International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Evaluating the efficacy of midwifery led-care unit for optimizing maternal and infant health outcomes in India: an evidence based systematic review
Get PDFThe establishment of midwife-led care units (MLCUs), a model in which midwives play pivotal roles in optimizing maternal and neonatal outcomes with minimal interventions, has shown promise in elevating care quality and enhancing childbirth experiences. This article examines the requisite investments for incorporating MLCUs into the public health framework by analysing their merits, contemporary maternal mortality trends, midwives' functions, pertinent contextual factors, and recent innovations in Indian midwifery practices. The midwifery-led care approach is underpinned by the philosophy that views pregnancy and childbirth as natural physiological processes. Employing midwives, especially in low-risk pregnancies, offers both adequate and economically viable care. India's government has commenced the integration of midwifery services nationwide to enhance care quality, equity, and efficiency, while reducing the strain on tertiary healthcare facilities. The World Health Organization's designation of 2020 as the "Year of the Nurse and Midwife" underscored the critical role that these professionals play in maintaining high-quality healthcare. Moreover, garnering support from both medical practitioners and the general public is essential for successful future development and implementation of MLCUs across India
Delayed cord clamping versus intact umbilical cord-milking and its effects on maternal blood loss: a randomised controlled trial
Get PDFBackground: The ideal timing of cord clamping has been controversial and debated over decades. Delayed cord clamping has many advantages owing to enhanced placental transfusion on neonates but provides limited evidence on maternal postpartum blood loss. The objective of the study was to estimate the maternal blood loss after delayed cord clamping versus umbilical cord milking.
Methods: A randomized controlled trial was conducted in KLE’s Dr. Prabhakar Kore Hospital, at Belagavi district in Karnataka over 18 months. In the delayed cord clamping (group A- DCC) group, the cord was clamped 60 seconds after the delivery of a newborn. In the intact umbilical cord milking (group B- UCM) group, cord blood was milked 5-8 times for 15-20 seconds towards the neonate. The primary outcome of the study was to estimate the maternal blood loss by comparing the change in hemoglobin and hematocrit values before and after delivery. Furthermore, neonatal outcome was assessed by comparing serum ferritin at third month of life.
Results: Maternal blood loss was estimated by a drop in post-delivery hemoglobin, showed a significant difference between the two groups (group A-DCC group=1.76±0.1 gm% and group B-UCM group=1.73±0.1 gm%; p<0.001). Additional administration of uterotonics for medical management of the cases also showed a significant difference (p=0.049) with higher usage among the DCC group.
Conclusions: From the present study, it was observed that umbilical cord milking was equally effective and time-saving with the advantages of delayed cord clamping with reduced estimated maternal blood loss
Estimation of vitamin D levels in low risk and high risk pregnancy and to evaluate maternal and neonatal outcome
Get PDFBackground: Vitamin D is linked with various physiological processes involving multiple organ systems and its deficiency is associated with pregnancy complication like pre-eclampsia, gestational diabetes mellitus, preterm delivery and low birth weight babies. The objective of this study was to estimate vitamin D levels in both low risk and high risk pregnant women and to correlate with the maternal and neonatal outcome.
Methods: This was a prospective case control study from December 2020 to June 2022 at M. S. Ramaiah Medical College and Hospital, Bengaluru. All pregnant women between 28 weeks and 40 weeks of gestation were included in the study. Enzyme-linked immunosorbent assay (ELISA) method was used for quantitative determination of 25 hydroxy vitamin D in serum of all pregnant women.
Results: A total of 166 pregnant women were included in the study, of which 81 subjects were high risk and 85 pregnant women were low risk. The mean vitamin D levels was 19.96 ng/ml in high risk group and 26.8 ng/ml in low risk group and this was statistically significant. In high risk group 23.45% were deficient and in low risk group 12.94% were deficient which was significant. The neonatal birth weight and serum vitamin D levels showed a strong correlation in low risk group as compared to the high risk group.
Conclusions: Vitamin D deficiency or insufficiency in pregnancy can lead to complications in both mother and fetus. Estimation of vitamin D levels in pregnancy and supplementation can lead to healthy baby and healthy mother
The uterine fibroid study: comparative study between total abdominal hysterectomy and laparoscopic assisted vaginal hysterectomy
Get PDFABSTRACT
Background: To compare safety and efficacy of total abdominal hysterectomy (TAH) and laparoscopic assisted vaginal hysterectomy (LAVH) in uterine fibroid patients.
Methods: It is a prospective observational study conducted at six major gynaecology hospitals located in Telangana State. The data was collected from November 2022 to April 2023 and all the safety and efficacy parameters were evaluated. The collected data entered in MS Excel and then analysed and statically evaluated by using GraphPad prism software. Internal consistency reliability Cronbach’s alpha was calculated.
