Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at tertiary level hospital of Uttarakhand

Background: Cardiac disease is the most common cause of indirect maternal deaths and most common cause of death overall. It complicates 1% of all maternal deaths. The maternal and neonatal risks associated with pregnancy in women with cardiac disease receiving comprehensive prenatal care have not been well defined. Objective of present study was to evaluate the burden of cardiac diseases in pregnancy in our hospital, their clinical presentation, type of cardiac lesion, associated complications, maternal and fetal outcome.Methods: A retrospective study was conducted in Obstetrics and gynecology department at Shri Guru Ram Rai Institute of medical and health sciences, Dehradun from January- 2013 to December-2015. All patients with cardiac diseases during pregnancy or developed during postpartum period were included in the study. Detailed Demographic profile of patients, mode of delivery, perinatal outcome, associated antenatal, intranatal and postnatal complications were analyzed in detail.Results: There were 37 patients with cardiac disease during pregnancy in our study period. Out of these 32.4% were diagnosed during current pregnancy. Rheumatic heart diseases were seen in 54.05% patients and congenital heart disease seen in 35.1%. out of these 81.1% patients belonged to NYHA class I and II and 18.9% patients in class III & IV. Majority of patients (78.3%) had vaginal delivery. We observed 5.4% maternal mortality and 2.7% of neonatal mortality rate.Conclusions: Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications. Multidisciplinary approach involving cardiologist, obstetrician and neonatologist improves fetomaternal outcome

Comparison between intravenous iron sucrose versus oral iron therapy in pregnant women with nutritional anemia: a prospective study

Background: In India, the prevalence of anemia during pregnancy may be as high as 80%. The objective of this study was determining the efficacy of intravenous iron sucrose and oral iron in nutritional anemic antenatal patients, presenting at Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun, Uttarakhand, India.Methods: The study was carried out in the department of obstetrics and gynecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India single center study was performed on 400 antenatal patients with nutritional anemia gestational age 14 to 36 weeks. Patients were divided in two groups A and B. Group A was treated with intravenous iron sucrose and group B was treated with oral iron sulfate.Results: There was significant improvement in the various hematological parameters in IV sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in IV sucrose group.Conclusions: This study has shown a significant improvement in the iron sucrose group. Iron sucrose is safe and well tolerated

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Background: The acronym HELLP was coined by Loise Weinstein in 1982 to describe a syndrome consisting of hemolysis (H) elevated liver enzyme (EL) and low platelets (LP). The purpose of the study was to detect and evaluate the feto maternal outcome of HELLP and partial HELLP syndrome among preeclamptic patients.Methods: Study analyzed fetal and maternal outcome in 110 patients with HELLP syndrome and 89 patients with partial HELLP Syndrome and compared with 1100 patients of preeclampsia only.Results: 1210 patients were included in this study. Out of these patients HELLP syndrome, partial help syndrome and preeclampsia were 10% and 7.3% and 82.7%. The systolic BP, gestational age at admission and at delivery, hematological and biochemical parameters, vaginal delivery and type of anesthesia were significantly different in HELLP syndrome and partial HELLP syndrome than in pre eclampsia group. There was significant difference in perinatal outcome like birth weight, IUD, neonatal death and NICU-admissions. Eclampsia was significantly increased in HELLP syndrome and partial HELLP syndrome.Conclusions: HELLP and partial HELLP syndrome must be diagnosed as soon as possible. Partial HELLP and HELLP syndrome are equally dangerous. HELLP Syndrome is severe then preeclampsia in terms of maternal and perinatal outcome

Conservative management of Cesarean Scar Ectopic Pregnancy

Caesarean scar pregnancy (CSP) refers to a gestational sac that has implanted in the scar of a previous caesarean delivery due to incomplete healing of the caesarean scar, as may be seen in CSP occurring few months of caesarean delivery. It is the rarest kind of ectopic pregnancy which is usually misdiagnosed leading to life threatening complications, like rupture with haemorrhage and hemodynamic collapse. Therefore, a high index of suspicion is required to diagnose CSP. Here, we present two case reports of CSP presenting at 6 and 7 months after cesarean delivery, respectively. The first one presented to us as a case of incomplete abortion following medical abortion, and the second patient was referred to us as a case of cervical pregnancy. A decrease in the primary caesarean rate and prolongation of the inter-pregnancy interval is essential to avoid CSP

A prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital

Background:In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section.  Methods:A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions.Results:In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%.  Conclusion:Immediate postpartum IUD insertion is a safe, convenient and effective method

Displaced intrauterine contraceptive device: a prospective study at tertiary level hospital of Uttarakhand, India

Background: The IUCD is a common method used for contraception. It is associated with complications like bleeding, perforation and migration to neighbouring organs as broad ligament, urinary bladder or omentum.Methods: A prospective study was carried out at SGRRIM and HS, Dehradun over a period of two years between January 2014 to December 2015. A total of 38 patients with a diagnosis of displaced IUCD were included for their detailed demographic profile, presenting complaints, required diagnostic and therapeutic modalities.Results: Ultrasound emerged as the preferred method to locate the displaced device. Majority of displaced IUCD were intrauterine (86.9%) and Hysteroscopy guided removal was the preferred method of removal regarding technique, safety, and cost and recovery time.Conclusions: Responsibility of care provider does not end at insertion of IUCD. Follow up is equally important. Every case of missing IUCD must be investigated carefully to rule out the possibility of uterine perforation

A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state

Background: Instrumental vaginal delivery is an age-long obstetric practice used to expedite vaginal delivery or avert recourse to caesarean delivery. Objective of the study is to compare maternal and neonatal outcomes of vacuum and forceps application in instrumental vaginal delivery.Methods: This is a retrospective observational study. Retrospective study of 70 consecutive ventouse and 70 consecutive forceps deliveries was done. Maternal and neonatal morbidity were compared in terms of perineal laceration, episiotomy extension, postpartum hemorrhage, apgar score, neonatal injuries and NICU admissions.Results: Maternal morbidity in terms of periurethral tear, second and third degree perineal tear were significantly more in forceps group (p=0.0332 and p=0.0173 respectively). However neonatal outcomes were found to be similar in both types of instrumental deliveries.Conclusions: Ventouse should be preferred over forceps whenever there is an indication for instrumental delivery (except in fetal distress) as it is associated with less maternal trauma and most of the neonatal morbidities were insignificant in comparison with both instruments

The need for multisectoral food chain approaches to reduce trans fat consumption in India.

BACKGROUND: The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. METHODS: Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). RESULTS: Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. CONCLUSIONS: A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production

Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India: A Case Study of the Food Environments of Rural Villages and an Urban Slum.

OBJECTIVE: To describe the food environment in rural villages and an urban slum setting in India with reference to commercially available unbranded packaged snacks and street foods sold by vendors, and to analyze the type and quantity of fat in these foods. DESIGN: Cross-sectional. SETTING: Two low-income villages in Haryana and an urban slum in Delhi. PARTICIPANTS: Street vendors (n = 44) were surveyed and the nutritional content of snacks (n = 49) sold by vendors was analyzed. MAIN OUTCOME MEASURES: Vendors' awareness and perception of fats and oils, as well as the type of snacks sold, along with the content and quality of fat present in the snacks. ANALYSIS: Descriptive statistics of vendor survey and gas chromatography to measure fatty acid content in snacks. RESULTS: A variety of snacks were sold, including those in unlabeled transparent packages and open glass jars. Mean fat content in snacks was 28.8 g per 100-g serving in rural settings and 29.6 g per 100-g serving in urban settings. Sampled oils contained high levels of saturated fats (25% to 69% total fatty acids) and trans fats (0.1% to 30% of total fatty acids). CONCLUSIONS AND IMPLICATIONS: Interventions need to target the manufacturers of oils and fats used in freshly prepared products to improve the quality of foods available in the food environment of low-socioeconomic groups in India