was and in 0.5% and 0%. in regular antibiotic group. This is statistically insignificant.
❖ Incidence of wound induration in prophylactic antibiotic group was 0.5% and 0% in regular antibiotic group. This is statistically insignificant.
❖ Incidence of respiratory tract infection is 0.5% in prophylactic group and none in regular antibiotic group.
❖ No cases of neonatal sepsis was seen in both groups.
❖ Prophylactic antibiotic regime is equally efficacious as Regular course of antibiotics. There was no significant difference noted between the two groups.
❖ The Prophylactic antibiotic regimen is cost effective than the Regular antibiotic usage and the number and duration of antibiotic used is both is very less.
❖ The Prophylactic antibiotic is safe, effective, convenient and saves manpower. Thus preventing irregularity in administering drugs and thus can be used instead of the usual 3 days of iv antibiotic followed by a oral antibiotics regimen that is routinely used in a tertiary care centre.
CONCLUSION:
From this study it is inferred that the maternal infections-like febrile morbidity, wound induration, wound discharge, urinary tract infection and respiratory tract infection-due to operative intervention and the neonatal effects of sepsis like –increased neutrophil count and increased C-reactive protein are equally distributed among the prophylactic, short course antibiotic 2 dose regimen and the regular 3 days-6 dose regimen.
◉ With the increasing fear of antibiotic resistance world wide, decreased usage in terms of 2 doses is the need of the hour regimen.
◉ Prophylactic 2 dose regimen is also cost effective-in terms of lesser usage of disposables & syringes also in lesser need of human resources and decreased contact time of the patient with the health care worker, especially during the pandemics
Maternal and Perinatal Outcome in Cases of Prelabour Rupture of Membranes: A Prospective study
No full textCONCLUSION:
❖ PROM is associated with maternal morbidity and perinatal morbidity and mortality, PROM is more common in primi. Hence health education should be given to all primi regarding importance of PROM and seeking health care facilities earlier. Genital tract infection should be identified early and treated.
❖ PROM is more common in low economic status, malnutrition.All women advised to have regular antenatal care and advise about diet, nutrition and personal hygiene should be given.
❖ Most common of delivery in our study was labour natural, so PROM is not an indication for LSCS. So the patients and attenders should be counselled regarding advantages of labour natural.
❖ Most common cause of neonatal death was neonatal sepsis.In order to reduce sepsis rate antibiotics-Inj.ampicillin 1g IV every 8 hours to all patients presenting with PROM should be started,should avoid frequent per vaginal examination,clean delivery surfaces.
❖ Combined effect of neonatologist and obstetrician is necessary for reducing perinatal morbidity and mortality.
❖ Thus a team approach, early recognition of prelabour rupture of membranes and their associated complication and appropriate. Management of situation helps in reducing the problems caused by PROM to a great extent
A Clinical study of Abruptio Placentae-Maternal and Perinatal Outcome in GVMCH
No full textThe clinical study of abruptio placenta-Maternal and Fetal outcome conducted as a prospective descriptive study in Government Vellore Medical College Hospital, Vellore with more than 10,0000 deliveries per year. The results of my studies are summarized as follows: Overall incidence of
Antepartum hemorrhage is 3.6 % with abruptio placenta about 1.2%. With respect to age, maternal age between 21-25 years (41.9%) is most commonly affected. The lowest age affected was 17 years and the highest was 38 years. Incidence of among Primi is 54.8% and that of multigravida is
55.2% in our study. This shows that there is no statistical difference in incidence among Primi and multigravida in our study. Among gestational age maximum incidence was found among those who were between 24-32 weeks. In term pregnancy is 27% that of preterm is 63% incidence. This
shows incidence decreases as gestational age advances .The predominant symptom with which the patient presented was vaginal bleeding (75%), pain abdomen (79%), tender uterus (79%). Among the signs FHS was absent in 56%, shock was present in 16.1%, hypertension (54%), and PROM in
