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Background: Grand multiparous pregnancies have been considered to be at higher risk of developing antenatal and perinatal complica?ons like pre-eclampsia, gesta?onal diabetes mellitus, anemia, antepartum hemorrhages, preterm labor, mal-presenta?on, mal-posi?on and feto-pelvic dispropor?on This study was done to know the magnitude of grand mul?para a?ending the ter?ary care center with possible complica?ons related to high parity. Objec?ves:To study the prevalence possible fetomaternal complica?ons associated with grand mul?para at rural setup. Methodology:Descrip?ve cross-sec?onal study conducted in medical college of rural area for 12 months. Grand mul?para with 5 or more deliveries before current pregnancy coming for antenatal checkup and delivery were enrolled. Antenatal history was recorded ?ll delivery and feto-maternal outcomes were noted. Results:Out of 1500 deliveries conducted during study period, 110 (7.5%) cases were grand mul?para. Majority of them (79.5%) were Muslim and 80% were anaemic. 60% delivered with FTND, and 25.4% had emergency LSCS with one intrauterine death and a single breach delivery. Predominantly preeclampsia (23.6%) and malpresenta?on (14.5%) were diagnosed as antepartum complica?ons. Almost one fi?h of them had postpartum hemorrhage which was controlled with no mortality. 13 (11.8%) grand mul?para women had s?ll birth or early neonatal death, though fetal distress was observed in 37 cases. Conclusion: Grand mul?party is s?ll a high-risk pregnancy associated with adverse maternal and fetal outcomes in our facility with mul?ple interrelated but mostly preventable causes.
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Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. We focus on two innovations by Indian gynecologists, the Panicker’s vacuum suction cannula and the SR suction cannula. These effective devices are economical and easy-to-use, and help prevent and manage PPH. They can also be used to reduce bleeding in non-PPH indications. These Indian innovations are a matter of pride, and need to be studied extensively in diverse settings. This will help ensure that their benefits can be shared across the world.
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Background - Covid 19 infection caused by corona virus SARS- COV -2To study the fetomaternal outcome in severely ill covid positive pregnant females. Methods- An Observational study was conducted at dedicated COVID care center, jhalawar from Jan 2021 to May 2021 among pregnant females. In this study we included all Severely ill symptomatic COVID positive females which could not maintain oxygen saturation, were included in this study. Results-A total of 54 pregnant women, 24women delivered with 2 twin pregnancy . Out of this 30% underwent cesarean section and 15% were delivered by vaginal route. Postpartum hemorrhage seen in 29% of patients.24% of baby were < 2.5 kg, 12% babies were admitted in NICU. Blood products transfused in 9 patients. Remdesivir were given in 26 (48%) patients. Conclusion-We found that severe COVID-19 infection in pregnancy was associated with risks of preeclampsia, stillbirth, preterm birth and NICU admission. Future studies are needed to collect more robust data to further validate or substantiate these findings, better understand the pathophysiologic pathways that explain these associations and identify effective strategies to prevent adverse outcomes in pregnant people with COVID-19
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@#Objective To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×109/L vs. (14.47±2.05)×109/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. Conclusion Compared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.
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Background: Globally and especially in the under developing nations Postpartum Hemorrhage (PPH) is the most common cause of maternal mortality. All women who deliver are at risk of complications of third stage of labor. Multiple researches have been done to compare active vs expectant management of third stage of labor. Placental Cord Drainage (PCD), one of the active method for control of third stage of labor, incudes opening of clamp from mother’s side of umbilical cord thereby allowing the blood from placenta to flow freely immediately after clamping and cutting of the umbilical cord. Aim: Thus, the following study was conducted to assess the effect of PCD via umbilical cord in decreasing the time period of third stage of labor and incidence of PPH. Materials and Methods: This hospital based comparative study was conducted in the department of Obstetrics and Gynecology, National Institute of Medical Sciences & Research, Jaipur. A total of 300 consecutive patients with term pregnancy (>37 weeks) fulfilling the inclusion criteria were taken after informed consent. These were divided into two groups of 150 cases each, study group (PCD group) and control group. The various parameters like blood loss, need for transfusion, duration of third stage of labor, manual removal of placenta, hospital stay, secondary PPH (after 24 hours and before 6 weeks) were noted for every female. Statistical analysis was done using t-test for quantitative data, nonparametric data was analyzed by Mann Whitney test and categorical data was analyzed using chisquare test. The significance threshold of p-value was set at <0.05. All analysis was carried out by using SPSS software version 21. Results: Average blood loss was significantly less in subjects of drainage group as compared to control group (273.8 ml vs 391.2 ml; p<0.05). Also, average duration of third stage of labor was significantly less in drainage group (4.1 vs 7.7 mins; p<0.05). No difference was observed between two groups based on placenta weight (p-0.121). Conclusion: In the present study, PCD had a beneficial effect on the duration of third stage of labor and on postpartum blood loss. Thus, use of PCD is recommended in active management of labor by trained professionals
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Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups.
