A Comparative Study of Sublingual Misoprostol Versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor.

Objective Misoprostol has attracted low-income low-resource countries for the active management of the third stage of labor. The objective of this study was to compare the efficacy of sublingual misoprostol and intramuscular oxytocin in the active management of the third stage of labor. Study design This was a prospective randomized controlled trial in which a total of 407 healthy pregnant women having singleton pregnancy, cephalic presentation, and normal vaginal delivery were divided into two groups. In the first group (n=203), women received 600 µg misoprostol tablet sublingually, and in the second group (n=204), women received 10 IU of intramuscular oxytocin, within 1 minute of the delivery of the baby during the third stage of labor. Three patients from the first group and four patients from the second group were excluded from the analysis due to traumatic postpartum hemorrhage (PPH). The primary outcome was an incidence of PPH. Secondary outcomes were the duration of the third stage of labor, amount of blood loss, fall in hemoglobin concentration after 48 hours of delivery, need for additional uterotonics, and side effects of the drugs. Data were compared using the chi-square and independent samples t-test. Results The incidence of PPH was 6.5% in the misoprostol group as compared to 2% in the oxytocin group (p=0.026). The misoprostol group also had significantly higher blood loss (293.75±125.8 mL) and a greater fall in hemoglobin level (0.58±0.25 g/dL) as compared to that in the oxytocin group (226.13±98.44 mL and 0.45±0.20 g/dL) (p<0.001). The mean duration of the third stage of labor was significantly higher in the misoprostol group (5.31±2.1 min) as compared to that in the oxytocin group (3.65±1.75 min) (p<0.001). The additional need for uterotonics was recorded in 15% of the study participants in the misoprostol group as compared to 8% in the oxytocin group (p=0.028). The incidence of side effects such as shivering and fever was significantly higher in the misoprostol group as compared to the oxytocin group. No significant difference between the two groups was observed concerning the incidence of nausea, vomiting, diarrhea, and headache. Conclusion Intramuscular oxytocin is a safe and useful alternative to sublingual misoprostol in facilitating the third stage of labor with minimal blood loss, fewer incidences of hemorrhage, and fewer adverse effects.

Drivers for COVID 19 vaccine hesitancy among breastfeeding women in Eastern tribal state, India.

Background: In the COVID-19 pandemic age, vaccination hesitancy also known as vaccine refusal is a cause for worry since it hinges on the five Cs of confidence, complacency, convenience, calculation, and shared responsibility. The current study was to pinpoint the elements that contribute to breastfeeding women's hesitation to receive the coronavirus disease-19 (COVID-19) vaccine. Materials and Methods: A cross-sectional observational study was carried out at the Department of Obstetrics and Gynaecology, Tertiary Care Hospital, Ranchi, Jharkhand. Result: Out of 365 nursing mothers, 242 (66.3%) were hesitant to get the COVID-19 vaccination. Those who chose not to receive the COVID-19 vaccination mostly belong to those aged 18 to 25 (38.1%), living in rural regions (44.9%), and belonging to non-tribal ethnic groups (41.1%). On application of logistic regression, it was found that rural areas had 3 times higher rate of vaccine hesitancy than urban residents, and that husbands' education levels up to the 12th grade had a 3.55 times higher rate and 5 times agriculture by husband's occupation, which was statistically significant (P value less than 0.05) The most prevalent grounds for rejection were fear of side effects (85.8%) and worry of adverse effects on newborns (83.48%). Conclusion: Both husband and wife, who had completed high school and were aware of the vaccination, were fearful of the COVID-19 vaccine. Concerns about the side effects and undesirable effects of vaccination on their newborns were the main reasons for refusal.

Study of cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity pattern.

Objective: Due to the lack of resources for culture and antibiotic susceptibility testing in most underdeveloped countries, puerperal sepsis is treated empirically with a wide range of antibiotics. Empirical treatment, on the other hand, does not ensure treatment effectiveness and may even contribute to antibiotic resistance. So, we studied cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity in a tertiary health center. Material and Methods: This was a cross-sectional study conducted at the obstetrics and gynecology department of a tertiary health center in India from April 2019 to September 2020. During this time, all patients with sepsis who met the criteria for inclusion were included. After granting an informed written consent, the subjects were registered on a pre-designed proforma. Results: There were 2,049 obstetrical admissions throughout this period, with 106 (5.1%) of these having puerperal sepsis. The majority of these women (58.7%) were between the ages of 21 and 30, were multiparous (96.5%), and unbooked. Fever 104 (98.1%) was the most prevalent clinical characteristic, whereas wound gape was the most common consequence (47.1%). Klebsiella aerogens was the most common organism found in various cultures. Many organisms were shown to be multidrug-resistant and sensitive to gentamycin and amikacin. Conclusion: Klebsiella aerogens wasthe most common cause of puerperal sepsis in this investigation. Because the causal agents of puerperal sepsis and their antibiotic sensitivity patterns change over time, positive blood culture and antibiotic susceptibility of the isolates are the best guides for selecting the optimum antimicrobial therapy for treating sepsis.

