ABSTRACT
Postpartum haemorrhage is the leading cause of direct maternal death in developing countries. The incidence of PPH may vary from less than 5% to more than 10%. About 30% of maternal deaths in India occur due to massive haemorrhage. Normal blood loss in a vaginal delivery may exceed 500 ml and can range from 500 to 1000 ml. A decline in hematocrit is a more reliable estimation of blood loss. Active management had definitely reduced third stage blood loss. World Health Organisation (WHO) recommends Intra muscular oxytocin in the third stage of labour. Misoprostol PGE1 is a potent uterotonic agent. Ergometrine is also an effective oxytocic. This study has been conducted to compare the efficacy and safety of oral misoprostol 600 mcg with parenteral syntometrine in the active management of third stage of labour in 100 pregnant women of low risk pregnancies by objective assessment of the difference in pre-and post-delivery haemoglobin values. This study concludes that misoprostol has the potential of an effective, stable oral oxytocic with rapid onset of action. Though this study was limited to low risk patients, misoprostol has scope for use even in high risk patients of bronchial asthma, gestational hypertension, pre-eclampsia and Rhesus (Rh) negative groups where syntometrine is contraindicated. Thus, misoprostol may be used as an alternative to IM syntometrine in the active treatment of third stage of labour.
ABSTRACT
Hydatiform pregnancy occurs in 1:1000 pregnancies worldwide. Incidence is higher in Asian countries. Prevalence of hyperthyroidism during complete molar pregnancy is as high as 7%. Trophoblastic hyperthyroidism poses a multitude of challenges to the anesthesiologist. High output cardiac failure secondary to thyrotoxicosis, thyroid storm, hypertension thyroid function test should be mandatory in all women with hydatiform mole and these women should be stabilised with beta blockers and anti-thyroid medication prior to induction of anaesthesia for their surgical evacuation.
ABSTRACT
Background: The foetal brain development can be influenced by thyroid gland functioning. Sub normal function of thyroid gland in first trimester of pregnancy leads to miscarriages, stillborn and anomalies of central nervous system in foetus. The environmental factors that will effect thyroid gland functioning are deficit soil iodine, high fluoridation of water and low dietary iodine intake. Rayalaseema is endemic for iodine and most of the communities are suffering from high fluoride levels of water. Therefore study was designed to estimate prevalence of thyroid dysfunction in pregnant women of Rayalaseema region. Materials and Methods: 139 first trimester pregnant women randomly selected from Obstetrics and Gynaecology department of Santhiram medical college and General Hospital, Nandyal during the period from April 2013 to June 2013 in respect of inclusion and exclusion criteria. And fasting blood samples of the participants were analyzed for T3, T4 and TSH. Based on the TSH levels subjects were categorised in to euthyroid, hypothyroid, subclinical hypothyroid and hyper thyroid. Results: The prevalence of antenatal thyroid dysfunction is 18.70% [10.0% - subclinical hypothyroid, 2.87% - overt hypothyroid, 5.75% - hyperthyroid and 81.29% - euthyroid]. 37.5%- tribal, 10.81% - rural and 21.21% urban antenatal are suffering from thyroid dysfunction. Median maternal age was 25 years and gestational age was 8.5 weeks. Prevalence of pregnancy related risk factors include 26.92% - personnel thyroid history, 11.53% - hypertension, 15.38% - elevated fasting blood glucose, 30.76 % - family thyroid history. Conclusion: Subclinical hypothyroidism was highly prevalent among Rayalaseema region antenatal women at first trimester of pregnancy. Study limitations: Study will not represent other population varies with iodine intake and ethnic.