scholarly journals Feto-Maternal outcomes in Intrahepatic Cholestasis in Pregnancy in a Tertiary Care Centre in Eastern Nepal

2016 ◽  
Vol 5 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Sita Pokhrel Ghimire ◽  
Ashima Ghimire ◽  
Gauri Shankar Jha ◽  
Manisha Chhetry ◽  
Mahanand Kumar
Keyword(s):  
Intrahepatic Cholestasis ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Liver Function Tests ◽  
Maternal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Cholestasis Of Pregnancy

Background Intrahepatic cholestasis of pregnancy has poor feto-maternal outcomes. To date there has been sparse publications regarding impact of intrahepatic cholestasis in feto-maternal outcomes in our setting. Therefore, we aimed to study the feto-maternal outcome in patients with intrahepatic cholestasis of pregnancy.Material and Methods A hospital based prospective cross-sectional study carried out in department of Obstetrics and Gynecology of Nobel Medical College, Biratnagar, Nepal from 1st January 2014 to 30th December 2015 in women who presented with pruritus in third trimester of pregnancy and having deranged liver function tests. All the cases were followed from admission to discharge. Socio-demographic, clinico-laboratory profile and feto-maternal outcomes were recorded in a preformed structured proforma. Descriptive statistics was used to present the data.Results Among 6,780 women admitted for delivery, 80 had cholestasis of pregnancy with incidence of 1.15%. 83% were of 18-35 years and 65% were primigravida. Most distressing symptom was generalized pruritus (75.0 %). The cesarean delivery rate was 46.25% and labor induction rate was (47.5%). Fetal complications were seen in majority of cases that included meconium aspiration syndrome 26 (32.5%), intrapartum fetal distress 21 (26.25%) and requirement of: intensive care 38 (48.75%). There were 7 perinatal and 3 neonatal deaths.Conclusion Intrahepatic cholestasis of pregnancy seems fairly common among pregnant women. It may be responsible for a large number of perinatal and neonatal deaths especially after 36 weeks of gestation. A large prospective study is needed to address the problems in time.Journal of Nobel Medical College Volume 5, Number 1, Issue 8, January-July 2016, 20-25

scholarly journals Eclampsia: Feto-Maternal Outcomes in A Tertiary Care Centre in Eastern Nepal

2016 ◽  
Vol 54 (201) ◽  
pp. 24-28 ◽  
Author(s):  
Sita Ghimire
Keyword(s):  
Perinatal Death ◽  
Early Recognition ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Maternal Outcomes ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Maternal Morbidity And Mortality ◽  
Common Causes

Introduction: Eclampsia is a preventable and treatable cause of maternal morbidity and mortality with poor feto-maternal outcome in developing countries. Despite development in the level of health education expertise in human resources and institutional obstetric care in our country, the delay in early recognition of the problem, transportation to proper health facility and getting proper expert care are major hurdles to reduce complications. Therefore we decided to study feto-maternal outcomes in our setting.Methods: A retrospective cross-sectional hospital based study carried out in Nobel Medical College, Biratnagar, from 17th June 2014 to 16th June 2015. Details and data obtained from Medical Record Section were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis.Results: Among 8,066 deliveries, 112 had eclampsia with incidence of 13.8/1000 deliveries. Majority (41%) were of <19 years of age. Above 90% were unbooked. Aoubt 63.4% were primiparas and 83% had antepartum eclampsia. Eclamptic fits were more common (41.6%) in 37-40 weeks period of gestation. Fits to delivery interval was more than six hours in 89.1% women and 69.3% women underwent caesarean delivery. About 18.9% women developed eclampsia related complications. Common causes of maternal deaths (5.36%) were pulmonary edema, aspiration pneumonia, cerebrovascular accidents and HELLP syndrome. Perinatal death was nine percent.Conclusions: Although the obstetric care facilities are improving with time, the feto-maternal outcomes are still poor in our country. Therefore early recognition and proper management are vital to tackle this challenge. Keywords: eclampsia; fetomaternal outcomes; retrospective analysis. | PubMed

scholarly journals Assessment of indications of lower section caesarean section at tertiary care centre: a cross sectional study

