Outcome of Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

Background: In Bangladesh eclampsia and severe preeclampsia or toxemia (PET) are the leading cause of perinatal morbidity and mortality. Its management is challenging for the obstetrician and anesthesiologist. Still now general anesthesia is commonly practiced for emergency LUCS in developing countries, but the outcome of spinal anesthesia is better than GA. Recently in developed countries like the UK and United States, spinal anesthesia is also accepted as a safer anesthetic technique. Objective: The objective of our study was to establish spinal anesthesia as a preferable method to reduce maternal and neonatal morbidity and mortality during emergency LUCS in severe PET and eclampsia patients. Materials and Methods: The study was done in the Department of Anesthesiology and ICU of Enam Medical College & Hospital, Savar, Dhaka during the period from January 2016 to December 2017. Total 62 cases of severe PET and eclampsia patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Thiopental sodium 50−100 mg was given to those who had convulsion during SAB. About 2−2.5 mL (10−12.5 mg) 0.5% bupivacaine heavy was used by 25−27 G spinocaine in L3−4 or L4−5 space. After the establishment of the desired block, LUCS was performed. Meticulous monitoring was done and all events were recorded and problems were effectively managed. Results: Our study shows higher maternal (96.6%) and neonatal (95.17%) success rate. Almost all patients were eclamptic (74.19%), primi (59.67%), term pregnancy (64.51%), aged between 21–30 years (43.54%) and rest of them had preeclampsia (25.80%), multigravida (40.32%), preterm (35.48%), aged <20 years (25.80%) and aged >30 years (30. 64%). Thiopental sodium was given in 9.65% cases for controlling convulsion during LUCS. Remarkable complications were hypotension (33.87%) with highly significant p value (0.000) and bradycardia (27.41%). Conclusion: With close monitoring of perioperative events, spinal anesthesia may be given as a safe alternative technique in severe preeclampsia and eclapmsia rather than GA or epidural even in cases of altered consciousness or restless in presence of an expert and skilled anesthesiologist and thereby perioperative maternal and neonatal morbidity and mortality will be reduced. J Enam Med Col 2019; 9(3): 170-176

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Microbiological Profile of Neonatal Septicemia by Automated Blood Culture System (BacT/ALERT) at a Tertiary Care Hospital in Jamnagar, Gujarat, India

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34346 ◽

2021 ◽

pp. 17-22

Author(s):

J. Ghedia Bindiya ◽

Manish R. Shah

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Neonatal Morbidity ◽

Signs And Symptoms ◽

Morbidity And Mortality ◽

Automated System ◽

Care Hospital ◽

Coagulase Negative Staphylococci ◽

Neonatal Septicemia ◽

Gram Negative Organisms

Background: This study was carried out to do rapid diagnosis of neonatal septicemia to prevent septicemia related complications and neonatal morbidity and mortality. Materials and Methods: This study was carried out in a tertiary care hospital from a period of March 2014 to August 2015. This is a non-randomized, prospective study in which one hundred and nine cases of suspected neonatal septicemia on the basis of antenatal high risk factors and signs and symptoms of sepsis were studied. Blood samples were collected from neonates in whom septicemia was suspected usually before antibacterial agents were given and both positive and negative samples were detected by automated system BacT/ALERT. Results: Out of 109 samples tested, 69 samples were positive and 40 samples were negative. The incidence of neonatal septicemia due to Gram positive organisms (62.85%) was found to be high. Among them Coagulase negative staphylococci (CONS) (27) (38.57%) was most common organism followed by Staphylococcus aureus (11) (15.71%), Enterococcus spp. (7.14%) and Streptococcus spp. (1.43%). Rate of Gram negative organisms was quite low (32.85%). Out of them Acinetobacter spp. (17.14%) was most common followed by Klebsiella spp. (7.14%), E.coli (5.71%) and Pseudomonas spp. (2.86%). Conclusion: Early detection of infection in neonates and proper antibiotics for the treatment leads to reduced morbidity and mortality.

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Study of changes in non-stress test following antenatal corticosteroid therapy in preterm pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194870 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4435

Author(s):

Renuka S. ◽

Sathiya S. ◽

Famida A. M. ◽

Vijayalakshmi K. ◽

Sailatha R.

