Comparison of efficacy of 600 and 800 micrograms vaginal misoprostol in early pregnancy failure in SMGS: a tertiary health care hospital in Jammu, India

Background: Misoprostol use in early pregnancy failure is varied and dose is not well established. Aim of this study was to compare efficacy and side effects of 600 versus 800 micrograms vaginal misoprostol in early pregnancy failure.Methods: A randomized prospective observational study was conducted in the postgraduate department of obstetrics and gynaecology, SMGS hospital Jammu from November 2018 to October 2019 after getting approval from the ethical committee. Hundred patients (50 in group A and 50 in group B) admitted in labour room before 12 weeks of gestation with an ultrasound diagnosis of early fetal demise (missed abortion or brightened ovum) were treated medically with different doses of vaginal misoprostol.Results: The success rate in patients in group A is 72% and group B is 88%, p=0.045 (difference is statistically significant). Patients who required suction and evacuation were 28% in group A and 12% in group B.Conclusions: Use of misoprostol for medical management of 1st trimester missed/anembryonic is an effective, cheap, safe and convenient alternative to surgical evacuation. It was concluded that 800 micrograms vaginal misoprostol is more effective than 600 micrograms vaginal misoprostol. But 800 micrograms misoprostol has more side effects than 600 micrograms vaginal misoprostol.

Women with Severe Anemia in Labor: Fetomaternal Outcomes

Background: Anaemia in pregnancy is the leading medical disorder in developing countries like India. Women with severe anemia in labor is a challenging situation for the obstetrician with increased maternal and perinatal morbidity and mortality. It has multifactorial etiology, Main cause of anemia in obstetrics is iron deficiency. There are specific risks for the mother like preterm labour pain, IUGR baby, preeclampsia, antepartum haemorrhage, sepsis etc and the fetus such as prematurity, lowbirth weight, birth asphyxia etc. Aim and Objectives: To determine the socio-demographic variables and also the maternal and perinatal outcomes of pregnant women admitted to labour room with severe anemia (Hb <7gm%) late in pregnancy. Results: It was seen that out of 50 severely anemic women, 82% had Hb between 4-7 gm% and 18% had Hb < 4gm%. Severe anemia is seen in 82% unbooked patients and only in 18% booked patients. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, mortality in anemic group as compared to non anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admission, low birth weight among the anemic group as compared to non anemic group. Conclusions: Severely anemic women reporting in labor had significantly high maternal and perinatal morbidity and mortality. Even a minor blood loss is much devastating for such patients. Extrapolating our observations, it can be said that a close vigilance, anticipation of complications and appropriate care and interventions during labor and puerperium will help in improving outcomes in these severely anemic women. Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy. Key words: Anaemia, Iron deficiency, Intrauterine growth retardation, prematurity, maternal outcome, neonatal outcome.

Pre-experimental Study to Assess the Effectiveness of Warm Compress on Lumbar Region during First Stage of Labour among Primi Parturient Mothers in Labour Room of Selected Hospitals at Amravati

The goal of this study was to determine the intensity of pain experienced by primiparturient women during the first stage of labour. To see how beneficial a warm compress is on the lumbar area. To see if there's a link between labour discomfort and certain demographic factors. At the 0.05 level of significance, the post-test pain score will be lower than the pre-test pain score. The research method chosen was quantitative, and the study design was pre-experimental, pre-test, and post-test. Purposive sampling was used to collect data from 60 primiparturient moms in the early stages of labour. The research was carried out at Amravati's Dayasagar Hospital. A pre-test was done using a numerical pain scale to determine pain levels among primiparturient moms who met the inclusion criteria. In the initial stage of labour, a warm compress on the lumbar area is applied for 15 minutes every half hour for four hours. The numerical pain scale is used to measure post-test pain levels. In the current study, 53.3 percent of primigravida moms in the control group reported moderate pain (scoring 4-6) and 46.6 percent had severe pain in post-test 1. (score 7-10). 36.6 percent had moderate pain (scoring 4-6) and 63.3 percent had severe pain (7-10) in post-test 2, while 13.3 percent had moderate pain (4-6) and 86.6 percent had severe pain in post-test 3. (score 7-10). In post-test 1, 70% of the experimental group experienced moderate pain (scoring 4-6) and 30% had severe pain (score 7-10). In post-test 2, 66.6 percent of participants reported moderate pain, while 33.3 percent reported severe pain. In post-test 3, 56.6 percent of participants reported moderate pain, while 43.3 percent reported severe pain. As a result, it may be stated that using a warm compress to relieve pain was successful.