2017 ◽  
Vol 4 (4) ◽  
pp. 1253
Author(s):  
Vijay L. Badge ◽  
Sumit Suresh Aggarwal ◽  
Deepti D. Ambalkar ◽  
Arun Humne ◽  
Neethika Raghuwanshi
Keyword(s):  
Caesarean Section ◽  
Care Center ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College

Background: Caesarean section is one of the commonly performed surgical procedures in obstetrics and is certainly one of the oldest operations in surgery. One of the most dramatic features of modern obstetrics is the increase in the caesarean section rate. The present study was conducted to estimate proportion of various indications of LSCS and also to assess socio demographic profile of mothers undergoing caesarean section in a tertiary care centre. Methods: The present cross sectional observational study was conducted at Government Medical College & Hospital, Akola in the post natal ward (PNC). Non probability convenient sampling method was used. All patients admitted to PNC ward after LSCS were included in study. For data collection paper based pre tested, semi –structured questionnaire was used. Results: Previous LSCS was indication for LSCS in 32% cases. Eclampsia, preeclampsia and Anaemia were the indications for LSCS in 19.3%, 8.6% and 5.3% cases respectively. Other common indications includes CPD, meconium stained liquor, fetal distress, breech presentations, twin pregnancy and preterm labour. Conclusions: The proportion of LSCS is more than WHO recommended proportion of LSCS. It may be due to present institute acts as tertiary care center. Still this proportion is high, so encouragement should be given to trial of labour in selected low risk cases and in Primi patients whenever possible. 

scholarly journals Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

2018 ◽  
Vol 7 (11) ◽  
pp. 4403
Author(s):  
Bhawna Sharma ◽  
Neetu Arora ◽  
Kusum Dogra ◽  
Kamal S. Negi
Keyword(s):  
Bile Acid ◽  
Cesarean Delivery ◽  
Intrahepatic Cholestasis ◽  
Perinatal Death ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Serum Bile Acid ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Vaginal Deliveries ◽  
Cholestasis Of Pregnancy

Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre.Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP.Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%).  Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well.  None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed.Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels.

scholarly journals Clinical and Etiological Profile of Mycotic Keratitis from a Tertiary Care Centre in South India

2021 ◽  
Vol 10 (27) ◽  
pp. 2001-2006
Author(s):  
John Britto Augustin ◽  
Sureshbaboo Variamkandi
Keyword(s):  
Risk Factors ◽  
Corneal Ulcer ◽  
Fusarium Species ◽  
Tertiary Care ◽  
Government Medical College ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Corneal Ulcers ◽  
Prompt Treatment

BACKGROUND Corneal ulcer is the leading cause of ocular morbidity and monocular blindness worldwide. To effectively prevent blindness in patients with corneal ulcer, a proper understanding of the risk factors predisposing to ulceration, its clinical and microbiological characteristics are essential. Timely identification of aetiological agents causing corneal ulcers and their prompt treatment helps to save the vision. We wanted to detect aetiological agents of corneal ulcer with special references to fungal causes and characterize the fungal aetiological agents to species level. METHODS This is a cross sectional study, conducted in Government Medical college, Kozhikode, between January 2016 and June 2017. All patients who were clinically diagnosed as cases of infectious corneal ulcer in the Ophthalmology department, Government Medical College, Kozhikode were included in the study. Corneal scrapings collected from the infected eye were subjected to microbiological examination and culture. A total of 120 cases were analysed. Each patient was examined with the slit lamp bio microscope after staining with fluorescein. Scrapings from cornea at the site of corneal ulcer were collected by ophthalmologist after a detailed clinical history and examination of the affected eye. The laboratory procedures used in the diagnosis of infectious keratitis were based on direct visualization of organisms by subjecting corneal scrapings to Gram stain and KOH wet mount and inoculation of material on to blood agar and Sabouraud dextrose agar. RESULTS Among the 120 cases, a total of 49 cases were culture positive. Twenty-one [17.5 %] were bacterial, twenty-two [18.34 %] were fungal and six [5.0 %] were poly microbial [bacteria and fungus]. Among the fungal aetiology, fusarium species was most common [32.14 %], followed by aspergillus species - 25.0 %. Trauma was the major risk factor. Diabetes mellitus, exposure keratitis were the other comorbidities / risk factors. CONCLUSIONS This study shows majority of infected corneal ulcers are associated with risk factors and the aetiology are mainly fungi. Microscopy, culture, and clinical correlation helped in adequate management. Thus, prognosis and outcome of corneal ulcers rely on timely identification of their aetiology and prompt treatment. KEY WORDS Corneal ulcer, Fungal Keratitis

