Unsafe abortion: journey from unmet needs to denial for contraception

Background: Easy over the counter availability of abortion pills leads to unsupervised rampant use of the pills which further results in physical and mental health complications and social and financial burdens for women, communities and health systems. Aims and objectives were to study the sociodemographic, obstetric and clinical profile of the women presenting with unsupervised intake of abortifacient, and to study the acceptance of post abortal contraception and also the method of contraception accepted.Methods: This present study was carried out in women with history of unsupervised self-intake of abortifacient and presenting with complain of bleeding per vaginum and various other complications in the emergency or outpatient department of obstetrics and gynaecology between October 2022 to September 2023 at Nehru Hospital, BRD Medical college, Gorakhpur. Complete personal, sociodemographic and obstetric history was obtained. Complete general and systemic examination was done and all routine investigations were sent.Results: A total of 197 women were enrolled in this study. In our study majority 39.48% (n=77) of women were between 25-30 years age. 56.34% (n=111) belonged to low socioeconomic strata and 69.54% (n=137) resided in urban area. 42.63% (n=84) were gravida 3 or more. 22.8% cases took abortifacient pills beyond 9 weeks of gestation. All patients procured the contraceptive from local practitioner, quacks, medical stores and chemists without any consultation from gynecologist. Most frequent complain was Chronic bleeding per vaginum with RPOC (n=112, 56.85%). Majority patients had moderate to severe anemia and 53.8% (n=106) required blood transfusion. 2.03% (n=4) presented with features of sepsis and 2.03% (n=4) presented with ruptured ectopic. Majority (n=160, 81.21%) didn抰 opt for post abortion contraception.Conclusions: One major contributor to unsafe abortions is the easy availability of abortion pills. These pills should be restricted from over-the-counter sales and made available to the public only through authorized MTP centres with a proper prescription.

Randomized control trial to find the safety and efficacy of the Kiwi OmniCup system in comparison with the conventional vacuum delivery

Background: Ventouse delivery, also known as vacuum extraction, is a medical procedure employed during childbirth to assist in the safe delivery of a baby when conditions necessitate a quicker or controlled delivery to safeguard the health and well-being of both the baby and the mother.Methods: The research was conducted in the labour room of the Department of Obstetrics and Gynaecology at Baba Raghav das Medical College in Gorakhpur, Uttar Pradesh during September 2019 to August 2020 involve all pregnant women undergoing the process of normal delivery. Thorough maternal histories, physical examinations, and diagnostic tests were conducted and documented. Group A undergoing conventional vacuum extraction and group B utilizing the Kiwi OmniCup. The outcomes of the procedures were meticulously recorded.Results: Instrumental deliveries in both the Ventouse and Kiwi OmniCup groups were primarily conducted due to fetal distress, with 16 cases (40%) and 23 cases (57.5%), respectively. Other medical conditions also contributed to instrumental deliveries, accounting for 16 cases (40%) in the Ventouse group and 9 cases (22.5%) in the Kiwi OmniCup group. Maternal exhaustion led to instrumental deliveries in 8 cases (20%) in both groups.Conclusions: Instrumental deliveries, primarily ventouse and Kiwi OmniCup, were mainly performed due to fetal distress, with ventouse often requiring longer cup application and resulting in more significant blood loss, while Kiwi OmniCup led to neonatal intensive care unit (NICU) admissions primarily due to respiratory distress; however, both methods showed comparable APGAR scores and low rates of severe neonatal complications.

Clinical bleeding patterns and management of abnormal uterine bleeding in non-pregnant women: a cross-sectional study

Background: Around 10 to 15 percent of women go through instances of unusual bleeding from their uterus at some point during their reproductive years. Additionally, up to one-third of women may come across irregular menstrual cycles. These irregularities often occur during two crucial phases in a woman's life: firstly, at the beginning of menstruation, which is known as menarche, and secondly, during the transition leading up to menopause, referred to as perimenopause. Aim of study was to determine the clinical bleeding patterns in nonpregnant women and its management.Methods: During the study period spanning from November 2021 to December 2022, a cross-sectional study examined non-pregnant females aged 15 to 55 experiencing abnormal vaginal bleeding (AUB) who provided consent. However, certain exclusion criteria were established to ensure that the study's findings remained pertinent to the target population. Females exhibiting vaginal bleeding attributed to pregnancy or pregnancy-related factors were excluded from the study, as were those with vaginal bleeding stemming from vaginitis, cervical benign, premalignant, or malignant conditions, or traumatic causes. Descriptive statistics were employed in the study.Results: Structural causes [PALM] accounts for 71 (61%) of cases whereas non-structural causes of chronic AUB account for 44 (39%) of cases. AUB-L, 45 (39.2%) was the most frequent finding in females with AUB. The second most common causes are AUB-O 23 (20%) followed by AUB-A 14 (12.2%), AUB-C 08(7%), AUB-M 07 (6.1%), AUB-E 06 (5.2%), AUB-P and AUB-I in 05 (4.3%) each and AUB-N 02 (1.7%).Conclusions: Focusing on Abnormal Uterine Bleeding (AUB), it was observed that AUB-L, attributed to leiomyomas, emerged as the most prevalent cause among affected females. Subsequently, AUB-O, arising from ovulatory dysfunction, and aub-a, linked to adenomyosis, ranked as the second and third most common causes, respectively. Among the clinical manifestations of AUB, prolonged bleeding was identified as the most frequent symptom, followed closely by heavy bleeding.

