scholarly journals Paperless partogram: a simple clinical tool in effective labour management

2021 ◽  
Vol 10 (6) ◽  
pp. 2308
Author(s):  
Shaik Reshma ◽  
Sri Lakshmi Ambarkar
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Tool ◽  
Maternal Deaths ◽  
Mortality And Morbidity ◽  
Obstructed Labour ◽  
Labour Room ◽  
A Prospective Study ◽  
User Friendly

Background: Maternal mortality is unacceptably high, about 830 women die from pregnancy or child birth related complications around the world every-day. Prolonged and obstructed labour is one of the major causes of maternal and perinatal mortality and morbidity worldwide. In developing countries like India, around 5% of total maternal deaths are caused by prolonged and obstructed labour. The purpose of the present study is to evaluate the role of paperless partogram in management of labour, identification of abnormal labour and early intervention to prevent the maternal and perinatal morbidity. The objective of this study was to assess the role of paperless partogram in labour monitoring and decision-making in overburdened Indian labour room setup and to evaluate the outcome of the cases.Methods: A prospective study was conducted at a tertiary care hospital, Kurnool, Andhra Pradesh, between January 2020 to March 2020. A total of 300 pregnant mothers in established labour who fulfilled the inclusion criteria, were included in the study after taking informed consent.Results: In our study, of all the pregnant women 23 crossed the alert ETD but 16 had delivered vaginally and 2 by caesarean section before action ETD and 5 women crossed the action ETD. Among the 5 who crossed action ETD 3 delivered vaginally and 2 had cesarean section. Majority, of the women who crossed the alert and action ETDs were primigravidae.Conclusions: From our study, it is concluded that paperless partogram was effective and user friendly in management of labour and prevention of abnormal or prolonged labour.

scholarly journals A prospective study of obstetric and gynaecological emergencies in a tertiary care hospital

2020 ◽  
Vol 9 (5) ◽  
pp. 1992
Author(s):  
Shahna Anishbhai Jindani ◽  
Asha Bhagwatibhai Sailor ◽  
Dipti A. Modi ◽  
Somika Kaul ◽  
Bijal D. Rami
Keyword(s):  
Prospective Study ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Care Hospital ◽  
Emergency Case ◽  
Mortality And Morbidity ◽  
Obstetrics And Gynaecology ◽  
Septic Peritonitis ◽  
A Prospective Study

Background: The management of obstetrics and gynaecological emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. The main aim of the study was to access the burden of surgical emergency and to study the course of management at a tertiary care hospital.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period from January to December 2018.Results: A total of 73 patients presented to our emergency room who required urgent surgical intervention. All patients were resuscitated and surgery was done at earliest possible time. The age of patient ranged from 18 to 45 years.  About 75.8% of female presented with the complaint of acute abdomen, followed by 32.9% with bleeding per vaginum. 16.4% had vomiting, 6.8% with fever and 4.1% with mass per abdomen. In majority of cases a diagnosis of ruptured ectopic pregnancy (34 patients) was made, followed by PPH in 14 patients and 12 cases of rupture uterus. Four cases of torsion of ovarian mass and 3 cases of septic peritonitis were operated. The most common surgery performed was salpingectomy followed by subtotal obstetric hysterectomy. A mortality rate of 8.2% was noted.Conclusions: This study emphasized the great role of timely surgical intervention as lifesaving procedures. Skilled clinicians and immediate intervention in a tertiary care is the main-stay of the emergency case management and are indispensable for decreasing mortality and morbidity.

scholarly journals A prospective study of the incidence and outcomes of eclampsia in a tertiary care hospital and teaching institute in India

2019 ◽  
Vol 8 (7) ◽  
pp. 2766
Author(s):  
Garima Gandhi ◽  
Kavita Chandnani
Keyword(s):  
Magnesium Sulphate ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Outcome Data ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Maternal Complications ◽  
Maternal Deaths ◽  
Neonatal Deaths ◽  
A Prospective Study

