Rising rates of caesarean section: an indicator of defensive medicine practiced by obstetricians

Background: Defensive medicine can be in the form of excessive tests, procedures, surgeries, or visits by the doctors to primarily reduce their exposure to legal liabilities. It also includes avoidance of high risk patients or procedures.  Medical profession has been included under consumer protection act which has led in developing hostile environment for medical practitioners.  This has led to increase in defensive medicine. In obstetrics and gynaecology incorporation of defensive medicine can be scrutinized by observing trends in caesarean section.Methods: It is a retrospective study carried out for 1 year from January 2015 to December 2015. All patients in whom caesarean section was done were included in this study. Indications for which Caesarean section was done were studied and results were compared with similar studies in other hospitals.Results: Overall rate of caesarean section observed in this study was 43.3%. Incidence of caesarean section in primigravidae was 59.5%. Only 2.1% of the patients underwent trial of scar resulting in vaginal birth. Foetal distress was one of the most common indicatorsfor caesarean section and its detection was based on foetal cardiotocograph readings. Out of all patients taken for caesarean section due to foetal distress only 28.5% of the babies required neonatal intensive care admission. Rising trend towards caesarean section on maternal request was also seen.Conclusions: Current climate of high professional liability is detrimental to good patient care as defensive medicine provides less benefit and much harm. Practice of medicine should be safe and hassle free. For this, standard protocols should be made and followed and if practitioners are abiding with standard protocols they should be protected against litigation

Helicobacter pylori infection and hyperemesis gravidarum: a prospective pilot study in India

Background: About 80% of all pregnant women experience some form of nausea and vomiting during their pregnancy. Hyperemesis gravidarum, the commonest indication for admission to hospital in the first half of pregnancy affects approximately 0.3%-2.0% of pregnancies. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy. The objectives of this study are to determine the proportion of H. pylori seropositivity among women with hyperemesis gravidarum (HG) and determine its relation with socio-economic status.Methods: This was a prospective study conducted in a tertiary hospital in Bangalore among 60 pregnant women with HG for a period of 12 months. Venous blood samples were obtained and serum IgG for H. pylori was measured using enzyme-linked immunosorbant assay (ELISA). Details regarding socioeconomic status, recurrence of symptoms and severity were noted.Results: The proportion of H. pylori seropositivity among pregnant women with hyperemesis in our study was 70%.There was a significant increase in severity and recurrence of vomiting among seropositive cases. Women belonging to rural areas had 1.17 times the risk of infection compared to women with urban area. We also found women belonging to the lower socioeconomic status had 0.52 times more risk to develop Helicobacter pylori infection.Conclusions: This study suggests that H. pylori is an independent risk factor for vomiting in pregnancy. Effective treatment and eradication of H pylori infection may help reduce severity and recurrence of vomiting among positive cases thus reducing its adverse consequences

Antimicrobial Sensitivity Pattern of Microorganisms Isolated from Vaginal Infections at a Tertiary Hospital in Bangalore, India

Background: The vagina contains dozens of microbiological species in variable quantities and is, therefore, considered a complex environment. Among the microorganisms, bacteria have important repercussions on women’s health. The present study was conducted to elucidate this type of vaginal isolates and their sensitivity towards currently used antibiotics. Methods: This was a retrospective study conducted at the Department of Obstetrics and Gynaecology, Sapthagiri Hospital, Bangalore, India from January 2012 to December 2013. All symptomatic women who had a high vaginal swab taken for culture and sensitivity testing were included in this study. Antibiotic susceptibility was tested using disc diffusion method (modified Kirby-Bauer’s method). The antibiotic sensitivity patterns of isolated microorganisms were studied. Results: Out of 200 patients, 95% had positive vaginal cultures. Fifteen types of microorganisms were isolated. The highest frequency of infection was seen at the age of 20-30 years, followed by 41-50 years and 31-40 years, and a low frequency of infection was observed above 50 years of age. The most prevalent pathogen was Escherichia coli, followed by Streptococcus agalactiae and diphtheroids with equal incidence. Among the antibiotics tested, isolated pathogens were completely resistant to nalidixic acid and highly sensitive to meropenem and imepenem. Conclusion: The high prevalence of gynaecological infections demands that patients with symptoms undergo thorough investigation with cultures and sensitivity essays. Changes in treatment protocols are required to treat vaginal infections effectively

