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Background: The incidence of caesarean sections has significantly increased over the previous thirty years and nearly doubled in the current decade, because of more liberalisation of indications of caesarean sections. India’s caesarean section rates have surpassed the WHO cutoff point of 15%, raising serious public health issues. The prevalence of the C-section in India was 8.5% in NFHS-3 while data in NFHS-4 show that it has increased to 17.2%. Thus, almost 9% has increased over 10 years. Objective was to compare the maternal morbidity in elective and emergency caesarean section.Methods: Institution based comparative study was conducted among 108 females undergoing lower segment caesarean section at JNUIMSRC, Jaipur. After taking written informed consent patients were enrolled for the study. Once the data was collected it was analysed as per appropriate statistical analysis.Results: Incidence of emergency LSCS was 23.6% and of elective LSCS was 76.4%. the most common maternal indication was previous LSCS (38.1%) and most common fetal indication was fetal distress (13.3%) followed by malpresentation (11.4%). Incidence of intraoperative complications was 29% with most common complications being atonic PPH (12.4%) followed by traumatic PPH (5.9%), bladder and bowel injury (0.7%). Incidence of post operative complications was 51.9% with most common being anaemia (20.8%), PPH (10%), puerperal sepsis (8%).Conclusions: If performed for medical reasons, CS can save the lives of both mothers and babies. Therefore, CSs should preferably only be performed when necessary for medical reasons. Morbidity is more with emergency LSCS than elective LSCS with PPH being the most common intraoperative complication and anemia being most common post operative complication.
RESUMO
Background: The incidence of caesarean sections has significantly increased over the previous thirty years and nearly doubled in the current decade, because of more liberalisation of indications of caesarean sections. India’s caesarean section rates have surpassed the WHO cutoff point of 15%, raising serious public health issues. The prevalence of the C-section in India was 8.5% in NFHS-3 while data in NFHS-4 show that it has increased to 17.2%. Thus, almost 9% has increased over 10 years. Objective was to compare the maternal morbidity in elective and emergency caesarean section.Methods: Institution based comparative study was conducted among 108 females undergoing lower segment caesarean section at JNUIMSRC, Jaipur. After taking written informed consent patients were enrolled for the study. Once the data was collected it was analysed as per appropriate statistical analysis.Results: Incidence of emergency LSCS was 23.6% and of elective LSCS was 76.4%. the most common maternal indication was previous LSCS (38.1%) and most common fetal indication was fetal distress (13.3%) followed by malpresentation (11.4%). Incidence of intraoperative complications was 29% with most common complications being atonic PPH (12.4%) followed by traumatic PPH (5.9%), bladder and bowel injury (0.7%). Incidence of post operative complications was 51.9% with most common being anaemia (20.8%), PPH (10%), puerperal sepsis (8%).Conclusions: If performed for medical reasons, CS can save the lives of both mothers and babies. Therefore, CSs should preferably only be performed when necessary for medical reasons. Morbidity is more with emergency LSCS than elective LSCS with PPH being the most common intraoperative complication and anemia being most common post operative complication.
RESUMO
Background: Unintended pregnancy, unplanned birth and unsafe abortion have been a major challenge to the reproductive health of women worldwide. Despite the availability of highly efficient contraceptive technologies, there are still many undesired pregnancies that put women at a higher risk of mortality, frequently as a result of unsafe abortion. Emergency contraceptive pills can be used to prevent these unwanted pregnancies. Aim of this study was to assess the knowledge, attitude and practice of use of emergency contraception among women of reproductive age group attending JNUIMSRC OPD, Jaipur, India.Methods: Institution based cross-sectional study was conducted among 100 females of reproductive age group attending JNUIMSRC OPD, Jaipur, India. Data was collected using pretested semi-structured questionnaire after written informed consent. Descriptive and inferential statistics were used to analyse the data generated.Results: Among respondents who were aware of ECPs, 64% had good knowledge of it, 90% had positive attitude towards ECPs and 63% have used earlier. A significant association was found between age, residence, educational level and occupational status with awareness of ECPs.Conclusions: Awareness and utilization of emergency contraceptive pills is low among females of reproductive age group attending OPD at JNUIMSRC. Thus awareness should be enhanced through formal education, communication from healthcare professionals and media that can offer trustworthy and accurate information on ECPs.
