A rare case report of uterine rupture in a case of suspected septic abortion

There was a progressive rise in the rate of caesarean sections globally from 17.2% to 21.5% from 2017 to 2021. Caesarean sections have an improved feto-maternal outcome but come with a set of challenges. A second-trimester abortion in a previously scarred uterus is one of them. The incidence of uterine rupture is about 3.8�3% in a scarred uterus, which is much higher than in an unscarred uterus. Mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally within 24� hours has been proven to be an effective method for medical abortion, but its safety in a previously scarred uterus has not been fully established. A 27-year-old P2L2A1 with two previous caesarean sections at 19 weeks of gestation was referred to our tertiary care center with bleeding per vagina following consumption of medical termination of pregnancy (MTP) pills, followed by dilatation and curettage outside. She was pale, and tachycardia was noted. Septic abortion was suspected due to repeated bouts of fever, raised total counts, and starting on higher antibiotics. Due to persistent tachycardia and computed tomography (CT) findings, she was subjected to exploratory laparotomy, and a uterine rupture was confirmed. She underwent an obstetric hysterectomy as a lifesaving procedure. Second-trimester abortions with misoprostol in a previously scarred uterus require a high index of suspicion and close monitoring. Detecting life-threatening complications early in at-risk patients plays a crucial role in uterine preservation. There is scope for research to incorporate methods like Foley's induction in these cases. The clinical picture of a ruptured uterus can be initially non-specific, delaying the diagnosis. Surgery depends on the extent of the rupture, maternal hemodynamic status, and family completion. It is challenging to rule out uterine rupture when there is a similar presentation as septic abortion, so ultrasound is the first investigation of choice in the diagnosis of uterine rupture, whereas CT abdomen and pelvis are confirmatory.

Importance and Benefits of Green Audits to Education Institutions and Industrial Sectors

Green auditing is a vital process that ensures the diversity of plants on an organization's campus, reducing ecological pollution and soil destruction. It is beneficial intended for biodiversity protection, landscape management, irrigation/economic water utilization, and maintaining natural topography. Green audits are conducted at educational institutions and industrial sectors using the National Building Code (NBC) Part 11 - A 360° Risk Assessment Approach to Sustainability checklist. The importance of green auditing lies in its ability to create an eco-friendly environment and encourage green initiatives was studied at Nehru Arts and Science College, Coimbatore, Tamil Nadu, India. The results revealed that the campus has sufficient number of flora and fauna and established various gardens such as terrace, herbal, kitchen, zodiac, and decorative gardens. All the plants were labelled properly with common and botanical names and used biofertilizers, organic and green manures for the cultivation of plants. Agrochemicals and chemical fertilizers were minimally used to save the soil health and to protect the ecosystem from soil and water pollutions. The benefits of green audit included understanding the organization's internal and external green campus inspection and execution procedures, creating data on plant quantities, recommending biofertilizers, conserving economically valuable, rare, and endangered species, documenting rainwater collection systems, water reservoirs, percolation ponds, and irrigation technologies to the plants were well understood by the Oragnization with respect to the green audit.

Epidural analgesia in labour and its obstetric outcome

Background: Labour is a natural phenomenon which produces intolerable pain that requires effective methods for pain relief which is often challenging and complex task without regional analgesia. Epidural analgesia is most widely accepted method used to reduce labour pain. Aims and objectives were assessment of epidural analgesia in pain relief during labour, duration of different stages of labour, maternal and foetal outcome.Methods: This study was a prospective observational study conducted at RL Jalappa Hospital, Kolar from January 2020 to June 2021. 40 women admitted for normal vaginal delivery opting labour analgesia were studied. Data collected was entered in Microsoft excel spread sheet and results were analysed.Results: The mean duration of first stage of labour was 153 minutes, mean duration of second stage was 30 minutes, and mean duration of third stage was 12 minutes. During first stage of labour, 20 women (52%) had no pain, 12 women (31%) had mild pain and 6 women (15%) had moderate pain. During second stage of labour, 16 women (42%) had mild pain, 15 women (39%) had no pain and 7 women (18%) had moderate pain. During third stage of labour, 30 women (78.9%) had no pain and 8 women (21%) had mild pain. The mean Apgar score of all babies at 1 minute was 7/10 and 5 minute was 9/10.Conclusions: Epidural analgesia is a safe and effective technique during labour and provides significant pain relief with excellent patient satisfaction.