A COMPREHENSIVE REVIEW ON IN SITU GELS

The current review on in situ gelling systems becomes one of the most popular and prominent. It had a tremendous potential advantage of delivery systems due to many benefits like easy to use simple manufacturing; improve both adherence and patient comfort by minimizing the frequency of drug administration by its unique characteristics feature of sol to gel transition. It also provides in situ gelling nanoemulsions, nanosphere, microspheres, and liposomes. The drawbacks associated with conventional systems of both solutions and gels, such as accurate dosing, ease of administration overcome by using in situ gelling systems. This review focused on definitions, types, advantages, disadvantages, polymers used, and suitable characteristics of polymers, including the preparation of in situ gels covered in the introduction. Approaches, applications, and evaluation of in situ gels were explained with examples

Alpha methyldopa induced hepatotoxicity in pregnancy

We report a case of gestational hepatitis due to alpha-methyldopa and briefly review the literature on alpha-methyldopa-induced hepatotoxicity in pregnancy. A 32 year old woman, primigravida with 34 weeks of gestation with pre eclampsia, presented with symptoms of nausea, dark coloured urine and jaundice. She was on alpha methyldopa (Aldomet) 250 mg thrice a day since the last five weeks. Laboratory investigations revealed raised bilirubin, serum aspartate transaminases and serum alanine transaminases. Platelets were normal. Peripheral smear did not show haemolysis. With the exclusion of viral, haemolytic and obstructive causes, drug induced jaundice was considered as a differential diagnosis. Alpha methyldopa was withdrawn and replaced with nifedipine for her pre eclampsia treatment. Her repeat bilirubin level done two weeks later showed a drop. She went into labour at 38 weeks and delivered vaginally. In postpartum follow up her liver tests returned to normal in two weeks, about six weeks after stopping methyldopa. Hepatotoxicity should be considered as one of the adverse drug reaction of alpha methyldopa. It is not possible at present to predict which patients will develop liver disease following the administration of this drug. An awareness of the possibility of methyldopa induced hepatotoxicity should be present in the clinician’s mind and liver function tests should be done at regular intervals. The occasional occurrence of this harmful side effect is not a contraindication to the use of this antihypertensive agent

A study of factors associated with tokophobia and its effect on pregnancy

Background: Tokophobia is pathological fear of childbirth which has bearing on the women’s health with the physical and psychosocial morbidity. It includes fear of injury to the baby, genital tract, death and is a common cause for which a woman opts for caesarean section. Recognition of tokophobia and close liaison with  obstetricians/specialists can help to reduce its severity and ensure treatment. Aim of the current study was to assess the incidence of tokophobia and correlation with the sociodemographic variables to evaluate the possibility of reducing the requests for caesarean section.Methods: 150 pregnant women attending the antenatal OPD and labour ward in a tertiary care centre constituted the study population. Data was gathered using standard questionnaire to assess fear of child birth, anxiety associated and was analysed with chi-square test for statistical significance.Results: 150 women included in the study, the incidence of tokophobia was 55.3% and severe tokophobia was 30.7%. Of these 62% were primigravidae and 38% multigravidae.15.3% of the total requested for caesarean section with the major reason being fear of childbirth. However, 84.7% of the study population did so without any such request for caesarean section. Higher incidence of tokophobia was observed in women with intermediate education as against those who completed their graduation and post-graduation.Conclusions: Tokophobia is associated with pregnant women in different severity. It’s influenced by sociodemographic variables like educational and socioeconomic status. Improvement in sociodemographic conditions could reduce tokophobia

A review on novel COVID-19: background, etiology, pathogenesis, transmission, prevention and management

