Prophylaxis of post-operative nausea and vomiting in major obstetrics surgeries: a comparative study between palanosetron and neit guam point stimulation

Background: Post-operative nausea and vomiting (PONV) prophylaxis is an important component in providing safe anesthesia in antenatal women. Pharmaceutical interventions like metoclopramide and 5-HT3 antagonists are the current treatment of choice for PONV prophylaxis. However newer drugs are less easily available and more expensive and there is always a concern regarding the effects on fetus. The objective of the study was to evaluate and compare efficacy and safety of antiemetic effects of stimulation of neitguam point stimulation with palonosetron for PONV prevention in obstetric surgeries.Methods: A randomized control trial was done on 150 patients with ASA grade I-II, between ages of 18-45 undergoing obstetric surgery under spinal anesthesia at a tertiary care center. The patients were randomly allocated into two groups using a random sequence. In group I, 76 patients received 75μg palonosetron IV 5 minutes prior to induction. Group II contained 74 patients in which neitguam point stimulation was done by acupressure (wrist band) . All patients were followed till 24 hours post-surgery and incidence of PONV was recorded intra-operative and till 30 minutes, at 2 hours, 6 hours and 24 hours post-surgery. The results were analyzed using SPSS software and chi square test.Results: Both neit guam point stimulation and palanosetron were effective in prevention of PONV (p=0.32). neit guam point stimulation can be considered as effective as palonosetron in prevention of nausea. The cost analysis signifies the advantage of neit guam point stimulation.Conclusions: Neit guam point stimulation is a safe and highly effective method to prevent PONV. It can help in bringing down cost and can be easily made at the small primary healthcare centers and trained midwives

A rare case of spontaneous expulsion of a very large fibroid

Leiomyomas are the most common benign tumour of uterus and affect 5-20% of females. Approximately 5% of leiomyomas are of submucous types. Usually they are asymptomatic. Symptomatic leiomyomas are managed with either medical therapy or surgical management in the form of myomectomy or hysterectomy. We are reporting an interesting and rare case of a large submucous fibroid which was spontaneously expelled per vaginally during clinical examination

A comparison of visual analog scale and Wong Baker facial pain scale for pain measurement in post lower caesarean section case

Background: There is various pain measurement tools commonly used to measure pain intensity. However, no single standard exists for quantifying pain in post caesarean section. In our study, we have divided two groups according to use of pain scales and found one scale is more useful than the other in the post caesarean cases.Methods: The study has been conducted in upper India Sugar Exchange Maternity Hospital department of obstetrics and gynaecology, GSVM Medical College, Kanpur for the duration of 18 months starting from February 2014 to August 2015 on 100 women who were operated for lower caesarean section (LSCS) under spinal anesthesia. Women were divided into two groups according to pain scales visual analog scale (VAS) and Wong Baker facial pain scale (WBFPS). All these selected women were studied in details with regards to clinical history, general examination and local examination. Women from respective group were asked to rate their pain intensity on these pain scales. SPSS was used to analyze the data statistically.Results: Using analysis of variance, we found that there is significant relationship within the groups having different parameters at different time interval at different probability level. There is a mutual relationship between the groups at different probability level.Conclusions: The study shows that VAS is the most sensitive and reliable tool to measure post LSCS pain as compared to WBFPS and minimum consumption of rescue analgesia in VAS group to maintain minimum pain score to keep the patient pain free

A study to compare the efficacy of ormeloxifene with norethisterone and conventional oral contraceptive pills