Epidural analgesia in labour and its obstetric outcome

Background: Labour is a natural phenomenon which produces intolerable pain that requires effective methods for pain relief which is often challenging and complex task without regional analgesia. Epidural analgesia is most widely accepted method used to reduce labour pain. Aims and objectives were assessment of epidural analgesia in pain relief during labour, duration of different stages of labour, maternal and foetal outcome.Methods: This study was a prospective observational study conducted at RL Jalappa Hospital, Kolar from January 2020 to June 2021. 40 women admitted for normal vaginal delivery opting labour analgesia were studied. Data collected was entered in Microsoft excel spread sheet and results were analysed.Results: The mean duration of first stage of labour was 153 minutes, mean duration of second stage was 30 minutes, and mean duration of third stage was 12 minutes. During first stage of labour, 20 women (52%) had no pain, 12 women (31%) had mild pain and 6 women (15%) had moderate pain. During second stage of labour, 16 women (42%) had mild pain, 15 women (39%) had no pain and 7 women (18%) had moderate pain. During third stage of labour, 30 women (78.9%) had no pain and 8 women (21%) had mild pain. The mean Apgar score of all babies at 1 minute was 7/10 and 5 minute was 9/10.Conclusions: Epidural analgesia is a safe and effective technique during labour and provides significant pain relief with excellent patient satisfaction.

Serum CA 125 level in normotensive and pre-eclamptic pregnancies in a tertiary care hospital

Background: Preeclampsia is one main reason for high-risk pregnancy. Among the disorders in hypertension, preeclampsia develops in antenatal period and it is defined by high blood pressure of more than 140/90 mmHg and arteriolar vasoconstriction, both of which lower uteroplacental perfusion and ultimately lead to placental hypoxia. The objectives of this study was (a) to estimate CA125 level in normotensive and pre eclamptic pregnancies; and (b) to predict severity of pre-eclampsia with CA125 levels with cut off value of CA125 level as 23.7 IU/ml.Methods: This two year cross sectional study was conducted on all antenatal mothers bestween 20 -40 weeks gestational age getting admitted RLJH and research centre Tamaka (January 2021-December 2022), for the period of 2 years who fulfilled inclusion and exclusion criteria. Detailed clinical history along with antenatal examination was done. For each study subject the blood pressure was recorded. Complete blood picture was done and CA125 levels were done of the study subjects.Results: Mean CA125 among normal subjects was 24.24±13.71 IU/ml and Mean CA125 among pre-eclampsia subjects was 30.61±15.69 IU/ml. There was a statistical significance found between two groups with respect to CA125.Conclusions: In pre-eclampsia, CA125 was increased more compared to normotensive group. This indicates the importance in estimation of CA125 level in preeclampsia. The same has been determined with significant p value.

Evaluation of outcome of mode of delivery in severe preeclampsia

Background: Preeclampsia is new onset hypertension of more than 140/90 mmHg on 2 occasions, 4 hours apart in pregnancy, which occurs after 20 weeks of gestation and frequently near term. If there are other symptoms like as headache, blurred vision from end organ damage, and thrombocytopenia, it is characterized as severe preeclampsia. Regardless of the foetal outcome, treatment for severe preeclampsia is immediate delivery. The goal of the current study is to assess how different delivery methods affect individuals with severe preeclampsia.Methods: It is a retrospective study conducted in RL Jalappa hospital, Kolar from January 2021 to February 2022. Out of 2568 deliveries at our facility throughout the study period, 150 singleton pregnancies complicated by severe preeclampsia delivered at 24-34 weeks of gestation were chosen for the study. Women who had additional obstetric, foetal, or medical difficulties were not included in the study.Results: 110 study participants had an LSCS form of delivery out of the total. Among them, non-reassuring fetal heart rate, obstructed labor, and malpresentation were the most typical indicators for LSCS. The difference between Bishop's score and the mode of delivery was statistically significant. There was no discernible difference between the newborn's APGAR score immediately following delivery and the method of delivery.Conclusions: There are strong chances of a normal vaginal birth if the Bishop score at the time of admission and induction is more than 4.