The outcome of preterm births in pregnant women with hypertensive disorders: an observational study

Background: Hypertensive conditions occurring during pregnancy are linked to heightened chances of severe consequences, including preterm birth, intrauterine growth restriction, perinatal mortality and morbidity, acute kidney failure, sudden liver malfunction, excessive postpartum bleeding, HELLP Syndrome, disseminated intravascular coagulation, and seizures.Methods: A prospective hospital-based study was conducted in a tertiary care hospital of eastern Uttar Pradesh, over the period of one year. The total sample size calculated was 235. Data was collected using the structured questionnaire. This study recruited the hypertensive pregnant women with a blood pressure reading of 140/90 mmHg or higher, irrespective of the timing of the blood pressure elevation, who visited the hospital for delivery over the course of one year. Various maternal variables were examined, including age, gestational age, number of previous deliveries, the status of the mother's blood pressure, and the type of delivery.Results: In the present study, the births revealed the following distribution among different hypertensive disorders: chronic hypertension preterm: 100.0% 06 vs. term: 0% 0, eclampsia, preterm: 60.4% 64 vs. term: 39.6% 42, mild preeclampsia, preterm: 55.3% vs. term: 44.7%, severe preeclampsia, preterm: 48.5% vs. term: 51.5%, and gestational hypertension, preterm: 23.5% vs. term: 76.5%.Conclusions: Based on the findings of this study, it was determined that hypertensive disorders play a pivotal role in influencing both the frequency of preterm delivery and the associated complications in infants resulting from premature birth.

Comparison of maternal outcome in COVID-19 positive and negative antenatal women: a comparative study

Background: Coronavirus is an RNA virus causing respiratory and gastrointestinal infections. It caused SARS and MERS epidemics. In late 2019, a mutation called SARS-CoV-2 caused COVID-19, a severe respiratory illness. Pregnant women are at risk, but information is limited. The second wave affected pregnant women more. Maternal COVID-19 can lead to preterm births and caesarean sections. Vertical transmission to neonates is possible. Ongoing research is crucial to understand COVID-19's impact on mothers.Methods: A comparative prospective hospital-based study was conducted, including antenatal women with COVID-19 symptoms in the case group. The control group consisted of antenatal women who tested negative for COVID-19. The study analyzed 150 COVID-19-positive antenatal women and 350 COVID-19-negative antenatal women, excluding those who left the study prematurely or tested positive during the study period.Results: In the case group, no abortions were reported (0%), while in the control group, there was 1 abortion (0.29%). PROM occurred in 5.78% of cases and 1.43% of controls, with a significant difference. PPROM occurred in 2.31% of cases and 2.57% of controls, showing no significant difference. Preterm labor was observed in 11.53% of cases and 3.71% of controls, with a significant difference.Conclusions: Pregnant women with COVID-19 experience diverse symptoms, highlighting the importance of vigilant monitoring. Adverse maternal outcomes, including preterm labor and ICU admission, are more common in infected individuals. Managing comorbidities, such as diabetes, is crucial.

Comparison of maternal outcome in COVID-19 positive and negative antenatal women: a comparative study

Background: Coronavirus is an RNA virus causing respiratory and gastrointestinal infections. It caused SARS and MERS epidemics. In late 2019, a mutation called SARS-CoV-2 caused COVID-19, a severe respiratory illness. Pregnant women are at risk, but information is limited. The second wave affected pregnant women more. Maternal COVID-19 can lead to preterm births and caesarean sections. Vertical transmission to neonates is possible. Ongoing research is crucial to understand COVID-19's impact on mothers.Methods: A comparative prospective hospital-based study was conducted, including antenatal women with COVID-19 symptoms in the case group. The control group consisted of antenatal women who tested negative for COVID-19. The study analyzed 150 COVID-19-positive antenatal women and 350 COVID-19-negative antenatal women, excluding those who left the study prematurely or tested positive during the study period.Results: In the case group, no abortions were reported (0%), while in the control group, there was 1 abortion (0.29%). PROM occurred in 5.78% of cases and 1.43% of controls, with a significant difference. PPROM occurred in 2.31% of cases and 2.57% of controls, showing no significant difference. Preterm labor was observed in 11.53% of cases and 3.71% of controls, with a significant difference.Conclusions: Pregnant women with COVID-19 experience diverse symptoms, highlighting the importance of vigilant monitoring. Adverse maternal outcomes, including preterm labor and ICU admission, are more common in infected individuals. Managing comorbidities, such as diabetes, is crucial.