scholarly journals Attitude towards mental illness among doctors and nurses in a tertiary care centre, Pondicherry, India

2017 ◽  
Vol 5 (7) ◽  
pp. 3059 ◽  
Author(s):  
V. Sujaritha ◽  
M. Partheeban ◽  
T. Thiviya ◽  
M. Sowmiya
Keyword(s):  
Mental Illness ◽  
Tertiary Care ◽  
Psychiatric Morbidity ◽  
Educational Status ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Gender Influence ◽  
Positive Attitudes ◽  
Doctors And Nurses

Background: Stigma can prevent care and treatment of mentally ill. About 54% of diagnosable mental disorders are seen in primary care settings. There is a gross underestimation of psychiatric morbidity among patients by substantial proportion of non-psychiatric clinicians. Hence there is a need to assess the attitude towards mental illness among doctors and staff nurses. The objectives of the study were to assess the attitude towards mental illness among doctors and nurses, to compare the attitude between doctors and nurses, to find if there is any correlation between duration of training or posting and attitude, to find if educational status had any influence on attitude, to find if there is any gender influence on attitude. Methods: It is a cross sectional descriptive study conducted in a private medical college, Pondicherry among doctors and nurses who had completed their under graduation with a sample size of 221 (Doctors-120, Nurses-101). The instruments used were a semi-structured demographic profile and 34 items of OMICC (Opinion About Mental Illness in Chinese Community). The data was entered in Microsoft Excel 2013 analyzed using descriptive statistics, unpaired t-test, pearson’s correlation coefficient.Results: Only 25% of doctors and 4.9% of nurses positive attitude when overall score was considered. Doctors group had higher positive attitudes compared to nurses in domains separatism, stereotyping, benevolence and stigmatisation.Conclusions: There was no correlation between duration of psychiatry posting and attitude.

scholarly journals Cross sectional study to assess the awareness of pharmacovigilance among post graduate residents of tertiary care medical college hospital of central India

2018 ◽  
Vol 7 (3) ◽  
pp. 386
Author(s):  
Pooja Solanki Mishra ◽  
Gopal Gudsurkar
Keyword(s):  
Graduate Student ◽  
Single Point ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Cross Sectional ◽  
Post Graduate ◽  
Global Database ◽  
Medical College ◽  
Post Graduate Student

Background: Pharmacovigilance knowledge and awareness in post graduate student doctors is key factor for proper implementation of PvPI. This study was planned to evaluate the knowledge &awareness of pharmacovigilance in post graduate students in tertiary care centre in Indore.Methods: It was a single point cross sectional questionnaire-based study conducted in a tertiary care Institute MGM Medical College & M.Y. Hospital in the state of Madhya Pradesh at Indore. It was conducted among post graduate student doctors from various clinical departments. Total of 150 questionnaires were distributed, 115 of them were returned back and were analysed.Results: Overall knowledge level was satisfactory. 91.30% knew about ADR while 95% were aware about PVPI. 13% knew about local AMC at Indore while only 4.34% knew global centre for Pharmacovigilance is at Sweden Uppsala. 86.95% thought Med watch as global database for ADR against only 13% knew its Vigibase. 96.50% thought ADR reporting is necessary. 97.40% thought it should be included in UG curriculum. 95.65% had not reported any ADR till date while 86.95% had not seen an ADR form.Conclusions: Post graduate doctors are the prime candidates to impart the importance of pharmacovigilance. The study strongly suggested that there was a great need to create awareness among the post graduate doctors to improve the reporting of ADRs.