Mankind's history is watching a bizarre time battling an imperceptible adversary, the novel COVID-19 Coronavirus. At first seen in the Wuhan province of China, presently limitlessly spreading all over world. How the COVID 19 has been made on the globe become Pandemic needs no depiction. The virus has been accounted for affecting the lungs and related respiratory tracts promoting harm of the alveoli. It has been accounted that the respiratory sickness is the prevailing Clinical symptom of COVID-19. This review article discusses an easily understanding of the causes, different type of Human viruses regarded of Coronavirus, clinical diagnosis of RT-PCR, FET, Primary prevention and control of the virus. Therefore, this review article main theme is to provide more reliable and valid information to control and manage public emergency in both acute and chronic conditions of coronaviru

Obstetric outcomes in women with mullerian duct malformations

Background: Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aims to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.Methods: This retrospective study evaluates the obstetric outcome of 24 in patients with uterine malformations with pregnancy in Sapthagiri Hospital from August 2010 to August 2013. A total of 60 randomly selected pregnant women with a previously confirmed normally shaped uterus were taken as a control group.Results: A total of 2595 women were admitted for various obstetric reasons during August 2010-2013 (period of 3 years). Of them 24 cases had uterine anomaly, the rate of anomaly being 9.2 per 1000 pregnant women. A bicornuate uterus was present in 7 (29%) septate uterus in 6 (25%) arcuate in 5 (20.8%), and unicornuate with rudimentary horn in 2 (8.4%). Unicornuate uterus without rudimentary horn in 1 (4.2%) and uterus didelphys in 1 (4.2%). Transverse vaginal septum was seen in 2 (8.4%) patients. The rate of malpresentation was high in uterus didelphys, arcuate and bicornuate uterus. Abortion rates were equal in both septate and bicornuate uterus. A comparison of mode of presentation and termination of pregnancy is illustrated. Preterm deliveries (33.4%) and miscarriage rates (20.8%) were more common compared to controls. Less than half the women (45.8%) had term deliveries compared to controls where pregnancies which reached term were 86.7%. An assessment of mode of delivery, termination, period of gestation at delivery and birth weight between study group and control group is given.Conclusions: Women with congenital uterine malformation usually have higher incidence of complications during pregnancy and delivery. Early diagnosis and treatment can improve obstetric outcomes

Aggressive angiomyxoma of uterine corpus

Aggressive angiomyxoma (AA) is a rare slow growing mesenchymal tumour that preferentially involves the vulvovaginal, pelvic or perineal regions. It is called aggressive due its frequent local recurrences and infiltrative behavior. They occur most commonly in the reproductive age group in women. A 37 year old with AA of endometrial polyp, presenting with acute pain abdomen and friable, fleshy mass protruding out of introitus, precipitated by a dilatation and curettage for heavy menstrual bleeding. A clinical diagnosis of fibroid polyp with acute red degeneration was considered. There was a spontaneous expulsion of fleshy mass. HPE showed AA with features of torsion. MRI showed T2 heterogenous hyperintense mass lesion of 9 x 3 x 3.9 cm pedunculated polypoidal arising from upper anterior uterine wall. Hysterectomy specimen confirmed HPE findings of AA. Radiological studies and pathological evaluation aids in the diagnosis and planning of appropriate treatment of AA. Close and long term follow up of these patients should be emphasized due to high rate of local recurrence

Modified biophysical profile in antepartum fetal surveillance of high risk pregnancies

Background: Fetal biophysical profile is a well-established method of antepartum surveillance in high risk pregnancy. Classical biophysical profile with all parameters (fetal breathing movements, fetal tone, fetal gross body movements, amniotic fluid volume and non-stress test) needs two phase testing by ultrasound and external Doppler monitor to record fetal heart rate, is more cumbersome, time consuming and expensive.Methods: This study was a prospective clinical study which consisted of 70 patients having pregnancy with high risk factors. The patients were evaluated with the modified biophysical profile consisting of NST recording for 20mins, followed ultrasound assessment of amniotic fluid volume, using four quadrant technique.Results: When the Modified biophysical profile is normal, it gives reassurance that the fetal status is good with good perinatal outcome. When the MBPP is abnormal there is increased incidence of perinatal morbidity as well as mortality.Conclusions: Modified biophysical profile is an effective primary antepartum fetal surveillance test in high risk pregnancies in predicting perinatal outcome