Case series on uterine rupture depicting the atypical presentations in the labour room

Uterine rupture is the complete division of all the three layers of uterus. Most uterine ruptures occur during labor in pregnant women, most commonly seen in previously scarred myometrium. Consequences of uterine rupture depend on the time between diagnosis of uterine rupture and intervention, and can be as grave as fetal and maternal death. Vigilance and avid action by the obstetrician can lead to better outcomes. Case 1 represented a 28-year-old moderately anemic G4P2L2A1 having previous 2 LSCS at POG 39 weeks 1 day presented in COVID emergency in active labour and was found to have a uterine scar rupture (5 cm rent) extending towards bladder wall with shoulder presenting on rent. A live female baby with thick meconium staining was delivered and uterine repair along with bilateral tubectomy was performed. Case 2 represented a 21-year-old primigravida with breech presentation at a gestation of 34 weeks 6 days with preterm labour pains who had been referred to our centre. Decision for LSCS was taken and on entering the abdomen rupture uterus with an inverted T-shaped rent in the upper segment extending up to the fundus was seen. A stillborn male fetus was delivered through the rent, followed by successful uterine repair. In spite of massive blood loss, the mother had survived. Case 3 represented a 30-year-old grand multipara at a gestation of 38 weeks 3 days with ultrasound documented fetal demise with fetal hydrocephalus and holoprosencephaly with labour pains was taken up for laparotomy due to suspicion of uterine rupture based on examination findings. Intra-operatively, baby was found lying in the peritoneal cavity with an unsalvageable uterus with a rupture in lower uterine segment and left lateral wall extending upto round ligament above and cervix below. A stillborn male fetus was delivered and peripartum subtotal hysterectomy with left salpingoophorectomy and right salpingectomy was done with a good maternal outcome. The above series suggest that the signs and symptoms of uterine rupture are usually variable and nonspecific, hence posing a challenge for the diagnosis. Early diagnosis and timely intervention by the obstetrician, can help us to improve the fetal and maternal outcome drastically.

Midwives’ knowledge of COVID 19 and pregnancy in four maternity units in Brazzaville in 2021

Purpose: To evaluate midwives' knowledge of Covid 19 and Pregnancy. Materials and methods: This was a knowledge analytical study. Midwives working in delivery units and outpatient clinics were included. The variables were focused on socio-demographic and professional aspects, general information on Covid-19, the clinical and biological manifestations, the prevention of corona virus transmission and the prevention of mother-to-child transmission. Results: Out of 82 respondents, 73 (89.1%) were secondary school graduates, working mainly in Talangai Hospital. The media was the source of information for 78 (95.1%); Covid 19 is a viral infection 78 (95.1%); the route of contamination was respiratory 79 (96.3%) and transplacental 16 (19.5%) of respondents. The clinical signs were: fever 76 (92.7%), cough 77 (93.9%) and dyspnea 77 (93.9%) of the respondents. Biological diagnosis was done by RDT (rapid diagnosis test) 73 (89, 1%), completed by PCR confirmation 43 (52.4%) of the respondents. Prevention methods: hand washing several times a day 72 (87,8%) and alternative by disinfectant gel 75 (91,5%); lifting the fold of the elbow when sneezing or coughing 76 (89%); used handkerchief thrown in the trash 70 (85,4%) of the respondents; out of 3 preventive measures in the labour room, 20 (23,4%) answered correctly, 48 (58,5%) gave only 1 to 2 correct answers and 14 (17%) did not identify any measure. The overall knowledge of midwives on Covid 19 was insufficient 25 (30.5%), average 52 (63.4%), good 5 (6.1%) of the respondents. For the factors that can influence the level of knowledge, there is no link between the level of knowledge and the socio-professional characteristics of the midwives (Chi2 test: P-value ˃ 5%). However, the fact of working at the CHUB could have a slight influence (sensitive P-value close to 95%). Conclusion: There is a need to diversify sources of information for an improvement of knowledge in order to place the midwife at the top of the medical news.

Care’s Profit

Using a layered, ethnographic approach focusing on four small non-corporate private maternity hospitals, we turn a critical lens on what it means to work within this self-regulated bubble and examine the ‘creation’ of a cadre of healthcare workers. Our analysis addresses how a space of care and business is generated out of the precarious positions of both women and the health workers who depend on employment there. Clinic owners’ staffing strategies centred on hiring unlicensed labour room staff, trained on the job rather than in accredited institutes, who take care of all aspects of patient care, including deliveries. By exploring narratives surrounding training and overtreatment, this chapter highlights the tensions between the value placed on profit, care, and working conditions in the private maternal health sector, and examines the structural vulnerability of unlicensed health providers working there.