The efficacy of doppler indices in predicting the neontal outcome in term preeclamptic women with intrauterine growth restriction: an observational study in a tertiary care centre

Background: Doppler flow velocimetry of the umbilical and fetal cerebral circulation is a non-invasive modality used to access the fetal well-being. Doppler is comparatively more specific and is potentially a useful tool in predicting adverse perinatal outcome in high risk cases. Objectives of this study were to evaluate the efficacy of Middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and cerebroplacental ratio (CPR) doppler indices in assessment of fetal well-being. To document neonatal outcome in preeclamptic women with doppler changes.Methods: A retrospective observational study of term preeclamptic women with clinical IUGR admitting in labour room of RLJ Hospital from January 2019 to December 2019. All these women underwent Doppler study and were followed up till delivery.Results: A total 89 term preeclamptic women, 47.19% women had normal delivery, 52.81% lower segment caesarean section. 74.16 % delivered babies required NICU (neonatal ICU) care, 51.69 % babies had a longer duration of NICU care (more than 5 days). The perinatal complications like respiratory distress 8.99% low birth weight 39.33%, meconium stained 10.11%, still born 4.49% and perinatal asphyxia (6.06%). Women with abnormal MCA-PI 46.07% of cases, UA-PI in 40.45% and CPR 57.30%.Conclusions: It was observed that all three parameters CPR, MCA-PI and UA-PI when taken into account together are good utilities in predicting perinatal outcome.

Feto-maternal outcome in patients with peripartum cardiomyopathy: a 5-year study in a tertiary care hospital in Kolar district

Background: Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first 5 months postpartum. PPCM remains a diagnosis of exclusion. There have been numerous proposed causes including hormonal abnormalities, inflammation, viral pathogens, autoimmune response, and genetic predisposition. Aim of study was to study the clinical profile, risk factors, and the management along with obstetric and perinatal outcome, in women with peripartum cardiomyopathy.Methods: This retrospective observational study was conducted on the antenatal women of age group of 18 years to 40 years, admitted in the labour ward of R. L. Jalapa hospital who presented with heart failure in last month of pregnancy till 5 months postpartum, without previously having a heart disease over the 5 year period, January 20 15 to December 2019.Results: Majority of the patients (15/18) presented with complaints of exertional dyspnoea. Mean LVEF at the time of diagnosis was 38.39%. There were 5 (27%) maternal mortality and all of them had global hypokinesia on echocardiography and presented in NYHA class III and IV. Two (11%) out of eighteen patients had intrauterine death, and all the patients who had IUFD belonged to class IV. Four babies (22.22%) had intrauterine growth restriction.Conclusions: The present study came to conclusion that in rural tertiary center, maternal outcome and prognosis was poor as patients presenting to us were majority of them in cardiogenic shock and lower LVEF in terminal stages. The associated risk factors were preeclampsia, anemia and multiple gestation which could also contribute to the poor prognosis which was noticed in the study. Early recognition of the disease is of paramount importance as the clinical manifestations can conceal and can lead to high morbidity and mortality especially within 3 months postpartum.

Neutrophil and Platelet to Lymphocyte Ratio in Prevailing the Oxidative Stress and its Relation with the Endothelial Dysfunction in Preeclampsia