Case series of unscarred uterine rupture in primigravida.

Objective: To present a highly rare case series of uterine rupture in primigravida individuals with an unscarred uterus. Case: The unscarred uterus in primigravida patients is supposed to be impervious to rupture, yet we have four cases of ruptured uterus in primigravida patients in our institute over a three-year period (2018-2021). In this case series, the ruptured uterus was discovered in primigravida women with premature labour, obstructed labour, instrumental delivery, and abruptio placentae. In the absence of previous surgery or multiparity, uterine rupture may go unnoticed, resulting in late diagnosis and considerable mortality and morbidity. All four cases required immediate resuscitation and laparotomy; uterine repair was performed in three cases, although a peripartum hysterectomy was needed in one. Conclusion: Rupture uterus can occur even in the unscarred uterus of primigravida patients and early diagnosis and timely management can prevent high maternal mortality and morbidity.

Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis.

BACKGROUND: Coronavirus disease 2019 has emerged as a global pandemic causing millions of critical cases and deaths. Early identification of at-risk patients is crucial for planning triage and treatment strategies. METHODS AND FINDINGS: We performed this systematic review and meta-analysis to determine the pooled prognostic significance of procalcitonin in predicting mortality and severity in patients with COVID-19 using a robust methodology and clear clinical implications. DESIGN: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions guidelines. We included thirty-two prospective and retrospective cohort studies involving 13,154 patients. RESULTS: The diagnostic odds ratio of procalcitonin for predicting mortality were estimated to be 11 (95% CI: 7 to 17) with sensitivity, specificity, and summary area under the curveof 0.83 (95% CI: 0.70 to 0.91), 0.69 (95% CI: 0.58 to 0.79), and 0.83 (95% CI: 0.79 to 0.86) respectively. While for identifying severe cases of COVID-19, the odds ratio was 8.0 (95% CI 5.0 to 12.0) with sensitivity, specificity, and summary area under the curve of 0.73 (95% CI 0.67 to 0.78), 0.74 (0.66 to 0.81), and 0.78 (95% CI 0.74 to 0.82) respectively. CONCLUSION: Procalcitonin has good discriminatory power for predicting mortality and disease severity in COVID-19 patients. Therefore, procalcitonin measurement may help identify potentially severe cases and thus decrease mortality by offering early aggressive treatment.

Study on types of anaemia and foetomaternal outcome in antenatal patients.

Anemia is the most common haematological disorder in pregnancy. Anemia increases maternal morbidity and mortality. It is a condition that can be diagnosed and treated during antenatal period, preventing the serious complications of anemia during pregnancy and labour. Aims: This study investigated the prevalence of types of anemia during pregnancy and fetomaternal outcomes among pregnant women. Study Design: This was a cross-sectional study that enrolled 1100 pregnant women who were in the third trimester of pregnancy with haemoglobin level <11.0 gm/dl between March 2019 and August 2020. Methods and Material: Participants were selected by consecutive sampling and baseline data were collected by using a predesigned and pretested structured questionnaire. Data Analysis: Data were entered and analysed by using SPSS version 20. Results: The prevalence of anemia in third-trimester pregnancy in this study was 91.05%. Iron deficiency anemia was most common (69.18%) among pregnant women followed by megaloblastic anemia (2.5%). Most of pregnant women (45.90%) were mildly anemic. Mean ± SD of haematological parameters among the anemic pregnant women during third trimester of pregnancy were haemoglobin (8.08±2.24 gm/dl), haematocrit (28.92±7.78%), mean corpuscular volume (MCV) (93.02±11.32fl), mean corpuscular haemoglobin (MCH) (26.03±2.90 pg), mean corpuscular haemoglobin concentration(MCHC) (27.99 ± 2.01 gm/dl), RBC count (3.05 ± 0.67million/mm3). Most common maternal complications due to anemia in pregnancy was preterm labour (30%). Fetal outcome in the form of an alive term, most commonly seen in mild anemia (34.7%), fetal complications like Preterm alive (11.3%), preterm intrauterine fetal death (IUFD) (2.7%) most commonly associated with severe anemia. Conclusion: The present study concludes that the prevalence of anemia among pregnant women in third trimester of pregnancy was 91.05% which is a serious public health problem. Proper counselling to the patients and their family members regarding cause of anemia, effect of anemia and complications of anemia. So, that such preventable condition can be prevented.

