8 research outputs found
Vaginal birth after caesarean section: why and how?
Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC
Suicidal attempt by woman in labor
Suicidal ideation during delivery is extremely rare. Very few cases have been reported in the literature. Unwanted pregnancies, pre-existent mental disorders, substance abuse or addictions, marital dis-harmony, fetal demise or stillbirths have been documented as associated factors in reported cases of suicidal attempts by women in labour. Women tried taking overdose of sedative pills or have attempted hanging, drowning or jumping from hospital terrace. Lack of prenatal education, suboptimum use of labour analgesia, ill-treatment by health professional and relatives have been the contributory factors for suicidal ideation during pregnancy and labour. We report a rare case of attempted suicide by woman in active labour. She tried to cut the forearm and wrists with the help of razor blade used for preparation of part in preparation room attached to the labour room. The situation was recognized early by vigilant nurse on duty. The woman was resuscitated, treated, and counselled by psychiatrist before discharge from the hospital.
Comparative study of peri-operative outcome following laparotomy versus laparoscopic technique of abdominal hysterectomy for benign gynaecological lesions
Background: Laparoscopic technique of hysterectomy is becoming increasingly popular in developing and developed world. Laparoscopic hysterectomy is a minimal access procedure that allows patients to recover faster. The study was undertaken to assess the impact of two abdominal techniques (laparoscopic and conventional laparotomy) on various variables like operative time, hospital stay, complications and convalescence period.Methods: An observational longitudinal study was carried out at tertiary care centre. Two hundred and ten women, as per inclusion and exclusion criteria, who had undergone abdominal hysterectomy for benign uterine pathology, either by laparotomy (Group A) or by laparoscopic technique (Group B) during study period were included. Data was analyzed and compared by using different variables between two methods of hysterectomy, using percentages and Chi square test for normal distribution. P value less than 0.05 was considered significant.Results: The mean duration of surgery was 100 minutes in group A and 175 minutes in Group B. There were two cases (1.90%) of minor injury to urinary bladder in Group A and one case (0.95%) of thermal injury to urinary bladder in Group B. The mean blood loss was around 240 ml and 70 ml in Group A and B respectively. The need for postoperative analgesia was observed in 100% cases from Group A and 38.09% from group B. The average duration required for out of bed ambulation was 25 hours and 14 hours in Group A and B respectively. The mean hospital stay in group A and B was 7.5 days and 3.5 days respectively.Conclusions: Following laparoscopic hysterectomy, women had less morbidity, less need for post-operative pain relief, had early ambulation, short hospital stay and early resumption of routine activities at home as compared to women who had undergone abdominal hysterectomy by conventional method
Pattern of utilization of blood and blood components in obstetrics at tertiary care hospital
Background: Obstetric emergencies occur suddenly and unexpectedly. Blood transfusion becomes one of the live saving measures in such situations. Severe anaemia due to nutritional deficiency, obstetric haemorrhage either during pregnancy, labour or in postpartum period are the commonest indications for blood transfusion worldwide. Blood bank services play important role in saving lives in obstetric emergencies. Health institutions must carry out internal blood transfusion audits to reassure optimal and judicious use of blood and blood components.Methods: Analysis of 755 Obstetric patients requiring blood transfusion in eighteen months period was done to find out the incidence and indications for blood transfusion at tertiary care hospital.Results: Overall, 5.33% of obstetric admissions required transfusion of blood or its components. Severe anaemia (36.55%), accidental haemorrhage (20.92%), postpartum haemorrhage (8.34%), placenta praevia (5.03%) and caesarean section (10.33%) were the common indications for blood transfusion. In more than 65% cases, two or three unit of blood were transfused. In majority of cases (96%) components were used.Conclusions: Blood transfusion helped to save many lives in the present study. Severe anaemia and obstetric haemorrhage of varied aetiology were the common indications for blood transfusion. Component therapy helped to correct specific deficiency. Voluntary blood donation should be encouraged in the younger generation to keep adequate stock of blood in blood bank for emergency use. Preventive measures like improving dietary iron intake and prophylactic iron therapy will go a long way in reducing the need for blood transfusion in Obstetrics
