Study to determine feto maternal outcomes of programmed labor in a tertiary care hospital of Jharkhand

Background: Programmed labor aims to minimize duration and inconvenience of labor both for patient and obstetrician. The present study attempts to provide labor analgesia by using infusion paracetamol in place of conventional ketamine and tramadol. Methods: This study was conducted in the labor room of department of obstetrics and gynecology, RIMS, Ranchi from March 2019 to February 2020. 50 primigravida and 50 multigravidas were studied, with singleton pregnancy, cephalic presentation presenting with spontaneous onset of labor with Gestational age of 37-41 week. Results: 30% of patients were greater than 40 weeks gestation.65% of primigravida experienced severe pain, but only 20% of multigravidas had severe pain.60%primigravidas and 60% multigravidas (of 20% who had severe pain) experienced adequate pain relief with labor analgesia. 60 % primigravida presented with <4 cm cervical dilatation, whereas 40% multigravidas had <4 cm dilatation. 60% primigravida had shortened active phase (3.5 hrs), 60% multigravidas (2.5 hrs) which is suggestive of benefit of obstetrical analgesia in programmed labor. 90% patients had third stage labor less than 3 minutes. Only one multigravida landed in postpartum hemorrhage. All neonates had Apgar score greater than 8. There was no perinatal mortality. Only one primigravida landed in caesarean section due to arrest in second stage. 2 multigravidas had instrumental delivery. Maternal side effects like tachycardia, nausea, cervical and vaginal tears were more in primigravida. Conclusions: Participants with good response to obstetrical analgesia fared better than rest. Response was more satisfactory in primigravida in terms of labor progress

Health related behaviour changes in pregnant women during COVID-19 pandemic

Background: Pregnancy associated anxiety and depression is very well known for its prevalence. Pandemic like COVID-19 all the more is additive to the levels of anxiety and depression during pregnancy, especially for mothers who are concerned about feto-maternal wellbeing. This study makes an effort to analyze the health-related behavior changes and psychological impact of pregnant women after COVID-19 outbreak. Methods: Cross sectional, questionnaire-based study conducted on pregnant ladies visiting labor room and out-patients department RIMS, Ranchi from April 2020 to September 2020. Results: Most patients were primigravida and turned up only in third trimester. Pregnancy complications like heart disease, GDM, jaundice, PIH were present in 28% of participants. 48% participants had no family income during pandemic. The 92% women wore masks, 80% practiced social distancing, 72% practiced frequent handwashing, 72% practiced frequent handwashing during pandemic, 80% had no regular antenatal check-up. Almost 64% participants showed mild to moderate anxiety, 34% had moderate depression and 40% had moderate stress. Four percentages had severe anxiety, 2% had severe depression and 12% had severe stress. Usage of mask was inversely related to GAD7 scores, but had no correlation with EPDS scores. Rest parameters like frequent handwashing, social distancing, stressful behavior, not going out and frequent handwashing were directly related to GAD 7 and EPDS score. Conclusions: Mental health and preventive behavior of respondents could be attributed to socio demographic, social, situational, economic status, family conditions and perception of severity of Covid19

Study to detect infection and diagnose chorioamnionitis to aid in management of cases of preterm premature rupture of membranes in a tertiary care centre of Jharkhand

Background: The present study undertaken is to identify the risk factors causing Preterm premature rupture of membranes (pPROM) and to study fetal and maternal outcome associated with pPROM, to diagnose and manage chorioamnionitis associated with pPROM and to evaluate levels of C reactive protein (CRP). Methods: This study was conducted in the department of obstetrics and gynaecology, Rajendra institute of medical sciences from March 2019 to February 2020.50 cases of confirmed preterm premature rupture of membrane before 35 weeks of pregnancy were taken as cases and 50 cases of normal pregnancy (28-40 weeks) were taken as controls. Results: Highest incidence of premature rupture of membrane was among 20–25-year (68%) age groups. Incidence of premature rupture of membrane was more in low socioeconomic status (72%). Maximum incidence of premature rupture of membrane in 31-33 weeks gestational age (52%). Most cases of premature rupture of membrane in 24–48-hour group (38%). Most of study group (90%) and control group (80%) delivered by vaginal route. 11 study cases with clinical chorioamnionitis had elevated CRP (43.5 mg/l). One presented with clinical chorioamnionitis. CRP was most sensitive (92%). Total maternal morbidity was due to puerperal pyrexia (22%). Four patients with neonatal sepsis had CRP>6 mg/l. CRP and presence of polymorphs in gastric aspirate have 100% association with septicemia in neonates. Conclusions: Preterm premature rupture of membrane can be associated with adverse foetal and maternal outcome if immediate measures are not taken

Effect of Iron/Folic Acid Supplementation on the Outcome of Malaria Episodes Treated with Sulfadoxine-Pyrimethamine

Folic acid supplementation may potentially alter the efficacy of sulfadoxine-pyrimethamine (SP) treatment in children with malaria. However, there is lack of evidence fromrandomized controlled trials and effects of folic acid supplementation on clinical efficacy of SP therapy remainmoderately understood among children. In a doublemasked, placebo-controlled trial among preschool children in Pemba Island (Tanzania), iron and folic acid supplementation (Fe/FA) showed an increased risk of hospitalizations and death. In the present paper, we evaluated if folic acid supplementation reduced the efficacy of malaria treatment and thereby contributed to observed adverse effects. During the study, 1648 children had confirmed malarial episodes and received either sulphadoxinepyrimethamine(SP) treatment and iron folic acid or SP treatment and placebo. These children were evaluated for recovery and incidence of hospitalization during the next 15, 30, and 140 days. Two groups did not differ in malarial episode or hospitalization rate on subsequent 15, 30, and 140 days. Altered efficacy of SP by folic acid was not observed and did not contribute to adverse events in the previous trial.This trial is registered with Controlled-trials.com ISRCTN59549825

