scholarly journals A comparative study of induction of labour with intravaginal misoprostol and intracervical dinoprostone gel and its fetomaternal outcome in a tertiary care hospital

2021 ◽  
Vol 8 (4) ◽  
pp. 463-469
Author(s):  
Sheryl S Valvi ◽  
Bhavesh B Airao
Keyword(s):  
Vaginal Delivery ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Control Group ◽  
Care Hospital ◽  
Delivery Time ◽  
Dose Requirement ◽  
Emergency Cesarean ◽  
Vaginal Misoprostol ◽  
Group D

The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.This is prospective case-control study conducted in department of obstetrics and gynecology, C. U. Shah Medical College and Hospital, Surendranagar over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

scholarly journals A comparative study of the effect of induction of labour with vaginal misoprostol versus prostaglandin E2 gel on the incidence of pathological cardiotocography tracing

2020 ◽  
Vol 9 (6) ◽  
pp. 2274
Author(s):  
Archana Kumari ◽  
Nikita Chauhan ◽  
Anubha Vidyarthi
Keyword(s):  
Vaginal Delivery ◽  
Case Control Study ◽  
Fetal Distress ◽  
Control Group ◽  
Delivery Time ◽  
Dose Requirement ◽  
Vaginal Misoprostol ◽  
Failed Induction ◽  
Group D ◽  
Control Study

Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

scholarly journals Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Tulasa Basnet ◽  
Baburam Dixit Thapa ◽  
Dipti Das ◽  
Ramesh Shrestha ◽  
Sarita Sitaula ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Care Hospital ◽  
Breech Delivery ◽  
Vaginal Breech Delivery ◽  
Emergency Cesarean

Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

scholarly journals Thyroid disorders in pregnancy: prevalence and its fetomaternal outcome in a tertiary hospital of Delhi, India

2020 ◽  
Vol 9 (2) ◽  
pp. 549
Author(s):  
Neha Bansal ◽  
Divya .
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Group Versus ◽  
Fetal Distress ◽  
First Trimester ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Thyroid Disorders ◽  
Care Hospital

Background: This study was conducted to determine the feto maternal outcome in pregnant women with thyroid disorders. The prevalence of thyroid disorders in present study was 15.75%.Methods: This was a prospective observational study carried out in all pregnant women irrespective of their parity, who attended ANC clinic in department of obstetrics and gynaecology in a tertiary care hospital over a period of 2 years. After registering, the patients were followed up with routine antenatal visits up to delivery and records were reviewed for development of abortion, PIH, preterm delivery, GDM, anemia, placental abruption, still birth, anomalies, fetal distress, meconium stained liquor, low birth weight and neonatal outcome by neonate Apgar score and TSH value.Results: Mean age group in our study was 27.61±3.14. Family history was present in 8% of study group versus 0% in control group which was statistically significant (p=0.028). Eighteen percent of preeclampsia was diagnosed in study group as compared to 4% in control group which was statistically significant (p-value= 0.005). Fourteen percent patients had preterm labour in study group as compared to 6.7% in control group which was statistically significant (p value= 0.047). Increased neonatal TSH was found in study group (61.3%) as compared to control group (32%), this difference was statistically significant (p-value <0.001). There was increased importance of measuring TSH in first trimester as it was statistically significant in study group (p-value <0.001).Conclusions: All pregnant women should be screened for hypothyroidism as early as possible or before conception to prevent any fetomaternal complications.

scholarly journals The effect of care transition pathway implementation on patients undergoing joint replacement during the COVID-19 pandemic: a quasi-experimental study from a tertiary care hospital orthopedic department in Beijing, China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ya-ping Xu ◽  
Pei-yu Zhao ◽  
Yi-tong Bai ◽  
Shuang Li
Keyword(s):  
Joint Replacement ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Transition ◽  
Control Group ◽  
Care Hospital ◽  
Quasi Experimental ◽  
And Control ◽  
Beijing China

Abstract Background The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. Methods A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. Results The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. Conclusions A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.