24%. Among risk factors hypertension was present was the most common cause with 54.8% followed by PROM (24%), p/H/O abruption (17.7%), trauma in 1%, short cord in 4.8%, hydramnios in 6.5%, multiple pregnancy in 6.5%, and unknown etiology in 32%. Majority of them had grade 3 abruption (64.5%), followed by grade 1 (19.4%) and the least being
grade 0 (4.8%) This is because of delay in referrals to our hospital. Majority of the patient in this study reported after 6 hours of onset of symptoms (82.3%) Most of them presented with mixed type of abruption (58.06%),
concealed type being (16%) and revealed (29%)in this study. In 83.9 % cases mode of delivery is LSCS, and 16% NVD conducted. Normal delivery conducted in patient presented with absent FHS. In terms of complications, 16% were complicated with shock with 16% requiring ionotrope and ventilatory support, 16% had renal failure, 3cases required dialysis, 24% had DIC, 6.5% with HELLP, 13% couvelaire uterus, were 4 cases required massive blood transfusion immediately, 37% had severe post partum hemorrhage, 33% B/uterine artery ligation done and in 2 cases hysterectomy
was done as a life saving procedure. We also seen 5 cases of rupture uterus with abruption. Overall maternal mortality in our study is 2 cases which accounts for 13% of overall morbidity in our study.Combination of shock, acute renal failure and DIC seen are the probable cause of death. In terms of perinatal outcome 63% babies were delivered preterm with 70% babies are of low birth weight. 33% were live born, 11% still born and 54% dead born.
Case fatality is 66%. Abruption in pregnancy carries a very high perinatal mortality in our study.
With advances in treatment of shock ,availability of blood transfusion and rational in blood transfusion practices maternal mortality has come down .Even though, there in advancement in management, abruption is always a nightmare for obstetricians, Anesthetist, Pediatricians as these occurs without prediction.
CONCLUSION:
Placental abruption carries a significant risk for both maternal and fetal morbidity. The prevalence of placental abruption was found to be 1.2 % in this study which was similar to what has been reported in the literature.
Antenatal risk factors associated with this condition must be identified and the importance of antenatal care should be emphasized. In the study hypertensive disease remains an important risk factor for this condition. These risk factors can be obtained from the patient’s history and can thus help in reducing the morbidity and mortality associated with this condition. Prompt diagnosis and early referral of the patients for tertiary level care can result in better outcomes in these patients. This signifies the importance of early recognition and proper referral of the patient to ensure adequate management
Risk Factors, Pattern and Outcome of Third Trimester Bleeding in a Tertiary Care Hospital
No full textBACKGROUND AND OBJECTIVES:
Antepartum Hemorrahge is one of the leading causes of uterine bleeding during the later stages of pregnancy, resulting in high maternal morbidity, perinatal mortality and occasionally maternal mortality. Hence this study was conducted in a tertiary care hospital in order to study the incidence, causes, risk factors, mode of delivery and effectiveness of various management protocols on maternal and perinatal outcome.
METHODOLOGY:
A Prospective study was done at Coimbatore Medical College Hospital for a period of 1 year from March 2020 to March 2021.All cases of vaginal bleeding after 28 weeks were admitted in the labour room and were diagnosed by Clinical examination and Ultrasonography, as Placenta previa , Abruption placenta and Unclassified hemorrhage were included in the study.
RESULTS:
The incidence of APH was 2.04%. Abruptio placenta formed the largest group 78% followed by Placenta previa 21.5%. Majority of them were from the rural areas 68.5%. 59% occurred in Multigravida with most frequent occurrence of 56% between 33-36 weeks of pregnancy. In our study, majority of the pregnancies 79% were complicated by Hypertensive disorders. Most of the antepartum hemorrhage occurred between 21-30 years of age. Caesarean section was the commonest mode of delivery constituting about 93%. Perinatal mortality was 29%. There was no maternal mortality in our study because of active management in 88% of cases. But maternal morbidity was quite high. Mean duration of stay in ICU and Hospital was 1day and 15 days respectively.
