Complications after post placental insertion of Cu T 380 A in women undergoing caesarean delivery

Background: India is the second most populated country in the world after China with more than a billion people and has highest number of maternal deaths in the world. The aim of the study was to find out the complications after insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra (Rural Medical College) after taking approval of Protocol Review and Institutional Ethics Committee of the Institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: There were no major complications and only minor side effects like pain and fever were observed in 6.25 and 6.90 and 9.37 and 11.11% of women who were admitted electively and in emergency, respectively during follow-up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow-up visit and their visibilities increased with time and at 6 months follow-up in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow-up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.30% at six months post-partum follow-up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Post placental insertion of Cu T 380 A in women undergoing caesarean section was safe and effective method of postpartum family planning, the complaints and complications initially increased but decreased at 6 months follow-up.

Comparative study of effectiveness of Papanicolaou smear and visual inspection using acetic acid and visual inspection using Lugol’s iodine for screening of premalignant and malignant lesions of cervix

Background: In developing and resource-limited countries alternative screening methods like VIA, VILI, and Pap smear are used in detection of premalignant and malignant lesions of cervix. The aim of our study was to compare the efficacies of VIA, VILI, and Pap smear in detection of premalignant and malignant lesions of cervix.Methods: The study was conducted for a period of one year in the department of obstetrics and gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. Women who attended the outdoor patient department of obstetrics and gynecology were subjected to collection of Pap Smear, VIA followed by VILI and a thorough pelvic examination.Results: Among the 350 women studied, 59 women (16.9%) had abnormal VIA, 64 women (18.2%) had abnormal VILI. On pap smear, 10 women were reported as ASCUS, 11 as L-SIL and 1 as H-SIL. Cervical biopsy was done in 98 women, out of which 70 had one or more abnormality on VIA, VILI, or Pap, and 28 women who had normal results. Sixteen women (16.3%) reported as CIN-1 and 2 women (2.07%) as CIN-3. VIA and VILI had a higher sensitivity as compared to pap. However, pap was more specific. The PPV of pap was also much higher as compared to VIA and VILI, whereas there was no difference in NPV of the three.Conclusions: Authors observed that VIA presented the best sensitivity (88.8%), followed by VILI (83.3%), and Pap (72.2%). Pap smear had the highest specificity of 97.2%. The positive predictive value of Pap was higher as compared to VIA and VILI, whereas there was no difference in NPV of the three. VIA and VILI have good sensitivity, with reasonable specificity and because of their cost effectiveness and ease of availability, these can be an alternative screening modality for cervical cancer screening.

Comparative maternal outcomes of oral nifedipine and intravenous labetalol for severe hypertension during pregnancy: an open label randomized controlled trial

Background: Hypertensive diseases are commonly seen during pregnancy and remain one of the leading causes of maternal morbidity and mortality. Mostly commonly preferred drugs by health care providers for treatment of severe hypertension during pregnancy are labetalol and hydralazine. However, they require proper storage, intravenous access, and adequately trained staff for usage. Oral nifedipine in contrast is easier to use and widely available.  Objective of this study was to report the efficacy and safety of oral nifedipine as compared to intravenous labetalol for treatment of severe hypertension during pregnancy.Methods: It was an open label randomized controlled trial in which 100 women with severe hypertension during pregnancy were enrolled. They were randomized to receive either incremental doses of intravenous labetalol every 20 minutes (total 300 mg) or 10 mg oral nifedipine every 20 minutes (up to 50 mg) to lower the blood pressure to safer levels.Results: Women receiving oral nifedipine took significantly less time to achieve target blood pressure [(37.6±23.3) minutes (SD) as compared to those receiving intravenous labetalol (52.0 minutes±27.95 (SD)]. Women receiving nifedipine for treatment also required significantly lesser doses to control the blood pressure [mean dose 1.8±1.1 (SD) versus 2.6±1.2 (SD) p=0.006]. There were two failures in labetalol group and one failure in nifedipine group. No serious adverse events were reported in either group.Conclusions: Oral nifedipine is equally efficacious to I.V. labetalol for treatment of severe hypertension during pregnancy and is easier to use in low resource settings.