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Background: Eclampsia is a life threatening condition and one of the leading causes of maternal deaths worldwide. It is also associated with complications like acute renal failure, DIC, postpartum hemorrhage, etc. and adverse fetal outcomes. Hence we aimed to study fetomaternal outcomes in cases of Eclampsia.Methods: A total of 75 cases of eclampsia out of 13524 deliveries were evaluated, from 1st January 2016 to 30th June 2017 at RZ Hospital, a government tertiary referral centre. Maternal outcomes were studied for its complications, effectiveness of magnesium sulphate treatment, fetal outcome and mode of delivery.Results: Incidence rate of eclampsia was 0.55%, 62.66% of all cases were primigravida, 76% of cases were in age group of 21-26 years, 84% cases were from lower socio economic status, maternal mortality occurred in 2 of 75 cases. 66.67% of patients were of term pregnancy (37 to 42 weeks). 71%(53) patients delivered vaginally out of which 9 deliveries were spontaneous and 44 deliveries were induced vaginal delivery. 22 patients required caesarean section.Conclusions: Early detection and prevention of pregnancy induced hypertension and pre-eclampsia and other associated risk factors for eclampsia might help to reduce the incidence of eclampsia. Maternal adverse outcomes in this study were magnesium toxicity, acute renal failure (ARF), disseminated intravascular coagulation (DIC) and post partum hemorrhage (PPH) while 92% patients had no complications.
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A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.
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Background: PPH is responsible for 25% of all maternal deaths. In India, PPH incidence in India is 2%-4% following vaginal delivery and 6% following cesarean section. PPH as the important cause of 19.9% of maternal mortality in India. The objectives of the study were to study the incidence, risk factors, cause, morbidity and mortality pattern and management of PPH.Methods: This is a cross-sectional study conducted among 102 pregnant women selected by convenient sampling and admitted in labour room during the study period who will be deliver by vaginally or by caesarean section. The patient having PPH were divided into two groups: Group I: Patients having primary atonic PPH, Group II: Patients having traumatic PPH.Results: Mean age of participants was 33.6 and 32.9 years, 59.3 and 51.2 have ‘0’ parity, mean BMI 22.8 and 23.9 kg/m2, 34.6% and 17.1 babies were delivered by LSCS, 11.7% and 12.2% have history of PPH in the group of atonic and traumatic respectively. In the group of atonic PPH cases, 77.2%, 15.4%, 4.3% and 3.1% cases managed by the method of ‘Uterotonics +<2 blood transfusions’, ‘Uterotonics + >2blood transfusions’, ‘Perineal Tear Repair’ and ‘Surgical Intervention’ respectively. All the traumatic PPH cases (100.0%) were managed by ‘surgical intervention’.Conclusions: A multi-disciplinary approach include medical, mechanical, surgical and radiological is required in severe haemorrhage. Availability of blood and blood products is very crucial. Prediction and assessment of blood loss and timely identification of uterine atony are remaining the cornerstone for prompt and effective management of PPH.
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Background: Third stage of labour is still the “sword of Damocle’s” hanging above an obstetrician , inspite of today’s advanced technologies and personal care .The importance in the management of this deadly stage lies in the anticipation of complications and being quick enough to treat them timely. Hence in such scenarios, B-lynch suture is most popular method in treatment of uterine atony during caesarean section. The objective is to study and evaluate the cases in which the B-Lynch suture was used to treat the uterine atony during caesarean section.Methods: A prospective randomized study consisting of 50 women with high risk factors for atonic pph during caesarean section were included as study group patients were subjected to B-Lynch suture application when conventional drugs failed to control PPH. Blood loss was measured using a measuring jar. The fall in Hb% and the need for blood transfusion, and the need for hysterectomy as a last resort to save the life was evaluated.Results: The average blood loss was 1490 ml and the majority of patients had reduction in Hb% from 1.1-1.5 gm% (52%), 36% of the patients did not receive any blood transfusion after B-Lynch suture, and in 80% of cases hysterectomy was avoided.Conclusions: Our study shows cases treated with B-Lynch procedure showed that it is an effective method of containing pph. It has the advantage of being applied easily and safely. It should be attempted when conservative management fails and before any radical surgery is considered.