Background: Preeclampsia (PE) is a pregnancy specific,hypertensive disorder. It affects 2-8% pregnancies.Oxidative stress and systemic inflammation areproposed to contribute significantly to the preeclampsiapathophysiology. The present study, aim is to determineand compare the markers of oxidative stress, endothelialdysfunction, systemic inflammatory markersNeutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) in preeclampsia andgestational age matched healthy controls. Material andMethods: This study was conducted in the Departmentof Biochemistry and Department of Obstetrics andGynecology, Sri Devaraj Urs Medical College, Kolar,Karnataka. The study included 98 preeclamptic womenand 98 normotensive pregnant women. Five ml venousblood was collected from all the study subjects. Bloodsample in EDTA vials was used for the complete bloodcount. NLR and PLR were calculated. Plasma was usedfor Ferric Reducing Ability of Plasma (FRAP) assay.Serum was used for the estimation of Malondialdehyde(MDA), nitric oxide, blood sugar, renal parameters andliver enzymes i.e., Aspartate Transaminase (AST),Alanine Transaminase (ALT), Lactate Dehydrogenase(LDH) and magnesium. Corresponding urine sampleswere collected for urinary protein analysis by dipstickmethod. Fetal outcome was recorded. Results:Gestational age was significantly low in preeclampticwomen as compared to those of controls. Bloodpressure (Systolic and diastolic), mean arterial pressure,body mass index, pulse rate, serum creatinine, uric acid,AST, ALT, LDH, MDA and NLR were increasedsignificantly in preeclamptic women as compared tothose of controls. In subgroup analysis, NLR wasincreased significantly in severe preeclamptics ascompared to mild preeclamptics. Serum Nitric Oxide(NO) and FRAP levels were decreased significantly inpreeclamptic women as compared to those of controls.Significantly decreased birth weight was observed inbabies born to preeclamptic mothers compared withcontrols. Conclusion: The present study resultsconclude that increased oxidative stress in termsincreased MDA, decreased NO and reduced antioxidantstatus (FRAP) in preeclamptic women, results inadverse perinatal outcome. In addition, maternal NLRcould be considered as a marker for severity ofpreeclampsia

Obstetrical and perinatal outcome in adolescent pregnancy: a retrospective study at a tertiary care center in rural India

Background: Adolescent pregnancy is a serious health and social problem worldwide. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a tertiary care centre in rural India.Methods: This is a retrospective study conducted between April 2017 and March 2018.Adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. The factors under study included obstetric complications and neonatal outcomes. The association was considered significant at P-value <0.05.Results: 450 women were included in the study group and 460 to the control group. The incidence of adolescent pregnancy was 18.3% during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia (12.8 % vs 8.4 %; p = 0.03), eclampsia (3.5% vs 1.5%; p = 0.01), preterm delivery (18.6% vs 10.8%; p = 0.0009), low birth weight (39.1 % vs 24.2 %; p = 0.00001),very low birth weight babies (13.7 % vs 8.7 %; p = 0.01) compared to control group. There was higher proportion of NICU admissions in adolescent group (20.8% vs 12.3 %; p = 0.0005) compared to control group. No significant difference was found regarding postpartum complications and still birth.Conclusions: Adolescent pregnancy is associated with poorer feto-maternal outcomes. Regular antenatal visits, adequate nutritional supplementation and early detection of high-risk factors may contribute in decreasing the obstetric risk of childbirth in adolescent mothers.

Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site antisepsis in caesarean section

Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection. Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.

Evaluation of Maternal Thyroid Hormone Status and Atherogenic Potency in Pre Eclampsia in Kolar District- A South West of India.

Aim: To determine maternal thyroid hormone status and lipid profile in preeclampsia. Study Design: A prospective case control study consist of two groups such as group 1 normotensive non-preeclamptic group and group 2 as cases with clinically diagnosed preeclampsia Place and Duration of Study: Department of Obstetrics and Gynaecology, RL Jalappa Hospital and Research Centre kolar, between January 2012 and June 2013. Methodology: A total number of 100 pregnant patients were enrolled in the present study. Amongst, normotensive and preeclamptic pregnant women Group 1 (n=50) as controls (n=50). Group-2 (n=50) were preeclampsia cases. Five ml of blood samples were collected from each normal pregnant and preeclampsia patients. Thyroid hormone levels and lipid parameters were estimated using spectrophotometric method. Statistical analysis carried out by using Mean ± SD, and ‘t’ test. Results: The Mean ± SD values of T3 ng/ml (1.56±0.38), T4 (1.37±0.36) mcg/dl, TSH (2.45±1.23) mcIU/ml in normal pregnants and T3 ng/ml (1.37±0.36), T4 (9.87±2.83) mcg/dl, TSH (6.15±5.51) mcIU/ml in preeclampsia cases were presented. Similarly Mean ± SD values of total cholesterol (181.62±44.33) mg/dl, HDL cholesterol (49.44±11.54) mg/dl, Triglycerides (198.10±49.84) mg/dl, LDL cholesterol (104.90±29.58) mg/dl, and Total cholesterol/HDL cholesterol ratio (3.67) were from control group and total cholesterol (222.60±70.07) mg/dl, HDL cholesterol (45.92±11.81), Triglycerides (278.66±93.46) mg/dl, LDL cholesterol (116.52±49.26) mg/dl, and cholesterol and HDL cholesterol ratio (4.84) in preeclampsia were presented respectively. Conclusion: Pre eclampsia patients have higher levels of TSH and lower levels of T3 and T4 in comparison to normotensive pregnant women. This changes in the thyroid hormones did not correlate with the severity of preeclampsia between mild and severe pre eclampsia groups. Dyslipidemia was observed in pre eclampsia group than in the normotensive group indicates the possible atherogenic potential. This association may be useful in understanding the pathologic processes of preeclampsia.