Keyword(s):

Tamil Nadu ◽

Stress Test ◽

Tertiary Care ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Major Public Health Problem ◽

Care Hospital ◽

Antenatal Corticosteroid ◽

Corticosteroid Administration

Background: Preterm birth is the largest unsolved problem in obstetrics and the single most significant cause of neonatal morbidity and mortality. Preterm labour constitutes 5-10% of pregnancies and is the leading cause of neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life, long term disability (cerebral palsy, blindness, deafness, chronic lung disease). The objectives of this study were to determine whether antenatal corticosteroid administration affects the non-stress test. To evaluate the effect of antenatal steroid on foetal movements. To assess the incidence of respiratory distress syndrome and neonatal mortality after antenatal corticosteroid administration.Methods: All antenatal cases between 28-32 weeks of gestation judged to be at risk for preterm delivery attending the outpatient department or admitted in a tertiary care hospital, Tamil Nadu during the study period of 3 years.Results: The present study was undertaken to evaluate the NST for a period of 3 days following antenatal corticosteroid administration and to study the immediate changes in the mother and the foetus. We found out that there was a statistically significant change (p <0.01) in non-stress test when compared with the pre-betamethasone assay.Conclusions: Corticosteroids can cause metabolic alterations in mother, short- and long-term effect in the foetus.

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Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity

American Journal of Perinatology Reports ◽

10.1055/s-0037-1599124 ◽

2017 ◽

Vol 07 (01) ◽

pp. e59-e63 ◽

Cited By ~ 1

Author(s):

Maureen Downing ◽

Suela Sulo ◽

Barbara Parilla

Keyword(s):

Intrauterine Growth Restriction ◽

Tertiary Care ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Morbidity And Mortality ◽

Care Hospital ◽

Intrauterine Growth ◽

Increased Risk ◽

Prenatal Management ◽

Baseline Characteristics

Objective To compare perinatal and neonatal outcomes of dichorionic (DC) and monochorionic (MC) with trichorionic (TC) triplet gestations. Methods A retrospective cohort study of DC + MC versus TC triplet gestations delivered at a tertiary care hospital from 2009 to 2015. The results include 42 sets of triplets (TC, n = 26; DC + MC, n = 16). Maternal demographics and pregnancy data were compared. Neonatal outcomes were assessed using composite morbidity and mortality. Results Maternal baseline characteristics including age, mode of conception, race, parity, body mass index, and previous preterm delivery were statistically comparable. Comparison of prenatal management and complications yielded no significant differences in terms of presence of shortened cervix, cerclage placement, use of tocolytics, intrauterine growth restriction, premature rupture of membranes, pregnancy-induced hypertension, or gestational diabetes. However, evaluation of composite morbidity and mortality (RDS, IVH, NEC, IUGR, and death) illustrated that all infants born from DC + MC triplet gestations suffered some morbidity or mortality compared with TC pregnancies (p < 0.01). Conclusion DC + MC triplet gestations are at an increased risk of neonatal morbidity and mortality compared with TC triplet gestations.

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Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192165 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2240

Author(s):

Pamulaparthi Bindu Reddy ◽

Gurram Swetha Reddy

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Tertiary Care Hospital ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Morbidity And Mortality ◽

Care Hospital ◽

Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os. Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

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Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽

10.1161/hyp.60.suppl_1.a147 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Naomi Shike ◽

Santosh Vardhana ◽

Judith Briant ◽

Robert Peck

Keyword(s):

Heart Failure ◽

Medical Center ◽

Tertiary Care ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Hospital Death ◽

Care Hospital ◽

Common Cause ◽

Related Disease ◽

Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

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Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

Current Women s Health Reviews ◽

10.2174/1573404817666210208210008 ◽

2021 ◽

Vol 17 ◽

Author(s):

Shuchi M. Jain ◽

Ketki. Thool ◽

Manish A. Jain ◽

Poonam V. Shivkumar

Keyword(s):

Caesarean Section ◽

Prospective Study ◽

Neonatal Outcome ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Central India ◽

Neonatal Morbidity ◽

Bladder Injury ◽

Care Hospital ◽

Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

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AEROBIC BACTERIOLOGICAL PROFILE WITH ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF PUS SAMPLES AT A TERTIARY CARE HOSPITAL IN JAIPUR

10.36106/ijsr/2304773 ◽

2021 ◽

pp. 65-67

Author(s):

Hemendra K Sharma ◽

Niketa Gupta ◽

Mahesh Yadav ◽

Aruna Vyas ◽

Rajni Sharma

Keyword(s):

Antimicrobial Susceptibility ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Diffusion Method ◽

Care Hospital ◽

Susceptibility Pattern ◽

Gram Positive ◽

Gram Negative ◽

Inappropriate Use ◽

Antimicrobial Susceptibility Pattern

Background: Pyogenic infections can be caused by various microorganisms and may co-exist as poly microbial infections which require antibiotic therapy. The inappropriate use of antibiotics has led to major problems of MDRO's contributing to morbidity and mortality. Even though the bacteriological prole of pus samples in many studies remain the same, antimicrobial susceptibility pattern of these isolates has shown a lot of variation. This study was conducted to assess bacteriological prole of pus samples and their antimicrobial susceptibility pattern Materials and Methods:Aretrospective study was carried out from April to June 2021. 540 pus culture aerobic bacterial isolates were included. The samples were cultured on Blood and MacConkey agar. After aerobic incubation at 37oC for 18-24 hrs, organisms were identied by conventional bacteriology methods as per laboratory protocol and antimicrobial susceptibility was tested by Kirby Bauer disc diffusion method as per CLSI 2020 guideline. Results: Out of 540 pus isolates , 452(83.7%)were gram negative bacili and 88(16.3%) were gram positive cocci Pseudomonas spp. 173(31.9%), was most common gram negative isolate while S.. aureus 66(12.19%) was most common Gram positive isolate. Most of gram negative isolates were susceptible to Imipenem and Polymyxin and gram positive isolates to vancomycin and linezolid . Conclusion: To combat resistance irrational use of antibiotics should be avoided. Also regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality

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Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

BIRDEM Medical Journal ◽

10.3329/birdem.v7i3.33779 ◽

2017 ◽

Vol 7 (3) ◽

pp. 194-197

Author(s):

Tasnima Ahmed ◽

Abdul Baki ◽

Tahmina Begum ◽

Nazmun Nahar

Keyword(s):

Clinical Features ◽

Intraventricular Hemorrhage ◽

Tertiary Care ◽

Clinical Signs ◽

Sudden Onset ◽

Morbidity And Mortality ◽

Preterm Neonates ◽

Cranial Ultrasound ◽

Care Hospital ◽

One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

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To Determine the Correlation between Anthropometric Variables of Obesity and Hypertension at NGMC: A Tertiary Care Hospital

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v14i2.21544 ◽

2018 ◽

Vol 14 (2) ◽

pp. 70-74

Author(s):

Bhawana Neupane Pant ◽

Manoj Pant ◽

Rajesh Kumar Goit ◽

Ashish Neupane ◽

Ganesh Prasad Neupane ◽

...

Keyword(s):

Blood Pressure ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Care Hospital ◽

Hip Circumference ◽

Specific Population ◽

Anthropometric Indices ◽

Arterial Blood ◽

Skin Fold ◽

Scientific Validation

Aim: Obesity is associated with the metabolic risk factors such as high blood pressure, body fat abnormality, and glucose intolerance which may influence the morbidity and mortality due to cardiovascular diseases. The present study is to determine the correlation of common anthropometric indices of obesity with blood pressure among population in mid-western region of Nepal. The result will provide us insight on relevant anthropometric indices for predicting hypertension based on linear correlation calculated from our data. Methods: We screened 500 healthy subjects to study the correlation between anthropometric indices and blood pressure.Result: Our result showed strong correlation between Sum of Skin fold, waist circumference, and waist hip ratio with blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial blood pressure). However some of the anthropometric indices like hip circumference and body mass index did not have significant correlation with blood pressure. Conclusion: Provided obesity related morbidity and mortality is burgeoning in our society it is imperative to identify right indicators of cardiovascular disease for specific population. Relevant anthropometric indices can serve as excellent indicators if used based of scientific validation. JNGMC, Vol. 14 No. 2 December 2016, Page:70-74

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Prospective study of midline abdominal incisional hernia repair by component separation technique augmented with prosthetic mesh

International Surgery Journal ◽

10.18203/2349-2902.isj20204121 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3273

Author(s):

Ravi Saroha ◽

Shivani B. Paruthy ◽

Sunil Singh

Keyword(s):

Abdominal Wall ◽

Tertiary Care ◽

Component Separation ◽

Separation Technique ◽

Close Monitoring ◽

Care Hospital ◽

Early Recovery ◽

Component Separation Technique ◽

Early Return ◽

Mesh Augmentation

Background: In our tertiary care hospital, we receive a large number of acute abdomen cases. Raised intra-abdominal pressure (IAP) makes laparostomy mandatory initially and abdominal wall approximation cannot be completed due to compromised state in most cases. Large incisional hernias were seen on complete healing and this study was done to see the feasibility of component separation technique (CST) with mesh augmentation.Methods: 30 patients were subjected to CST with mesh augmentation. Preoperative defect size mapping, Pre- and post-operative monitoring of IAP were done. Pain scoring by visual analogue scale (VAS), early and late complications was noted. Patients were followed up for 60 months.Results: CST with mesh augmentation was found to be feasible with 96.77% success rate as no recurrence was noted in follow up. Preoperative average Basal metabolic index was 26.09. Size of defect varied from 17-20×9-16 cm2 (length X width). Seroma seen in 50% of patients was managed without any intervention. Skin necrosis in 6.6% and wound dehiscence in 3.33%, managed with minimal debridement & local wound care respectively. Respiratory compromise and hematoma were not seen and no patient required any active ICU care. Average length of hospital stay was 5.22 days. Close monitoring of IAP in immediate post-operative period was found to be significant.Conclusion: Physical acceptance of stable abdominal wall gives a psychological boost to patients with early recovery in form of ambulation and early return to work.

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