RESUMO
Background: Over the course of pregnancy, there is a steady decline in maternal plasma folate concentration and vitamin B12 concentration about 50%of non pregnant levels. Insufficient folate and vitamin B12 status has been associated with many reproductive complications including abruption, IUGR, pre eclampsia, early pregnancy loss. The aim of the study was to determine the role of serum folic acid and vitamin B12levels in patients with abruptio placentae and to study the feto-maternal outcome in these patients. Feto maternal outcome is seen in terms of mode of delivery whether vaginal or caesarean, period of gestation whether term or preterm, need of blood transfusion, stillbirths.Methods: In this prospective observational study conducted in a tertiary hospital from 2018-2020, 50 pregnant women with abruptio placentae were included and their serum folic acid and vitamin B12 levels were measured by ELIZA method using commercially available kits.Results: Serum folic acid levels were not low in the cases of placental abruption with range= 25 ng/ml to 80.5 ng/ml. Mean folic acid level 盨D is 47.98�.15 ng/ml and median is 48 ng/ml. In this study vitamin B12 levels were low in the cases, range 14 pg/ml to 70 pg/ml. Mean vitamin B12 value 盨D is 27.15�.63 pg/ml and median is 25 pg/ml.The rate of caesarean section was 44%, preterm delivery was 64% and stillbirth was 38% in these cases with mean folic acid levels of 48.7�.4 ng/ml, 46.94�.85 ng/ml and 46.03�13 ng/ml respectively and mean vitamin B12 levels of 23.34�74 pg/ml, 28.73�.44 pg/ml and 28.32�.75 pg/ml respectively. There was a significant association (p=0.006) between vitamin B12 and mode of delivery. No other significant association was seen between serum folic acid and vitamin B12 levels and the different fetomaternal outcome.Conclusions: Low levels of vitamin B12 is seen in cases with abruptio placentae. The rate of caesarean section, preterm delivery, stillbirth and need of blood transfusion is high but no significant association is seen.
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Review Focus: General considerations on ablation procedure advocated in clinical contexts using electromagnetic (EM) energy are comprehensively reviewed. Relevant radiofrequency (RF) and/or microwave ablation techniques that have been in vogue and in traditional use across clinical procedures are revisited. Traditionally, RF/microwave ablations have been applied to a variety of pathological states, (in lieu of surgical methods and/or electrocautry procedures) so as to remove unwanted/cancerous tissue layers. Relevantly, new avenues of adopting unexplored electromagnetic (EM) energy falling in the spectral range of mm-wave/THz frequencies for such medical ablation purposes are studied. These higher frequencies for ablation can be considered either to supplant or used in parallel with the existing RF/microwave bands (at 915 MHz and 2.45 GHz). The motivation thereof is to identify certain improved ablation feasibility and derivable merits in clinical sense. Hence, the efficacy of the proposed scheme is identified for two exemplar ablation therapy procedures pertinent to Barrett’s esophagus and menorrhagia. Pertinent pros and cons are discussed and practical ablator designs are indicated. Study Details: Considering the strategy of using the proposed mm-wave/THz EM energy would amount to a shallow ablation via ‘thermal scouring’ of the tissue-linings intended for ablation and prevent otherwise undesirable hot-spots in deep-tissue media. This is conceivable because the advocated frequency bands would allow a very shallow skin-depth of penetration of EM energy; and hence, tissue-heating will be limited only to superficial linings. Further, the associated super-high frequency will heat the ablation site extremely fast reducing the procedure time considerably. In a Nut-shell: The study first offers a comprehensive review on classical and projects de novo aspects of EM ablation therapy with unexplored electromagnetic spectral resources of mm-Wave/THz band. Illustrated as examples are feasibility details concerning the ablation of the endometrium and Barrett’s esophagus. Design aspects of ablators are presented. Place and Duration of Study: The study reported is limited to a review on the subjectmatter and provides analytical designs and computational models on the procedure performed (2012-2013) at: Department of Computer and Electrical Engineering and Computer Science, College of Engineering & Computer Science, Florida Atlantic University, Boca Raton, Florida 33431, USA.