A Study to decrease the incidence of PPH in our hospital setting

Objective: This study aimed to measure incidence, identify risk factors (pre‐existing or acquired) forPPH and to prevent progression to severe PPH. Methods: This is a prospective observational study.The causes are likely to be multifactorial with shifting demography and health status widely cited,e.g. age, obesity, comorbidity, multiple pregnancy and ethnicity. Results: Prepregnancy factors forPPH include age, ethnicity, BMI, previous PPH and assisted conception Conclusion: Prophylacticuterotonic agents in high-risk patients, use of intramuscular or intravenous oxytocin, timelyapplication of B –lynch suture, adequate and timely arrangement of blood and blood factors can helpprevent PPH.

Comparative efficacy of protein creatinine ratio and calcium creatinine ratio in determining organ dysfunction in ante-natal patients with pre-eclampsia

Aim: To evaluate the biochemical parameters in determining the severity of pre-eclampsia andcompare the efficacy between protein creatinine ratio and calcium creatinine ratio in determiningorgan dysfunction in ante-natal women with pregnancy-induced hypertension. Material andMethods: 150 cases of pregnancy-induced hypertension admitted in the labour room were studiedin the Department of Obstetrics and Gynaecology, SRMSIMS and were divided into two groups mildand severe pre-eclampsia depending on blood pressure, clinical and biochemical parameters. Variousparameters for renal function and liver function were evaluated along with fundoscopy. Results: Onthe evaluation of various parameters of renal function test and liver function test, a statisticallysignificant p-value was observed with increase in grade of pre-eclampsia. When abnormal organfunctions were compared, it was observed that PCR ≥ 0.3 is associated with 85%, 75.6% and81.25% cases of abnormal fundoscopy, deranged renal function test and deranged liver function testcompared to CCR ≤ 0.04 which was associated with 77%, 78.6% and 65% cases of abnormalfundoscopy, deranged renal function test and deranged liver function test respectively. Conclusion:The degree of derangement among biochemical parameters increases as the disease progresses.Early determination by a single test helps to predict organ involvement and correlates with diseaseseverity.

Assessment of serum adiponectin levels in women with polycystic ovary syndrome

Background and Aim: Serum adiponectin levels were found to be altered in women with polycysticovary syndrome (PCOS) due to the increased adiposity commonly observed in them. Accordingly,earlier studies have reported decreased adiponectin levels in PCOS women. the present study wasconducted to measure serum adiponectin levels in women with PCOS and to evaluate its associationwith the biochemical parameters studied.Material and Methods: The present study included 50women of reproductive age attending the department of Gynecology, tertiary care institute of Indiaand diagnosed with polycystic ovary syndrome based on Rotterdam criteria. Fifty age-matchedhealthy women were recruited as controls. t. Adiponectin levels were measured along withmeasurement of fasting blood glucose, lipid profile using commercial kits and insulin resistance(HOMA-IR) was calculated. Results: Both the study groups were matched concerning age, however,PCOS women were obese when compared to healthy women (p<0.001). Serum total cholesterol andtriglyceride levels were significantly higher (p≤0.05) and serum adiponectin concentration wassignificantly lower in PCOS women when compared to controls (p≤0.05). HDL cholesterol, fastinginsulin and HOMA-IR were similar between cases and controls. Adiponectin did not show significantassociation with any of the parameters studied (Table 2). Conclusion: Serum adiponectin levels aresignificantly lower in women with polycystic ovary syndrome compared to healthy women. Thehyperandrogenemia which is one of the characteristic features of PCOS leads to a state of adipositywhich can further cause a decrease in adiponectin levels.

