scholarly journals Comparative Study on Fetomaternal Outcome after Lower Uterine Segment Caesarean Section and Vaginal Delivery in Eclamptic Patient

2020 ◽  
Vol 15 (1) ◽  
pp. 16-20
Author(s):  
Monika Khandoker ◽  
Swapna Biswas Joy ◽  
Sanjoy Kumar Das ◽  
Ananta Kumar Biswas

Eclampsia has a high prevalence in our country with a high mortality rate. Eclampsia is uniquely a disease of pregnancy and regardless of gestational age. It is recognized that termination of pregnancy is the only definitive care of pathophysiological event in eclampsia. This study was done to observe fetomaternal outcome in Lower Uterine Segment Caesarean Section (LUCS) and vaginal delivery in eclamptic patient. This cross sectional analytical study was carried out in eclampsia department of Obst and Gyane in Dhaka Medical College Hospital from July 2016 to June 2018. A uniform protocol was followed in all cases to have appropriate history, physical findings and laboratory investigations. In this study 98.0% patients were conscious on admission in group I and 96.0% in group II. This study showed significant difference in recurrence of convulsion after delivery between two groups. Recurrence of convulsion was 30% in vaginal delivery group and 6% in the cesarean section group. Total complications were found in 46.0% and 16.0% patients in group I and group II respectively in this study. The difference was statistically significant (p<0.05) between two groups. In this study PPH was the most common complication in both the groups. Abruptio placenta was found more common among the vaginal delivery group. On the other hand, electrolyte imbalance was found more in cesarean section group. Maternal death was only 2% and 1% in group I and group II respectively. In this study live birth was found 64.0% and 79% in group I and group II respectively. Asphyxia was more in neonates in group I than group II which was statistically significant. Referral of asphyxiated babies to NICU was found 63.0% and 56.0% in group I and II respectively. The difference was statistically not significant between two groups. Faridpur Med. Coll. J. Jan 2020;15(1): 16-20

2010 ◽  
Vol 138 (1-2) ◽  
pp. 50-55 ◽  
Author(s):  
Biljana Pejovic ◽  
Milica Rankovic-Janevski ◽  
Niveska Bozinovic-Prekajski

Introduction. Drug safety depends on trough levels. Objective. Objective of the study was to measure gentamicin and amikacin trough levels in neonates and to identify risk groups by gestational and postnatal age. Methods. Gentamicin and amikacin were applied according to the clinical practice guidelines. Trough levels (mg/l) were deter- mined using fluorescence polarization immunoassay methodology. Target trough levels were <2 mg/l for gentamicin, and <10 mg/l for amikacin. Patients were divided in 3 groups by gestational age: I ?32, II 33-36, and III ?37 gestational weeks and, by postnatal age, in 2 groups: ?7 and >7 days. Results. Out of 163 neonates, 111 were receiving gentamicin and 52 amikacin. Mean amikacin trough level was 7.8?4.8 mg/l and, in group I 10.5?4.9 mg/l, which was above the target range and significantly higher than in group II (LSD, p<0.05). In the amikacin group, 26 patients were 7 and less, and 26 more than 7 days old, without significant differences in trough levels between the groups. In the gentamicin group, 52.3% of neonates had trough values within the target range. Gentamicin trough level in group I was above the trough range, 3.7?1.8, 2.3?1.5 in group II and, 1.8?1.4 mg/l in group III. The difference in trough levels among the groups was highly significant (F=9.015, p<0.001, ?2=17. 576, p<0.001). Further analysis revealed that differences between groups I and II (LSD, p=0.002) and between I and III (LSD, p=0.000) were highly significant. Conclusion. Obtained gentamicin and amikacin trough levels are high. Inverse correlation has been confirmed between trough level and gestational age, with highly significant difference, and the risk group has been identified. There is obviously a need to change the dosing regimen in terms of those with extended intervals, particularly for neonates of the lowest gestational age, along with pharmacokinetic measurements.