Spousal support during pregnancy in the Nigerian rural context: a mixed methods study

Background Pregnancy constitutes a global health concern, thus the need for spousal support during this period cannot be overemphasized. This study examined the kinds of support pregnant women expected and received from their spouses as well as the effect of such supports during pregnancy, labour, and delivery. Methods The study adopted both quantitative and qualitative methods of data collection. The respondents were selected using multistage and simple random sampling techniques. Results Findings showed that respondents expected and received maximum support from their spouses during pregnancy, labour, and delivery. Spiritual support such as praying and fasting was top of the kinds of support pregnant women expected and received from their husbands during pregnancy and delivery. Others include helping in house chores, financial provision, taking care of other children, accompanying to labour room, and sexual support. More than three-quarters of the respondents stated that maximum support from their husbands made pregnancy, labour, and delivery easier. Cramer’s V showed that the association between support and husbands’ occupation was 0.233 and Pearson Chi-square showed that the association was statistically significant χ2(2) = 27.894,p < .001. Conclusion The study concluded that spousal support during pregnancy was high among rural women in Southwestern Nigeria, and it impacted positively on their wife’s period of pregnancy, labour, and delivery. A high level of spousal support should be sustained to promote family bonding and development as well as reduce maternal and child mortality.

Outfacing second wave of pandemic in COVID-19 positive mothers at Gandhi hospital

The novel coronavirus is a single stranded RNA virus with spike proteins triggering an immune response leading to cytokine storm and coagulopathy. Pregnancy is an immunocompromised and hypercoagulable state, with predisposition to severe illness. An insight into impact of COVID-19 in pregnancy is essential to combat its future.This study was conducted at a tertiary care centre. Analytical study was conducted from the data collected regarding COVID-19 positive labour room admissions, deliveries and deaths during the second wave of pandemic.There was a discharge rate of 88.14% after safe delivery. Among COVID-19 maternal mortalities, most deaths were due to ARDS. Quick SOFA score was a good predictor for morbidity and mortality. Deranged coagulation profile and D-Dimer levels more than 500 ng/ml were good predictors of mortality. Silent hypoxia needs to be identified and corrected at admission. Delay in seeking medical advice was a major contributory risk factor.Increasingawareness among public about seeking medical advice during early stages of disease. Early identification and treatment according to latest guidelines for a positive outcome.Making aware the policy makers regarding risk-benefits of vaccination in mothers can come a long way in changing the fate of COVID-19 in pregnancy.

MATERNALAND PERINATAL OUTCOME IN HYPOTHYROIDISM IN PREGNANCY.

BACKGROUND: Pregnancy is a period that places great physiological stress on both the mother and the foetus .This study was conducted to analyse the fetomaternal outcome of pregnant women with hypothyroidism. The commonest thyroid disorder found in pregnancy is hypothyroidism and it adversely affects the maternal and foetal health in the form of infertility, early pregnancy loss, pre eclampsia , anaemia ,FGR, PROM, preterm labour, neonatal and maternal morbidity and mortality. Routine screening, early detection and conrmation of diagnosis and prompt treatment is required to ensure favourable maternal and foetal outcomes. METHODS: The present study was conducted in the department of obstetrics and gynaecology of Adhichunchanagiri Institute of Medical Sciences ,B.G Nagara , Mandya from November 2019 to October 2020.All pregnant females who are diagnosed as hypothyroidism , admitted to labour room were included in the study . RESULTS: In the present study the most common maternal complication is preeclampsia , postpartum haemorrhage and fetal complication is preterm labour. CONCLUSION: Maternal hypothyroidism is a disorder with great potential to adversely affect maternal and foetal outcomes .If the condition is diagnosed early and prompt initiation of treatment ,adequate follow up is done then the condition can be easy treated with very little detrimental effects to the mother and the foetus. This study concludes that sufcient education of the doctors and the patients about the universal screening, thyroid associated complications along with ease and advantages of prompt management is very much necessary.

Practices of Skilled Birth Attendants about AMTSL in Prevention of Post-Partum Haemorrhage: Cross-sectional Study

Aim: To assess the practices of SBAs about AMTSL working in labour room at tertiary level of care in-order to minimize the accidence of PPH. Study Design: Cross-sectional descriptive study. Methodology: This study with enrolled SBAs (n=120) was done following ethical review committee’s (ERC) approval at Government tertiary care hospitals of the Lahore-Pakistan. For data collection a WHO standardized check list as a questionnaire was used to assess the practices of SBAs. Results: Results showed that there were gaps in competencies of SBAs about AMTSL working in labour room. Most of the steps that are S1, S3, S4, S8, S12, S13, S14 and S15 were not done by the majority of the SBA working in labour room. Almost 12 (10%) out of 120 SBAs just got 60% and above marks, 100 (83.3%) out of 120 got marks between40 to 59% and only 8 (6.7%) got less than 40% marks. Conclusion: We concluded that SBAs had unsatisfactory knowledge about standardized check list of AMTSL by WHO and their practices were not according to standard. Keywords: Skilled Birth Attendants, Labour Stages, Post-partum Haemorrhage and Practices.