CONCLUSION:
Antepartum hemorrhage is one of the important causes of maternal and perinatal mortality. Majority of cases of Antepartum haemorrhage admitted as Emergencies in the labour ward were from rural areas and were associated with Hypertensive disorders and Anaemia of moderate degree. Maternal and Perinatal morbidity was high mainly because of late presentation to the Hospitals, Hypertensive disorders and Anaemia. Hence with good antenatal care, early diagnosis and timely referral to higher centres with adequate avaliability of blood transfusion facilities, implementing emergency obstetric intervention in a short time period and satisfactory neonatal care improves maternal and perinatal outcome
Role of Oral Mifepristone for Cervical Ripening and Induction of Labour in Term Pregnancy: Randomized Controlled study
No full textINTRODUCTION:
Induction of labour is defined as the stimulation of uterine contractions to bring about the delivery before the onset of spontaneous labour or after the period of viability. Induction of labour is indicated when complications of pregnancy may have a negative impact on the health of the mother, fetus, or both. Induction of labour is therapeutic option when the benefits of the delivery outweigh the risks of continuing the pregnancy.
AIM AND OBJECTIVES:
Induction of labour is artificial initiation of uterine contractions before spontaneous onset of labour or after the period of viability of the fetus. Induction of labour is indicated when complications of pregnancy may have a negative impact on the health of the mother, fetus, or both. Induction of labour is therapeutic option when the benefits of the delivery outweigh the risks of continuing the pregnancy. Routine antenatal ultrasound for confirmation of EDD has been shown to reduce induction rates for post dated pregnancies after correction of dates. Prolonged pregnancy is known to be associated with significantly increased risks of perinatal and maternal complications.
PRIMARY OBJECTIVES:
1. To study the effectiveness and safety of mifepristone for cervical ripening for induction of labour in term pregnancies.
2. To compare the effect of mifepristone in study group with control group of same size.
3. To observe the improvement in cervical score as compared to control group.
4. To critically evaluate the effect of these drugs on primigravida and multigravida.
SECONDARY OBJECTIVES:
1. Induction to Delivery interval,
2. Mode of delivery,
3. Maternal and Fetal outcome.
METHODOLOGY:
After Institutional ethical committee approval and informed written consent, 88 patients will be selected for the study based on inclusion and exclusion criteria. Patient will be randomly allocated into 2 groups (i.e. Group A and Group B) using computerized random number. A computer-generated randomization schedule will be prepared and placed into numbered opaque envelopes by an uninvolved third party before the initiation of the study.
Randomization will be done after the decision had been made that the patient required an induction of labour and after a cervical examination demonstrated a Bishop’s score of <6. On admission detailed history, and complete general and obstetric examination carried out. Vaginal examination was done under strict aseptic precautions and the cervical status, fetal station are assessed. Gestational age was calculated by Naegele's rule and a routine obstetric scan for fetal maturity and wellbeing was done.
Out of 88, 44 pregnant women will be given tablet mifepristone 200mg orally and other 44 are allowed for spontaneous onset of labour.
After the waiting period of 24 hours or when the bishop’s score was > 6 or when the membranes ruptured or when the patient was well in labour whichever is earlier labour is accelerated with oxytocin drip,2nd dose of PGE2 gel will be given after 6 hours if there is no improvement in Bishop’s score.
The efficacy was assessed by favourability of bishop’s score at 24 hours, need of oxytocin for augmentation, duration of first, second, third stage of labour, drug administration to delivery interval, mode of delivery ,c-section rate, APGAR Score, neonatal complications, maternal complications.
RESULTS:
Our study included 88 patients out of which 44 were treated with Mifepristone, 44 were allowed for spontaneous onset of labour with waiting period of 24 hours. Among the study group, 64 women are Primigravida and 24 women are multigravida.
Out of 44 in Group A, more than half of them were belonged to 18-24 years and 29% were in 25-29 years of age group. In Group B 56% were fall in 18-24 years age category and nearly 40% (38.6%) were belonged to 25-29 years of age. Both the groups are similar in age.
