Estimating the Mode of Delivery through Cause Analysis A Systematic Literature Review on the context of Reducing Cesarean

In developing countries, many health workers force pregnant women in private hospitals having baby through cesarean delivery, even though most pregnant mothers are skeptical about the risk of going under such operations. Doctors often encourage pregnant mothers to have a cesarean on the basis of their physical condition and medical reports. Emergency cesarean patient cannot be prepared in advance but on real time, If a system can be developed that can forecast whether a woman need natural or cesarean delivery, then rate of the risk of the pregnant women get reduce. To design such system, we need to know what factors influences the doctors to choose cesarean over normal delivery. We have conducted a systematic review in well-known databases to understand the various factors of pregnant mothers. A total of 19 studies were selected among 2512 studies based on the relevancy to the research objective. The objective of this study is to predict the mode of delivery based on 10 specific parameters identified separately from 180 parameters present in various test reports.

Congenital Granular Cell Tumour: Report of a case with review of literature and differential diagnosis.

Congenital Granular Cell Tumour (CGCT) is a rare benign lesion and presents in newborn as fibrous mass arising from the alveolus.The prenatal screening of lesion can help in parent counselling, determining the complications, as larger size lesion may interfere with normal delivery and require caesarean section.

COVID-19 among pregnant women: management outcome and risk of transmission to newborns in western India

Background: The WHO declared a global pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in March 2020. With so much female population in reproductive period in India the effect of corona virus in pregnancy warrants attention as the impact of maternal infection during pregnancy in India remains poorly understood. Objectives of current study were to know the management outcome and risk of transmission among COVI-19 positive pregnant women admitted in a tertiary care institute in western India.Materials: The present cross sectional study was conducted among 217 admitted COVID-19 positive pregnant women in a tertiary care institute in western India from May 2020 to April 2021. Data were collected from the department of obstetrics and gynaecology after taking permission from the head of department of obstetrics and gynaecology. Results: Most of patients were asymptomatic and managed conservatively but some also needed special interventions. Out of 217 patients 124 patients delivered in the hospital, 5 maternal deaths, one stillbirth and one congenital anomaly was reported. Only 25% of patients had normal delivery rest had caesarean and one neonate was found COVID-19 positive. Around one forth deliveries were pre term.Conclusions: The study suggests that most women do not have severe illness and that transmission of infection to infants of infected mothers is uncommon but there are increased chances of pre-term delivery. Majority of the women and neonates were managed and discharged without any major complications. But in some cases COVID in pregnancy may complicate the situation; so it should be handled by a multidisciplinary team of experts in COVID-19.

Therapeutic Effect of Cervical Cerclage on Cervical Insufficiency during Pregnancy Analyzed by Magnetic Resonance Image under Neural Network Algorithm

Objective. This research was developed to investigate the effect of magnetic resonance imaging (MRI) analysis based on neural network algorithm for cervical ligation in the treatment of cervical insufficiency. Methods. 44 patients who were suspected to be pregnant with cervical insufficiency and needed cervical ligation were selected. MR imaging analysis was performed before cervical ligation. MR images were analyzed based on the back propagation neural network (BPNN) algorithm, and patients were randomly divided into experimental group and control group. Preoperative MRI analysis was performed in the experimental group, while simple transvaginal ultrasonography was used to diagnose cervical insufficiency in the control group. Then, postoperative fetal preservation time, vaginal bleeding rate, and infection rate within one week after surgery were compared between the two groups. Results. Based on experience and experimental testing, the relevant parameters were set as follows. The number of particles n = 50, the inertia weight ω = 0.9, and c1 = c2 = 2. The weight range of the output layer of the neural network was [−1, 1], the target error e = 10−5, and the maximum number of iteration steps was 3,000. Compared with the control group, the experimental group’s postoperative bleeding rate and infection probability were substantially reduced, while the normal delivery rate was substantially increased ( P < 0.05 ). Conclusion. MR image analysis based on neural network algorithm played an important role in cervical cerclage surgery. The image map showed the local anatomy clearly, increasing the success rate of the operation and improving the prognosis of the patient.