scholarly journals Magnitude of hypothyroidism among patients of cholelithiasis in a tertiary care centre in rural West Bengal: a prospective study

2021 ◽  
Vol 8 (11) ◽  
pp. 3375
Author(s):  
Jaganmoy Maji ◽  
Debjyoti Mandal
Keyword(s):  
Stone Formation ◽  
Tertiary Care ◽  
Gall Stone ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Elder Patients ◽  
A Prospective Study

Background: Cholelithiasis is a common pathology of the gall bladder affecting about 10 to 15% of the adults in western countries and 2 to 29% in India. More than 80% of the patients with cholelithiasis are asymptomatic. Hypothyroidism may cause gall stone formation due to the hyperlipidemia, motility disorders affecting the bile duct and sphincter of Oddi.Methods: This was a descriptive cross-sectional study conducted at Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura from March 2019 to February 2020 for duration of one and half year. The sample size was 54 and consecutive non-probability sampling technique was used for the sampling. All the collected data were recorded in a pre-designed proforma and analyzed in MS excel.Results: Out of 54-patients with cholelithiasis, 28% patients were from the age group 45-54 years.40% patients were hypothyroid pre-dominantly females. Among 30-female patients 11 (26.82%) were hypothyroid and among 11-male patients 2 (15.38%) were hypothyroid. Hypothyroidism in male and female was statistically significant.Conclusions: This study was introduced to determine the relationship between hypothyroidism and cholelithiasis. It was concluded that hypothyroidism was more common in female, obese and elder patients. The gender distribution of the hypothyroidism in patients with cholelithiasis was statistically significant while all other variables were statistically not significant.  

scholarly journals Obstetric Cholestasis: A Review and Update

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Olawumi Adaramodu ◽  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Liver Function ◽  
Bile Acids ◽  
Intrahepatic Cholestasis ◽  
Liver Function Tests ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Third Trimester ◽  
Serum Bile Acids ◽  
Function Tests ◽  
Cholestasis Of Pregnancy ◽  
In Pregnancy

Obstetric cholestasis (OC) is a liver disorder that occurs in the late second and early third trimester of pregnancy characterized by pruritus with increased serum bile acids and other liver function tests. The pathophysiology of OC is still not completely understood. The symptoms and biochemical abnormality rapidly resolve after delivery. OC is associated with an increased risk of adverse obstetrical outcomes. The aetiology of obstetric cholestasis of pregnancy is poorly understood and is thought to be complicated and multifactorial.  OC typically occurs in the late second trimester when the oestrogen levels are the highest in pregnancy. The most common complaint is generalized intense pruritus, which usually starts after the 30th week of pregnancy. Pruritus can be more common in the palms and soles and is typically worse at night. Other symptoms of cholestasis, such as nausea, anorexia, fatigue, right upper quadrant pain, dark urine, and pale stool, can be present. Clinical jaundice is rare but may present in 14% to 25% of patients after 1 to 4 weeks of the onset of pruritus. Some patients also complain of insomnia as a result of pruritus. Generally, physical examination is unremarkable except for scratch marks on the skin from pruritus. Pruritus is a cardinal symptom of intra-hepatic cholestasis of pregnancy (ICP) and may precede biochemical abnormalities. The diagnosis of intrahepatic cholestasis of pregnancy is via the presence of clinical symptoms pruritus in the third trimester with elevated maternal total serum bile acids and excluding other diagnoses, which can cause similar symptoms and lab abnormalities. Fasting blood samples should be used to check for the total bile salt acid level as it can become elevated in the postprandial state. Once the diagnosis of OC of pregnancy is confirmed, immediate treatment is necessary, and the primary goal of therapy is to decrease the risk of perinatal morbidity and mortality and to alleviate maternal symptoms. Maternal pruritus can be alleviated with use of moisturisers and oral antihistamines. Ursodeoxycholic acid (UDCA) is the drug of choice for the treatment of ICP. Many authors have advocated elective early delivery of women with intrahepatic cholestasis of pregnancy to reduce the risk of sudden foetal death. The Royal College of Obstetricians and Gynaecologists recommends induction of labour after 37+0 weeks of gestation. Obstetric cholestasis of pregnancy is not an indication for Caesarean delivery. Postpartum pruritus typically disappears in the first 2 to 3 days following delivery, and serum bile acid concentrations will normalize eventually. ICP is not a contraindication to breastfeeding, and mothers with a history of ICP in pregnancy can breastfeed their infants. Postpartum monitoring and follow up of bile acids and liver function tests should be done in 4-6 weeks to ensure resolution. Women with the persistent abnormality of liver function test after 6 to 8 weeks require investigation for other aetiologies.