The mode of delivery in the women who were enrolled in the study was found to be significant as 84% of patient in group A delivered vaginally compared to 68% in group B(Spontaneous onset of labour with waiting period of 24 hrs). 16% patients were undergone caesarean section in mifepristone group A as compared to 32% in group B. The mean duration of induction –delivery interval was found to be 25 hours in group A compared to 35 hours in group B. The incidence of Meconium stained liquor in group A was found to be 5% compared to 21% in group B. The incidence of PPH observed in the study was found to be insignificant.
CONCLUSION:
Thus, based on the results observed in our study, Tab.Mifepristone can be considered as effective in induction of labour in term pregnancy. (40 Weeks)
Contraceptive Efficacy and Safety of Centchroman with Biweekly cum Weekly Schedule in Postnatal Women in Tertiary Care Hospital: A Prospective study
No full textBACKGROUND:
25% of worlds eligible couples with an unmet need for contraceptive lives in India. Under our national health mission, family planning is now positioned as a critical intervention for improving women’s health,thereby reducing MMR and NMR.
❖ By imparting effective control, we can decrease the colossal MATERNAL MORTALITY RATE by atleast 25 percent.
❖ Eventhough several contraceptive methods have been there throughout the century, the need for a safer alternative to OC pills has been there since the sixties.
❖ After 22 years of extensive research, scientists at the CDRL, LUCKNOW has developed CENCTCHROMAN, the world’s first non steroidal contraceptive agent. The drug was finally approved in 1991. It was marketed as SAHELI and CHOICE 7 in 1992 India has now licensed centchroman in NEHP under the name CHHAYA from April 2016.
The contraceptive efficacy of centchroman was is found to be 93% to 100% has evidence by most observational studies. Most common side effects was documented as were menstrual irregularities.
Apart from contraceptive benefits of centchroman other steroidal pills the drug has got many non contraceptive benefits like its rolin, AUB, any other malignancies like Endometrial CA ,Head and neck cancer, Pancreatic Cancer and Breast Cancer.
AIMS AND OBJECTIVES:
The aim of this study was to assess the Effectiveness, Side effects, Compliance,
Discontinuation rates, Resumption to fertility after stoppage of drugs and Failure rate.
Among the users of Centchroman (Chhaya) in our tertiary center after its introduction in 2016 under National Family planning Programme.
1. To study the Effectiveness of centchroman as a non steroidal oral contraceptive.
2. To study the possible causes of centchroman failure.
3. To study the incidence of other side effects of centchroman.
Moreover, there are very few studies and literature available on efficacy of centchroman as contraceptive other than published report from Central Drug Research Institute, LUCKNOW (CDRI).
A systemic review demonstrates that despite evidence of effectiveness of centchroman, more research is needed on side effects and mechanism of action.
MATERIALS AND METHODS:
• For intiation of centchroman the first pill is taken on the 7th week of post natal period and the 2nd pill 3 days later.
• This pattern of days is repeated through the 1st three months .Starting from the 4th month, the pill is to be taken once a week on the 1st pill day and should be continued on the weekly schedule regardless of her menstrual cycle
• If the pill is missed by 1 or 2 days but lesser than 7 days, the normal schedule should be continued and client need to use a back up method (eg. condoms) till the next period starts.
• If the pill is missed by more than 7 days, client needs to start taking it all over again like a new user that is twice a week for 3 months and then once a week.
RESULTS:
• During the study period 118 patients were screened and administered.
• Centchroman for the study of its contraceptive efficacy. Data from the study was analysed in relation to the age at acceptance, parity, obstetric details at the time of acceptance .The salient features are summarized as follows:
1) The age pattern ranged from 20 to 40 years of age with maximum number in the age group of 21-30 yrs of almost 66%.
2) 75 % of patients had one living child, 25 % of patients in the study group had 2 living chil.
3) The maximum no of acceptors were following delivery of almost 87.5% in my study group.
4) All patients in the study group used centchroman for one year except 5 people who dropped from study since they want to conceive.
5) The drug related side effects were very few and included headache, vomiting and nausea. 6) Menstrual complaints were noted in 13% of acceptors. Delayed Menstrual complaints were noted in 7%, menorrhagia in 2% and oligomennorhoea in 4% of cases.
7) Resumption of fertility is prompt within 2 or three menstrual cycles after stoppage of drugs is evident from my study.
