Analytical Study of Complications of Third Stage of Labour in a Tertiary Care Centre in Bhopal, Madhya Pradesh - An Observational Prospective Study

2021 ◽  
Vol 8 (32) ◽  
pp. 2923-2927
Author(s):  
Geetika Thakur ◽  
Aruna Kumar ◽  
Deepti Gupta
Keyword(s):  
Postpartum Haemorrhage ◽  
Tertiary Care ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
The Third ◽  
Uterine Inversion ◽  
Study Results ◽  
Third Stage ◽  
Gandhi Medical College ◽  
Associated Risk Factors

BACKGROUND The third stage of labour starts when the fetus has completely delivered and ends with the complete expulsion of the placenta. The third stage of labour is usually uneventful, although significant complications can occur in this period, the most common is postpartum haemorrhage (PPH). The purpose of this study was to identify the various third stage complications, their incidence, and associated risk factors in patients admitted to the centre. METHODS This is a prospective observational study performed in the Department of Obstetrics and Gynaecology, Gandhi Medical College and Sultania Zanana Hospital (SZH), Bhopal conducted from 1 st October 2010 to 30th September 2011. All patients who delivered in our centre or outside and developed a third stage complication were included in the study. RESULTS There were a total of 10,277 deliveries during the study period and 171 cases of third stage complications. The incidence of third stage complication was 1.66 %. The most common third stage complication was traumatic PPH (52.1 %) and the least common was inversion of uterus (2 %) but the case fatality rate (20 %) was higher in the latter. The incidence of traumatic PPH was highest among the primipara patients (72.9 %) and in the grand multipara, atonic PPH topped the list occurring in 57.8 % of the patients. CONCLUSIONS As third stage complications occur in approximately 1 in 60 deliveries and cause 19.3 % of the total maternal deaths, it is of utmost importance to outline an effective treatment for the management of postpartum haemorrhage. This could further help in reducing maternal mortality significantly. KEYWORDS Third Stage of Labour, Atonic Postpartum Haemorrhage, Traumatic Postpartum Haemorrhage, Retained Placenta, Uterine Inversion, Peripartum Hysterectomy

scholarly journals Study of ovarian cancer at a tertiary care centre

2020 ◽  
Vol 9 (8) ◽  
pp. 3228
Author(s):  
Jayashree Mulik ◽  
Swapnil Khadse
Keyword(s):  
Ovarian Cancer ◽  
Tertiary Care ◽  
Case Fatality ◽  
Final Diagnosis ◽  
World Health ◽  
Ca 125 ◽  
Tertiary Care Centre ◽  
History Of ◽  
Associated Risk Factors

Background: Despite major advances in case management, ovarian cancer continues to have the highest case fatality rate of all gynaecologic malignancies. There is paucity of meaningful screening and diagnostic protocols. Present study was planned with the objective of assessment of the prevalence of ovarian cancer and the associated risk factors at a tertiary care centre.Methods: The present prevalence study was conducted at a tertiary care government hospital and entailed analysis of data of 73 patients of ovarian cancer. All the participants were subjected to comprehensive history taking, followed by general, systemic, per-speculum and per-vaginal examination. Serum tumour markers of the patients were assessed. Imaging studies including ultrasound, CT or MRI abdomen/pelvis were done as per need. Final diagnosis was confirmed on histopathology and the cases were classified according to histological classification of World Health Organization.Results: Majority (41, 56.2%) were aged more than 45 years and above, most of them with one to two previous issues (64.3%). The disease was observed to be more common in postmenopausal women (65, 89%). Three fourth participants had negative family history of ovarian or breast cancer. Out of 73 patients, 31 had value of CA 125 between 150-400 U/mL and 42 had values >400 U/mL. Epithelial ovarian cancer (serous- 33, 45.2%, mucinous- 18, 24.7%) was observed to be the commonest histological type.Conclusions: To diagnose ovarian tumours early using multipronged approach with focussed risk factor identification and screening with CA-125 is very important and is strongly recommended.

scholarly journals A case report of uterine inversion after home delivery

2021 ◽  
Vol 4 (2) ◽  
pp. 050-054
Author(s):  
M Sena-Martins ◽  
V Tadini ◽  
BG Bolsonaro ◽  
C Mariani-Neto ◽  
ABN Pires ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Postpartum Haemorrhage ◽  
Hypovolemic Shock ◽  
Home Birth ◽  
Home Delivery ◽  
The Third ◽  
Uterine Inversion ◽  
Third Stage Of Labor ◽  
Third Stage

Puerperal acute uterine inversion is a rare obstetric condition observed as a serious complication during the third stage of labor. Reported as one of the causes of postpartum haemorrhage, it commonly requires quick diagnosis and surgical treatment in order to reduce morbidity and lethality. The authors describe a case of uterine inversion with hypovolemic shock after home birth, brought to Hospital Leonor Mendes de Barros. The purpose of this article is to describe a case of acute uterine inversion and its management and a review of aetiology, predictive and risk factors, diagnosis and treatment.

scholarly journals Evaluation of complication during third stage of labour at tertiary care center

2020 ◽  
Vol 9 (6) ◽  
pp. 2446
Author(s):  
Komal K. Rangholiya ◽  
Saumya P. Agrawal ◽  
Sapana R. Shah ◽  
Hetal Dodiya
Keyword(s):  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Conservative Surgery ◽  
Maternal Outcome ◽  
Tertiary Care Centre ◽  
Uterine Inversion ◽  
Third Stage ◽  
Life Threatening

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication.

