Lack of experience is a main cause of maternal death in placenta accreta spectrum patients.

INTRODUCTION: Placenta accreta spectrum (PAS) is a serious condition with a mortality as high as 7%. However, the factors associated with this type of death have not been adequately described, with an almost complete lack of publications analyzing the determining factors of death in this disease. The aim of our work is to describe the causes of death related to PAS and to analyze the associated diagnosis and treatment problems. MATERIAL AND METHODS: This is an inter-continental, multicenter, descriptive, retrospective study in low- and middle-income countries. Maternal deaths related to PAS between January 2015 and December 2020 were included. Crucial points in the management of PAS, including prenatal diagnosis and details of the surgical treatment and postoperative management, were evaluated. RESULTS: Eighty-two maternal deaths in 16 low- and middle-income countries, on three continents, were included. Almost all maternal deaths (81 cases, 98.8%) were preventable, with inexperience among surgeons being identified as the most relevant problem in the process that led to death among 87% (67 women) of the cases who had contact with health services. The main cause of death associated with PAS was hemorrhage (69 cases, 84.1%), and failures in the process leading to the diagnosis were detected among 64.6% of cases. Although the majority of cases received medical attention and 50 (60.9%) were treated at referral centers for severe obstetric disease, problems were identified during treatment in all cases. CONCLUSIONS: Lack of experience and inadequate surgical technique are the most frequent problems associated with maternal deaths in PAS. Continuous training of interdisciplinary teams is critical to modify this tendency.

Knowledge, Attitude and Practices towards Medical Research amongst the Postgraduate Students of Pravara Institute of Medical Sciences University of Central India.

BACKGROUND: Health research training is an essential component of medical education and a vital exercise to help develop physician research skills. OBJECTIVES: This study was carried out to assess the knowledge, attitude, and practices towards health research amongst the postgraduate students of Pravara Institute of Medical Sciences University of central India. MATERIALS AND METHODS: A cross-sectional study was carried out from August to October 2012. A total of 116 postgraduate students were interviewed. Knowledge, attitude, and practices related to health research were assessed using a predesigned, pretested and validated questionnaire. Results were analyzed in the form of percentage and proportions whenever appropriate. RESULTS: In present study, the concept of research hypothesis was known to only 18.9% of the postgraduate students, whereas 17.2 and 21.5% students knew the full form of MEDLARS and MEDLINE respectively. Majority (91.4%) students believed that patient outcome improves with continued medical research and 70.7% are willing to participate in workshop for research methodology. Lack of time due to vast curriculum of postgraduate subjects (59.5%), lack of research curriculum (25%), and inadequate facilities (25.8%) were stated as major obstacles for pursuing research. CONCLUSION: Postgraduate students have inadequate knowledge, but have positive attitudes towards health research. Postgraduate training and research facilities at the institution need to undergo major transformation in order to encourage meaningful research by postgraduate trainees.

Vaginal birth after cesarean section.

BACKGROUND: The rate of primary cesarean section (CS) is on the rise. More and more women report with a history of a previous CS. A trial of vaginal delivery can save these women from the risk of repeat CS. AIMS: The study was conducted to assess the safety and success rate of vaginal birth after CS (VBAC) in selected cases of one previous lower segment CS (LSCS). MATERIALS AND METHODS: The prospective observational study was carried out in a tertiary care teaching hospital over a period of two years. One hundred pregnant women with a history of one previous LSCS were enrolled in the study. RESULTS: In the present study, 85% cases had a successful VBAC and 15% underwent a repeat emergency LSCS for failed trial of vaginal delivery. Cervical dilatation of more than 3 cm at the time of admission was a significant factor in favor of a successful VBAC. Birth weight of more than 3,000 g was associated with a lower success rate of VBAC. The incidence of scar dehiscence was 2% in the present study. There was no maternal or neonatal mortality. CONCLUSION: Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas.

Knowledge and attitude of medical undergraduate, interns and postgraduate students in India towards emergency contraception.

BACKGROUND: Although India was the first country in the world to have national family planning policy, the acceptance of contraceptive methods has been unsatisfactory. Many women in their peak reproductive years, who wish to control their fertility, are not aware about the different methods of contraceptives available. Unregulated fertility results in unplanned pregnancies. Emergency contraceptive pills can avoid many such unplanned pregnancies. AIM: The study was to assess the knowledge and attitude about emergency contraception (EC) among the undergraduate, interns and postgraduate medical science university students. MATERIALS AND METHODS: A cross-sectional study was carried out among 180 medical students which include undergraduate (final year MBBS), interns, and postgraduate students (60 from each group) studying at Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences University of central India by a convenient sample method over a period of February 2009 to May 2009. Data were collected by pre-designed, pre-tested, self-administered questionnaire. Data was analyzed in the form of percentage and proportions and Chi-square test was applied. RESULTS: In this study, a total of 180 respondents, of which 110 (61.2%) were male and 70 (38.8%) were female. The knowledge about EC was highest (47.6%) among postgraduates in comparison to interns (43.3%) and undergraduate students (41.6%). Overall positive attitude toward EC was observed among 73.8% of the respondents. CONCLUSIONS: Considering the role of a medical graduate as counselor and health-care provider, the technical knowledge about different aspects of EC among the study population was inadequate.

Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration.

INTRODUCTION: Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality. METHODS: The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed. RESULTS: Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%. CONCLUSION: These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.

HIV seroprevalence among the pregnant population and utilisation of integrated counselling and training centre facilities at a teaching hospital in Rural Maharashtra.

BACKGROUND: Human Immunodeficiency virus (HIV) transmission is widespread across the globe. Millions of pregnant women are affected due to the high risk behaviour of their partners. Mother-to-child vertical transmission, has increased the burden of paediatric HIV population. METHOD: A retrospective analysis of data on the utilisation of Integrated Counselling and Training Centre (ICTC) services by pregnant women at a tertiary care hospital in Ahmednagar district of Maharashtra, India from 1 January 2003 to 31 December, 2009. Pre-test counselling, HIV testing and post-test counselling was done by the trained staff of an ICTC centre as per National AIDS Control Organisation (NACO) guidelines. Anti-retroviral prophylaxis in the form of single dose oral Nevirapine (200mg) was given to seropositive women during active labour. Nevirapine syrup was administered to newborn babies. Analysis of the demographic profile of seropositive women was done. RESULTS: Out of 12,719 pregnant women attending the antenatal clinic, 10,491 (82.48%) accepted pre-test counselling and HIV testing. One hundred and forty-five women were found to be seropositive with a seroprevalence rate of 1.38%; 11% did not come for collection of the laboratory report and missed the post-test counselling. Most of the seropositive women belonged to rural areas (81.37%), had lowsocioeconomic status (77.93%), were illiterate, and were unaware of their serostatus and their husband's risk behaviour. Less than 30% of women were using contraceptives. After registration, the majority of seropositive women (89.65%) attended the antenatal clinic regularly; 11% opted for pregnancy termination; 76% delivered vaginally and 12% underwent Caesarean section. A further 86% of women and 80% of newborns received Nevirapine prophylaxis. Postnatal follow-up of babies was very limited. CONCLUSION: HIV seroprevalence among the pregnant population is declining steadily. More and more women are availing the facilities of ICTC centres. Integration of PPTCT (Prevention of Parent To Child Transmission) and RNTCP (Revised National Tuberculosis Control Programme) has improved the uptake of services. Free Anti-Retroviral Treatment (ART) for seropositives will help in controlling the disease progression and will reduce the vertical transmission.