CONCLUSION:
Since Centchroman has 100% contraceptive efficacy with minimal side effects and Resumption of fertility is also proned after stoppage of drugs, Centchroman can be prescribed as an Ideal Postnatal contraception.
Robest randomized control trails are required for documenting long time follow up and side effects of the drug for global recommendation as an Ideal contraception
Validation of fullPIERS Score in Predicting Adverse Maternal Outcomes in Hypertensive Disorders of Pregnancy: A Prospective study
Get PDFINTRODUCTION:
Hypertensive disorder represents the most common medical complications of pregnancy. Majority of maternal mortality from hypertensive disorders of pregnancy occurs in low and middle income countries, accounting for 7-15% of all gestation and remains as a leading direct cause of maternal mortality. Although many risk factors are attributed to the chance of gestational hypertension most patients have no obvious identified risk factors. The enormous burden of adverse maternal outcomes and neonatal morbidities necessitates the need to correctly identify women at high risk of developing such adverse outcomes in time to avoid their occurrence and aid in decision making in the management of preeclampsia. The PIERS MODEL [Preeclampsia Integrated Estimate of Risk] is a combination of variables formulated to predict adverse maternal outcomes within the first 48 hours of hospital admission among women with hypertensive disorders of pregnancy. The fullPIERS model predicts severe maternal complications including central nervous system, cardiorespiratory and hematological outcomes from preeclampsia occurring within 48 hours of admission; this time frame was chosen to allow for clinical decisions, such as administration of corticosteroids, transfer to higher care units and delivery.
FullPIERS score can guide the district or sub-district hospital settings to identify mothers at risk of developing complications of pre eclampsia since it is very easy to use and is only based on a few clinical and biochemical parameters that does not require extensive laboratory testing.
AIM OF THE STUDY: study the validity of fullPIERS score to predict adverse outcome within 48 hours of admission in a tertiary care centre.
OBJECTIVES:
1. Delaying delivery where possible thereby reducing preterm birth due to hypertensive diseases of pregnancy.
2. To formulate time frame for clinical decisions such as administration of corticosteroids, transfer to a higher care centre and delivery.
3. To avert the complications of preeclampsia such as antepartum eclampsia, postpartum eclampsia, HELLP syndrome, acute pulmonary edema, acute renal failure etc using the clinical and biochemical parameters obtained on admission.
METHODOLOGY:
This is a prospective observational study done on a sample of 350 mothers with hypertensive disorder of pregnancy admitted as inpatients in Institute of Obstetrics and Gynecology, Egmore & Institute of social Obstetrics during 2021-2022. Gestational age, h/o chestpain, SpO2, serum aspartate aminotransferase, serum platelets, serum creatinine are obtained at the time of admission.
The lab values can be entered in mobile app or website that automatically generates the outcome percentage [https://pre-empt.obgyn.ubc.ca/evidence/fullpiers]. fullPIERS score is generated at the time of admission and patients are obsvered for any adverse events such as antepartum eclampsia, postpartum eclampsia, acute renal failure, acute pulmonary oedema, abruption, HELLP syndrome. The outcome is compared with the risk score predicted by fullPIERS model. Data was analyzed by using SPSS software, V.22.
RESULTS:
FullPIERS model has good performance and calibration accuracy in prediction of adverse maternal outcomes with AUROC 0.839, 95% confidence interval 0.76-0.876, significance p value 31.1, categorized as high risk, 93 cases (82.3%) had adverse outcome whereas 20 patients (17.7%) did not had any adverse outcome. 15.2% of the cases stratified as low risk by the fullPIERS score developed adverse events. Similarly 17.7% of the cases stratified as high risk by the fullPIERS score did not develop adverse event.
CONCLUSION:
The fullPIERS score because of its good discrimination and calibrating performance makes it a suitable triage tool for accurately identifying mothers for in utero transfer to tertiary care centre. With good agreement between the predicted and observed risk of complications in PIERS score in the low and intermediate risk groups, women with low PIERS score can avoid unnecessarily transfer to tertiary units