2020 ◽  
Vol 5 (1) ◽  
pp. 153-155
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P< 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P> 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P> 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.


2019 ◽  
Vol 7 (1) ◽  
pp. 40-43
Author(s):  
Nazlima Nargis ◽  
Md Iqbal Karim ◽  
Salma Loverine

Background: Uterine myomas are the most common benign tumour of female reproductive tract and the prevalence of myomas in pregnancy has been reported to be 2%to 5% . Myomectomy during cesarean section has traditionally been discouraged due to risk of intractable haemorrhage and fear of hysterectomy. But recently large scaled studies indicated that cesarean myomectomy could be safely performed in majority of cases without any serious or life threatening complications. Materials and Methods: This prospective study was done at Ibn Sina Medical College Hospital, Dhaka, Bangladesh between January 2016 and December 2016. Fifty patients were recruited into the study, 25 patients had undergone myomectomy during cesarean section and 25 patients had undergone only cesarean section. Results: Average value of haemoglobin both pre and post-operatively was 12.31±1.22 g/dl and 10.64±1.51 g/dl for patients who had cesarean section with myomectomy and 11.61±1.3 g/dl and 10.3±1.7 g/dl in the other group in which cesarean section without myomectomy was performed. The difference in average haemoglobin for patients who had a cesarean section and myomectomy was 1.41 while those who had caesarean section alone was 1.32±1.12. This was not significant. The average duration of operation was longer in patient who had cesarean section and myomectomy (54.32±18.06 mins) than those who had caesarean section alone (38.54±8.42mins). The incidence of hemorrhage was5.45±1.23% and 5.23±1.03% respectively and the mean length of postoperative hospitalization was2.42±1.45and 2.17±0.70 days and no hysterectomy was needed in any group. Blood transfusion was given in 6 patients with 3 patients in each group. Sixty eight percent of the fibroids were subserous and in the body of the uterus. Conclusion: Cesarean myomectomy is a safe and effective procedure and does not increase the incidence of intraoperative and postoperative complications. Bangladesh Crit Care J March 2019; 7(1): 40-43


2013 ◽  
Vol 3 (2) ◽  
pp. 77-83
Author(s):  
Sheuly Begum ◽  
Ferdousi Islam ◽  
Arifa Akter Jahan

Background: Over  half-a-million women die each year  from pregnancy-related  causes, and  99 percent of these occur in developing countries. In Bangladesh though maternal mortality  rate (MMR) declined  significantly  around 40% in  the  past  decade,  still  eclampsia  accounts  for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure  is  delivery  regardless  of  gestational  age.  A  rational  therapy  for  general  management  of  hypertension and convulsion has been established in Bangladesh by the Eclampsia Working  Group.  But  controversy  still  exists  regarding  obstetric  management. Objective: To  evaluate  the  feto-maternal  outcome  in  cesarean  section  compared  to  vaginal  delivery  in  eclamptic  patients. Materials  and  Methods: This  prospective  cohort  study  was  conducted  in  the  department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from  January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus  were purposively included in the study (Group I, 50 patients with vaginal delivery and Group  II, 50 with cesarean section). Results: Out  of these 100 patients 56% were aged <20 years,  71%  were  primigravida  and  77%  were  from  low  socioeconomic  status.  Sixteen  percent  patients from vaginal delivery group and 18% from cesarean section group had no antenatal  care. The mean gestational age was about 38 weeks in two groups. No significant difference  was found between the two groups regarding blood pressure, proteinuria, consciousness level  and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group  compared  to  6%  in  cesarean  section  group.  Maternal  complications  such  as  postpartum  hemorrhage,  cerebrovascular  accident,  renal  failure,  obstetric  shock  and  abruptio  placenta  were  higher  among  vaginal  delivery  group  patients  (46%)  than  cesarean  section  patients  (16%).  Maternal  mortality  was 6% in  the  vaginal  delivery  group  and  none  in  the  cesarean  section  group.  Regarding  fetal  outcome,  stillbirth  was  20%  after  vaginal  delivery  and  6%  after cesarean section,  the result was statistically  significant.  Birth asphyxia was less  in  the  cesarean  section  group  (23.4%)  than  in  vaginal  delivery  group  (60%)  and  this  was  statistically  significant. Conclusions:  The  result  of  the  present  study  shows  a  better  feto- maternal outcome in the cesarean section group than in the vaginal delivery group. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128


