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Background: Effective implementation of the near-miss concept will help analyze the high-risk group and strengthen the entire healthcare setup for enabling favorable outcome.The present study aims to assess the features of near-miss obstetric cases reporting to government tertiary hospital in order to propose significant interventions to save the high risk group of patients. Methods: The present study was conducted among patients admitted in labour room including referred, emergency and booked admissions. Women with severe complications of pregnancy / labour/ puerperium irrespective of gestational age as per the WHO near miss criteria were identified and studied. The first step in implementing the near-miss approach was to systematically identify women with severe complications of pregnancy. Results: Most common direct complicating factor being hemorrhage 26%, eclampsia 18.7%, sepsis 9.8%, rupture uterus 4% (rupture uterus was present in 2 cases of grandmultipara and 3 cases had more than 2 previous LSCS) and obstructed labour 3.2%. Among the indirect causes anaemia 34.1% was leading cause. Out of this iron deficiency anaemia was seen in 88% cases and 12% cases had other types of anaemia like megaloblastic and thalassemia minor. Respiratory disease 4%, liver disease 5.7% (mainly hepatic encephalopathy) and heart disease 1.6% (1 patient had dilated peripartum cardiomyopathy and 1 patient was revived from sudden cardiac arrest). Conclusion: The most common direct cause for maternal near miss is hemorrhage. Although hemorrhage is the leading cause of maternal death worldwide but postpartum hemorrhage is highly unpredictable and poses a major challenge to obstetricians. Eclampsia and severe preeclampsia are one of the easiest identifiable and avoidable factors for preventing maternal death. Health care providers like ASHA workers and ANMs who have first contact with the antenatal women should be trained to tally and read the dipstick test results and inform the doctor accordingly.
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Introduction: WHO maternal near miss approach is astandardized method which is implemented in 3 steps i.e.baseline assessment,situation analysis and interventions forimproving health care. Hence, present study was undertakento identify and evaluate the occurrence and causes of severematernal morbidity i.e. near miss cases.Material and Methods: The present study was conductedin the department of Obstetrics and Gynaecology, RajindraHospital, Patiala over a period of one and a half year. Thestudy was conducted on the patients admitted in labourroom including referred, emergency and booked admissions.Women with severe complications of pregnancy / labour/puerperium irrespective of gestational age as per the WHOnear miss criteria were identified and studied.Results: Distribution of cases according to clinical criteriainclude maximum cases of loss of unconsciousness formore than 12 hours i.e. 18.7%, shock 13.8%, clotting failure13%, respiratory rate <6/min or >40/min in 8.1%, oliguria in7.3% and jaundice with severe preeclampsia in 5.7% cases.Distribution of near miss cases according to laboratorycriteria, and oxygen saturation<90% for >60 min in 14.6%cases. 5.6% cases with acute thrombocytopenia and serumbilirubin >6 mg/dl and serum creatinine >3.5% in 0.8% cases.Conclusion: The need for identifying the patient’s conditionand deciding for the referral on time and to the right centre isa critical step towards saving a maternal death. The core ofthe health system should emphasize on ‘when to refer’ and‘where to refer’ policy. Referral should be on time so that anyuntoward incident can be averted and referring a patient to atertiary care centre where all the emergency back up facilitiesare available like ICU, 24 hour Blood bank services, apexobstetrical intervention and inter departmental expertise andcare. The problem of initial assessment, problem identification,management plan and follow-up of cases depends on a verycrucial task of history taking.
