ABSTRACT
Background: Unwanted pregnancies in women and complications of induced abortions are an important health problem in the world. There is recent trend of self-induced medical abortion pill use over the counter without knowing the recommendations. Objectives of this study were to study socio demographic profile, presentations, management of hospitalized women for medical abortion related complications. To explore out contraceptive practices in those women. To way out the reasons for choosing medical abortion by women.Methods: Women of reproductive age group (15-45 years) who admitted in department of Obstetrics and Gynaecology Medical College with the complications following self-induced medical abortion were enrolled. Patients’ demographic profile, socio-economic status, obstetric profile, KAP of contraception, logical reasons for self-induced abortion were studied. Management of each case was done according to hospital protocols.Results: The total number of patients that were enrolled for the study period was 100. 37% of hospitalized women were between 18-25 years age group and 45 % of them had marriage at early age (15-20 years) and 46% were belonged to lower middle-class group. Majority of women with single living child with their last child <1-year age had taken abortion pills for unplanned pregnancy (49%). 74% women had taken abortion pills over the counter for the first time and 88% women did have idea about contraception but never used. 70% of the women had to undergo surgical evacuation and six of them had undergone emergency laparotomy for ruptured tubal ectopic pregnancy. Post abortion counselling successfully convinced to accept combined oral contraceptive (31%), followed by IUCD and permanent sterilization and 16% of women by medical abortion pill refused to accept contraception.Conclusions: Pregnancy termination should be done by qualified medical personal with accurate information about safe medical abortion. Counselling of each couple is must to enhance continuous and consistent use of family planning methods.
ABSTRACT
Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
ABSTRACT
Background: A total 4-11% of women in India are affected by PCOS. Studies show that incidence and prevalence is increasing. It is a constellation of metabolic and endocrine abnormalities with significant cost to quality and quantity of life. Aim of this study was to find out the association of metabolic syndrome with PCOS. Objectives of this study were identified subjects suffering from PCOS and measure strength of association of metabolic syndrome.Methods: Case-control study conducted in the department of Obstetrics and Gynaecology Agartala Government Medical College, Agartala, Tripura from January 2017 to June 2018. Fifty cases were diagnosed by Rotterdam criteria and 50 cases age matched controls were recruited. Hundred subjects underwent evaluation for metabolic syndrome according to ESHRE/ASRM criteria. Statistical analysis was done using SPSS 17.0.Results: Mean age was 19.4±3.5 years. Oligomenorrhea found in 42 out of 50 cases. Hirsutism found in 54% of cases. There is a statistically significant difference in weight, BMI and waist circumference among PCOS cases and controls. Hypertriglyceridemia was found to be significantly higher among PCOS cases. Fasting glucose and 2-hour OGTT were found to be statistically significantly different. No association was found between metabolic syndrome and clinical hyperandrogenism, but metabolic syndrome was significantly associated with higher BMI. BMI, Hip circumference and oral glucose tolerance test were independent predictors of polycystic ovarian syndrome. Metabolic syndrome was present in 34% of cases. The odds ratio of having metabolic syndrome in a case of PCOS is 5.92.Conclusions: Association between PCOS and metabolic syndrome is statistically significant. The two entities are intrinsically linked to each other and early identification of one may lead to the diagnosis and management of the other.
ABSTRACT
Background: Induction of labour at term is a common obstetric intervention. Prostaglandin E2 has been the agent of choice for pre-induction of cervical ripening for several decades. In recent time, prostaglandin E1 analogue (misoprostol) is a preferred new agent for pre-induction cervical ripening and labour induction owing to inexpensive, stable in room temperature, administrable through several routes. The ideal dose, route, and frequency of administration of misoprostol are still under investigation.Methods: A double blind parallel group placebo control randomized clinical trial was done in the department of obstetrics and gynecology of Agartala Govt. Medical College among 130 pregnant women those required induction of labour. In this clinical trial, the women were allocated by lottery to receive oral misoprostol (25 μg) and vaginal placebo (same dosage) or vaginal misoprostol (25 μg) and oral placebo (same dosage. Both active and placebo drug (25 mcg) were repeated at 4 hours. interval till the parturient reached active labour (not exceeding 5 doses). Both primary (induction delivery interval) and secondary outcomes (failed induction, vaginal/caesarean delivery rate, maternal and foetal complications) were statistically analyzed.Results: The mean induction delivery interval (primary outcome) differences were insignificant among both groups (oral versus vaginal). Success rate of induction (56.9% versus 75.4%), mean dosage (misoprostol 90.5 mcg versus 96 mcg) requirement, maternal and foetal complications was indifferent among two groups. The rate of vaginal delivery (within 24 hours of induction) was significantly higher when misoprostol was used through vaginal route. Caesarean section rate trends to be higher when misoprostol was administered orally.Conclusions: Low dose of misoprostol (25 mcg) offer an additional statistically significant clinical advantage in successful vaginal delivery when used vaginally.