MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% delivered vaginally. 23.53% patients had postpartum haemorrhage whereas only 2.98% had undergone Postpartum Hysterectomy. The most common fetal complication in Abruptio Placenta was prematurity (35.71%). 5.89% patients of Abruptio Placentas died during Peripartum period. Perinatal mortality was high 48.58%. Conclusions: Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcomes.

PERCEPTIONS OF TRAINEES ABOUT USE OF SIMULATION IN GYNAECOLOGY AND OBSTETRICS

Objective: To explore the perception of Obstetrics and Gynaecology (OB/GYN) postgraduates about the use of simulation in improving their clinical skills. Study Design: Explanatory sequential mixed method design. Place and Duration of Study: Obstetrics and Gynaecology department of Sharif Medical and Dental City (SMDC) Lahore Pakistan, from Jun to Oct 2019. Methodology: By using a homogenous purposive sampling technique eight postgraduate residents from Obstetrics and Gynaecology department were recruited. The study had two phases: In the first phase, quantitative data was collected and analyzed while in the second phase qualitative data were collected by following the quantitative phase and then analyzed. This framework was tracked through the procedure of instrumental delivery with vacuum application in a real-life situation. A survey was conducted before and after the simulation training by using a researcher-developed Likert scale questionnaire. After that in-depth qualitative interviews were conducted. The improvement in clinical performance was evaluated by pairedsample t-test and thematic analysis. Results: Significant performance improvement (p<0.001) after simulation training was reported. The thematic analysis revealed a lack of proficiency in clinical experience before simulation at behavioural and technical levels while enhancement in clinical experience after simulation at both levels. The perceived benefits of simulation with the major trends of simulation as time-friendly, as a source of deliberate practice, and as safe practice in the unthreatened environment were explored. The theme of suggestions was also explored. Conclusion: The participants showed improvement in their clinical skills by describing the optimized benefits of simulation. Few of them are.......

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.

A Study on the Prescription Pattern of Antimicrobial Agents Used in the Treatment of Infectious Disease

Antibiotics are anti-infective agents produced from natural sources, whereas antimicrobial agents are generated through chemical synthesis. It was a prospective and observational study and was conducted in the medicine, OBG, and urology departments in Sagar Hospitals. The study was conducted over a period of 18 to 20 months. Among 542 participants, 325 (60%) were males, while 217 (40%) were females. The frequency of patients surviving different hospital departments was 416 (76.6%), and they survived the medicine department. Moreover, the urology department had 80 (14.8%) patient visits, while in the obstetrics and gynaecology departments, only 46 (8.5%) patients visited. It was found that the percentage and order of various micro-organisms isolated as Neisseria meningitides 20 (3.7%) and a lesser number of organisms were found in K. Pneumonia 01 (0.2%), respectively. The cephalosporin class of drugs is commonly prescribed in empirical and prophylactic therapy because they are more effective in infectious diseases Furthermore, 36 patients out of 542 had drug interactions; quinoline derivatives, such as Ciprofloxacin, typically have a higher number of drug interactions. Among 542 patients, 38 had severe drug reactions in that most of the reactions were dermatological reactions caused by cephalosporin drugs. Most of our physicians prescribed based on patient characteristics and behaviors, and the recovery rate was also good. In our study, we observed common outcomes of DIs, such as increased theophylline toxicity and digoxin toxicity, increased laboratory values, and also reduced some drugs' effectiveness. Correlations of drug and disease characteristics were found more in ciprofloxacin drugs.

Exploring healthcare providers’ perceptions of mental health amid COVID-19 pandemic in obstetrics and gynaecology department of a tertiary care public sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol

IntroductionIn the wake of the unprecedented public health challenge of the COVID-19 pandemic, it is highly significant to recognise the mental health impact of this mounting threat on healthcare providers (HCPs) working in the obstetrics and gynaecology department. Experience from epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that HCPs are dealing with is linked with the increased burden of mental health conditions. We aim to conduct an exploratory qualitative descriptive study to assess HCPs’ perceptions of mental health amid the COVID-19 pandemic in the obstetrics and gynaecology department of a public sector tertiary care hospital of Karachi, Pakistan.Methods and analysisThis study will use a qualitative descriptive approach where approximately 20–25 HCPs from the obstetrics and gynaecology department will be recruited using a purposive sampling approach. Data will be collected through semistructured interviews and it will be analysed thematically using NVivo V.12 Plus software.Ethics and disseminationEthical approval for this study has been obtained from the Institutional Review Board Committee of Jinnah Postgraduate Medical Center hospital. The study results will be disseminated to the scientific community and the HCPs participating in the study. The findings will help us to explore the doctor’s perceptions of mental health during the current pandemic of COVID-19 and its impact on their daily lives and mental well-being.