To Assess Social Demographic Characteristics of Women with Pelvic Organ Prolapse

Introduction: One of the prevalent clinical conditions in daily gynecological treatment is pelvic organ prolapses (POP), particularly in parous women. The entity comprises vaginal wall descent and/or uterine descent. Pelvic organ prolapse is a common pelvic disorder among women. Objective: To determine the social demographic characteristics and types of pelvic organ prolapse and to find out the association between social demographical characteristics with pelvic organ prolapse. Methods: The descriptive survey was used and the sampling technique was non probability convenient sampling technique and the sample size was 60. Results: Twenty six (43.3%) women were belongs to in the age group of 33-40 years. 54 (90%) of women were married.29 (48.3% ) of women never had abortion. 26 (43.3%) of women had normal delivery whereas 17(28.3) had instrumental delivery .19 (31.3%) of women had perineal tear, 20 (33.30%) of women had cervical tear in previous pregnancy . 21(35% ) of women had cystocele whereas 20(33.3) has rectocele . There is significance association between the of age of women, marital status, occupation, Place of previous delivery, type of previous delivery, complications during previous labour except the parity with pelvic organ prolapse. Conclusion: Pelvic organ prolapse is common gynecological condition .The patients are relatively middle age group. Parity, Occupation, Injuries to birth canal was may be contributory to severity of pelvic organ prolapse.

MENUJU KEHAMILAN YANG SEHAT DENGAN BEBAS ANEMIA DI ERA PANDEMI COVID-19

ABSTRAKMasa pandemi Covid-19 di Indonesia sangat berdampak di berbagai sektor layanan publik, terutama sektor layanan kesehatan khususnya pemanfaatan layanan Antenatal Care (ANC). Pemerintah merekomendasikan menunda pemeriksaan kehamilan ke tenaga kesehatan kecuali ibu mengalami tanda – tanda bahaya kehamilan. Terkait dengan kondisi ibu hamil tetap harus mendapatkan informasi yang adekuat dan terpantau kesehatannya maka diperlukan kelas ibu hamil guna meningkatkan pengetahuan tentang kehamilan, persalinan, nifas dan parenting. Pengabdian kepada masyarakat bertujuan untuk memberdayakan kelompok ibu hamil dalam meningkatkan pengetahuan dan merubah sikap dan perilaku ibu hamil agar memahami tentang kehamilan yang sehat tanpa anemia agar dapat mencegah komplikasi secara dini selama masa kehamilan dan dapat mempersiapkan persalinan normal, mengikuti protokol kesehatan secara optimal. Metode yang diberikan melalui edukasi interaktif, dengan pendekatan secara langsung, curah pendapat, ceramah, tanya jawab tentang pencegahan anemia pada kehamilan, diikuti 19 ibu hamil dibagi 2 kelompok di Puskesmas kecamatan Tanah Abang. Hasilnya menunjukkan bahwa terjadi peningkatan rata-rata skor pengetahuan sebesar dari 70,53±26,34 SD menjadi 88,94±14,48 SD. Kata kunci: anemia; ibu hamil; kelas ibu hamil. ABSTRACTThe Covid-19 pandemic in Indonesia has greatly impacted various public service sectors, especially the health service sector, especially the use of Antenatal Care (ANC). The government recommends postponing Antenatal Care to health workers unless the mother experiences danger signs of pregnancy. Regarding the condition of pregnant women, they still have to get adequate information and their health is monitored, so a class for pregnant women is needed to increase knowledge about pregnancy, childbirth, postpartum and parenting. Community service aims to empower groups of pregnant women in increasing knowledge and changing attitudes and behavior of pregnant women in order to understand about a healthy pregnancy without of anemia in order to prevent complications early during pregnancy and be able to prepare for normal delivery, following health protocols optimally. The method provided was through interactive education, with a direct approach, brainstorming, lectures, questions and answers about preventing anemia in pregnancy, followed by 19 pregnant women divided into 2 groups at the Tanah Abang sub-district health center. The results showed that there was an increase in the average knowledge score from 70.53±26.34 SD to 88.94±14.48 SD. Keywords: anemia; pregnant women; class of pregnant women.

Hubungan Paritas dengan Kejadian Rupture Perineum pada Persalinan Normal

Introduction: Even though labor was going normally, after giving birth the mother had various risks of complications that might occur, such as bleeding due to uterine atony, retained placenta, and perineal ruptur. Objective: to see the relationship between parity and the incidence of perineal ruptur in normal delivery. Methods: this type of research uses an analytical method based on a cross sectional design. The population is all mothers who give birth at the Kassi Kassi Health Center Makassar City can use 30 people. The sampling technique used was Consecutive Sampling. Results: The results showed 76.7% of respondents experienced perineal tears, of which 26.7% of respondents experienced 1st degree perineal tears and 50.0% of respondents had grade 2 perineal tears. 23.3% of respondents did not experience perineal tears. From the results of the chi-square test with a value of p=0.05, the probability of the result is greater than a significant tarf of 5% (0.071> 0.05), meaning that there is no parity relationship with perineal tears in mothers with normal delivery at the Kassi-Kassi Community Health Center, Makassar City. 2020. The strength of the relationship between variables is rather low, the value of the Phi coefficient (μ) = 0.488 or 48.8%. Conclusion: Based on the results of the research that has been done, it can be denied that there is no relationship between parity and perineal tearing in normal delivery.