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Background: Postpartum hemorrhage (PPH) is globally one of the most common causes of maternal death, especially in developing country like India. Pregnancy and childbirth involve significant health risks, even to women with no preexisting health problem. The objective of this study was to analyze the role of various interventions in the management of PPH and its complications.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology of Department of Obstetrics and Gynecology, Dr. D Y Patil Medical college, Pimpri, Pune, Maharashtra, India. A total number of 80 cases of postpartum hemorrhage that fulfilled the selection criteria were included. Data collected and analyzed in PPH patients with medical and surgical management.Results: In present study, most of cases were multigravida (60%) and more than 50 percent of patients required blood and blood products. In present study, most of the postpartum bleeding or postpartum hemorrhage (PPH) cases managed by medical methods. Uterotonic drugs (42.5%) This was possible due to early identification and timely intervention.Conclusions: Active management of third stage of labour is recommended in all cases. Seventy percent cases were managed by medical methods while rest of the cases required surgical management. Among the medical management uterotonic drugs and bimanual uterine compression was used while among the surgical methods repair of cervical and vaginal laceration was mostly required.
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Postpartum haemorrhage accounts for nearly 28% of maternalmortality in developing countries. This prospective study ofthird stage bleeding prevention was conducted among the 96patients, who got admitted into the OBGY units of DhakaMedical College Hospital for normal vaginal delivery. 96patients were allocated to receive either 600 µg misoprostolorally (57 patients) or rectally (37 patients) 5 min after cordclamping and cutting. The primary objective was to find outwhether there was any dissimilarity present between these tworoutes of misoprostol in case of blood loss in third stage oflabor. A total of 59 patients received 600 mug of misoprostolorally, while 37 rectally. Both groups were comparable indemographic and parital data.
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Background: Peripartum hysterectomy is a life-saving obstetric procedure that is performed at the time of a caesarean section or postpartum following either vaginal delivery or caesarean section. The purpose of the present study was to determine the incidence, risk factors ,indications ,maternal and neonatal morbidity, mortality and complications of emergency peripartum hysterectomy performed at a tertiary teaching hospital in South India and to compare the results with other reports in literature.Methods: During the period of study between January 2015-December 2016, there were 50 cases of emergency peripartum hysterectomy at Tirunelveli medical college hospital, Tirunelveli, Tamil Nadu, South India. Medical, pathology and operation theatre records were analyzed retrospectively. Details of maternal age, parity, booking status, underlying risk factors, past obstetric history, gestational age at delivery ,mode of delivery ,indications for emergency peripartum hysterectomy, type of operation, intraoperative and post-operative complications, blood components transfusion ,maternal and neonatal outcomes were noted and analyzed.Results: During the 2-year study period there were 50 emergency peripartum hysterectomy out of 14,363 deliveries, a rate of 1 per 294 deliveries (3.4/1000 deliveries). 80% of hysterectomies were performed after caesarean delivery and 20% after vaginal delivery. The two major indications were abnormal placentation (40%) and uterine atony (28%). There were 6 maternal deaths among patients who underwent emergency peripartum hysterectomy during the period of study.Conclusions: Improved antenatal care, correction of anaemia, identification of risk factors for peripartum hysterectomy, timely referral, expedite management, timely decision, availability and liberal use of blood components and appropriate management of post-operative complications by experienced clinical team are the main stay for saving maternal lives. With increasing rate of caesarean section there is rise in the incidence of abnormal placentation.
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Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.Methods: A sample size of 200 normal delivered patients between age group 18 and 45 years is chosen with excessive bleeding after third stage of labour and after administration of oxytocics. These 200 patients are divided into two groups: First group receiving Misoprostol and applying condom catheter in other group. Both groups are evaluated for PPH.Results: It was found that CG balloon condom catheter was a much better and more effective alternative in controlling PPH than Misoprostol as the failure rate with CG balloon condom catheter were much less than that with misoprostol. Due to its cost effectiveness and being easily available at primary health center and due to absence of any drug reactions and easy technique of formation makes it a better modality in controlling PPH even at PHC.Conclusions: Patients with condom catheter in situ must show better result than patients receiving misoprostol.