2020 ◽  
Vol 28 (4) ◽  
pp. 341-344
Author(s):  
Muhammad Adnan ◽  
Babar Ali ◽  
Muhammad Mohsin Sajjad ◽  
Ali Rahman ◽  
Omair Rafiq Qurashi ◽  
...  

ABSTRACT: Objectives: To compare the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Current (IF) in patients with nonspecific chronic low back pain. Material and Methods: This quasi experimental study was performed in Khyber Teaching Hospital and Khyber Medical University Peshawar from August 2015 to January 2016. All patients were assessed before and after TENS and IF therapy using Visual Analogue Scale 0-10 (VAS) and Oswestry Disability Index (ODI). Thirty patients were divided into two groups. TENS (group I) & IF (group II). In group I, patients received 10 minutes session with heat therapy (hot pack) and 20 minutes session with TENS. In group II, the patients received 10 minutes session with heat therapy (hot pack) and 20 minutes session with IF current. Results: Mean age of participants was 34.85±4.80 and 33.50±5.20 years in group I and group II. The mean of pain before treatment in group I was 6.47±.29 and that of group II was 5.60±.33 in which the minimum pain on VAS was 4 and maximum pain was 8. A pair T test was done to identify the difference between pre and post treatment score on VAS in the intervention. The p values shows .000 which is less than .05 indicate that there is significant difference present between pre and post treatment pain on VAS.  The pair T test for disability percentage on ODI was done to identify the difference between pre and post treatment  in the interventions. The p value was less than .05 which shows that there is significant difference and reduction of disability percentage on ODI. Conclusion:  The study concluded that both the treatment methods TENS and IF are effective in decreasing pain intensity and disability in low back pain patients.


Author(s):  
Taneem Mohammad ◽  
Moinul Hossain Chowdhury ◽  
Shamima Akter ◽  
Mohammad Abdul Karim Miah ◽  
Mohammad Mohsin ◽  
...  

Background: Volume loading by rapid infusion of crystalloid solution before/during induction of spinal anaesthesia may effectively reduce the incidence of anaesthesia induced hypotension.Objective:To compare the efficacy of crystalloid pre-loading and co-loading to preventhypotension and related adverse effects as well aspoor neonatal outcome in caesarean section delivery under spinal anaesthesia.Methods:This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, between January 2013 and December 2014. A total of 90 patients were selected –45patients of group I received co-loading with Ringer’s lactatesolution, while another 45 patients of group II received a pre-loading of the same fluid.Blood pressure and heart rate were recorded. Ephedrine and adrenaline were administered as needed to treat hypotension.APGAR scores of the newborn were recorded at 1st minute and 5th minute after delivery. Adverse effects like nausea, vomiting, light headedness and shivering was observed all through during operation and post-operative phase in all patients, if any, and recorded.Results:The incidence of hypotension was 17 (37.8%) in group I (co-loading) and 27 (60%) in group II (pre-loading), which was significantly higher in group II (p<0.05).Adverse effects – nausea, vomiting, light headedness and shivering was observed more in group II patients; however, the difference was not statistically significant. In neonates, APGAR score at 1 minute was found ≤7 in 18 (40.0%) from group I, while 28 (62.2%) from group II; the difference was statistically significant (p<0.05). No significant difference was observed in APGAR score at 5 minutes, as found ≤7 in 6 (13.3%) and 3 (6.7%) in group I andgroup II respectively.Conclusion:Severity of hypotension, increased ephedrine requirement and poor APGAR score wereevident in patients who received crystalloid pre-loading group(group II), which meanscrystalloid co-loading group(group I) procedurewas more effective in preventing spinal anaesthesia induced hypotension and secured better neonatal outcome.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 90-95


