A comparative study of the effects of programmed labour protocol and expectant management of labour

Background: Childbirth is one of the most wonderful and anticipated moments in a woman’s life. But the excruciating pain associated with labour makes it a really undesirable one. Objective of present study was to compare the effects of programmed labour protocol and expectant management of labour.Methods: A clinical study was conducted on 120 low risk primigravida, 60 of them were managed with programmed labour protocol (group A) and the rest 60 (group B) were managed expectantly. Primary parameters were pain relief and changes in the mean duration of labour. Secondary parameters were changes in the amount of blood loss and APGAR score of delivered babies.Results: Among group A, 25% had good pain relief, 60% had moderate pain relief, 15% had mild pain relief and 0% had no relief of pain. The mean duration of labour from active phase through third stage in group A was 234.27±50.38 minutes and 304.58±41.72 minutes in group B. The average blood loss during labour was 89.33±19.06 ml in group A and 142.15±32.27 ml in group B. In group A, 4 babies had APGAR score less than 7 at 1 minute, but had score more than 7 after 5 minutes following resuscitation. In group B, 9 babies had APGAR less than 7 at 1 minute. Of these, 6 babies had score more than 7 after 5 minutes following resuscitation. 3 babies had score less than 7 even after 5 minutes and were shifted to neonatal ICU.Conclusions: Programmed labour protocol is an effective method to reduce the deleterious effects of labour on both mother and foetus.

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries

A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility

Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomized controlled trial

Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output

Community perception and utilization of services for the severe wasted children aged 6–59 months in the Forcibly Displaced Myanmar Nationals and their nearest host communities in Bangladesh: a qualitative exploration

IntroductionThere is a paucity of data on community perception and utilization of services for wasted children in Forcibly Displaced Myanmar Nationals (FDMN) and their nearest host communities.MethodsWe conducted a qualitative study to explore community perceptions and understand the utilization of services for severely wasted children among the FDMN and their nearest host communities in Teknaf, Cox’s Bazar. We carried out 13 focus group discussions and 17 in-depth interviews with the caregivers of the children of 6–59 months, and 8 key informant interviews.ResultsCaregivers’ perceived causes of severe wasting of their children included caregivers’ inattention, unhygienic practices, and inappropriate feeding practices. However, the context and settings of the FDMN camps shaped perceptions of the FDMN communities. Caregivers in both the FDMN and host communities sought care from healthcare providers for their children with severe acute malnutrition (SAM) when they were noticed and encouraged by their neighbors or community outreach workers, and when their SAM children suffered from diseases such as diarrhea and fever. Some caregivers perceived ready-to-use therapeutic food (RUTF) as a food to be shared and so they fed it to their non-SAM children.DiscussionCaregivers of the children having SAM with complications, in the FDMN and host communities, were reluctant to stay in stabilization centers or complex respectively, due to their households’ chores and husbands’ unwillingness to grant them to stay. The findings of this study are expected to be used to design interventions using locally produced RUTF for the management of SAM children in the FDMN, as well as to inform the health sector working on SAM child management in the host communities

Genotyping of cattle based on kappa-casein and alpha-lactalbumin genes

211-218Milk yield, protein and fat content are regulated by milk protein genes. However, genetic makeup of different milk protein genes of cattle available in Bangladesh is not known. This study determined the genetic variants of kappa-casein (κ-CN) and α-lactalbumin (α-LA) gene in cattle. DNA was extracted from 50 blood samples collected from indigenous and crossbred cattle. Polymerase chain reaction (PCR) was performed with gene specific primers. For genotyping PCR products of κ-casein gene was digested with HindIII and HaeIII restriction enzymes while the PCR products of α-LA gene was digested with Bsp1286I. Overall from all the tested samples we could amplify specific DNA viz. 935 and 429 bp for κ-CN and α-LA genes, respectively. In case of κ-CN gene 30 samples were analyzed for genotyping and of these 66.67, 30.00 and 3.33% samples were genotyped as AA, AB and BB, respectively. AA genotype was found dominant for κ-CN gene. Allele frequency for A was 82%. AA genotype was found higher in indigenous (0.366) than crossbred (0.30) animals. Homozygous BB genotype was not found in crossbred animals. For α-LA gene 50 samples were genotyped and all the samples (100%) were belonging to AA genotype. Three genetic variants of κ-CN gene viz. AA, AB & BB and one genotype (AA) of α-LA gene were detected in tested samples. Alleles of both the genes are reported to be associated with higher milk, protein, and fat yields