The effect of prophylactic use of intravenous tranexamic acid in abdominal hysterectomy

Introduction: Hysterectomy is one of the frequently performed major gynecological surgicalprocedures for various uterine pathologies. The objective of this study is to assess the effect ofintravenous tranexamic acid in reducing intraoperative and postoperative blood loss in womenundergoing abdominal hysterectomy. Materials and Methods: The study was a randomizeddouble-blind study, involving a total of 120 women undergoing abdominal hysterectomy for benignetiology were randomly assigned to two groups: Group 1 (non TA): (n=60) women receiving normalsaline and Group 2 (TA): (n=60) women receiving prophylactic Tranexamic Acid in 100 ml saline IVjust before skin incision. The primary outcome was intraoperative, postoperative, and all blood lossestimation. Results: Group 2 (TA) showed a great reduction in intraoperative and postoperativeblood loss (blood in the intra-abdominal drain) compared with Group 1 (non TA), (P = 0.0001,0.0001), so the overall estimated blood loss in groups 2 showed significant reduction compared withGroup 1 (P = 0.0001). Conclusion: Intravenous tranexamic acid is a safe and reliable method tohelp decrease blood loss during and after abdominal hysterectomy.

A study of Maternal BMI as Determinant of Pregnancy & Perinatal Outcomes in Hazaribagh Medical College and Hospital, Hazaribagh.

Introduction: Maternal nutrition plays an important role in maternal and fetal outcomes. The lowmaternal BMI or Obesity are both associated with adverse outcomes. Objectives: To evaluate theimpact of the maternal body mass index on the pregnancy outcome and neonatal outcomes.Materials and Methods: This is a prospective cohort study in which a total of 200 patients meetingthe inclusion criteria were enrolled in the study after informed consent of which 100 patientsenrolled after 18 weeks of gestation had a low BMI and 100 patients with a higher BMI than normal.Results: Pregnant females having low BMI as baseline had more risk of IUGR, fetal distress and lowbirth weight in newborns while those having high maternal BMI had more incidence of PIH inmothers, oligohydramnios, increased birth weight, increased risk of LSCS and NICU admissions anddelayed maternal wound healing. Conclusion: The health of women, throughout their childbearingages, should be cared, to improve their obstetrical and perinatal outcomes. Also, the high-riskgroups should be managed properly.

Antibiograms of uropathogens in obstetric patients

Background: Urinary tract infections (UTI) are the most commonly encountered infections inobstetric patients. Aim: The current study was undertaken to find the spectrum of micro-organismsresponsible for causing UTI in obstetric patients and to find out the most appropriate antibiotic.Materials and Methods: Consecutive patients in different stages of pregnancy with or withoutsymptoms of UTI attending the antenatal clinic from June 2019 to November 2020 were screenedfor significant bacteriuria. The bacterial uropathogens isolated were then subjected to antimicrobialsusceptibility testing and screened for ESBL production and methicillin resistance. Results: Duringthe 18-month study period, out of the 110 samples screened, a total of 66 (60%) samples of urinefrom pregnant females, in different stages of pregnancy were found to be positive on culture. TheEnterobacteriaceae accounted for nearly 69.69% of the isolates and E. coli alone accounted for42.42% of the urinary isolates followed by Acinetobacter 19.69%. Among the Gram-positive cocci,Enterococcus 25.75% were more frequently isolated than Staphylococcus aureus (4.54%).Significantly high resistance was noted to the beta-lactam group of antimicrobials, fluoroquinolonesand cotrimoxazole, both by the Gram-negative bacilli as well as Gram-positive cocci. Resistance wasquite low against the aminoglycosides and nitrofurantoin and virtually absent against imipenem.Conclusion: The susceptibility patterns seen in our study seem to suggest that it is necessary toobtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI.

Management of Postpartum Haemorrhage: A study on Transfusion of Blood and its components

Introduction: Blood Transfusion is identified as one of the essential components of comprehensiveemergency obstetric care which has drastically reduced maternal mortality. Material and Methods:This is a prospective study conducted at NC Medical College and Hospital, in the Department ofOBGY. (Tertiary care center) from January 2019 – September 2020. All patients requiringintrapartum transfusion of blood or blood products are enrolled in the study. No exclusion criteria.Results: In the present study, various age groups of patients were enrolled. Maximum transfusion(77.8%) rates are seen in the age group of 21-30 years and the minimum no. of patients wereranges from 31-40 years (8.4%). Conclusion: Postpartum hemorrhage, placental causes, andanemia are the commonest causes of the need for transfusion in obstetric practice.