Updated meta-analysis on the diagnostic accuracy of serum anti-Mullerian hormone in poly cystic ovary syndrome involving 13 509 subjects.

AIM: To determine the diagnostic accuracy of anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). METHODS: Two independent reviewers searched the electronic databases and search engines using PubMed, Cochrane library, and Google Scholar systematically to retrieve relevant articles published from inception to September 2021. The diagnostic efficacy of AMH was computed using the random-effects model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). A meta-regression and subgroup analysis were performed to check for any source which could explain possible heterogeneity. Risk of bias assessment was conducted using the QUADAS-2 tool recommended by Cochrane Library. RESULTS: This meta-analysis included a total of 41 studies involving 13 509 subjects. We observed promising pooled sensitivity 0.78 (95% CI 0.74 to 0.81), specificity 0.87 (95% CI 0.84 to 0.90), and diagnostic odds ratio (DOR) 24 (95% CI 15 to 37), for AMH in detecting PCOS and discriminatory power (summary receiver operating characteristic [SROC] curves, 0.89 [95% CI 0.86-0.92]). The most prominent bias was noted in the patient selection and index test assessment. CONCLUSIONS: With the findings of this current meta-analysis, we conclude serum AMH to be a promising biomarker for the diagnosis of PCOS, however, substantial heterogeneity among studies needs individual patient data analysis in order to identify an optimal cut-off value and homogenous findings. REGISTRATION NUMBER AND GUIDELINES: This meta-analysis was performed according to constructed protocol registered in the PROSPERO database with registration number CRD42021246910.

Knowledge and practices of nursing staffs related to Maternal Nutrition and Infant and Young Child Nutrition (MIYCN) services at Rajendra Institute of Medical Sciences, Jharkhand, India: A cross-sectional study.

Background: The first 1000 days of life is a unique window of opportunity when the foundation of overall optimum health and neurodevelopmental growth across the lifespan is established. Objective: To explore the level of knowledge and practice of service providers in delivering maternal, infant, and young child nutrition (MIYCN) services at the point of care. Methodology: This was a cross-sectional study done in the department of Obstetrics and Gynecology and Pediatrics of RIMS, Ranchi, Jharkhand from May to September 2019. Result: The practices and counseling skills of nursing staff pertaining to maternal nutrition interventions like IFA and calcium supplements was good. Though counseling on maternal minimum dietary diversity, frequency, and quantity of meals was done during the antenatal care period, its knowledge and expected total weight gain during pregnancy were suboptimal. The practice of early initiation of breastfeeding was significantly higher in those who delivered normally (79%) than those by cesarean section (7%). The nursing staff's knowledge and technical skills on early initiation and exclusive breastfeeding were good, but inadequate for cesarean section. Forty-one percentage of recently delivered women were counseled on colostrum feeding, 17% about positioning and attachment, and 38% on exclusive breastfeeding (EBF) during the first 6 months. In the pediatrics OPD and immunization clinic, 93% of mothers with an infant below 6 months of age, received counseling on EBF, 47% on feeding during illness, and 13% on breastfeeding difficulties and their solutions. Sixty percentage of mothers of children >6 months old received counseling on timely introduction of complementary feeding and 40% on minimum dietary diversity. Forty percentage of mothers were counseled on feeding techniques during and after illness. Conclusion: The nursing staffs were providing the services related to MIYCN during antenatal, intranatal, and postnatal services, sick child visits, and immunization visits but their technical knowledge and skills on the specific components were not in accordance with the standard guidelines.

Spontaneous Rectus Sheath Hematoma in Pregnancy Complicated by the Development of Transfusion Related Acute Lung Injury: A Case Report and Review of the Literature.

BACKGROUND: Rectus sheath hematoma (RSH) represents a rare, but serious cause of abdominal pain. CASE: Here we discuss the case of a healthy multigravida female who presented at 28 weeks gestation with spontaneous RSH. Conservative management with multiple blood transfusions led to the development of transfusion related acute lung injury (TRALI) and intensive care unit admission. She was managed with noninvasive ventilatory support, gradually improved, and was weaned of ventilation. After hospital discharge, she progressed to full term and delivered a viable male infant vaginally at 37 weeks gestation. CONCLUSION: Review of the literature demonstrates 13 cases of RSH in pregnancy, including our own. No other cases were complicated by transfusion related morbidity. RSH and TRALI are rare, but life threatening entities that can complicate pregnancy.