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Fiberoptic nasotracheal intubation is an effective method for the management of patients with difficult airways. An ideal sedation regimen would ensure patient’s comfort, attenuation of airway reflexes, patient’s co-ordination, haemodynamic stability and amnesia. It is critical for both the surgeon and the anesthesiologist to understand the physiologic consequences of laparoscopy and to work in cooperation to achieve a good surgical outcome. Methods: Patients were randomly allocated to midazolam (MDZ) group (group 1) and dexmedetomidine (DEX) group (group 2). DEX patients received dexmedetomidine 1μg/kg, followed by an infusion of dexmedetomidine 0.1μg/kg/hr titrated to 0.7μg/kg/hr to achieve RSS ≥2. MDZ subjects received IV midazolam 0.05mg/kg with additional doses given to achieve a RSS ≥ 2. Measurements: Pulse rate, systolic and diastolic blood pressures and SpO2 recorded during pre-oxygenation, one minute prior to introduction of fiberscope and then every minute for the following five minutes and beginning one minute before endotracheal intubation and then every minute until the endotracheal tube was secured, patient’s tolerance assessed on 5 point fiberoptic intubation score during fiberscopy and endotracheal intubation, total comfort score values assessed during pre-oxygenation, fiberscopy and endotracheal intubation and patient’s response to 24 hour post op questionnaire assessment were measured. Results: DEX group patients were significantly more quiet and more harmonius during awake fiberoptic intubation (AFOI) than were the MDZ group patients. The DEX group patients were found to have a lower mean Heart Rate than the MDZ patients. Conclusions: Both dexmedetomidine and midazolam are effective for fibreoptic intubation. Dexmedetomidine allows better endurance, stable haemodynamic status and a patent airway.
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An interstitial pregnancy is an uncommon type of ectopic pregnancy, accounting for 2-4% of all ectopic pregnancies. We present a patient with history of ruptured interstitial pregnancy who had been managed successfully at our hospital. The patient had refused tubectomy and conceived against medical advice within six months after laparotomy. She was counseled for risk of rupture of uterus and admitted to the hospital at the beginning of 9th month. She underwent an elective cesarean section and a male baby was delivered. Palpation of the uterine scar revealed that it was papery thin. Had there been any delay, the uterus would have ruptured with resultant maternal and fetal morbidity and mortality.
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Objective: To compare the effect of sublingual versus vaginal misoprostol on preoperative cervical priming in first trimester abortion. Material and methods: One hundred women seeking first trimester abortion were randomized into either sublingual or vaginal groups of 50 each. They were given 400 μg misoprostol via sublingual or vaginal route for cervical priming three hours before the procedure. The outcome measures assessed were cervical dilatation before surgery, duration of procedure, intraoperative blood loss and preoperative side effects. Results: Subjects in the sublingual group achieved significantly higher mean cervical dilatation compared to vaginal group (8.34 ± 0.62 mm vs 7.60 ± 0.67 mm, p = 0.0001). The mean duration of procedure for sublingual group was significantly lower compared to the vaginal group (2.62 ± 0.64 minutes vs 3.17 ± 0.71 minutes, p = 0.0001). The mean intraoperative blood loss was found to be more in sublingual group as compared to vaginal group (34.90 ± 10.90 ml vs 32.90 ± 7.42 ml), but the difference was not significant (p = 0.286). The sublingual group experienced more preoperative side effects such as pain, bleeding, nausea and shivering as compared to vaginal group. Conclusion: Sublingual misoprostol is more effective and convenient route than vaginal misoprostol for preoperative cervical priming in first trimester abortion.
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Background: 14C-urea breath test (14C-UBT) is employed as a ‘gold standard’ technique for the detection of active gastric Helicobacter pylori infection and is recommended as the best option for “test-and-treat” strategy in primary health care centers. Aim: To compare the performance of capsulated and non-capsulated 14C-UBT protocols for the detection of H. pylori infection in patients. Methods: Fifty eight H. pylori infected patients underwent routine upper GI endoscopy and biopsies were processed for rapid urease test (RUT) and histopathology examination. Capsulated 14C-UBT was done in a novel way by using 74 kBq of 14C-urea along with 6.0 MBq of 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) to simultaneously monitor the movement and the fate of ingested capsule after delineating the stomach contour by using 20.0 MBq of 99mTechnetium pertechnetate (99mTcO4-) under dual head gamma camera. Noncapsulated 14C-UBT was performed within 2 days of the previous test and the results of these protocols were compared. Results: In 3 out of 58 H. pylori positive cases (5.17%), 14C-UBT results were found to be negative by using the capsulated method. Interestingly, on monitoring the real time images of the capsule in these cases it was found that misdiagnosis of H. pylori infection occurred mainly due to either rapid transit of the 14C-urea containing capsule from the upper gastric tract or its incomplete resolution in the stomach during the phase of breath collection. Conclusion: Use of non-capsulated 14C-UBT protocol appears to be a superior option than the conventional capsule based technique for the detection of H. pylori infection.