2021 ◽  
Vol 61 ◽  
pp. 186-191
Author(s):  
І. F. Chernev

Purpose of research: In the process of growth and development of pigs, to study the hematological and biochemical parameters of the blood of young pigs obtained by combining two breed sows with purebred and hybrid boars. Material and research methods. The studies were carried out at the State Agrarian University of Moldova and at the pork production enterprise "SC Agroseminvest SRL". To achieve the goal, the research material was two breed sows large white x Landrace (maternal form) and purebred and hybrid boars: I-pietrain; II-large white x landrace x pietrain; III-(large white x landrace x pietrain) x pietrain; IV-duroc; V-pietrain x duroc, (paternal form). In order to determine the influence of hybrid boars on the growth and development of the offspring, five experimental groups were formed according to the principle of analogs of 6 sows and 30 heads of young animals (15 pigs and 15 castrates). Research results .The data obtained indicate an insignificant increase in the hemoglobin content in group I in comparison with group V animals with a moderate significance of the difference, which was 4 g/l (B ≥ 0.95). Consequently, in groups where meat breeds Pietrain and Duroc were used in various combinations, the hemoglobin content was higher. The best results in terms of the content of erythrocytes were obtained in groups III and V, respectively 7.61 x 1012 и and 7.59 x 1012, and a significant difference was established between groups III and IV (B ≥ 0.99), while in the second group the content of erythrocytes was 0.39 lower than in group III (7.22 x 10¹²). Reliable data on the ALT content were obtained between young pigs of groups I and V (B ≥ 0.95). Some tendencies towards a higher content of AST in the second group have been established. The blood glucose level in hybrid young animals in different combination combinations ranged from 5.68 mmol/l (group I) to 6.19 (group II), and the calcium level from 2.55 mmol/l (group III) to 2.81 mmol/l (group II) with a moderate tendency to increase these indicators in group II. Conclusions: A higher hemoglobin content was found in the I group of animals in comparison with the V group with a moderate significance of the difference, which was 4 g/l (B ≥ 0.95). A significant difference was established between groups III and IV (B ≥ 0.99). A higher content of protein in the blood is found in groups I–II, and is more than 89 g/l. In hybrid young animals, the glucose level in different combination combinations ranged from 5.68 mmol/l (group I) to 6.19 (group II), and the calcium level from 2.55 mmol/l (group III) to 2.81 mmol/l (Group II) with a moderate tendency to an increase in these indicators in group II.


2020 ◽  
Vol 5 (1) ◽  
pp. 100-102
Author(s):  
Rangit Priyakar Pandey ◽  
Richa Chandra

Background: The present study was conducted to evaluate and compare dexamethasone and tramadol as adjuvant to levobupivacaine in supraclavicular block. Subjects and Methods: The present study was conducted on 50 patients of American Society of Anesthesiologists (ASA) grade I and II. Patients were divided in to two groups of 25 each. In group I, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml tramadol (100 mg) was used. In group II, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml dexamethasone (8 mg) was used. Visual Analogue Scale was used. The onset of sensory and motor block was evaluated.Results: The mean onset of sensory block in group I was 5.41 minutes and in group II was 3.86 minutes, motor onset was 9.12 minutes in group I and 7.25 minutes in group II, duration of sensory block in group I was 12.14 hours and in group II was 15.34 hours, duration of motor block in group I was 14.34 hours and I group II was 16.23 hours, duration of analgesia in group I was 16.1 hour and in group II was 18.4 hours. The difference was significant difference (P<0.05). The mean VAS score in group II was better as compared to group I (P <0.05). Conclusion:Authors found that dexamethasone is a better adjuvant than tramadol when added to levobupivacaine in supraclavicular brachial plexus block.


