ABSTRACT
Background: Thyroid disorder is often overlooked in pregnant women this is because of nonspecific symptoms and hyper metabolic state of normal pregnancy. To evaluate the thyroid function in pregnant women in all the three trimesters and to study their impact on pregnancy outcome.Methods: A prospective study in 200 randomly selected antenatal cases was carried out during a period of two years in a tertiary care medical college in Western Maharashtra. A detailed general and systemic examination was carried out and Thyroid stimulating hormone (TSH) was done in all cases. Any case with an abnormal TSH level was further tested for T3 T4 levels.Results: The mean TSH level was 1.6 µIU/l which was less than the standard cut off of 2.5 µIU/l. 61% had decreasing level of TSH with advanced gestation. An abnormal thyroid function was seen in 8.5% cases.Conclusions: Standardization of TSH, T3, T4 is still a concern as it varies significantly in different studies. Estimation of TSH with T3 T4 could not be correlated during pregnancy with advancing gestational age. The real impact of hypo/hyperthyroidism on fetal outcome could not be statistically established.
ABSTRACT
Background: Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns.Methods: This large multi-site study was conducted in Pune district having population of 9.43 million. A total of 13 hospitals were selected which included all government hospitals performing more than five cesarean sections per month, and one government and one private medical college hospital. Cesarean section and vaginally deliveries were enrolled in 1:1 ratio. Their children were followed till discharge. Data were collected by obstetrician or qualified nurse.Results: During study period 3,112 women were enrolled. The relative risk of not getting vaccine Hepatitis B birth dose before 24 hours among cesarean delivered newoborns was 1.08. The relative risk of not getting zero polio and BCG among cesarean delivered newborns was 0.71 and 0.76 respectively. All these differences were significant. The coverage for all vaccines was better in sub district hospitals than others. Coverage of all vaccines in government teaching hospital was better than private.Conclusions: Cesarean section enabled better coverage among newborns probably due to length of stay. Whereas the physical and mental stress after cesarean section resulted lesser coverage of hepatitis B birth dose within 24 hours. Opportunities of timely Hepatitis B birth dose administration were missed probably due to lack of knowledge among health workers about ideal timing.
ABSTRACT
Background: Intra-peritoneal instillation of local anesthetics has been shown to minimize post-operative pain after laparoscopic surgeries. The present study was undertaken with the following aim to compare the efficacy of intra-peritoneal instillation and local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation. To correlate the advantages and side effects of the drugs during the procedure. To establish a protocol for the use of bupivacaine instillation and infiltration for post-operative analgesia after laparoscopic tubal ligation.Methods: A prospective study was carried out in a tertiary care hospital attached to a teaching medical institute. Institutional ethics committee approval was obtained for this randomized control study (double blind) including 50 women who will be divided in two groups. Group A will be administered intra-peritoneal bupivacaine along with local infiltration. Group B will be administered normal saline. Post-operative pain will be monitored by a blind observer and rescue analgesia will be administered at visual analogue score of 3.Results: Both the groups were comparable with respect to age and BMI. The mean duration of analgesia in Group A with bupivacaine was 315.60±79.9 min (Median 300 min). The mean duration of analgesia in Group B with normal saline was 138.20±46.97 min (Median 150 min, p value <0.001).Conclusions: The study depicts a significant pain relief after use of bupivacaine. Bupivacaine instillation in the peritoneal cavity along with local infiltration of the drug gives prolongs pain relief as compared to normal saline.
ABSTRACT
This interventional study was done in the Dept of OBGY of Bharati Vidyapeeth medical college, Pune, during Sept to Dec 2013. Context of the study: This educational research project was planned to introduce a formative structured assessment method for residents in OBGY and assess its impact on student learning. Primary Objectives:1) To design and conduct DOPS in Dept of OBGY, for second year postgraduate students.2) To assess impact on learning after 1 week of practice. Methodology: All participants were sensitized about the new assessment method: DOPS. Standard Operative Procedure for the core skill ‘Female Genital Tract Examination’ was prepared. A 5 point scale for DOPS Evaluation was designed, peer reviewed and piloted. DOPS was conducted by senior faculty members over 2 week’s time frame. Students were reassessed using same checklist by same observer after one week. Feedback about the entire experience was taken from all participants. Evaluation: 1) Student DOPS scores before and after feedback and practice 2) Analysis of feedback from all participants. Results and Conclusion: All participating students and faculty members felt that DOPS is 100% relevant to the curriculum and feasible to accept as a regular formative assessment and learning tool for PG students in OBGY. Higher Patient satisfaction expressed during second session suggests that such an intervention will result in better clinical care in long run.