Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications

Correlation of ultrasound with histopathology for retained products of conception in medically managed abortions

Background: Medical abortion uses an anti-progestin, mifepristone (RU486), followed by a prostaglandin (misoprostol). Objective of present study was to correlate findings of transvaginal ultrasound with histopathology for retained products of conception in medical abortions.Methods: An observational, prospective study was conducted on hundred women with gestation upto 12 weeks who underwent medical abortion with excessive or prolonged post abortal vaginal bleeding. Transvaginal scan followed by uterine evacuation was done under anesthesia, followed by histopathology.Results: Analysis was done statistically using Pearson Chi- square method. Sixty five percent subjects took MTP pill by unsupervised, self-intake and 35% on prescription. Among women who took misoprostol in dose of 400mcg, 89% had RPOC on histopathology. At the dose of 800 mcg, 73.3% had retained Products of Conception (RPOC) on histopathology. The correlation was found to be statistically non-significant (p value at 5% was 1.13). Ultrasound showed echogenic mass in the uterine cavity in 62 (62%) women, increased endometrial thickness ≥10mm in 13 (13%), gestational sac with no fetal pole in 6 (6%), blood clots in uterine cavity in 6 (6%), and empty uterine cavity in 3 (3%). Seventy five percent of women had histologically proven RPOC at endometrial cut off of equal to or greater than 10mm. The sensitivity, specificity, positive and negative predictive value of transvaginal ultrasonography in detection of retained products of conception were 92%, 60%, 87.3%, 71.4% respectively. The diagnostic accuracy was 84%.Conclusions: Transvaginal ultrasound for detecting retained products of conception in medically managed abortions has a high sensitivity and positive predictive value and is useful for screening women with clinically suspected incomplete abortion who require further intervention -medical or surgical

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.</jats:p

Efficacy of 10% Povidone Iodine in Children Affected with Early Childhood Caries: An In Vivo Study

For prevention of dental caries, S. mutans numbers must be reduced and prevented from returning to the original level. An antibacterial agent that is effective and also acceptable to young children can help to establish a favorable oral environment and halt the caries process. Purpose: This study was conducted to evaluate the efficacy of topical antimicrobial (10% Povidone- Iodine) on S.mutans counts in children with Early Childhood Caries after full mouth rehabilitation. Also its effects on the clinical outcomes in terms of incidence of new caries and secondary caries were evaluated.Method: Full mouth rehabilitation was done in 30 children (mean age 4.2 years) suffering from Severe Early Childhood Caries (SECC). Stimulated saliva samples were collected to determine the post operative baseline S.mutans counts. Thereafter the subjects were randomly divided into two groups. The experimental group received 10% Povidone Iodine at 3 months interval for a period of 12 months while the control group received placebo (deionized water) at similar intervals.Change in the S.mutans count at 6 and 12 month intervals were compared to the baseline post-operative mutans score. Results revealed that application of 10% Povidone Iodine caused a significant reduction in the rise of Streptococcus mutans levels from the baseline postoperative score after 12 months of treatment thus decreasing the oral load of the organisms. Reduction in counts; in turn decreased the relapse of caries in these children. Conclusion: Thus oral rehabilitation coupled with regular application of 10% Povidone Iodine application can be a good alternative to control dental caries in children affected with Early Childhood Caries (ECC).</jats:p