Background: Dysfunctional uterine bleeding is one of the commonest conditions for which patients seek advice in gynaecological outpatient department. Objective of present study was comparative evaluation of ormeloxifene with norethisterone and conventional oral contraceptive pills in dysfunctional uterine bleeding.Methods: This randomized study was conducted on 300 cases of dysfunctional uterine bleeding and they were distributed into three groups. group I were given ormeloxifene 60 mg biweekly for first 12 weeks followed by 60 mg weekly for next 12 weeks. Group II were given norethisterone 5 mg BD from 5th to 25th day of cycle and group III were given oral contraceptive pills from 5th to 25th day of cycle.Results: Subjective improvement was outstanding in group I in comparison to other two groups. There was also statistically significant increase in Hb g/dl and statistically significant decrease in endometrial thickness.Conclusions: Ormeloxifene was found to be superior to both norethisterone and conventional OCPs

To study the painless labour by epidural analgesia and its effects on cardiotocographic parameters and labour

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labor. The objective was to study the effect of epidural analgesia on cardiotocographic parameters and relief of pain, effect on course of labor and its outcome in terms of duration, any complications and mode of delivery.Methods: A prospective observational study was done on 100 subjects. They were randomly divided into study and control groups, study group (50) were given epidural analgesia after 3cm dilatation while control group (50) did not receive any analgesic. NST was taken before and after analgesia, course of labor, duration of labor, mode of delivery.Results: The study shows no significant effect of epidural analgesia on the duration of labor, mode of delivery, and CTG parameters.Conclusion: Epidural analgesia group shows better pain relief. It favors normal course of labor, no effect on cardiotocographic parameters. Subjects in study group were more satisfied

Visual inspection with acetic acid for cervical cancer screening in a tertiary health care centre

Background: Cervical cancer is one of the most prevalent malignant neoplasms among women in developing countries. Invasive cervical cancer is preceded by a long premalignant phase known as cervical intraepithelial neoplasia (CIN). The goal of cervical cancer screening is the detection and treatment of precancereous lesions before cancer develops. The objective of the study was to assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center , to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low resource ones.Methods: This was a prospective study of 1520 asymptomatic women, carried out in 2014-2015. The study was performed at a tertiary care center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy.Results: More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P =0.0001). There were 27 women with histologic cervical intraepithelial neoplasia grade 1 (CIN1); of these, 12 were detected by Pap and 15 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN2–3) was confirmed in a total of 11 cases; Pap detected 4 of the cases and VIA 9 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.5% for VIA and 6.2% for Pap (P = 0.5). Most importantly, while only 2.8% of patients with a positive VIA were lost to follow-up before colposcopy that was true for 26.5% of the women with a positive Pap smear (P < 0.0001).Conclusions: VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology based screening

Predicting risk and prognosis of preeclampsia by evaluating platelet indices

Background: Preeclampsia is an obstetric disorder affecting 2-8% pregnancies globally and 8-10% pregnancies in India. The study was conducted to evaluate platelet count, mean platelet volume and platelet distribution width as potential predictor of preeclampsia. It also aimed to see if these platelet indices have a prognostic significance in determining the preeclampsia severity.Methods: A prospective study was conducted on 120 pregnant women at 20 to 24 weeks of gestation with singleton pregnancy. At monthly intervals CBC (complete blood count) was done from 20 to 24 weeks till delivery and 7 days after delivery. Data with increasing gestation were collected, analysed and expressed as mean, standard deviations and correlation coefficients.Results: We observed significant decrease in PC and increase in MPV and PDW in patients with preeclampsia compared to normotensive patients. We also observed that it was more significant in severe preeclampsia than non-severe preeclampsia. The r value of PC for normotensive, non-severe and severe preeclampsia was -0.58, -0.59 and -0.94 respectively. The r value of MPV for normotensive, non-severe and severe preeclampsia was 0.89, 0.97 and 0.98 respectively. The r value of PDW for normotensive, non-severe and severe preeclampsia was 0.98, 0.98 and 0.99 respectively.Conclusions: Patients with preeclampsia are more likely to have changes in PC, MPV and PDW, which can be observed in early pregnancy. Thus, estimation of PC, MPV and PDW can be considered as an early, simple and cost-effective procedure in the estimating the severity of preeclampsi

Obstetric hysterectomy, still a life saving tool in modern day obstetrics: a five year study

