Perimortem Caesarean Section : A Guideline-based Management of Maternal Cardiac Arrest

Maternal Cardiac Arrest is a rare event and Perimortem Caesarean Section (PMCS) has an established role in concurrence with maternal resuscitation to save the life of a dying mother as per various International Guidelines. Despite being a lifesaving procedure, this procedure has not yet gained acceptance amongst Obstetrician. Present case is first reported case of PMCS of this country where an out of Operation Theatre Perimortem Caesarean Section was performed with a positive maternal and foetal outcome.

A randomized controlled study on expectant management of incomplete abortions caused by self medication

Background: Medical method of termination of pregnancy is a very effective method when used as per recommended regimen and under proper supervision. Self-administration of these drugs has become a very common practice these days, resulting in incomplete abortion because of improper use. Traditionally surgical curettage has been the preferred mode of treatment for these cases but is associated with very high complication rates. Expectant management of incomplete abortion has been recently adopted as a better method of management of incomplete abortions worldwide. Present study compares expectant management with surgical curettage in cases of incomplete abortions caused by self medication.Methods: It was one-year prospective randomized controlled study. Total of 220 patients were recruited for the study out of which 103 were randomized to undergo expectant management while 117 to undergo surgical curettage. Results were compared using chi square test..Results: Success rate of expectant and surgical management was found to be 82% and 95% respectively. Complication rate was found to be comparable in both the group while acceptability of expectant management was found to be much higher in expectant group. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management than surgical management.Conclusions: Expectant management is a safe and efficacious option in carefully selected cases. If used properly it can avoid complications associated with surgical management and therefore should be utilized whenever suitable.

Efficacy of conventional pharmacotherapy of syndromic management of STIs: a two year cross-sectional prospective study

Background: Syndromic management has been the centre for treating STIs in a resource constraint facility since its introduction by WHO and CDC more than a decade back. Recently there has been lots of debate on its empirical use in an era of antibiotics resistance and ever-changing varieties of microorganisms causing these infections. Present study evaluated the efficacy of pharmacotherapy of syndromic management measured by symptomatic improvement in females presenting with STIs.Methods: It was a two year cross-sectional prospective study including all the females of STI syndromes, attending Gynecology OPD of Sanjay Gandhi Memorial Hospital and results were assessed in pharmacology department, Gajra Raja medical college Gwalior from Jan 2015 to December 2016.Results: During the study period total of 24,556 patients attended the Gynecology OPD out of which 8562 patients presented with different STI syndromes. Lower abdomen pain with vaginal discharge was the most common symptom while Ulcerative lesions were the least common complaint. Maximum recurrence was seen in patients of vaginal discharge and itching followed by PID syndrome which responded to second line of drugs.Conclusions: Syndromic Management of STIs is an old approach to deal with a very common gynecological problem and needs to be reviewed in an era of wide spread antibiotics resistance.

A one year case control study on oxytocin use in labor and its effect on maternal: fetal outcomes

Background: Oxytocin is a drug commonly administered drug to a pregnant lady during labor, nowadays even without an indication, in the hope that the progress of labor can be improved and the need for cesarean delivery may be reduced. This study emphasizes the need for using safeguards like use of checklists before starting oxytocin augmentation, therefore ensuring its rational use to minimize maternal and neonatal complications when augmenting labor with oxytocin, including rigorous indications, use of minimal useful dose and careful efficacy evaluation.Methods: This is a retrospective, Case-Control, descriptive and analytical study. Study population included women delivering in labor room of Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa, from July 2015 to June 2016, then after data were compiled and assessed in department of pharmacology G.R. Medical College, Gwalior.Results: Results show that the use of oxytocin in labor stimulation can be detrimental to both the mother and the newborn, since they indicate that the use of oxytocin is associated with increased cesarean section rates both in primiparous and multiparous. Furthermore, it was also observed, a significant association between stimulation with oxytocin and low Apgar scores at 1 and 5 minutes both, of the newborns.Conclusions: Therefore, it may conclude that stimulation with oxytocin should not be used without any indication, but only in very specific cases, in which its use is particularly necessary. These results provide to health professionals a better understanding of the effects of the use of oxytocin during labor, which can be useful for decision-making in clinical practice.