Pregnancy outcome in women with intrahepatic cholestasis of pregnancy

Background: Intrahepatic cholestasis of pregnancy is a multifactorial condition of pregnancy diagnosed when otherwise unexplained pruritus with abnormal liver function test and neither of which has an alternative cause. The most appropriate gestational age for the delivery of women with ICP is yet to be determined. The present study is designed to determine whether with active intervention, pregnancy with ICP can be carried to a later gestation.Methods: Fifty Women with diagnosed a case of ICP were recruited into the study. The diagnosis of ICP was based on the symptoms, clinical examination and lab investigations. Group I: 25 women planned for delivery at POG 37 - 37+6 weeks of pregnancy. Group II: 25 women Planned for delivery at POG ≥38 weeks of pregnancy.Results: In group, one woman had preterm delivery at POG 36+2 weeks and rest of 24 women were delivered at POG 37-37+6 weeks. In group II, out of 25 women one woman had emergency LSCS at POG 35+3 weeks for MSL and induction of labour was done in 2nd for abnormal fetal well-being tests at POG 37 weeks. One woman had pre-term delivery at POG 36+1 weeks. Remaining 22 women in group II were delivered at POG ≥38 weeks. In the present study there was no significant difference in the gestational age at delivery between the two groups.Conclusions: It can be concluded that pregnancies with obstetric cholestasis can be carried to later gestation of ≥38 weeks under surveillance with UDCA treatment.

Evaluation of clinical outcome of post placental insertion of Cu T 380 A in women undergoing caesarean delivery

Background: The objective of the study was to evaluate clinical outcome of insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra at Tanda (Rural Medical College) to evaluate the clinical outcome of post placental Cu T 380 A insertion in women undergoing caesarean section after taking approval of protocol review and institutional ethics committee of the institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: The present study showed that there were no major complications and only minor side effects were like pain, fever, discharge and irregular bleeding which were observed in only 5-15% of women during hospital stay and during follow up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow up visit. The string visibility increased with time and at 6 months follow up stings became visible in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.3% at six months post-partum follow up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Intra caesarean insertion of PPIUCD is practical, convenient, safe, effective and acceptable contraceptive method for spacing of the birth in this rural setting.

Assessment of labor room communication skills among postgraduate students of obstetrics and gynecology

Background: “Communication with patients” is an important skill needed for every physician in their clinical practice.  These soft skills are required in dealing with patients at every step which include history taking from the patients, explaining them the diagnosis, the prognosis of the disease with associated complications. Dealing with empathy, taking informed consent, explaining the operative procedure and the complications associated with surgery, the art of breaking bad news are the mandatory skills for a good clinician. Labouring women like other patients also require special attention and empathy. So, the residents working in labor room need commitment to develop these soft skills in order to improve the labor room experience of expectant mothers. Objective of this study was to analyse role of a formal training in labor room communication skills among post graduate students of the department of obstetrics and gynecology.Methods: Faculty and students’ sensitization was done after approval from institutional ‘ethics committee’ for conducting this study. Pre-workshop assessment of residents for communication skills attitude and effective communication was done through ‘communication skill attitude scale’ (CSAS) and ‘GAP-KALAMAZOO scale’. Workshop for communication skills on the framework of Calgary Cambridge patient interview model and online teaching of students through what’s app videos, role-play demonstrations was followed by reassessment of the residents through above used scales.Results: Results depicted both improvements in attitude and effective communication skills among residents. 100% of the students were convinced and opined that good communication skills necessary for perfect clinical practice.Conclusions: The skill to communicate with patients is a fine art and needs to be mastered to be a good clinician. A formal training in effective communication skills is absolutely necessary to bring professionalism in medical practice.

Comparative study of sublingual versus vaginal misoprostol for induction of labor

Background: Induction of labor done, when the benefits to either mother or fetus outweighs those of continuing pregnancy. Pharmacological methods used for induction includes oxytocin, prostaglandin (E1, E2) and mifepristone. However the ideal dose, route and frequency of administration of misoprostol are still under investigation. Hence we plan to do a comparative study between sublingual and vaginal misoprostol for inducing labor.Methods: A prospective randomized interventional study was conducted on seventy pregnant women who met the inclusion criteria. They were explained about the study on admission and were randomized into two groups: Group I (sublingual) and Group II (vaginal). Bishop score at start of induction, number of pelvic examinations, doses required, mode of delivery, induction to delivery interval, duration of different stages of labor and perinatal outcome of the women were recorded followed by statistical analysis.Results: Patients in both the groups were comparable with respect to demographic data, period of gestation, gravidity and parity. There was no significant difference with regard to number of doses, p/v examinations and number of patients required augmentation. Mean induction to delivery interval, average duration of first, second and third stage was almost comparable. Out of 35 women in each group, 29 women (82.8%) in both groups had normal vaginal delivery, one woman in Group I and three women in Group II had instrumental delivery. Emergency LSCS was done in 5 women (14.28%) in Group I and 3 women (8.57%) in Group II.Conclusions: Sublingual misoprostol seems as effective as vaginal misoprostol for induction of labor at term. Sublingual route represents a valid alternative to vaginal route with the advantage of convenience of administration. In view of limited sample size, we cannot reach definitive conclusions in regard to the preference of sublingual or vaginal route of misoprostol for induction of labor.