Effect of the use of dexmedetomidine as a local anesthetic adjuvant to bupivacaine 0.125% in epidural labor analgesia: randomized controlled study

Background Multiple methods exist for the management of pain during normal labor. Epidural analgesia has been reported to be an effective method in that perspective. The current study was conducted to evaluate the efficacy of dexmedetomidine as an adjuvant to local anesthetics in epidural analgesia for pregnant females presented for normal delivery. Sixty pregnant females were included in this prospective randomized study, and they were divided into two equal groups: control group which received bupivacaine alone and dexmedetomidine group that received bupivacaine with dexmedetomidine. The primary outcome was the onset of analgesia, while the secondary outcomes included the duration of analgesia, hemodynamic changes, labor progress, neonatal outcomes, and maternal complications. Results Dexmedetomidine group was associated with earlier onset of analgesia (P ˂ 0.001), prolonged duration (P ˂ 0.001), and lower need for top-up doses (P ˂ 0.001) compared to control group. Also, sedation and maternal satisfaction were significantly better in the same group (P = 0.001, 0.025; respectively). Labor progress parameters and neonatal outcomes were comparable between the two groups. Dexmedetomidine group has lower heart rate and mean arterial blood pressure compared to the control group. Despite of dexmedetomidine group had higher incidence of hypotension and bradycardia, it was statistically insignificant when compared to control group. Conclusions Dexmedetomidine is a reliable and an effective adjuvant to the local anesthetics in epidural analgesia during normal delivery as it resulted in earlier onset and significant prolongation of the analgesic time with decrease in the top-up doses intake. Trial registration Pan African Clinical Trial Registry (PACTR201710002664704). Register on 3 October 2017.

Economic consequences of caesarean section delivery: evidence from a household survey in Tanzania

Background Caesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care. Yet, there is limited understanding of the costs of utilising C-section delivery care in sub-Saharan Africa. Thus, we estimated the direct and indirect patient cost of accessing C-section in Tanzania. Methods Cross-sectional survey data of 2012 was used, which covered 3000 households from 11 districts in three regions. We interviewed women who had given births in the last 12 months before the survey to capture their experience of care. We used a regression model to estimate the effect of C-section on costs, while the degree of inequality on C-section coverage was assessed with a concentration index. Results C-section increased the likelihood of paying for health care by 16% compared to normal delivery. The additional cost of C-section compared to normal delivery was 20 USD, but reduced to about 11 USD when restricted to public facilities. Women with C-section delivery spent an extra 2 days at the health facility compared to normal delivery, but this was reduced slightly to 1.9 days in public facilities. The distribution of C-section coverage was significantly in favour of wealthier than poorest women (CI = 0.2052, p < 0.01), and this pro-rich pattern was consistent in rural districts but with unclear pattern in urban districts. Conclusions C-section is a life-saving intervention but is associated with significant economic burden especially among the poor families. More health resources are needed for provision of free maternal care, reduce inequality in access and improve birth outcomes in Tanzania.

Study of mode of delivery and fetal outcome in pregnancies with oligohydramnios

Background: The significance of amniotic fluid volume as a marker of fetal status is an ongoing turn of events. Oligohydramnios causes adverse fetal outcomes like meconium-stained liquor, meconium aspiration syndrome, fetal heart rate abnormalities, poor APGAR scores, fetal growth restriction and fetal prematurity. It is associated with maternal hypertension, infections, and placental insufficiency. It causes maternal complication because of increased incidence of induction of labour and operative intervention.Methods: Hundred cases of oligohydramnios were included in our study conducted at the Navodaya medical research, hospital and research centre, during a period of two years after obtaining the informed consent of patients and institutional ethical clearance. All gravidas were included with a gestational age greater than 28 weeks with singleton pregnancies with oligohydramnios. Associated fetal and maternal risk factors were observed. The amniotic fluid index (AFI) was measured by ultrasound. The nonstress test, the fetal biophysical profile and the Doppler study were carried out to evaluate the fetal condition. Then we have observed for delivery and fetal outcome.Results: Incidence of oligohydramnios was 2.85% in our study. The 53% of cases had LSCS while 47% had normal delivery. Fetal distress was the commonest indication for LSCS. Poor neonatal APGAR score was 16.9% in LSCS while 36% in vaginal delivery.Conclusions: From the above study, the caesarean delivery seems to be a safer mode of delivery than vaginal delivery because it is associated with a good perinatal outcome.