ALKALINE PHOSPHATASE AS A PROGNOSTIC MARKER IN CANCER BREAST PATIENTS IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 14-16
Author(s):  
Asha Premlata Omega Oraon ◽  
Bela Rose Ekka
Keyword(s):  
Alkaline Phosphatase ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Prognostic Markers ◽  
Tertiary Care Hospital ◽  
Serum Alkaline Phosphatase ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Cancer Breast

OBJECTIVE: To estimate the value of Alkaline Phosphatase in cancer breast patients in a tertiary care hospital. MATERIAL AND METHODS: The study was conducted to estimate the value of Serum Alkaline Phosphatase in 50 cancer breast patients and 50 normal patients of same age as a control group. RESULTS: The level of serum Alkaline Phosphatase was signicantly increased (p<0.05)in cancer patients compared to the control group. CONCLUSION: There is an increase in serum Alkaline Phosphatase in cancer patients compared to the control group and can be a prognostic markers for the progress of the disease.

scholarly journals 1225. How Frequently Should Sink Drains Be Disinfected?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S440-S440
Author(s):  
Jorge A Ramos-Castaneda ◽  
Matthew L Faron ◽  
Joshua Hyke ◽  
Blake W Buchan ◽  
Rahul Nanchal ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Group ◽  
Care Hospital ◽  
Bacterial Reduction ◽  
Post Intervention ◽  
Bacterial Colony ◽  
Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

“A TRUE EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF XYLOCAINE 2% GEL ON PAIN INTENSITY DURING INTRAVENOUS CANNULATION AMONG PATIENTS AT SELECTED TERTIARY CARE HOSPITAL BELAGAVI”

2021 ◽  
pp. 22-23
Author(s):  
Mounesh Badiger ◽  
Honnagouda Patil
Keyword(s):  
Pain Intensity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Adult Patients ◽  
Control Group ◽  
Care Hospital ◽  
Intravenous Cannula ◽  
Cannulation Site ◽  
Post Test ◽  
Experimental Group

A true experimental, post test only control group design was used to nd out the effectiveness of Xylocaine 2% gel on pain intensity reduction during intravenous cannulation among the adult patients tertiary care hospital of Belagavi, Karnataka. Quantitative approach was used for the study. The study was done on 80 adult patients using standardized pain numerical scale. (Based on pilot study the prevalence rates in both group calculated p1=82% p2=100%, q1=18 q2=0, d=18% , Z= 1.96 (at 5% α error), Z= 0.842 (at 80% power) n=38 40). Simple random (lottery method) technique was used .in this study the patients, who have a patent intravenous cannula in place and who are unable perceive and responds for pain (unconscious patient). Demographical variables analyzed for the study Age, Gender, Education, Occupation, Previous experience, duration of pain during intravenous cannulation, site of cannulation and size of intravenous Cannula (Variables Independent variable: Xylocaine 2% gel. Dependent variable: Pain intensity experience during intravenous cannulation). Total 21 reviews were taken under the title of the above study (Indian- 03, International- 18). The conceptual framework used for this study is based on General Systems Theory introduced by Ludwig Von Bertalanffy in 1968. The obtained data was analyzed by using descriptive and inferential statistics. The mean of post test pain intensity during IV cannulation in experimental group was 1.93 and 4.30 in control group and SD of 0.60 in experimental group, 0.61 in control group. In this study 62.50% of participants have mild pain and 15% have moderate pain in experimental group as compared to 55% have severe pain followed by 37.50% have worst pain in control group. The difference is found to be statistically signicant

scholarly journals Instrumental delivery: a comparative study in a tertiary care hospital

2018 ◽  
Vol 7 (3) ◽  
pp. 1079
Author(s):  
Bhanu B. T. ◽  
Anitha G. S.
Keyword(s):  
Post Partum ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Care Hospital ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Maternal And Neonatal Outcomes ◽  
Vertex Presentation

Background: To compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery.Methods: Women in labor with vertex presentation were delivered by indicated/propylactic vacuum or forceps. A total of 500 cases were included in this retrospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, neonatal jaundice, perinatal mortality, NICU admissions etc. Chi square test was used to analyze the data.Results: Maternal morbidity was significant in the forceps group. With regards to neonatal morbidity, in NICU admissions, statistically significant difference was noted.Conclusions: Vacuum and forceps should remain appropriate tools in the modern obstetrics. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother and decrease NICU admissions.

