A comparative study on the effect of intravenous Ringer lactate at 125 ml/hour versus 250 ml/hour on the duration of labour in nulliparous pregnant women

Background: Several factors may influence the progression of normal labour. It has been postulated that the routine administration of intravenous fluids to keep women adequately hydrated during labour may reduce the period of contraction and relaxation of the uterine muscle, and may ultimately reduce the duration of the labour. However, the routine administration of intravenous fluids to labouring women has not been adequately studied although it is widely practiced, and there is no consensus on the type or volume of fluids that are required, or indeed, whether intravenous fluids are at all necessary. This study was conducted to study the effect of intravenous Ringer lactate at 125 ml/hour versus 250 ml/hour on the duration of labour.Methods: In the study, patients were divided in two groups of nulliparous pregnant women in spontaneous early labour (between 3-5 cm dilatation), at term with singleton pregnancy and cephalic presentation, where one group received intravenous Ringer lactate at 125 ml/hour and the other group received Ringer lactate at 250 ml/hour. The duration of labour, mode of delivery and caesarean rates were measured in both groups along with incidence of prolonged labour and need for oxytocin augmentation.Results: The incidence of prolonged labour and oxytocin augmentation were less in the group receiving intravenous RL at 250 ml/hour but was not statistically significant. Remaining outcomes were comparable in both the groups with no outcome reaching statistical significance.Conclusions: Rate of fluid administration is one of the many variables which affects the labour outcomes. The incidence of prolonged labour and oxytocin augmentation was less in the group which received intravenous RL 250 ml/hour. There was no statistically significant difference in both groups in respect of duration of labour, mode of delivery and caesarean rates.

Vitamin D deficiency and adverse fetal outcome

Background: Vitamin D deficiency is recognized as the most untreated nutritional deficiency in the world. It is plausible that vitamin D deficiency could make the fetal heart more vulnerable to distress/birth asphyxia. Vitamin D deficiency has been hypothesized to be associated with low birth weight, low Apgar score at birth, higher rates of still births and admission to NICU. The aim of present study was to study prevalence of vitamin D deficiency in pregnancy and evaluate perinatal outcome.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: All the mothers who had still births suffered from vitamin D deficiency and the severe vitamin D deficiency was there in 90.91% (30) of these subjects. Severe vitamin D deficiency was seen in 78.95% (75) of the subjects having babies with birth weights <2.5 kg compared to 61.16% (288) subjects of the other group.Conclusions: Adverse fetal outcome are more common in vitamin D deficient group.

Vitamin D deficiency and maternal complications

Background: Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, Himachal Pradesh, India over a period of 12 months. Six hundred women were included in the study.Results: Forty-eight (8%) subjects developed preeclampsia-eclampsia syndrome, of which none had sufficient vitamin D levels, whereas 48 (100%) subjects had vitamin D deficiency.Conclusions: Maternal antenatal complications are more common in vitamin D deficient group.

Analysis of still births in a tertiary care system and changed scenario over six year period

Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention.

Prevalence of vitamin D deficiency in antenatal women

Background: Vitamin D has an increasingly recognised repertoire of non-classical actions, such as promoting insulin action and secretion, immune modulation and lung development. It therefore has the potential to influence many factors in the developing fetus. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section. The present study was undertaken to study the prevalence of vitamin D deficiency in antenatal women of Shimla, India.Methods: The study was conducted in the department of Obstetrics and Gynaecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: Out of 600 subjects, 568 (94.67%) subjects had vitamin D deficiency and only 32 (5.33%) subjects had sufficient vitamin D levels. Vitamin D deficiency was more common in the vegetarians, dark skinned subjects and in those who were taking vitamin D supplements.Conclusions: It is concluded from this study that there is high prevalence of vitamin D deficiency in antenatal women of Shimla, India.