Embolization of Cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report

We report a case of embolism of the sclerosant dye with subsequent formation of foreign-body giant cell reaction within the veins of pulmonary and portal circulation in an autopsy case of hepatocellular carcinoma developing over an underlying primary biliary cirrhosis

NSAIDs-Related Pyloroduodenal Obstruction and Its Endoscopic Management

Endoscopic balloon dilatation (EBD) has important role in the management of benign gastric outlet obstruction. Although there are many reports on the role of EBD in the management of corrosive-induced and peptic benign GOO, there is scanty data on its role in the management of NSAID-induced GOO. We report 10 cases of NSAID-induced pyloroduodenal obstruction and their endoscopic management. The most common site of involvement was duodenum (5/10) followed by both pylorus and duodenum (4/10) and pylorus (1/10). Most of the strictures were short web-like, and the mean (SD) number of stricture was 2.0 (0.94). Endoscopic balloon dilatation was successful in 90% (9/10) cases requiring mean (SD) of 2.0 (1.6) sessions of dilatation to achieve target diameter of 15 mm and mean (SD) of 5.3 (2.7) sessions to maintain it over a treatment period of 4.5 months (IQR 2–15 months). There was no procedure-related complication or mortality

Effi cacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomised controlled trial

Background In low-income countries, including the east African region, a third of neonatal deaths are due to infections. A substantial proportion of these have been attributed to sepsis, which can result from umbilical cord infections. Evidence from Asia suggests that chlorhexidine application to the neonatal umbilical cord reduces mortality, but no data from Africa are available. We aimed to assess the eff ect of umbilical cord cleansing with 4% chlorhexidine solution on neonatal mortality and omphalitis in rural settings of sub-Saharan Africa. Methods We did a community-based randomised controlled trial on Pemba Island, Zanzibar, Tanzania. All eligible babies (aged 1 h to 48 h, without congenital malformations) from hospital-based and community-based deliveries on Pemba Island were enrolled. Participants were randomly assigned to either 4% free chlorhexidine for cord care or to dry cord care using a computer-generated random sequence. For babies allocated to the chlorhexidine group, mothers or caretakers were advised to apply the solution to the cord every day until 3 days after the cord had dropped off . Cord stumps were examined for redness, pus, swelling, and foul odour on day 0, 1, 4, 10, and 28. The primary outcome for this study was mortality until day 28 on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, number NCT01528852. Findings Between May 19, 2011, and Aug 31, 2014, 36 911 newborn babies were enrolled into the chlorhexidine (n=18 015) and dry cord care study (n=18 896) groups. 17 468 (96·9%) of 18 015 neonates in the chlorhexidine group were available for complete follow-up (28 days) compared with 18 384 (97·3%) of 18 896 neonates in the dry cord care group. Mortality rate in the chlorhexidine group (10·5 deaths per 1000 livebirths) was not signifi cantly lower than that in the dry cord care group (11·7 per 1000 livebirths; relative risk 0·90, 0·74–1·09; p=0·27). Interpretation Our fi ndings do not support the use of chlorhexidine for reduction of neonatal mortality in this east African setting, which might not justify a change in the WHO policy. To inform global policy, a detailed meta-analysis and pooled analysis needs to be undertaken using data from both African and Asian settings

Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth – a randomized double blind controlled trial among school children in Bangladesh

BACKGROUND: Interventions providing foods fortified with multiple micronutrients can be a cost-effective and sustainable strategy to improve micronutrient status and physical growth of school children. We evaluated the effect of micronutrient-fortified yoghurt on the biochemical status of important micronutrients (iron, zinc, iodine, vitamin A) as well as growth indicators among school children in Bogra district of Bangladesh. METHODS: In a double-masked randomized controlled trial (RCT) conducted in 4 primary schools, 1010 children from classes 1–4 (age 6–9 years) were randomly allocated to receive either micronutrient fortified yoghurt (FY, n = 501) or non-fortified yoghurt (NFY, n = 509). For one year, children were fed with 60 g yoghurt everyday providing 30% RDA for iron, zinc, iodine and vitamin A. Anthropometric measurements and blood/urine samples were collected at base-, mid- and end-line. All children (FY, n = 278, NFY, n = 293) consenting for the end-line blood sample were included in the present analyses. RESULTS: Both groups were comparable at baseline for socio-economic status variables, micronutrient status markers and anthropometry measures. Compliance was similar in both the groups. At baseline 53.4% of the population was anemic; 2.1% was iron deficient (ferritin <15.0 μg/L and TfR > 8.3 mg/L). Children in the FY group showed improvement in Hb (mean difference: 1.5; 95% CI: 0.4-2.5; p = 0.006) as compared to NFY group. Retinol binding protein (mean diff: 0.05; 95% CI: 0.002-0.09; p = 0.04) and iodine levels (mean difference: 39.87; 95% CI: 20.39-59.35; p < 0.001) decreased between base and end-line but the decrease was significantly less in the FY group. Compared to NFY, the FY group had better height gain velocity (mean diff: 0.32; 95% CI: 0.05-0.60; p = 0.02) and height-for-age z-scores (mean diff: 0.18; 95% CI: 0.02-0.33; p = 0.03). There was no difference in weight gain velocity, weight-for-age z-scores or Body Mass Index z-scores. CONCLUSION: In the absence of iron deficiency at baseline the impact on iron status would not be expected to be observed and hence cannot be evaluated. Improved Hb concentrations in the absence of a change in iron status suggest improved utilization of iron possibly due to vitamin A and zinc availability. Fortification improved height gain without affecting weight gain. TRIAL REGISTRATION: ClinicalTrial.gov: NCT0098073