Caesarean delivery on maternal request (CDMR): clinical and ethical dilemma

Now a days, in developing countries like India, one of the most common contributing factor for increasing caesarean section rate is CDMR (Caesarean delivery on maternal request). Incidence of CDMR reached upto 18 percent of total caesarean deliveries worldwide. The issue of CDMR is ongoing bioethical debate which highlights the struggle to balance patient autonomy with duty of obstetrician to uphold the principle of beneficence, non maleficence and justice. Our mission should be to promote safe, effective and satisfying maternity care for all women and their families through research, education, expertise and advocacy

Misplaced intra uterine devices: a rare case of vaginal entrapment

Intra uterine devices (IUD) are the second most common accepted methods of contraception worldwide after sterilization. It is a long acting reversible contraceptive (LARC) which is now being promoted as a simpler, safer and effective method of contraception for those women who do not want a permanent method of contraception. Missing thread is the most common complaint seen within 6 weeks of insertion and may be the only presentation of misplaced IUD. Most women who spontaneously expel the IUD are unaware of the situation. We are presenting a case of misplaced IUD which was partially expelled and got embedded in the vagina which is a rare site of misplaced IUD

Breastfeeding-Prevent the Preventable

Background: Breastfeeding is the best way of providing ideal food for growth and development of infants. There is urgent need for counselling of mothers in antenatal and postpartum period to promote effective breastfeeding practices. The aim of this study was to assess the knowledge, attitude and practices of breastfeeding among postnatal mothers admitted in inpatient department of obstetrics and gynaecology of Babu Jagjivan Ram Memorial hospital.Methods: 200 postnatal mothers were enrolled using random sampling method and data collection was done by face to face interview using structured questionnaire.Results: Most women (42.5%) belonged to age group (21-25 years), were multiparous (60.5%) and belonged to joint family. All of them were housewives, had vaginal delivery and belonged to lower socioeconomic status. Most women knew the importance of exclusive breastfeeding, early initiation, colostrum and feeding on demand. 16% women gave pre lacteal feed most common being honey. False cultural belief as discontinuing breastfeeding while being sick, and menstruating is still prevalent in the society. However according to 93% women breastfeeding decreases family expenses. Few women are still hesitant in breastfeeding in public places and find it as an interference to sexual life. Practices of breast feeding in the form of knowledge of proper attachment and latching techniques was found to be very poor in this study.Conclusions: Most mothers had good knowledge (49%), good attitude (76%) but only 5% women had good practices of breastfeeding

Platelet transfusion in pregnancy: clinical profile and pregnancy outcome

Background: Thrombocytopenia, being second important hematological disorder of pregnancy can result in maternal and neonatal morbidity and mortality in some women. Some of these disorders are not associated with adverse pregnancy outcomes while in others it is associated with maternal and neonatal morbidity and mortality. So this study was conducted to evaluate the various causes of thrombocytopenia associated with platelet transfusion and its effect on maternal and neonatal outcome.Methods: It is a retrospective data analysis of 70 peripartum women admitted in a tertiary level hospital with thrombocytopenia, requiring platelet transfusion over a period of 9 months (January 2013 to September 2013). Patients were analyzed for the cause of thrombocytopenia, requirement of platelet transfusion, additional treatment, duration of hospital stay and maternal and neonatal morbidity and mortality.Results: In this study, pre-eclampsia and HELLP was present in 37.1% (n=26) of women requiring platelet transfusion while obstetrical hemorrhage (APH, PPH and Rupture uterus), combined iron deficiency anemia and infective causes accounted for 27.1% (n=19), 17.1% (n=12) and 15.7% (n=11) of women respectively. One case each of APLA and idiopathic thrombocytopenia was seen. 70% of women had to stay in hospital for more than 5 days. Four women expired and the incidence of morbidities was 73.1%. Prematurity was present in 41.1% neonates and three expired in nursery. Neonatal morbidity and mortality was not affected by maternal thrombocytopenia.Conclusions: Thrombocytopenia associated with pathological conditions like HELLP, dengue and malaria were associated with profound maternal and neonatal morbidity

Meditation and Yoga in pregnancy: maternal and fetal impact

Background: Yoga is a practice which amalgamates the emotional, mental, physical and spiritual aspects of the human body through physical postures(asanas), breathing exercises (pranayama), concentration and meditation (dharana and dhyana). Evaluation of databases suggests a positive role of yoga in pregnancies associated with depression, anxiety and lumbosacral pain and also in reducing antepartum complications and pain score during labor. These beneficial effects of yoga are suggested but more systematic researches are required to validate it. With the background of above researches, we undertook the study to evaluate the effect of prenatal yoga and meditation on maternal and fetal outcomes. Aim of the study was to determine the effect of antenatal meditation and yoga on obstetric and fetal outcome. Methods: This was a prospective randomized trial conducted in the antenatal OPD of the institute. Sixty primigravida women with low risk pregnancy between 18 to 26 weeks gestation were included in the trial.They were randomly divided into two equal groups;  interventional group underwent meditation and yoga sessions of 30 minutes twice in a week till delivery. Obstetric outcomes including gestational age, antepartum and intrapartum complications, cord blood cortisol levels at delivery and neonatal outcomes were recorded. Results: Thirteen women went post-dated as compared to 3 in the interventional group which was statistically significant (p=0.0003). APGAR scores of neonates in the interventional group showed a highly significant improvement with p=0.0013 as compared to the control group. Cord blood cortisol levels were higher than 10 ng/ml in 16 women in the control group compared to 7 in the group who performed yoga and meditation with p=0.01. NICU admissions were significantly more (p=0.002) in the control group. Conclusions: Meditation and yoga during pregnancy improves maternal and neonatal outcomes

Leprosy in Pregnancy: Obstetric Diligence is the Key

Leprosy in pregnancy is a rarely encountered event. Out of the 2000 patients detected of leprosy annually, two to three are pregnant women and majority of them are diagnosed in the third trimester. We, hereby, report a case of borderline tuberculoid leprosy with Type I lepromatous reaction in a 26-year-old pregnant woman in early second trimester with a large raised red coloured lesion over the forehead and six other small lesions involving the trunk and limbs with reduced sensory perception over involved skin. Occurrence of leprosy in an obstetric patient belonging to low prevalence area of India is infrequent especially in the post elimination era. However, we do need to have a high index of suspicion in lesions suggestive of the disease