Peluang Pelaksanaan dan Tantangan Pengembangan Hospital without Walls pada Pelayanan Kebidanan dan Kandungan di RSUD Noongan

Hospitals as the health referral facilities play an important role in decreasing the maternal mortality rate (MMR) since they also belong to the personal health service as a whole including mother child health care. This study was aimed to analyze the implementation opportunities and challenges of developing ‘hospital without walls’ program in obstetrics and gynaecology services at RSUD (Rumah Sakit Umum Daerah) Noongan. This was a qualitative study. Informants in this study were taken from three places, as follows: the hospital, namely the Director of the Hospital and obstetrician-gynaecologist doctors; puskesmas (primary health center), namely the heads of puskesmas; and the community. Data were collected through in-depth interviews and direct observation. The results indicated that ‘hospital without walls’ in obstetrics and gynaecology services at RSUD Noongan had the opportunity to be implemented because this program had been partly applied by the hospital and it had a good impact on the hospital, health center, and the community as well as PONED-PONEK collaboration. The challenges of imple-menting this program at RSUD Noongan were the existence of cold cases caused by gatekeeper failure, lack of health facilities and human resources at the puskesmas, and insubstantial collaboration between PONED-PONEK. In conclusion, ‘hospital without walls’ program in obste-trics and gynaecology services can be implemented at RSUD Noongan with awareness to the possible challenges in its development.Keywords: opportunity and challenge; hospital without walls; obstetrics and gynecology services Abstrak: Rumah sakit sebagai fasilitas kesehatan rujukan paripurna berperan penting dalam menurunkan angka kematian ibu (AKI) termasuk pelayanan kesehatan ibu dan anak (KIA). Penelitian ini bertujuan untuk menganalisis peluang pelaksanaan dan tantangan pengembangan program hospital without walls pada pelayanan kebidanan dan kandungan di RSUD Noongan. Jenis penelitian ialah kualitatif. Informan penelitian diambil dari tiga tempat yaitu: RSUD Noongan (Direktur Rumah Sakit dan dokter spesialis obstetri dan ginekologi); puskesmas (kepala puskesmas); dan masyarakat. Data dikumpulkan melalui wawancara mendalam dan observasi langsung. Hasil penelitian memperlihatkan bahwa hospital without walls pada pelayanan kebi-danan dan kandungan di RSUD Noongan berpeluang untuk dilaksanakan karena sebagian pro-gram ini telah diterapkan oleh rumah sakit dan juga berdampak baik bagi rumah sakit, puskesmas dan masyarakat, serta kolaborasi PONED-PONEK. Tantangan pelaksanaan program ini di RSUD Noongan yaitu adanya cold case yang merupakan kegagalan gatekeeper, fasilitas kesehatan dan sumber daya manusia (SDM) yang masih kurang di puskesmas, serta kolaborasi PONED-PONEK belum optimal. Simpulan penelitian ini ialah program hospital without walls pada pelayanan kebidanan dan kandungan berpeluang untuk dilaksanakan di RSUD Noongan dengan memperhatikan tantangan pengembangan.Kata kunci: peluang dan tantangan; hospital without walls; pelayanan kebidanan dan kandungan

Study of mode of delivery and maternal morbidity in preterm and term COVID-19 positive pregnant women

Background: Pregnant women are likely to represent a high-risk population during current coronavirus 2019 pandemic caused by severe acute respiratory syndrome coronavirus-2. The aim and objective of this study was to evaluate how COVID-19 pandemic has affected the mode of delivery and whether complications of the disease and mortality rate are higher in pregnant women than in non‐pregnant women.Methods: This ambispective observational study was conducted in department of obstetrics and gynaecology of our institute. Pregnant women diagnosed with positive for COVID-19 via the SARS-CoV-2 RT-PCR test in the third trimester and all neonates with complete COVID-19 testing and delivery data. This data was analysed.Results: Out of total 66 cases studied, 48 patients (72.7%) were asymptomatic, while 13 (19.7%) had mild respiratory or gastro intestinal symptoms on initial assessment at admission, including cough, sore throat, fever, weakness or diarrhoea. Cesarean sections were performed in 57.6% of cases. There were no cases of maternal or neonatal mortality.Conclusions: The study revealed that COVID-19 positive pregnant women are usually asymptomatic or mild-moderately symptomatic, similar to COVID-19 positive non-pregnant women. There was a noted rise in the rate of caesarean sections as a mode of delivery.