Results: There were 200 patients 100 each of TAH and LAVH. LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. On average, LAVH operations took significantly longer than TAH operations (47.9±5.953 minutes, 117.6±26.174 minutes, p<0.0001). The total length of hospital stay was significantly shorter after LAVH than after TAH (11.4±2.81 days, 2.66±0.95 days, p<0.0001). Although the haemoglobin drop in TAH was significantly higher than LAVH (173.15±40.872 and 92.5±6.83, p<0.0001), blood transfusions were more common in TAH (25 case versus 15 cases p=0.0306). The drug requirement to control pain during hospitalization after the two surgeries was not significantly different between the two groups. Fever was observed more often in the TAH group (P=0.01). Finally, Intra-operative and post-operative complications were lower in LAVH than TAH.
Conclusions: LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. It has been concluded in present study that LAVH has become a major alternative to conventional abdominal hysterectomy with patient often opting laparoscopic approach for the result of cosmetic and faster recuperative reasons
Prevalence and factors linked to inappropriate gestational weight gain: a cross-sectional study at Hung Vuong hospital
Get PDFBackground: Gestational weight gain (GWG) serves as an indirect indicator of the nutritional and energy supply status for both mother and fetus throughout pregnancy. However, excessive GWG beyond recommended levels increases the risk of hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), macrosomia, and cesarean delivery, while inadequate GWG heightens the risk of fetal growth restriction and preterm birth. This study aimed to determine the proportion of pregnant women with inappropriate GWG according to the 2009 Institute of Medicine (IOM) recommendations, identify associated factors, and evaluate the relationships between GWG and pregnancy outcomes.
Methods: A cross-sectional study was conducted on singleton pregnant women managed from the first trimester until delivery at Hung Vuong Hospital, with data collected within 7 days postpartum. The study period spanned from April 2023 to May 2023.
Results: A total of 354 singleton pregnant women, who received regular prenatal care from the first trimester and delivered at Hung Vuong Hospital, were analyzed. The rate of inappropriate GWG was 58.8%. Three factors were identified as influencing inappropriate GWG: pre-pregnancy body mass index (BMI), history of preterm birth, and parity. Additionally, three associations were found between GWG and pregnancy outcomes: GDM, macrosomia, and newborn length greater than the 90th percentile.
Conclusions: The prevalence of inappropriate GWG was notably high (>50%). Pre-pregnancy BMI exhibited a strong association with GWG. Furthermore, a history of parity and preterm birth was linked to the risk of inappropriate GWG. Women with excessive GWG had an increased risk of macrosomia, while those with inadequate GWG faced a higher risk of GDM and a reduced likelihood of newborns with length exceeding the 90th percentile
A case of ovarian serous borderline tumors with normal ovarian findings on preoperative imaging
Get PDFOvarian serous borderline tumors (SBTs) are typically diagnosed through imaging techniques such as ultrasound and magnetic resonance imaging (MRI); however, diagnosis can be challenging when the tumor exhibits unusual growth patterns or is of small size. We report the case of a 55-year-old woman in whom bilateral SBTs were discovered during surgery, although preoperative imaging showed no ovarian abnormalities. The patient underwent laparoscopic total hysterectomy and bilateral adnexectomy for uterine fibroids. Preoperative MRI and transvaginal ultrasound did not reveal any ovarian abnormalities, but during laparoscopic surgery, small nodules growing outward were observed on both ovaries. Pathological examination led to the diagnosis of a serous borderline tumor with micropapillary pattern (SBT-MP). This case highlights the limitations of preoperative imaging in detecting small serous borderline tumors with surface papillary growth, as no abnormalities were observed preoperatively despite bilateral ovarian involvement. When an ovarian tumor exhibiting surface growth is identified during surgery, even if it is too small to be detected preoperatively, it is crucial to consider the possibility of a borderline tumor. In such cases, it is essential to perform pathological examination, including intraoperative frozen section analysis, and conduct a thorough macroscopic inspection of the abdominal cavity
A comparative study of co-morbidities and outcomes between HELLP syndrome and severe pre-eclampsia without HELLP syndrome in a tertiary care centre
Get PDFBackground: Pre-eclampsia is a pregnancy specific, multi-system, life-threatening complication. Incidence of severe pre-eclampsia varies between 10-20% of all pregnancies and that of HELLP syndrome is 0.2-0.6% of all pregnancies. This study aims to provide a comprehensive view of maternal and perinatal outcomes in HELLP syndrome and that of severe pre-eclampsia without HELLP.
Methods: This prospective, observational, comparative study was conducted at a tertiary care centre- Grant medical college and sir JJ group of hospitals, in a period of 10 months (March 2024 to December 2024). 30 patients of pre-eclampsia with severe features were compared with 30 patients of HELLP syndrome. The maternal and perinatal outcomes were studied and results analysed.
Results: Incidence of maternal complications and the need for blood and blood products transfusion was greater in HELLP syndrome. However, only marginal differences were noted in the perinatal outcomes.