Changing pattern of birth weight over a decade in rural India
Background: Birth weight is one of the important determinants of neonatal wellbeing. Birth weight has many determinants that mainly include maternal nutritional status and the term of gestation. Low birth weight is associated with high neonatal and childhood mortality and morbidity. Over the years the birth weight is showing the increasing trend in developing countries like India. The study aimed at finding out the changing pattern of birth weight over a decade in rural India.Methods: A retrospective analysis of over 45,000 births that took place in Tertiary care hospital from year 2008-2017was undertaken. The socio economic determinants of birth weight were studied.Results: The incidence of low birth weight declined from 47 percent to 35 percent over ten years. The mean rise in birth weight in ten years was observed in both male (176 grams) and female (151grams).The incidence of very low birth and extremely low birth was found declined. There was positive co relationship between improved birth weight and improved socio economic status, delay in age at marriage, higher maternal weight gain during pregnancy, improved pre pregnancy nutritional status of women.Conclusions: There is steady decline in incidence of low birth weight over last ten years in study area. Improved maternal health, better nutrition, improved quality of antenatal care and various efforts and actions from the government side have contributed in improving the birth weight
Applicability of NDVI temporal database for western Himalaya forest mapping using Fuzzy-based PCM classifier
Information about the spatial distribution of the different tree species is important for sustainable ecosystem management and planning in the western Himalaya. Remote sensing has proved to be useful to assess the spatial and qualitative distribution of vegetation cover over large areas. Present investigation has been carried out to discriminate three different gregarious forest types, i.e. sal (Shorea robusta), chir pine (Pinus roxburghii) and oak (Quercus spp.) in part of western Himalaya. The use of existing classical classifiers has limitation in classification of overlapping classes and in mixed vegetation formations. To overcome this, fuzzy-based possibilistic C-means (PCM) classifier was used to separate the classes. Temporal Landsat 8 imagery (representing the different phenological states) has been used to classify the three forest types. Phenological information and spectral variability were used to select the best suitable dates, i.e. temporal NDVI to use in PCM classifier. It was observed that the satellite data of March, April, May and November were the best suited for discrimination of sal, pine and oak. The overall accuracy of the classified image was found to be 86%. This method can be used for automated extraction of different species in mixed vegetation formations with appreciable accuracy
Comparative study of peri-operative outcome following laparotomy versus laparoscopic technique of abdominal hysterectomy for benign gynaecological lesions
Background: Laparoscopic technique of hysterectomy is becoming increasingly popular in developing and developed world. Laparoscopic hysterectomy is a minimal access procedure that allows patients to recover faster. The study was undertaken to assess the impact of two abdominal techniques (laparoscopic and conventional laparotomy) on various variables like operative time, hospital stay, complications and convalescence period.Methods: An observational longitudinal study was carried out at tertiary care centre. Two hundred and ten women, as per inclusion and exclusion criteria, who had undergone abdominal hysterectomy for benign uterine pathology, either by laparotomy (Group A) or by laparoscopic technique (Group B) during study period were included. Data was analyzed and compared by using different variables between two methods of hysterectomy, using percentages and Chi square test for normal distribution. P value less than 0.05 was considered significant.Results: The mean duration of surgery was 100 minutes in group A and 175 minutes in Group B. There were two cases (1.90%) of minor injury to urinary bladder in Group A and one case (0.95%) of thermal injury to urinary bladder in Group B. The mean blood loss was around 240 ml and 70 ml in Group A and B respectively. The need for postoperative analgesia was observed in 100% cases from Group A and 38.09% from group B. The average duration required for out of bed ambulation was 25 hours and 14 hours in Group A and B respectively. The mean hospital stay in group A and B was 7.5 days and 3.5 days respectively.Conclusions: Following laparoscopic hysterectomy, women had less morbidity, less need for post-operative pain relief, had early ambulation, short hospital stay and early resumption of routine activities at home as compared to women who had undergone abdominal hysterectomy by conventional method