The impact of using nurses to perform postpartum intrauterine device insertions in Kalyani Hospital, India.

In the postpartum period women are vulnerable to unintended pregnancy, which may lead to legal or illegal abortion and impact on maternal and neonatal morbidity and mortality. Although several postpartum family planning options are available, lack of access to and availability of family planning services and trained staff pose serious challenges. Peripheral centers may not have a doctor; however, they will have nursing staff that can be trained to offer family planning counselling and services. The present study demonstrates how task sharing with nurses to provide postpartum intrauterine device (PPIUD) services worked to give women a convenient and safe contraceptive method. PPIUD insertion provides women the additional advantage of leaving hospital with appropriate long-term contraception after institutional delivery, and also decreases the costs borne by patients and the government. This approach also impacts maternal and newborn health by avoiding unwanted pregnancy.

An epidemiological study of mortality among mothers admitted in a rural tertiary hospital of West Bengal.

BACKGROUND: Maternal mortality reflects the quality of obstetric services given to pregnant women in the community. OBJECTIVES: The objectives of this study were to calculate the maternal mortality rate in a teaching institution, to assess the epidemiological aspects of maternal mortality, and to assess the different causes of maternal mortality. MATERIALS AND METHODS: This was a retrospective study where individual records of all maternal deaths occurring in our hospital during the past 6 years from 2009 to 2014 were studied. The cause of death and the factors which led to death in each individual case were analyzed. RESULTS: A total of 105 maternal deaths occurred during the study period. The mean maternal mortality ratio in the study period was 233/100,000 live births. Most maternal deaths (37.14%) occurred in the age group of 20-24 years, multiparous women (74.28%) and in women from rural areas (70.47%). Most of the women were unbooked or unregistered patients (64.76%), and 40.95% cases were referred cases. Direct causes accounted for 90.47% of maternal deaths whereas 9.52% of maternal deaths were due to indirect causes. Hemorrhage (26.6%) and eclampsia (27.6%) were the major direct causes of maternal deaths. CONCLUSION: There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers, and proper transport system is the need of the hour.

Role of oral misoprostol for treatment of incomplete abortion.

To study the role of oral misoprostol in the management of Incomplete abortion, 98 women with a clinical diagnosis of incomplete abortion and the uterine size < 12 weeks were recruited for this study. A single dose of 600 microg of oral misoprostol was given to these patients. If abortion was clinically complete at follow-up after 3 days, the woman was released from the study. If it was still incomplete, immediate suction and evacuation was performed. Percentage of successful abortion (success defined as no secondary surgical intervention needed) and adverse effects were observed. Success was achieved in 96 (97.96%) out of 98 cases. In 32.6% cases adverse effects were found. Misoprostol used orally in the management of incomplete abortion, forms an alternative treatment modality, particularly in resource poor set up. It is highly effective with little adverse effects.

Practical symphysiotomy: an overview.

Symphysiotomy is an alternative operative procedure where a deliberate division of symphysis pubis is carried out to facilitate delivery in cases of cephalopelvic disproportion, so as to permit the birth of baby by natural passages. Symphysiotomy results in a permanent increase in pelvic diameter (up to 1 cm) by surgically dividing the ligaments of the symphysis under local or general anaesthesia. Symphysiotomy should only be done in a established case of obstructed labour but not in anticipation of obstructed labour. This operation was reviewed in 21 cases of established obstructed labour in Silchar Medical College with little modifications of original operations. All the cases were done by subcutaneous method which is cosmetic and simple. The operation was carried out by dividing upper ligament completely and anterior arcuate ligament partially under local anaesthesia. The posterior arcuate ligament was not touched at all. None of the cases required forceps or vaccum extraction. It resulted in almost negligible complications in comparison to morbidity and mortality in primary caesarean section. Considering the usefulness of the operation it can even be started in rural hospitals by the gynaecologist if they are properly trained to do it in a justified manner in properly selected cases.