Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.

Sonographic assessment of fetal head deflexion using occiput: spine angle measured during first stage of labour and its role in predicting the mode of delivery among nulliparous women

Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71).  The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.

Compare the manual vacuum aspiration with electrical vacuum aspiration in 1st trimester MTP

Background: Unplanned and unwanted pregnancies are common occurrences in all societies, regardless of the level of medical, economic, educational or religious development present within them. Despite wider availability of contraceptive methods, the incidence of induced abortion is increasing. Aim: To study the efficacy of Mifepristone 200 mg orally followed 48 hours later by Misoprostol 600 µg per vaginally in women undergoing medical termination of early pregnancy (up to 73 days of gestational age). Materials and methods: The present study included 50 pregnant women requesting termination of pregnancy in first trimester attending the department of Obstetrics and Gynecology. Women with gestational age up to 73 days from the first day of the last menstrual period with previous regular cycles were studied. Patients without medical or surgical contraindications to Mifepristone and Misoprostol were included. Women without prior caesarean section were studied. Results: Majority of the patients were of age group between 21-25 years. 92% of these women were married, 15% were nulliparous and 35% were multiparous. The period of gestation varied from 38-73 days. Majority of women were between 36-50 days of gestational age, constituting 50%. 94% of the patients had complete abortion and 4% had incomplete abortion. Success rate was not affected by the parity or gestational age, 72% of the patients expelled the products of conception within 10 hours, 84% in 15 hours and almost all the patients within 24 hours of prostaglandin administration. Most of the adverse effects reported were of the gastrointestinal system of which nausea was reported by 40%, abdominal pain by 70%, vomiting by 16% and diarrhoea by 4% of the cases. 6% of the patients reported excess bleeding at the time of abortion but none of them required hospitalization or blood P. Yamini Shobha Vani, A. Niranjani Devi. Efficacy of Mifepristone and Misoprostol combination in termination of early pregnancy. IAIM, 2016; 3(12): 48-54. Page 49 transfusion. The mean duration of bleeding was 7.24 days. A significant fall in hemoglobin was not observed in any patient (less than 1 gm/dl). This combination has the advantage of high complete abortion rate with low frequency of side effects. Conclusion: The combination of RU 486 200mg orally and misoprostol 600 µg intravaginally appears to offer safe, efficient, acceptable, out-patient procedure and an alternative to surgical abortion in early termination of pregnancy (up to 73 days of gestation).

Assessment of microbial contamination of toothbrush head: An in vitro study.

Background: The most common oral hygiene aid used to improve the oral health of an individual is toothbrush and it is often neglected to maintain in a proper aseptic condition, which could probably result in contamination by various micro-organisms. Aims: 1) To assess the microbial contamination of the hard deposit on the toothbrush head, between the bristle tufts, after 1 and 3 months of use. 2) To assess the microbial contamination of the hard deposit on the toothbrush head, between the bristle tufts, which were kept in the bathrooms with and without attached toilet. Setting and Design: An in vitro study. Materials and Methods: Twenty toothbrushes kept in the bathrooms with an attached toilet and 20 toothbrushes kept in the bathrooms without an attached toilet were collected from the participants, making it a total of 40. Among these 20 toothbrushes in each group, 10 were used for 1 month duration and 10 were used for 3 months duration. Results: Streptococcus mutans, Staphylococcus aureus, Pseudomonas, Lactobacillus, Klebsiella, Candida species were isolated in 1 month and 3 months used toothbrushes kept in the bathrooms without attached toilet. Escherichia coli was found in 3 months used toothbrushes kept in the bathrooms with attached toilet. Micro-organisms were found in isolated form in toothbrushes used for 1 month, whereas in toothbrushes used for 3 months they are found in clumps. Conclusion: Hard deposit on the toothbrush head between bristle tufts is a nidus for growth of micro-organisms, which not only affects the oral health but also affects the general health of an individual.

Macular serpiginous choroiditis.

PURPOSE: To report a variant form of serpiginous choroiditis, that initially or predominantly involved the macular area. METHODS: Nine eyes of 6 patients with the macular form of serpiginous choroiditis were evaluated clinically and angiographically in a longitudinal fashion for a period of 12-36 months. The active stage and the recurrences were treated by oral and periocular cortico steroids; and two patients were supplemented with oral azathioprine. Most of these patients were referred to our center with varied diagnoses. RESULTS: In this group, 4 were male and 2 were female with an average age of 30.5 years. Three patients had bilateral macular lesions, two had typical serpiginous choroiditis in the fellow eye and the remaining one had unilateral macular involvement alone. The initial visual acuity was 6/60 or less in 60% eyes whereas the final visual acuity was 6/18 or better in 66% eyes. Angiographic findings were typical of serpiginous choroiditis characterised by early hypofluorescence followed by leakage and staining of the borders and the lesion itself without any evidence of choroidal ischaemia or retinal vascular abnormalities. CONCLUSION: The macular variant of serpiginous choroiditis can mimic many other macular pathologic lesions, thus posing a diagnostic dilemma. Because of its relentless destructive course, early diagnosis and prompt treatment is required to prevent sight-threatening complications.