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Background: Postpartum haemorrhage (PPH) is a life-threatening complication of delivery. The most common cause of PPH is uterine atony. Intrauterine balloon tamponade has been suggested as an effective, easily administered minimally invasive treatment option to control uterine bleeding while preserving the mother’s ability to bear additional children.Methods: Twenty women with normal vaginal delivery were studied over a period of six months, 10 were inserted conventional balloon tamponade and rest 10 were inserted CG balloon and outcome studied in terms of time to assemble, leakage, expulsion, lumen occlusion, volume of fluid used, time to arrest bleeding, cost, drainage port, inflation deflation interval.Results: Most of the women were para 4 or more, unbooked belonging to age group of 20-30. Mean time to assemble Condom balloon tamponade was 1.8min and that in CG balloon was 1.2 minute. There was leakage and expulsion in two and lumen occlusion in three in the conventional balloon catheter. In the second group there was no leakage ,lumen occlusion or expulsion . There is uterine drainage port present in CG balloon which is characteristic of it which helps in determining the actual blood loss in real time. The inflation deflation interval and mean volume of fluid are almost same in both the groups.Conclusions: Both conventional balloon and CG balloon are effective and lifesaving in low resource setting with few advantages of CG balloon over conventional balloon tamponade.
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Background: Maternal haemorrhage is the major cause of maternal mortality and morbidity all over the world and more so in developing countries. PPH is the commonest cause of maternal mortality in India. Identification of risk factors, early diagnosis and timely intervention can help in reducing maternal mortality and morbidity significantly. The aim of this study is to analyse the risk factors and causes and study the maternal and perinatal outcomes of PPH in North Karnataka.Methods: It is a retrospective study of 228 patients admitted with the diagnosis of PPH, at KIMS, Hubli during 2016.Results: Average age of the patients was 27 years. Commonest risk factor was PIH, followed by APH and prolonged labour. The commonest cause of PPH was atonicity followed by retained placenta. Majority of the patients recovered successfully with medical management. While 29 patients required Para cervical clamp. Sixteen patients underwent hysterectomy. Commonest complication was anaemia. Total maternal deaths were four; all of them were due to DIC, mostly due to late referrals.Conclusions: Maternal mortality and morbidity due to PPH can be reduced by encouraging regular anti natal visits, timely referral of high-risk patients, training of the health personals and timely intervention. Well stocked blood banks play an important role in management of PPH.
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MMR being an important index for evaluation of obstetric care of that area has a little information regarding actions to be taken to negotiate the maternal health issues of that area. Hence more number of cases who were moribund and critical but fortunately escaped death grouped as near miss was being studied to find out the shadowed causes of maternal mortality. Methods: All 312 near miss cases women were evaluated out of total 6040 admissions in obstetric ward of this institute during a period of one year from April 2017 to March 2018 to know the steps to be taken for improvement of maternal health in tribal and low resource newly started medical college. Result: Hypertensive disorders of pregnancy are the main culprit of maternal mortality whereas hemorrhage and its aftereffects are proved to be the most important cause of near miss. Incomplete abortion is the most common cause of hemorrhage and over the counter sell and misuse of Mifegest is found mainly responsible for incomplete abortion. Conclusion: To improve the obstetric care we have to educate the public for proper antenatal checkup. It will help health workers to identify the high risk pregnancies and their timely management. Apart from public awareness program there is necessity of well-equipped government health set ups where the poor tribal and also the other needy ones can report easily with all faith and confidence. Scarcity of skilled staff is also a subject to be noticed.
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Background: This study compares the efficacy of intramuscular oxytocin and oxytocin with sublingual misoprostol administration among the primary postpartum hemorrhage (PPH) mothers of vaginal deliveries. The aim is to compare the effectiveness of intramuscular oxytocin versus oxytocin with sublingual misoprostol in blood loss reduction among women at risk of PPH undergoing vaginal deliveries.Methods: Each group, 50 mothers were selected from the risk of PPH vaginal mothers in the labour ward of the study area.Results: The two groups’ mothers were not statistically significantly differed (P>0.05) in respect of their demographic and clinical variables such as age, gravida, risk factors, the onset of labour and type of delivery. The mean blood loss of group I was 315.4±111.4 ml and group II mean blood loss was 241.4±191.2 ml. The difference between the two groups’ blood losses was statistically significant (P<0.05).Conclusions: Oxytocin with sublingual misoprostol significantly reduced the blood loss during 3rd stage labour than only oxytocin administration.
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OBJECTIVE@#To explore effective treatments that can alleviate postoperative complications in patients with procedure for prolapsed and hemorrhoids (PPH).@*METHODS@#Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group. PPH routine treatment was given in the simple operation group. Electroacupuncture (EA) was applied at point 30 min before PPH in the preoperative electroacupuncture intervention group, and EA was applied at Ciliao (BL 32) and Xialiao (BL 34) for 30 min. The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups.@*RESULTS@#The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all <0.05).@*CONCLUSION@#Electroacupuncture at point 30 min before PPH can not only decrease the degrees of anal pendant and pain in the 6 h, 12 h, 18 h, but also shorten the persistent time of anal pendant and pain within 24 h after surgery and promote the first urination.