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

scholarly journals Medications for Anxiety: A Drug utilization study in Psychiatry Inpatients from a Tertiary Care Centre of Western Nepal

1970 ◽  
Vol 1 (4) ◽  
pp. 119-125 ◽  
Author(s):  
Indrajit Banerjee ◽  
Bedanta Roy ◽  
Brijesh Sathian ◽  
Indraneel Banerjee ◽  
Sai Sailesh Kumar ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Physical Dependence ◽  
Tertiary Care ◽  
Psychiatric Inpatient ◽  
Common Disease ◽  
Utilization Pattern ◽  
Tertiary Care Centre ◽  
Prescribing Pattern ◽  
Study Results ◽  
Anxiolytic Drugs

Background   Anxiety is the most widespread psychiatric disorder and generalized anxiety disorder is the most common disease seen in the primary care setting. Currently there are a number of anxiolytic drugs commercially available in the market for treatment of these disorders such as Benzodiazepines like Diazepam, Chlordiazepoxide, Alprazolam, Betablockers like Propranolol and H1 Antihistaminics like Hydroxyzine. Some of the newer anxiolytics like Buspirone in Azapirone group is marketed as better anxiolytic drug than the traditional drugs.  Buspirone is promoted as a better drug for anxiety, as it does not cause any sedation, tolerance or physical dependence. A need for study further increases as there is no sufficient data on utilization pattern of anxiolytics on Nepalese population. This is the first study done in the utilization pattern of anxiolytic drugs in inpatient in Nepal.  Methods This is an observational study undertaken between 1st October 2009 and 31st March 2010 at the Psychiatric inpatient Department of Manipal Teaching Hospital. The prescribing pattern of Anxiolytic drugs was measured. Out of a total of 240 cases who were admitted to psychiatry inpatient ward, 38 cases have received Anxiolytic drugs. Those who were critically ill with anxiety were included in the study.  Results Out of 240 cases who were admitted to psychiatry inpatient, 130 were male patients (54.2%), 95% CI [47.9,60.5] and the rest were female patients (45.8%), CI [39.5,52.1] . In 38 cases of anxiety, the age of the patient <40 years 89.5% and >40 years 10.5%. Anxiety was more common in females 71.1% than in males 28.9%. 68.4% of the patients were unemployed whereas only 31.6% of the patients were employed. 78.9% of the drugs were prescribed by trade name. Among the anxiolytics, the commonest drug prescribed was Alprazolam (50%), followed by Clonazepam (31.6%), Chlordiazepoxide (15.8%) and Lorazepam (2.6%). Conclusion Utilization patterns of drugs for anxiolytics were according to treatment guidelines and suggested a trend towards the use of shorter acting Benzodiazepines such as Alprazolam. Continuous and prolonged use of longer acting Benzodiazepines has resulted in dependence and may have withdrawal symptoms when the dosage of these drugs is reduced or treatment is stopped.http://dx.doi.org/10.3126/nje.v1i4.5753 Nepal Journal of Epidemiology 2011;1(4):119-125

scholarly journals Intrauterine condom catheter tamponade in the management of atonic postpartum haemorrhage: a case series from a tertiary care centre in Central India

2017 ◽  
Vol 6 (8) ◽  
pp. 3468 ◽  
Author(s):  
Moushmi B. Parpillewar ◽  
Shalini S. Fusey
Keyword(s):  
Postpartum Haemorrhage ◽  
Tertiary Care ◽  
Balloon Catheter ◽  
Case Series ◽  
Central India ◽  
Success Rates ◽  
Tertiary Care Centre ◽  
Non Invasive ◽  
Surgical Methods ◽  
Condom Catheter

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide with a prevalence rate of approximately 6% and 50% is due to atonic PPH. According to WHO 2014-  in India 45,000 maternal deaths take place annually and 20-60% are due to postpartum hemorrhage. Various medical and surgical methods are available. Uterine balloon tamponade is one of the methods reported increasingly with good success rates avoiding surgical morbidity.Methods: Prospective data of all women who went into atonic primary PPH after 28 weeks of gestation was collected over a period of one year.Results: Out of the 252 women who had atonic PPH, 23 were inserted with condom balloon catheter after medical management. Success rate was 18/23 (78.2%).Conclusions: Condom catheter is a non-invasive, effective, conservative method of PPH management.  In cases of failure it provides a temporary tamponade effect and time to prepare for other interventions.

scholarly journals Bacteriological profile of blood stream infections among febrile patients attending a tertiary care centre of Western Nepal