A comparative study of intra-cervical foley’s catheter and PGE2 gel for pre-induction cervical ripening

Background: Cervical ripening, before induction of labour, is needed to increase the success of labour induction, to reduce complications and to diminish the rate of cesarean section and duration of labour. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extra amniotic Foley catheter balloon and to compare it with intra-cervical prostaglandin E2 (PGE2) gel. The objective of this study was to the success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE2 gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE2 gel in cervical ripening for the successful induction of labor.Methods: A randomized, comparative study was conducted in the department of obstetrics and gynaecology, Assam Medical College and Hospita, Dibrugarh, during a period of one year from July 2014 to June 2015. 200 patients at term with a Bishop's score ≤3 with various indications for induction were randomly allocated to receive (100 pts) intra-cervical Foley's catheter or PGE2 gel (100 pts). After 6 hours post induction, Bishop's score was noted, labor was augmented if required. Statistical analysis was done using Chi square test and t test.Results: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.10±1.55 and 5.14±1.60 for Foley's catheter and PGE2 gel, respectively, P<0.001; However there was no significant difference between the two groups. There was no significant difference in the side effects and caesarean section rate in both groups. The induction to delivery interval was 16.01±5.50 h in group F and 16.85±3.81 h in group P (p = 0.073). Apgar scores, birth weights and NICU admissions showed no significant difference between the two groups.Conclusions: This study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening

Evaluation of factors influencing maternal and fetal outcome in eclampsia in a tertiary care hospital

Background: Eclampsia is a major cause of maternal morbidity and mortality in developing countries. Evaluation of factors contributing to occurrence of eclampsia and death of eclamptic mother is of paramount importance.Methods: A retrospective study of two years period was done in Assam Medical College, Dibrugarh. Pregnant woman diagnosed as eclampsia during this period were included. The events and outcome of mother and fetus were recorded and analysed.Results: During this two years period the total number of deliveries were 19150, total maternal death 180, eclampsia case 406 and maternal death due to eclampsia was 29. The incidence of eclampsia was 2.12%, case fatality rate 7.14%, stillbirth 16.29% and caesarean delivery in eclamptic mother was 30%. Pulmonary edema (34.48%) and anaemic heart failure (27.58%) were responsible for majority of the maternal death.Conclusions: Eclampsia is still a major cause of maternal death. Occurrence of eclampsia can be reduced by optimizing antenatal care of pregnant woman of low socioeconomic class. Improvement in capacity of intensive care unit and blood bank are essential prerequisite to reduce maternal death due to eclamptic mother

Evaluation of factors influencing maternal and fetal outcome in eclampsia in a tertiary care hospital

Background: Eclampsia is a major cause of maternal morbidity and mortality in developing countries. Evaluation of factors contributing to occurrence of eclampsia and death of eclamptic mother is of paramount importance.Methods: A retrospective study of two years period was done in Assam Medical College, Dibrugarh. Pregnant woman diagnosed as eclampsia during this period were included. The events and outcome of mother and fetus were recorded and analysed.Results: During this two years period the total number of deliveries were 19150, total maternal death 180, eclampsia case 406 and maternal death due to eclampsia was 29. The incidence of eclampsia was 2.12%, case fatality rate 7.14%, stillbirth 16.29% and caesarean delivery in eclamptic mother was 30%. Pulmonary edema (34.48%) and anaemic heart failure (27.58%) were responsible for majority of the maternal death.Conclusions: Eclampsia is still a major cause of maternal death. Occurrence of eclampsia can be reduced by optimizing antenatal care of pregnant woman of low socioeconomic class. Improvement in capacity of intensive care unit and blood bank are essential prerequisite to reduce maternal death due to eclamptic mother