Conclusions: HELLP syndrome is associated with increased maternal morbidity and mortality as compared to severe pre-eclampsia. Only marginal differences were noted in neonatal outcomes due to HELLP syndrome and severe preeclampsia without HELLP syndrome. Aggressive and timely treatment of these maternal conditions helps in reducing the maternal morbidity and mortality.
Correlation between placental weight and birth weight of the newborn and its effect on perinatal outcome: a hospital based cross-sectional study:
Get PDFBackground: The placental weight and its correlation with birth weight have been studied extensively for their potential associations with fetal growth and perinatal outcomes. This study aimed to investigate the correlation between placental weight and birth weight of newborns and evaluate the effects of this correlation on perinatal outcomes.
Methods: This hospital-based cross-sectional study included 50 pregnant women with singleton pregnancies without comorbidities. Placental weight was measured immediately after delivery, and birth weight was recorded within the first hour. Perinatal outcomes such as Apgar scores, neonatal intensive care unit (NICU) admission, and respiratory distress were documented. Statistical analysis included descriptive statistics, Pearson's correlation coefficient, and appropriate tests to analyze the effects of placental weight and birth weight on perinatal outcomes.
Results: A positive correlation was observed between placental weight and birth weight of newborns. No significant differences were found in mean birth weight and placental weight across gestational age groups. Lower birth weights and placental weights were associated with adverse perinatal outcomes, including lower Apgar scores, increased NICU admissions, and higher incidence of respiratory distress.
Conclusions: The positive correlation between placental weight and birth weight reinforces the crucial role of the placenta in supporting fetal growth and development. Deviations from normal placental weight may signal underlying placental insufficiency or pathological conditions, increasing the risk of adverse perinatal events. Monitoring placental weight and fetal growth during pregnancy may help identify high-risk pregnancies and optimize perinatal outcomes
A study of 44 cases of pure dysgerminoma of the ovary: a single institutional experience
Get PDFBackground: The extent of surgery and additional therapy required in patients with dysgerminoma is debated. This study evaluated the clinicopathologic characteristics, treatment modalities, long-term survival, and menstrual and fertility outcomes of women with ovarian dysgerminoma managed at our institute.
Methods: A total 44 histologically proven pure ovarian dysgerminoma cases were identified in this retrospective study. Patients who received treatment between 2006 and 2017 at Gujarat Cancer and Research Institute, either surgery or chemotherapy, or both were included.
Results: About 60.6% of patients presented with stage I, 9.09% with stage II, 27.27% with stage III, and 3.03% with stage IV disease. Initial management was surgery followed by observation in 9 (20.45%), surgery followed by adjuvant chemotherapy in 25 (56.81%), and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy in 9 (20.45%) patients. Recurrence occurred in 1 (2.32%) patient with stage III disease after 1 year and 5 months (17 months) post-chemotherapy successfully salvaged with platinum-containing chemotherapy. The 3-year disease-free survival (DFS) and overall survival (OS) were 93.18% and 95.45%, respectively. Thirteen patients attempted conception and 6 (46.15%) delivered after treatment completion. Thirty-five patients underwent fertility-sparing surgery. Out of these, thirty patients (85.7%) got regular menstrual cycles. All three prepubertal girls attained menarche.
Conclusions: Regardless of the stage, fertility-sparing surgery can be offered to the patient with good reproductive outcomes expected after fertility-sparing surgery followed by chemotherapy. Adjuvant chemotherapy is associated with significant improvement in DFS. NACT followed by surgery is a reasonable option for patients with advanced-stage dysgerminoma
Relationship between birth weight of the neonate with weight of placenta and cord length in a tertiary care hospital
Get PDFBackground: The study of birth-related parameters, such as umbilical cord length, placental weight, and neonatal birth weight, is crucial for assessing neonatal health. The placenta, known as the "lifeline of the fetus," plays a vital role in nutrient and gas exchange, with an average placental weight of around 508 grams. This study aimed to investigate the relationship between neonatal birth weight, placental weight, and umbilical cord length in term pregnancies.
Methods: This cross-sectional comparative study was conducted at the Department of Obstetrics and Gynecology in Bangladesh to examine the relationship between neonate birth weight, placenta weight, and umbilical cord length. A total of 100 singleton pregnancies delivered between 37 and 42 weeks of gestation were included from January to December 2021.
Results: Most mothers were aged 21-25 (40%), with a mean age of 24.84 years. Over half were primiparous (52%). Neonatal data indicated an average gestational age of 38.89 weeks and a mean weight of 2990 grams. Caesarean deliveries accounted for 60%, and the gender ratio was nearly equal (54% male, 46% female). The correlation analysis revealed that while umbilical cord length had no significant relationship with birth weight (p=0.192), placental weight showed a significant association (p<0.001).
Conclusions: The study demonstrates a strong correlation between placental weight and neonatal birth weight, suggesting that placental health is crucial for fetal development. However, umbilical cord length showed no significant relationship with birth weight. These findings highlight the importance of placental function in neonatal health and the need for further research