Impact of gum chewing on recovery of bowel activity after caesarean section

Background: Childbirth is a memorable part in every woman’s life. Each labour experience is unique and calls for a celebration. Objective of this study was to evaluate the effect of gum chewing on recovery of bowel motility after caesarean section.Methods: This prospective randomized controlled trial was conducted on 220 women who had undergone cesarean section and were further sub-divided into two groups of 110 women each Group I (Study group, n=110) in whom chewing gum was advised postoperatively and Group II (Control group, n=110)  who were managed as per standard departmental postoperative feeding protocol.Results: Mean age in Group A women was 24.86±3.89 years and 25.28±3.34 years in Group B. There was no statistically significant difference between the study and control group regarding their age, parity, occupation, LSCS/previous abdominal surgery, type of cesarean section, indications of cesarean section, skin incision, intraperitoneal adhesions. The mean time of bowel sound appearance in Group A was 3.27±0.95 and it was 8.22±2.0 hours in Group B. The mean time of passage of flatus was found to be 9.77±3.21 hours in Group A and 7.15±3.07 hours in Group B. In Group A, the mean time of passage of stools was 18.79±4.23 hours and it was 39.12±6.56 hours in Group B. Mean duration of hospital stay was significantly lesser (3.23±0.60 days) in gum chewing group than in the non-gum chewing group (4.18±1.28 days).  Seventy-six (69.09%) women of Group A needed only one chewing gum before appearance of bowel sound / flatus / feces. Only three women required three chewing gums. Out of 31 cases, who required two chewing gums, five were of previous 1 LSCS and 12 were previous 2 LSCS, thus suggesting delayed return of gut motility in women with > 1 previous LSCS.Conclusions: It was evident that gum chewing, a form of sham feeding is considered as an effective and inexpensive method which hastens the return of gut motility after caesarean section

Current and emerging treatments for uterine myoma – an update

Uterine myomas, the most common benign, solid, pelvic tumors in women, occur in 20%–40% of women in their reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by reassurance and careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas, while surgical treatment should be reserved only for appropriate indications. Hysterectomy has its place in myoma management in its definitiveness. However, myomectomy, rather than hysterectomy, should be performed when subsequent childbearing is a consideration. Preoperative gonadotropin-releasing hormone analog treatment before myomectomy decreases the size and vascularity of the myoma but may render the capsule more fibrous and difficult to resect. Uterine artery embolization is an effective standard alternative for women with large symptomatic myomas who are poor surgical risks or wish to avoid major surgery. Its effects on future fertility need further evaluation in larger studies. Serial follow-up without surgery for growth and/or development of symptoms is advisable for asymptomatic women, particularly those approaching menopause. The present article is incorporated with multiple clear clinical photographs and simplified elaboration of the available management options for these tumors of uterine smooth muscle to facilitate clear understanding

Study of adequacy of informed consent in caesarean section in a tertiary care, teaching and research institute of Northern India

Background: Informed consent consists of availing information to the patient in an understandable manner without coercion to allow the patient to make an informed decision about their healthcare. In the case of caesarean section, information must include name, nature, proposed benefits of the procedure, risks of the procedure, alternative procedures, implications on the future reproductive health and anesthetic options. Aim and objective: To study the adequacy of informed consent in patients who undergo caesarean section at PT. B. D. Sharma, PGIMS, Rohtak.Methods: It was a cross sectional study. The study population was the group of patients who underwent emergency or elective caesarean section at PGIMS, Rohtak. A pretested questionnaire was adopted from a study carried out at School of Medicine, University of Zambia and was administered to the patients.Results: It was found that majority of the patients were in the age group of 21-30 years and most of them (71%) were from the rural areas. In 90% of the cases the outcome of caesarean section was term live births and majority of them (84%) were emergency caesarean section. The patients were asked fourteen questions regarding various aspects of informed consent based on the five point Likert scale.Conclusions: Majority of the caesarean sections were performed due to some emergency indications. It was found that overall patients were well informed about the procedure and the related consequences.

Clinical outcomes of ectopic pregnancy

Background: Ectopic pregnancy (EP) is a life threatening gynaecological emergency, and a significant cause of maternal mortality and morbidity worldwide. Aim of this study was to determine and evaluate the incidence, clinical presentation, risk factors, management strategies and outcome of the patients with EP.Methods: This was a prospective study of all cases of ectopic pregnancies admitted and managed at PGIMS Rohtak over a period of 1 year. All patients admitted through accident and emergency unit as well as the gynaecology clinic that were managed in gynaecological ward were included in the study. The diagnosis of EP was made by history, clinical examination, urinary pregnancy test and ultrasound examination. Patients were managed as per hospital protocol and relevant data on age, parity, clinical presentation, risk factors, management and findings at laparotomy, and the outcome of treatment were collected.Results: The incidence of ectopic pregnancy in this study was 1.056%. The mean age of the patients was 27±3 years. Of the 102 ectopic pregnancies, 86 (84.31%) were ruptured ectopic pregnancies, while 16 (15.68%) were unruptured ectopic pregnancies. The commonest clinical complaint was abdominal pain (97 of 102, 95.09%) History of previous abortion (induced or spontaneous) was the commonest risk factor (92 of 102, 90.19%) followed by past history of pelvic inflammatory disease (56 of 102, 54.90%). History of tubal surgery was present in 27 of 102 patients (26.47%). commonest surgical procedure done was emergency laparotomy followed by salpingectomy (67 of 102, 65.68%).Conclusions: EP is an important cause of maternal morbidity and mortality in early pregnancy and has remained a reproductive health challenge. Early diagnosis and treatment can improve reproductive outcomes.

Obstetric and neonatal outcome in women with epilepsy

Background: Epilepsy is the second most common neurological disorder complicating pregnancy next to migraine. Both mother and fetus stay at risk due to epilepsy and side effects of antiepileptic’s. This retrospective study was conducted to study fetal and maternal outcome in WWE.Methods: This study was conducted on 55 patients of epilepsy with pregnancy who attended antenatal clinic of our hospital from January 2016 to December 2016. Data was collected using antenatal registers in outdoor settings and medical case sheets in indoor patients and was analyzed statistically.Results: There were a total of 55 WWE in one year duration. Incidence of epilepsy being 0.4% in this study. 11 WWE were not on ante epileptic drug when conceived, while 34 WWE were on ante epileptic drugs when conceived, 8 WWE were newly diagnosed and 2 patients had both psychiatric disorders along with epilepsy. There were 3 IUDs, 4 major congenital malformation and 2 minor malformations. 2 major malformation occurred in patients taking both antipsychotic and ante epileptics since conception.Conclusions: There were a total of 55 WWE in one year duration. Incidence of epilepsy being 0.4% in this study. 11 WWE were not on ante epileptic drug when conceived, while 34 WWE were on ante epileptic drugs when conceived, 8 WWE were newly diagnosed and 2 patients had both psychiatric disorders along with epilepsy. There were 3 IUDs, 4 major congenital malformation and 2 minor malformations. 2 major malformation occurred in patients taking both antipsychotic and ante epileptics since conception