Knowledge and attitude on infant oral health among graduating medical students in Kerala.

Providing dental and oral health care to all children in Kerala remains a thorny challenge. Lack of community water fluoridation, dental workforce shortages and geographical barriers all aggravate oral health and access problems. Children from low-income and minority families and children with special needs are at particular risk. Family centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. Present study was conducted to evaluate knowledge and attitude of graduating medical students towards infant oral health qualitative methods were used to evaluate the program.

Acrodysostosis: autosomal dominant transmission.

We describe a two and half year old male child with acrodysostosis, presenting with nasal hypoplasia, peripheral dysostosis (gross shortening of hands and feet), cone-shaped epiphysis, advanced bone age, and mental retardation. He and his mother also had bilateral first ray hyperplasia of the feet thereby expressing the autosomal dominant inheritance pattern.

Griscelli syndrome: Rab 27a mutation.

An infant with partial albinism was suspected to have Chediak-Higashi syndrome because two of his elder siblings had albinism and died in childhood following accelerated phase. Detailed investigations of blood, hair and skin of the proband revealed that he had Griscelli syndrome.

Opsoclonus myoclonus syndrome: response to plasmapheresis.

An 18-month-old with idiopathic opsomyoclonus, refractory to therapy with ACTH, corticosteroids, and clonazepam received plasmapheresis along with oral corticosteroids and azathioprine. The subject improved dramatically following this treatment. Anticerebellar antibodies were detected from the plasma in this patient and in a two and a half year-old girl with cerebellar ataxia secondary to an adrenal ganglioneuroma.

Construction, electroporatic transfer and expression of ZpfJypGH and ZpfJrtGH in zebrafish.

Recombinant transformation vectors (ZPPypGH and ZpprtGH) consisting of fish growth hormone cDNA, and a reporter gene p-galactosidase driven by fish promoter (Zp) were constructed. Freshly fertilized eggs of zebrafish (Brachydanio rerio) were electroporated at optimum conditions (0.07 kV voltage; 25 J.1F capacitance; 00 ohm resistance and 2 pulses) in the presence of one of these transformation vectors (100 J.1g circular DNNml). In either cases 72% of the electroporated eggs successfully hatched, in comparison to the 85% hatchability of the control eggs. Genomic DNA extracted from fins of randomly chosen Fo individuals was screened (by Southern blot hybridization); the transgenes were retained in the host-. genome of all the randomly chosen adult transformants. Fin-positive presumptive founder parents were crossed with control counterparts and the DNA of randomly chosen F] progenies was screened for germ-line transformation. Southern analysis of chosen F1 progenies revealed the persistence of ZPPypGH or ZpPrtGH in 53% of the F1 progenies. Southern analyses of chosen F1 progenies and the frequency (53% of F1 ZpPrtGH and 53% of F1 ZPPypGH) of transmission revealed the degree of mosaicism i!1 F 0 transformants. Expression was confirmed from the 3-4 times elevated levels of activity of the reporter gene and 30-40% accelerated growth of transgenic Fo and F1 progenies.