2008 ◽  
Vol 65 (8) ◽  
pp. 619-625
Author(s):  
Slobodan Radulovic ◽  
Aleksandar Vuksanovic ◽  
Dragica Milenkovic-Petronic ◽  
Bozo Vavic

Introduction/Aim. Localization of ureteric stones and the difference in disintegration success are the most important but not the only factors in choosing the first treatment approach to ureteric stones. The aim of the study was to investigate the incidence of auxiliary procedures after different ureteric stones lithotripsy modalities. Methods. In a prospective bicentric study 260 patients with ureteric stones were analyzed. The patients were divided into two groups: group I - 120 patients subjected to extracorporeal shock ware lithotripsy (ESWL) treatment and group II - 140 patients treated endoscopicly with ballistic lithotripsy using "Swiss" Lithoclast. Results. Endoscopic treatment of all distal ureteric stones was significantly more successful than ESWL, but not significantly more successful than ESWL regarding proximal ureteric stones except for stones larger than 100 mm2 that were significantly better treated with endoscopic method. There was no general significant difference in auxiliary procedures rate after lithotripsy between the two groups. In the group I auxiliary procedures were significantly more performed than in the group II after the lithotripsy of stones larger than 100 mm2, calcium-oxalat-monohydrate stones and highly significantly more performed after the treatment of stones located in the iliac ureteric portion and impacted stones. After the lithotripsy of lumbar ureteric stones and multiple stones situated in different ureteric portions additional procedures were highly significantly more necessary in the goup II than in the group I. Conclusion. Being significantly more successful comparing to ESWL, ureteric stone treatment with "Swiss" Lithoclast should be considered the first therapeutic option for all, especially impacted stones located in iliac and pelvic ureter. In spite of a statistically significant difference in success rate, ESWL should be performed as the first treatment option in all cases of lumbar stones as well as multiple stones located in different ureteric portion because of lower auxiliary procedures rate except for stones larger than 100 mm2 that should be primarily treated endoscopicly. .


2020 ◽  
Vol 33 (2) ◽  
pp. 131-139
Author(s):  
Jaglul Haider Khan ◽  
Saifur Rahman ◽  
Chowdhury Taslima Nasreen ◽  
Jahangir Alam ◽  
Pervin Fatema

Background: Endometriosis is a common gynaecological disorder which is found in about5% of women and in 30% of infertile women. Identification of risk factors and timely interventionis useful. Methods: A case control study was conducted in the Dept. of obs & gynae of BangabandhuSheikh Mujib Medical University, Shahbag, Dhaka, from October 2015 to March 2016 on50 infertile patients attending the Infertility unit of the institute with the objective to determinethe risk factors of endometriosis. Twenty five women with endometriosis was taken ascases (group-I) and twenty five women without endometriosis was taken as controls(group-II). Result: The mean age was 32.8±5.4 years in group I and 35.1±5.7 years in group II which issimilar. Urban residents were 3.21 times (with 95% CI 0.87-12.71%) more likely to developendometriosis than rural resident which was statistically significant (p<0.05).Among the study population BMI of 72% patients in group I and 68% in group II were within19-24 kg/m2. The difference was not statistically significant (p>0.05) . There was notstatistically significant difference (p>0.05) between two groups in OCP use (84%vs80%).Women with endometriosis had less physical activity than the women without endometriosis;the differences was statistically significant (p<0.05). Consumption of caffeine, red meat,vegetables and fruits has no effect on endometriosis. Women with pain during menstruationwere 29.33 times (with 95% CI 5.17-100%) and women with heavy amount of blood flow were5.09 times (with 95% CI 1.24-22.06%) more likely to be endometriosis, which was statisticallysignificant (p<0.05) . Other risk factors like- age, occupation, educational status, age atmenarche and cycle length were not significantly (p>0.05) associated with endometriosis. Conclusion: Urban residence and all types of physical activities d”1 hour per day weresignificantly higher in infertile women with endometriosis. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 131-139


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