Fetal complications due to intrahepatic cholestasis of pregnancy

2015 ◽  
Vol 43 (2) ◽  
Author(s):  
Patrik Šimják ◽  
Antonín Pařízek ◽  
Libor Vítek ◽  
Andrej Černý ◽  
Karolína Adamcová ◽  
...  
Keyword(s):  
Intrahepatic Cholestasis ◽  
Current Knowledge ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Liver Disorder ◽  
Intrauterine Fetal Death ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Management Options ◽  
Fetal Complications ◽  
Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. Diagnosis is based on the clinical picture, particularly the presence of pruritus with a deterioration of liver function tests, and typically elevated serum levels of total bile acids. ICP manifests in the second half of pregnancy, predominantly during the third trimester. Symptoms of the disease resolve spontaneously after delivery. Etiology is still not fully understood. Genetic defects in specific transport proteins, elevated levels of sex hormones, and various environmental factors are thought to play a role in the development of this disorder. Although practically benign for the pregnant woman, ICP represents a serious threat to the fetus. It increases the risk of preterm delivery, meconium excretion into the amniotic fluid, respiratory distress syndrome, and sudden intrauterine fetal death. Identifying fetuses at risk of ICP complications remains challenging. The ideal obstetrical management of ICP needs to be definitively determined. The aim of this review is to summarize the current knowledge on fetal complications of ICP and describe management options for their prevention.

scholarly journals Maternal and perinatal outcome in pregnancy complicated by obstetric cholestasis: study from a tertiary care centre in North India

2021 ◽  
Vol 10 (7) ◽  
pp. 2830
Author(s):  
Deepika Jamwal ◽  
Gurpreet Kour ◽  
Anil Mehta
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Liver Function Tests ◽  
Liver Disorder ◽  
North India ◽  
Tertiary Care Centre ◽  
Impaired Liver Function ◽  
Nicu Admission ◽  
Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (IHCP) is the most common pregnancy related liver disorder. It typically presents with troublesome itching and can lead to complications for both mother and foetus. Present study was carried out to study the incidence of Obstetric Cholestasis and its fetomaternal outcome in a tertiary care hospital.Methods: It was a prospective epidemiological study during a period of one year (May 2020 to April 2021) over 120 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as perinatal outcome recorded. Appropriate statistical analysis done as applicable.Results: The incidence of Obstetric Cholestasis in our hospital was 9.3%. Majority of cases delivered at term (78.3%). 41.6% patients delivered vaginally, 43.3% had emergency caesarean section, and 2.5% patients had instrumental delivery. Maternal morbidities are due to sleep disturbance (60%), coagulation abnormality (13.3%), increase chance of operative delivery (55.8%) and postpartum haemorrhage (12.5%). Neonatal complications include meconium aspiration (46.6%), NICU admission (36.6%), prematurity (5%) and perinatal mortality (3.3%).Conclusions: Cholestasis of pregnancy causes maternal pruritus with impaired liver function tests. Maternal morbidity is increased in terms of increased caesarean section rates and discomfort due to pruritus. A timely intervention at 37-38 weeks will reduce the adverse perinatal outcome. 

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