Quinary Prevention and Lower Segment Cesarean Section

Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery.

Addressing Lower Segment Cesarean Section Hesitancy: A Patient-centered, Pragmatic Communication Guide

In women in whom a normal vaginal delivery is not possible or is not indicated, delayed acceptance of lower segment cesarean section (LSCS) or outright LSCS refusal, leads to complications that can easily be avoided. Hence, it makes sense for obstetricians and other health care professionals, to address LSCS hesitancy as an integral part of obstetric care. In this article, we discuss both the communication style and communication content, that is required to manage LSCS hesitancy in women in whom the intervention is indicated. We highlight the need to analyze the reasons for hesitancy, and address them in an appropriate and affable manner, using accurate information to buttress one’s points. We also encourage seeking assistance from colleagues in the health care team, utilizing audio-visual and social media aids, and offering alternatives if the patient so desires.

Early detection and prevention of oral cancer: an appraisal

In a bid mitigate the spread of HIV and AIDS since it was diagnosed, several interventions ranging from palliative care, increased access to HIV treatment to manage opportunistic infections and the current drive of improving clinical outcomes through suppression of viral load are all aimed at prolonging survival of HIV and AIDS patients. The authors endeavour to corroborate the effect of viral load (VL) suppression on ART HIV patients. The authors applied a comprehensive search by merging terms for survival of HIV patients to clinical, demographic and socio-economic factors in NCBI and MEDLINE databases. About 15 articles were considered by outlining research questions, generating key words and search terminologies. Only articles published since 2013 during scale up of VL interventions were considered. It is worth noting that unsuppressed VL clinically decisively causes death in HIV/AIDS patients, propelled by a number of associated causes including opportunistic infections (OIs) Tuberculosis (TB), Non communicable diseases (NCDs), age, sex, income, geographic location among others. Whereas there is marked decline in risk of dying among HIV/AIDS patients resulting from VL suppression, other factors including; early detection and timely treatment, managing OIs, NCDs and TB treatment, tackling socio-economic barriers and multi-pronged community focused interventions like Community Client Led ART Delivery CCLAD, Community Drug Distribution Point (CDDP) interventions enhance survival of HIV/AIDS patients on lifelong ART.

Discernment, apropos on dispensation of hospital waste among paramedics: a descriptive study

Background: India is one of the most populated and rapidly growing countries in the world and is the source of humongous amounts of waste every year, including municipal solid waste, hazardous waste, biomedical waste or e-waste. Healthcare is one of the largest sectors in India both in terms of revenue and employment. With growing healthcare, there is a requirement of management of bio-medical waste. This study is conducted to assess discernment, apropos on dispensation of hospital waste by paramedics.Methods: A cross-sectional study was conducted to assess the discernment and apropos of paramedical staff in 3 private hospitals regarding disposal of waste in Bhopal city and convenience sampling was used. A total of 204 individuals were approached for the study. The collected data analysed by using SPSS 21.0 and Descriptive analysis was done.Results: Total 204 paramedical staff participated in the study out of which 125 (61.2%) were males and 79 (38.7%) were males. It showed that there was limited level of knowledge, attitude and practices among class 3 workers i.e., attenders as compared to nurses and technicians.Conclusions: Study concluded that there is lack of knowledge about waste management which leads to improper waste disposal and pointed out that class 3 workers have less knowledge as compared to class 1 and class 2 workers. The technicians and nurses comparatively were having better knowledge and attitude, and also practiced waste management better than the attenders

Retrospective review of maternal deaths and maternal near misses due to major obstetric haemorrhage at a tertiary care centre in India

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani  Hospital over a period of 12 months (April 2016-March 2017), of  all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was  2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor  for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH.

Chronic Abruption In Early Second Trimester Mimicking Partial Mole - A Rare Case Report

Placental abruption is known as one of the most serious complications in pregnancy with detrimental effect on both the mother and the fetus. The clinical presentation and the ultrasound findings of this condition vary to a large extent as can be depicted from our case report. We report a rare case of a 30-year-old, G3P2L2 at 4 months of gestation, who presented with the complaints of dark altered bleeding along with pain lower abdomen for 1 day. Ultrasound findings were a dead fetus of 19 weeks 2 days with diffusely enlarged placenta with multiple cystic areas suggestive of intrauterine demise with partial mole. This case report is important as chronic placental abruption in the second trimester is rare, and a high index of suspicion is imperative to differentiate it from other conditions such as partial mole.