scholarly journals Derivation of a Model to Guide Empiric Therapy for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection in an Endemic Area

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Gregory Weston ◽  
Fathima Jahufar ◽  
Nikhil Sharma ◽  
Christopher Su ◽  
Eran Bellin ◽  
...  
Keyword(s):  
Blood Culture ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Classification Rule ◽  
Control Group ◽  
Care Hospital ◽  
Clinical Classification ◽  
Carbapenem Resistant ◽  
Good Ability

Abstract Background Appropriate therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is often given late in the course of infection, and strategies for identifying CRKP BSI earlier are needed. Methods A retrospective case–control study was performed at a tertiary care hospital, university hospital, and community hospital in Bronx, New York. All participants had a blood culture sent and received an antibiotic within 48 hours of the culture. The case group (n = 163) had a blood culture with CRKP. The control group (n = 178) had a blood culture with carbapenem-susceptible Klebsiella. Data were obtained by electronic or conventional medical record abstraction. A multiple logistic regression model was built to identify associated factors and develop a clinical model for CRKP BSI. Model performance characteristics were estimated using a 10-fold cross-validation analysis. Results A prior nonblood culture with carbapenem-resistant Enterobacteriaceae, skilled nursing facility (SNF) residence, mechanical ventilation, and admission &gt;3 days were strongly associated risk factors. A significant interaction led to development of separate clinical models for subjects admitted &lt;3 days at the time of positive blood culture from those admitted at least 3 days. The derived models had a good ability to discriminate between subjects with and without CRKP BSI. A clinical classification rule to guide therapy can prioritize sensitivity or specificity. Conclusions Prior nonblood cultures showing resistance and exposure to SNF and health care settings are factors associated with carbapenem resistance. The clinical classification rules derived in this work should be validated for ability to guide therapy.

scholarly journals Does Gender Influence Electroconvulsive Therapy Sessions Required across Psychiatric Diagnoses? A 5-Year Experience from a Single Center

2017 ◽  
Vol 08 (03) ◽  
pp. 427-430 ◽  
Author(s):  
Harshini Manohar ◽  
Karthick Subramanian ◽  
Vikas Menon ◽  
Shivanand Kattimani
Keyword(s):  
Electroconvulsive Therapy ◽  
Psychotic Disorders ◽  
Tertiary Care ◽  
International Classification Of Diseases ◽  
Yield Response ◽  
Psychiatric Diagnoses ◽  
Care Hospital ◽  
Dose Requirement ◽  
Related Data ◽  
And Gender

ABSTRACTContext: There is a paucity of systematic data reflecting the practice of electroconvulsive therapy (ECT) from developing countries. Aim: We aimed to identify the number of ECT sessions required to yield response and gender differences in the number of sessions across various diagnostic categories. Setting and Design: A record-based study from a teaching cum tertiary care hospital in South India. Subjects and Methods: Case records of patients who received modified ECT from January 2011 to January 2016 were reviewed. The sociodemographic details and ECT-related data were collected. Psychiatric diagnoses were ascertained as per the International Classification of Diseases, 10th Revision criteria. Statistical Analysis Used: Kruskal–Wallis test and Mann–Whitney U-test. Results: Among 148 patients, 82 (55.4%) had mood disorder (bipolar disorder and recurrent depressive disorder), 43 (29.1%) had schizophrenia, and 22 (14.9%) had other acute and transient psychotic disorders (ATPDs). Patients with mood disorders, schizophrenia, and other ATPD received 7.3 (± 3.8), 9.7 (± 6.1), and 5.4 (± 2.0) ECT sessions, respectively, to achieve response. There was no gender difference in the number of sessions received. Conclusion: Our findings show that number of ECT sessions required to yield response may be disorder-specific. Gender does not influence the ECT dose requirement. Variations in ECT parameters across settings may limit the generalizability of results.

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