A prospective, double blind randomised controlled trial on efficacy of laparoscopic uterosacral nerve ablation as an alternative of pharmacotherapy in treatment of chronic pelvic pain

Background: Chronic Pelvic Pain (CPP) is one of the commonest symptomatology in gynaecologist’s outpatient clinics. CPP has a profound impact on a woman's health and quality of life, including an economic impact through loss of working hours. Treatment for chronic pelvic pain is often unsatisfactory. Present study compares Laparoscopic Uterosacral Nerve Ablation (LUNA) with laparoscopy without pelvic denervation in patients presenting with chronic pelvic pain to our outpatient clinic.Methods: It was a Randomised Controlled Trial Study. After considering inclusion and exclusion criteria, 120 patients were selected, out of which 60 (Group I) had undergone diagnostic laparoscopy and 60 (Group II) had undergone diagnostic laparoscopy with LUNA.Results: The overall success rate for group I and group II were 80%, 78.3% and 66.6% versus 85%, 81.6%, and 83.3% at 3, 6, and 12 months, respectively. However, on subgroup analysis it was found that in patients suffering from Congestive Dysmenorrhoea, there was a significant difference in success rate of both the groups.Conclusions: It was found in present study that there was a benefit for patients with dysmenorrheal, further research in this area is desirable to reach towards a discrete conclusion regarding the benefits of LUNA in patients of CPP.

Analysis of various criteria for identification of severe acute maternal morbidity in a rural tertiary health care centre: A prospective one year study.

Background: Maternal mortality has been the indicator of measurement of maternal health. Over the last decade, identification of severe acute maternal morbidity (SAMM) has emerged as a compliment or alternative to investigation of maternal deaths. A review of causes of SAMM will help to find out the potential problems which in turn will enable women to get the treatment on time. Recent researches have suggested that proper identification of SAMM cases can prove to be a better method to monitor the quality and effectiveness of obstetric care than mortality alone. Although there have been many criteria which have been introduced from time to time to identify these cases, because of vast variation of different level of facilities, these criteria cannot be applied across the regions. WHO has recently come up with certain set of criteria which could be more applicable to low resource settings. Aims & Objective: Present study tried to identify SAMM cases through various criteria and compared the applicability of them in our setup which is resource poor setting catering mainly to a huge rural population. Materials and Methods: It is a prospective study done over a period of one year, from September 2012 to August 2013. All severely morbid pregnant women or who had delivered or aborted within 42days were included. Initial identification of these cases was done on the basis of general criteria and later on other criteria were applied according to the primary obstetric event, clinical features, Lab findings or management provided. A comparison was done amongst all criteria and their individual applicability was checked as per the facility available in our set up. Results: During the study period total 7819 women delivered in the hospital out of which 6498 delivered vaginally and 1321 delivered through caesarian section. Total live births during this period were 5219. The present study found an incidence of severe maternal morbidity/near miss ranging from 5.56 to 40 per 1000 live births. Among 244 women suspected to be SAMM/MNM, 179(73%) met Waterstone’s criteria, 48(20%) met Mantel’s Criteria and 63(26%) met WHO criteria, 20% women met Mantel and Waterstone’s criteria both while 17% met all three criteria. Conclusion: The study of SAMM cases and their identification through suitable criteria can contribute to know its magnitude, as well as to identify most frequent characteristics and clinical conditions which will help to recognize the problems in antenatal services, peripheral health care facilities and referral system. The criteria which are available now cannot be applied uniformly, and need to be tailored to identify more specific criteria according to infrastructure of a particular setting in order to utilize resources effectively.