Demographic parameters of women with uterine fibroids presenting as abnormal uterine bleeding

Background: Uterine fibroids are commonest benign uterine tumors. Only about 25% women with fibroids are symptomatic. Around 70-80% are discovered incidentally during routine pelvic examination. Using ultrasonography screening, some authors have estimated a cumulative incidence of 70% in all women by age 50. Symptoms attributable to fibroids are mainly abnormal uterine bleeding (AUB), pelvic pressure, pain, and reproductive dysfunction. Heavy and/or prolonged menses is the typical bleeding pattern with myomas. Uterine fibroids are a leading cause of hysterectomy in perimenopausal women, thus, this study was done to find out its prevalence and demography in women presenting with AUB. The objectives of the present investigation were to find out the prevalence of uterine fibroid in women with AUB and to find out the various demographic features of womenMethods: The study was done for 2 years in the Dept of Obstetrics and Gynecology of a rural tertiary institute after taking clearance from institutional ethical committee. All the women presenting with AUB were included in the study. History and demographic features was enquired and entered in a predesigned proforma. All women were clinically examined after consent. Women with suspicion of fibroid were subjected to diagnostic modalities and the reports were followed and correlated.Results: Total 11,841 patients came to Gynaeological OPD during the study period. Out of these 3,878 (32.75%) presented with AUB, 2,126 were diagnosed as having fibroids after examination and investigations. Hence, the prevalence of fibroids amongst the women with AUB was 54.82% and 17.95% amongst all gynaecological patients. Maximum women were between 31-40 years, (64.78% rural and 62.73% urban). Majority were having parity between 1-2 (40.73% in urban, 38.96% in rural).Conclusions: Uterine fibroids are the commonest reason of AUB in reproductive age group with the prevalence of 54.82%. The trends in age incidence have remained the same over the years, commonly affecting women in third decade. There is no difference in incidence of fibroids amongst various socioeconomic classes.

Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute

A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

Background: Worldwide CSR has been steadily increasing beyond recommended level of 15 %by WHO. High CSR have been reported in developed and developing countries. Reasons for increase in CSR are not obvious and somewhat complex. Thus, present study was undertaken to analyze various indications for CS performed at rural tertiary health care centre Sewagram, M.S.Methods: This was prospective study included all women who underwent CS from 1st January 2015 till 30th June 2016. Data was entered in MS excel sheet analyzed with percentage and chi square test using SPSS ver.17.Results: CSR was 36 .88% in present study. As per NICE guidelines CS were classified in four categories based on urgency, women were distributed in each category. Category I had 22.62%, category II -38.61%, category III - 28.37% and Category IV - 10.40% women. In CAT I common indication was foetal bradycardia (71.53%). In CAT II CS, common indication was non reassuring foetal status (38.82%).  Breech presentation (14.74%) and previous scar with doubtfull scar integrity (14.33) were next common indications. In CAT III (43.43%), IV (41.13%) previous LSCS with inadequate pelvis was the common indication. Confidential enquiry revealed that 26.17% (28/107), 20.3% (40/197), 23.17%, (35/151) and 8.3 % (5/60) of CAT I, II, III and IV CS had questionable indications.Conclusions: In this study, CSR was higher than WHO standard. Common indications in primipara was foetal distress while in multiparas primary indication previous LSC

Adherence to timeline for decision to delivery interval in accordance with NICE guidelines and its impact on neonatal outcomes in a rural tertiary health care centre of Central India

Objectives: Aims of this study were to determine the caesarean section rate in our rural tertiary health care centre, to perform an audit of decision to delivery interval for emergency caesarean sections, to compare our timings with the recommended DDI (decision to delivery interval), to evaluate the factors contributing to delay in DDI and to analyse the impact of DDI on maternal and fetal outcomes. Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra over a period of 18 months from January 2015 to June 2016. Data was retrieved from the hospital files during working hours within 24 hours of the caesarean section. Results: Caesarean section rate (CSR) during study period was 36.9%. Main causes of delay were the delay in obtaining consent in 312 (20%), arranging blood in 489 (31.3%) and anaesthesia procedural delay in 659 (42.2%) patients. Among category 1 CS, APGAR score at 1 minute and 5 minutes was not significantly different between CS with DDI≤30 minutes and those with DDI>30 minutes (p - value >0.05). Also, among category 2 CS, APGAR score at 1 minutes and 5 minutes was not significantly different between CS with DDI ≤75 minutes and those with DDI >75minutes (p- value >0.05). Conclusion: DDI should be considered as one of the important contributing factors but not the sole factor in determining the maternal and neonatal outcomes in emergency caesarean sections

Implementation of maternal near-miss guidelines in the selected district and womens hospitals of Maharashtra, India

Background: Effective implementation of operational guidelines depends on understanding the facilitating factors and barriers which are useful for scaling up the implementation at other facilities. The objective of the present study was to document the facilitating factors and barriers for implementation of the MNM‑R guidelines at the selected district and women’s hospitals in Maharashtra, India. Methods: The incidence and factors influencing MNM events in the selected hospitals were reviewed and delays based on three-delay model were identified during April 2018 to March 2022. All pregnant/post-partum women meeting eligibility criteria of MNM as per GOI guidelines were included as Near Miss cases (n=460) and interviewed. All the MNM cases were discussed during the monthly maternal death review (MDR) meetings at these hospitals. Results: Ratio of maternal deaths to MNM was 1:2.34. Leading causes of MNM were hemorrhage (64.6%) and hypertensive disorders of pregnancy (23.0%). Level one and two delays were reported by 41.7% and 7.6% women respectively. Level three delay at referral centers and at district hospitals was reported by 15.8% and 12.2% women respectively. Corrective measures were taken care of as per the gaps identified on the basis of three delay model for prevention of these cases in future. The study findings indicate facilitating factors and barriers which need to be addressed for effective implementation of MNM guidelines at the district hospitals. Conclusions: The study findings will help in scaling up the implementation of these guidelines across all district and women’s hospitals in India and lead to their effective implementation

Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute.</jats:p