Background: Eclampsia is a common cause of maternal and foetal morbidity and mortality in India and the rest of the world accounting for nearly 10% of all maternal deaths. However, there is a relative scarcity of outcome data for patients with eclampsia in India. Our goal was to estimate the incidence of eclampsia, the maternal and foetal outcomes of patients presenting with eclampsia, and predictors of clinical outcomes in these patients. Objective of this study was to estimate the incidence of eclampsia in patients who delivered at a single tertiary care institution over a 2-year period and to study the maternal and perinatal outcomes in those patients.Methods: Prospective cohort study conducted from September 2008 to August 2010 on all patients with eclampsia admitted during the study period at Lok Nayak Hospital, New Delhi, India.Results: The incidence of eclampsia among total deliveries was 0.45%.  About 97% of these patients received parenteral magnesium sulphate as the primary anticonvulsant therapy. Caesarean section was performed in 22.7% and majorities were done for foetal distress. Maternal complications were encountered among 17% of patients. There were 2 maternal deaths (2.3%), 13 stillbirths (14.1%) and 7 early neonatal deaths (7.9%).Conclusions: The incidence of eclampsia among all deliveries over a 2-year period at a tertiary care centre in India was 0.45%. Parenteral magnesium sulphate was effective in the vast majority of these patients in controlling the seizures. Further studies to evaluate whether early registration for antepartum care improves maternal and foetal outcomes in patients with eclampsia are warranted.

scholarly journals Diagnostic accuracy of clinical tool ‘STOPS’ and Serum Procalcitonin for optimizing antibiotic therapy in Neonatal Sepsis

2021 ◽  
Vol 13 (1) ◽  
pp. e2021019
Author(s):  
Vishal Vishnu Tewari
Keyword(s):  
Antibiotic Therapy ◽  
Diagnostic Accuracy ◽  
Neonatal Sepsis ◽  
Skin Color ◽  
Late Onset ◽  
Tertiary Care ◽  
Negative Likelihood Ratio ◽  
Care Hospital ◽  
Clinical Tool ◽  
Mortality And Morbidity

Background:  Antibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as injudicious prolonged use increases mortality and morbidity risk. Objective: To evaluate the diagnostic accuracy of clinical tool ‘STOPS’ and serum procalcitonin (PCT) for identifying neonates with early onset neonatal sepsis (EONS) or late onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis. Methods: The study had a prospective analytical design conducted at a tertiary care hospital. All neonates with suspected EONS or LONS were enrolled. The ‘STOPS’ tool comprising of sensorium, temperature, oxygenation, perfusion, skin color and blood sugar was applied at 6 and 12 hr of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated. Results:  The study enrolled 380 neonates of which 330 were given antibiotics for EONS and 50 for LONS. Temperature recording in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 – 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 – 29). Skin color assessment at 12 hr it had a PPV of 100% and PLR of 13.5 (9.7 – 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 – 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 – 29). Conclusion: Identifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The ‘STOPS’ tool allows early identification of neonates with no sepsis thereby optimizing antibiotic use.

scholarly journals A study on role of LATCH scoring in duration of exclusive breastfeeding in a rural tertiary care hospital, Puducherry: a prospective study

2019 ◽  
Vol 7 (1) ◽  
pp. 198
Author(s):  
Karthika S. ◽  
Mathivanan M. ◽  
Maheswari K. ◽  
Hiremath P. B. ◽  
M. Jesintha Devi
Keyword(s):  
Prospective Study ◽  
Exclusive Breastfeeding ◽  
Tertiary Care ◽  
Breastfeeding Duration ◽  
Care Hospital ◽  
Early Weaning ◽  
Point Data ◽  
A Prospective Study ◽  
High Chance

Background: Exclusive Breastfeeding (EBF) for 6 months is the optimal way of feeding infants. NFHS4 data shows 45.5% of children were exclusively breastfed at 6 months in Puducherry. The Global Nutrition Targets 2025 aims at increasing EBF rates in first 6 months up to at least 50%. The main objective is to find areas of needed intervention using LATCH scoring and to find factors responsible for fall in rates of EBF.Methods: A prospective study was conducted between November 2017 and April 2019 (1½years). Mothers were educated about breastfeeding. LATCH score assessed at 8 and 48 hours of life. At 48hours, score >8 indicates there is a high chance for EBF for next 6 months and score <8 indicates, mother is having difficulty in feeding and are intervened at this point. Data about EBF and reason for early weaning at 6 weeks and 6 months collected.Results: LATCH score at 8 hours was >8 in infants delivered via NVD: 50% as against 9.6% in babies delivered via LSCS. At 48 hours LATCH score improved in both groups: 60.8% in babies delivered via NVD, 38.3% in babies delivered via LSCS.  Compared to Primi-mothers, infants born to multigravida mothers had higher scores at 48 hours: 62.2% as against 31.1%. 84% were EBF at 6 weeks. 51% were EBF at 6 months. When mothers with LATCH score <8 at 48 hours were intervened, EBF rate at 6 weeks improved. Most common reason for early weaning at 6 weeks was maternal problems: 6.6% and at 6 months- due to influence of relatives: 27%.Conclusions: LATCH score helps in predicting breastfeeding duration as early as 48 hours of life. Low scores indicate, it requires intervention and identifies the areas of needed intervention. Counselling regarding EBF must include not only mothers but also relatives.