The ambit of congenital malformations in the Kachchh district- a hospital-based study at a tertiary care center

Background and Aim: Quantifying birth defects in a population is felt as a need as it helpsinappropriate allocation of the health budget to tackle and reduce perinatal, neonatal, and infantmortality rates. Hence a study on congenital anomalies was undertaken in the region of Kachchhdistrict. Material and Methods: Present cross-sectional study was performed on 10 patientsdiagnosed with having congenital malformed fetuses at tertiary care center- G.K. General Hospital,Bhuj, Kachchh district, Gujarat, India over three months – January, February, March 2019. Results:Mean age of the study participants were 22.3 years, most (70%) of the study participants wereprimigravida. Hydrocephalus was the most common birth defect among study participants. Eightypercentages (80%) of study participants had gross anomalies. Sixty percentages (60%) ofparticipants had the outcome of termination. Conclusion: Congenital anomalies were in babies tomothers between 20-30 years of age. Once an anomaly is detected, various management optionsare to be discussed with the patients in consultation with a neonatologist, pediatric surgeon, andneurosurgeon when necessary.

Study of Abdominal Shirodkar sling operation for uterocervical prolapse

Background and Aim: Quantifying birth defects in a population is felt as a need as it helpsinappropriate allocation of the health budget to tackle and reduce perinatal, neonatal, and infantmortality rates. Hence a study on congenital anomalies was undertaken in the region of Kachchhdistrict. Material and Methods: Present cross-sectional study was performed on 10 patientsdiagnosed with having congenital malformed fetuses at tertiary care center- G.K. General Hospital,Bhuj, Kachchh district, Gujarat, India over three months – January, February, March 2019. Results:Mean age of the study participants were 22.3 years, most (70%) of the study participants wereprimigravida. Hydrocephalus was the most common birth defect among study participants. Eightypercentages (80%) of study participants had gross anomalies. Sixty percentages (60%) ofparticipants had the outcome of termination. Conclusion: Congenital anomalies were in babies tomothers between 20-30 years of age. Once an anomaly is detected, various management optionsare to be discussed with the patients in consultation with a neonatologist, pediatric surgeon, andneurosurgeon when necessary.

Use of Low Dos Aspirin in Women with Increased Risk of Preeclampsia

Introduction: The role of aspirin in the primary or secondary prevention of preeclampsia has beenthe subject of numerous studies and great controversy. Our aim reports on LDA usage rates bywomen with an increased PE risk, as well as on determinants and reasons given for use and non‐use. Material and Method: In this multicenter, double-blind, placebo-controlled trial, the currentstudy randomly assigned 2100 women with singleton pregnancies who were at high risk for pretermpreeclampsia to receive aspirin, at a dose of 150 mg per day, or placebo from 11 to 14 weeks ofgestation until 36 weeks of gestation. The primary outcome was delivery with preeclampsia before37 weeks of gestation. The analysis was performed according to the intention-to-treat principle.Results: Preterm preeclampsia occurred in 13 participants (1.6%) in the aspirin group, as comparedwith 35 (4.3%) in the placebo group (odds ratio in the aspirin group, 0.38; 95% confidence interval,0.20 to 0.74; P=0.004). Results were materially unchanged in a sensitivity analysis that took intoaccount participants who had withdrawn or were lost to follow-up. Conclusion: This randomizedtrial showed that among women with singleton pregnancies who were identified using first-trimesterscreening as being at high risk for preterm preeclampsia, the administration of aspirin at a dose of150 mg per day from 11 to 14 weeks of gestation until 36 weeks of gestation resulted in asignificantly lower incidence of preterm preeclampsia than that with placebo.