Background: Objective of current study was to study the indications and maternal outcome of emergency obstetric hysterectomy and its role in reduction of maternal morbidity and mortality in complicated obstetric cases.Methods: A prospective study of the cases of emergency obstetric hysterectomy performed over a period of five years from 2009 to 2013 was done.Results: During the study period, 105 emergency obstetric hysterectomies were performed giving an incidence of 0.54% .The incidence of hysterectomy following vaginal delivery was 0.54% and that of caesarean hysterectomy was 2.08%. It was most common in the age group 26-35 years (66.66%) and in women of parity 3-4 (71.42%).Rupture uterus was the most common indication accounting for 59.04% cases followed by Atonic PPH (18.09%). Febrile illness and wound infection were the two most common co-morbidities. Maternal mortality was 5.71%.Conclusions: Emergency obstetric hysterectomy is potentially a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable haemorrhage. With the help of prostaglandins, modern policies of active management of labor, timely performance of caesarean section, internal iliac artery ligation, compression sutures etc. obstetric hysterectomy should be made a more rare procedure

Salivary uric acid as a non-invasive marker of early onset preeclampsia

Background: Preeclampsia is one of the most common complications in pregnancy and is a major cause of maternal and perinatal morbidity and mortality. Early prediction of preeclampsia is crucial in proactive management of the patient. Uric acid is a biomarker of hypertension. Methods: A prospective study was done on 200 pregnant females in their first or early second trimester of pregnancy and were followed till one week of delivery or termination of pregnancy. After taking socio-demographic details, detailed medical and obstetric history was taken. Blood pressure of the patients was routinely measured and mean arterial pressure was calculated. Blood and saliva samples were taken and were analysed following standard protocol for serum and salivary uric acid levels respectively. Participants were classified into normotensive and preeclampsia groups depending on the criteria met. Results: Preeclampsia group participants had significantly more adverse and feto-maternal outcomes. Salivary uric acid is a promising diagnostic predictor of preeclampsia in pregnant women by the virtue of being a non-invasive investigation with cut off value 4.86 mg/dl having a sensitivity of 70.8%, specificity of 45.7% and a PPV of 81.3%. Salivary uric acid level and mean arterial pressure were found to be better predictors of preeclampsia as compared to salivary uric acid level. Conclusions: Salivary uric acid is a reliable predictor of preeclampsia in pregnant females in first and early second trimester of pregnancy. Further largescale studies are warranted to establish an accurate cut off value with good diagnostic properties for Indian population

A study to assess knowledge and attitude of antenatal women about maternal nutrition attending a tertiary care centre

Background: Nutrition is the fundamental pillar of human life. All human beings need a balanced amount of nutrients for proper functioning of body system. Inadequate nutrition during pregnancy has a negative impact on the pregnant mother as well as short and long term consequences on the newborn. This study aims to assess knowledge and attitude of antenatal women about maternal nutrition in pregnancy and highlights the need of interventions aimed at promoting awareness about healthy diet during pregnancy in association with various socio demographic factors.Methods: This study was conducted on 850 antenatal women attending the antenatal clinic of UISEMH, Kanpur, Uttar Pradesh, India from August 2015 to February 2016. A 25 point- 10 minute questionnaire was designed to collect information about awareness and myths associated with nutrition in pregnancy from antenatal women.Results: Only 22 % of the women had good knowledge about nutrition during pregnancy and 82% showed willingness to acquire more information about maternal nutrition. Source of information for most pregnant women were immediate family members (41%). Most women were lacking in their knowledge about common local sources of nutrition, adequate weight gain during pregnancy and effects of over and under nutrition.Conclusions: There is need to impart more knowledge to pregnant women about nutrition in pregnancy. More attention should be paid on nutritional guidance among pregnant women especially in young and less well educated women for healthy outcome of mother and babies. This study emphasizes the importance of dietary counselling by attending doctors as an integral part of antenatal care