scholarly journals Laparoscopy in management of surgical causes of acute verses chronic pain abdomen in adults visiting tertiary care hospital in Telangana, India

2021 ◽  
Author(s):  
Talla Srinivas ◽  
Sudagani Sreenivas ◽  
Doddoju Veera Bhadreshwara Anusha
Keyword(s):  
Chronic Pain ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Diagnostic Uncertainty ◽  
Pain Abdomen ◽  
Background Pain ◽  
Laparoscopic Intervention ◽  
A Prospective Study

Background: Pain abdomen accounts for about 14.2% of all emergency hospitalization. Many patients remain undiagnosed even after excluding the common disorders by meticulous investigations. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis. The current study aimed at comparing the role of laparoscopy in management of surgical causes of acute and chronic pain abdomen.Methods: A prospective study was done in 168 adult patients attending tertiary care hospital, selected by convenience sampling method. After clinical examination and relevant investigation, patients in need of diagnostic and therapeutic laparoscopic management were included in study. Laparoscopic findings and postoperative status of patients, with acute and chronic pain abdomen were compared with relevant statistical tests.Results: Mean age of patients was 35.8 years. Majority of the patients were females (58.3%). 41.1% and 58.9% patients had acute and chronic pain abdomen, respectively. Though more patients with chronic pain abdomen (58.9%) underwent laparoscopy when compared with acute pain abdomen (41.1%) it was not statistically significant, also post-operative status though found to be better in patients with chronic pain abdomen was not statistically significant.Conclusions: Though prevalence of laparoscopic intervention and better outcome was found more in patients with chronic abdominal pain in the present study it was not statistically significant.

scholarly journals Correlation of qSOFA with Severity of COVID-19 Infection Assessed on Admission at Tertiary Care Hospital in Lahore

2021 ◽  
Vol 35 (1) ◽  
pp. 1-6
Author(s):  
Munaza Javed
Keyword(s):  
Pearson Correlation ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Care Hospital ◽  
Clinical Tool ◽  
Mortality And Morbidity ◽  
Mild Disease ◽  
Huge Impact ◽  
Qsofa Score ◽  
Tertiary Care Hospitals

Introduction: The COVID-19 crisis is continuously taxing the world with a huge impact on mortality, morbidity and disease related mental stress. COVID-19 has a variable presentation encompassing from simple myalgias to development of ARDS. Early detection of patients with severe COVID 19 infection by utilizing simple bed side clinical tool like qSOFA, which has been previously used for detection of severity of sepsis could help us in early triage and subsequent management of these patients in specialized dedicated units of the hospital. Thus help in limiting the mortality and morbidity because of this deadly contagion. Aims & Objectives: To correlate the severity of qSOFA score with the clinical severity and outcome of COVID-19 infection at presentation among admitted patients in tertiary care hospitals of Lahore. Place and duration of study: This study was conducted simultaneously at three tertiary care hospitals of Lahore, including Lahore General Hospital, Jinnah Hospital Lahore and Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore. Material & Methods: A retrospective descriptive study on 120 RT PCR positive confirmed COVID-19 patients of both genders, more than 18 years of age. Case records of patients admitted in General Corona ward, Isolation wards, HDUs and ICUs were analyzed. The data analysis was done in SPSS version 20. Factors including blood pressure, respiratory rate, and conscious level were used to calculate the qSOFA score. COVID 19 infection was divided into mild, moderate, severe and critically ill. The relationship of qSOFA score was studied with severity of COVID-19 infection, outcome of disease and age by using the Pearson correlation. Results: Eighty-four (70%) patients were male and thirty-six (30%) were female, with mean age of 59.42 ± 13.49 years. Sixty-eight, twenty-five, five and 0.8 percent patients had critical, severe, moderate and mild disease respectively. Most frequent comorbids found were hypertension, diabetes, ischemic heart disease. A statistically significant correlation was observed between qSOFA with severity of COVID 19, age, and outcome of infection at the level of 0.01. Conclusion: qSOFA is a reliable bedside tool to measure severity and predict outcome of COVID 19 infection.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

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