2013 ◽  
Vol 4 (3) ◽  
pp. 92-98 ◽  
Author(s):  
Dharm Raj Bhatta ◽  
Abhishek Gaur ◽  
HS Supram
Keyword(s):  
Tertiary Care ◽  
Blood Stream ◽  
Care Centre ◽  
Salmonella Spp ◽  
Tertiary Care Centre ◽  
Coagulase Negative Staphylococci ◽  
Cross Sectional ◽  
Blood Stream Infections ◽  
Acinetobacter Species ◽  
Study Results

Background Blood stream infections (BSI) are significant cause of morbidity and mortality in the world. This study was conducted to determine the common bacterial agents associated with BSI with their antimicrobial susceptibility patterns in a tertiary care centre in the Western region of Nepal. Method This cross-sectional study was conducted for a period of two years from May 2010 to May 2012. All patients with fever (temperature ≥ 38°C) were included in the study. Results A total of 4,145 patients with febrile illness were included in this study, bacterial agents were isolated in 251 (6%) cases. Common bacterial isolates were Salmonella spp., Klebsiella pneumoniae, Escherichia coli, Pseudomonas species, Acinetobacter species, Staphylococcus aureus and Coagulase negative Staphylococci. Paratyphoid fever (Caused by S. Paratyphi A) is more common than typhoid fever. The members of Enterobacteriaceae were found to be resistant to ampicillin and cefazolin. Majority of the nonfermenters were found to be sensitive to most antibiotics. Gentamicin and Ciprofloxacin were sensitive to majority of gram positive bacteria. Conclusion Gram-negative bacteria were the predominant causes of BSIs. The occurrence of drug resistance among the isolated bacteria is of great concern. Imipenem showed 100% sensitivity against Pseudomonas aeruginosa indicating lack or low level of MBL activity. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8165 Asian Journal of Medical Sciences 4(2013) 92-98

scholarly journals Evaluation of complications during third stage of labour among women delivering at tertiary care center

2018 ◽  
Vol 7 (7) ◽  
pp. 2706
Author(s):  
Tanya Agrawal ◽  
Ruchi Kalra ◽  
Aabha Suryavanshi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Active Management ◽  
Perineal Tear ◽  
Retained Placenta ◽  
Uterine Inversion ◽  
Perineal Tears ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

Background: The common complications occurring during third stage of labor are PPH Retained Placenta, Morbid adherent placenta- placenta accreta, placenta increta, percreta, perineal tears, uterine inversion increasing the maternal morbidity and mortality. The objective of the present study was to evaluate percentage and spectrum of obstetrics complication occurring during third stage of labor.Methods: An observational study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Center, Bhopal from January 2016 to December 2017. All women delivering vaginally including instrumental deliveries were included. The medio-lateral episiotomy was given to all primigravida and for multigravida decision was case based as big size babies, instrumental deliveries, rigid perineum. Active management of third stage of labor was practiced.Results: 899 women delivered vaginally during the study period of 2 years (Jan -Dec 2016 Jan -Dec 2017). Among these 6.45% (58 women) had various complications during third stage of labor . 55% were primigravida. Complications which were observed to occur during third stage of labor were perineal tear 4% (37/899 deliveries). Atonic PPH occurred in 0.5% (9/899 deliveries) Traumatic PPH was in 1.44% (13/899 deliveries and 0.3% cases had retained placenta. Associated condition in perineal tear cases were 92% had big size babies 5% cases were preterm labor and in 3% cases ventouse application was done.Conclusions: Common complications were 1st and 2nd degree perineal tears occurred in 4% deliveries and traumatic PPH were in 1.44% of cases.

Maternal and perinatal outcomes in cases of antepartum haemorrhage: a 3-year observational study in a tertiary care hospital

2017 ◽  
Vol 6 (3) ◽  
pp. 1025
Author(s):  
Sunil Kumar Samal ◽  
Setu Rathod ◽  
Reddi Rani ◽  
Seetesh Ghose
Keyword(s):  
Observational Study ◽  
Tertiary Care ◽  
Previous History ◽  
Perinatal Outcomes ◽  
Care Hospital ◽  
Perinatal Complications ◽  
Health Care Centre ◽  
Antepartum Haemorrhage ◽  
Gandhi Medical College ◽  
Associated Risk Factors

Background: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study is to study the demographic profile, type of antepartum haemorrhage (APH), maternal and perinatal complications in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH.Methods: The study was a retrospective observational study conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry from November 2013- October 2016 [3 years]. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section.  Statistical analysis done by using SPSS software version 21.Results: Total 218 cases were presented with APH and the incidence was 2.9%. Among these 49.5% were Placenta Praevia, 42.2% were abruption placentae, 6.8% cases were indeterminate (3 cases of vasa praevia and 12 cases of excessive show) and 1.5% cases were of extraplacental cause(Local causes). Most cases were multipara with most common age group was 26-30 years (42.2%). Pregnancy in most of the cases was terminated during 34-36+6 weeks of gestation (73.0%). Most common associated risk factors found were previous caesarean section, preeclampsia, previous history of curettage, malpresentation and anaemia. Postpartum haemorrhage was found in 42.2% cases while in 4 cases peripartum hysterectomy done. Most common perinatal complications were due to low birth weight (66.5%).Conclusions: The morbidity and mortality in pregnancies complicated with APH can be achieved by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care centre.

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