Analysis of Maternal Factors Impacting Neonatal Near Miss (NNM) Events: A Tertiary Centre Experience.

Objective: To find out the incidence of neonatal near miss (NNM) cases in comparison with the neonatal deaths and to study the different antenatal and intrapartum maternal variables and system-related delays influencing these events. Methodology: This is a descriptive retrospective study conducted over a year (2018-2019) at a tertiary referral hospital in India, where NNM cases were selected as per 'pragmatic criteria', and detailed maternal and neonatal biological variables and near miss indicators were procured from the medical record books and analysed. Results: Out of 6383 live births and 231 neonatal deaths in the hospital during the study period, 810 NNM cases were identified born to 710 mothers, i.e. 3.5 cases for each neonatal death. Birth weight and gestational age in combination contributed to the maximum number of cases-383 (47.28%). The most common reason for referral was threatened pre-term/PPROM with non-availability of NICU-197 cases (38.3%) out of 514 referrals. Out of 710 mothers, 529 (74.5%) had at least one comorbidity at the time of presentation. The most common comorbidity was anaemia in 267 women followed by hypertensive disorder of pregnancy-in 251 cases. Primary delay contributed to 54% of all delays in the study. Conclusion: NNM can be used as an effective tool for quality control and audits to effectively reduce maternal and neonatal morbidity and mortality but needs more research to establish a standardized definition and criteria for selection of cases.

Perineal Post-related Vulvar Necrosis: A Rare Case Series and Review of Literature.

Vulvar necrosis is a rare complication after lower limb fractures and hip surgeries either due to direct damage to internal pudendal artery or post-surgery ischemic necrosis due to use of a perineal post. We present a series of 3 cases post-orthopedic surgeries with vulvar necrosis. All three patients presented to us after history of orthopedic surgeries which used a perineal post intraoperatively. They developed vulvar edema and blackish discoloration 6-8 h after the orthopedic procedure and referred for further management. Traction post-related vulvar necrosis can have major psychological and functional consequences; hence, formulating measures for prevention and promptly diagnosing the condition and ensuring early management to maintain the functionality of vulva is of utmost importance.

The absent discourse of communication: understanding ethics of provider-patient relationship in six hospitals in urban India.

Understanding the complexities of a provider-patient relationship is considered to be of critical importance especially in medical ethics. It is important to understand this relation from the perspectives of all stakeholders. This article derives from a qualitative study conducted across six obstetric care providing institutions in the cities of Mumbai and Navi Mumbai, India, over a period of 10 months. Thirty obstetricians were interviewed in-depth to understand what they perceived as the most important aspect in developing a good provider-patient relationship. The study found that while most providers highlighted the point of communication as the most critical part of the provider-patient relationship, they admitted that they could not engage in communication with the patients for various reasons. Obstetric consultants and residents said that they were too overburdened to spend time communicating with patients; providers working in public hospitals added that the lack of education of their patients posed a hindrance in effective communication. However, providers practicing in private institutions explained that they faced a challenge in communicating with patients because their patients came from educated families who tended to trust the provider less and were generally more critical of the provider's clinical judgement. The article shows how provider-patient communication exists as an idea among medical providers but is absent in daily clinical practice. This gives rise to a discourse shaped around an absence. The authors conclude by decoding the term 'communication' - they read the word against the context of its use in the interviews, and argue that for the providers 'communication' was not intended to be a trope towards setting up a dialogue-based, egalitarian provider-patient relationship. Providers used the word in lieu of 'counselling', 'guiding', 'talking to'. It concludes that, despite the providers' insisting on the significance of communication and complaining about its absence, what they desired in reality was not the possibility of a dialogue with the patient or a chance to be able to share decision-making power with the patient, but to be able to provide better instructions and chart out what was best for them in a more detailed way.