Comparative study of various oxytocics in management of third stage of labour

Background: Causes of maternal mortality are haemorrhages, infections, unsafe abortions, and obstructed labour. 25% of these are caused by haemorrhages and are preventable, one of the measures is active management of third stage of labour (AMTSL). For prevention, treatment of postpartum haemorrhage oxytocics are available oxytocin, methylergometrine, misoprostol, prostaglandin F2α.Methods: Study was conducted, 160 patients were randomly given one of following oxytocics a) tablet misoprostol 600 µg per rectal b) Inj. Oxytocin 10 IU IM c) Inj. Methylergometrine 0.2 mg IM d) Inj. PGF2α. Duration for the delivery of placenta and amount of blood loss was measured, side effects were noted, and comparison of haemoglobin and blood loss done.Results: No significant difference in mean blood loss in all group with respect to parity and type of labour. In present study it seems that no oxytocic is superior to other in reducing the blood loss. Misoprostol has variable onset of action. Mean duration of 3rd stage in various groups is same. In respect to side effects HTN is common with methylergometrine, shivering and fever with misoprostol and diarrhoea with PGF2α.Conclusions: Study concluded that all uterotonics have some advantages, oxytocin is ultimate drug of choice in skilled hand due to its definite onset of action while Tab misoprostol in unskilled hands, other oxytocin are reserved for complementary usage and treatment of PPH but Misoprostol has variable onset of action

Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored

Placenta percreta - an audacious experience

Maternal and fetal morbidity and mortality from placenta accreta are considerable and are associated with high demands on health resources. There is abnormally firm attachment of placenta to the uterine wall with the absence of deciduas basalis and incomplete development of Nitabuch’s layer. The reported incidence of placenta accreta has increased from approximately 0.8% in 1980s to 3 per 1000 in the last decade, occurring more frequently in future deliveries after caesarean section. Management of patients with a morbidly adherent placenta (placenta accreta, increta, or percreta) varies widely. Although the impact of a morbidly adherent placenta on pregnancy outcomes is well-described, no randomized trials have examined the management of pregnancies complicated by this disorder. As a result, recommendations for its management are based on case series and reports, personal experience, expert opinion, and good clinical judgement. We report a case of placenta percreta that was successfully managed by planned caesarean hysterectomy with prophylactic ligation of bilateral anterior division of internal iliac artery

Awareness of contraception in post-partum women in a tertiary care centre

Background: In this modern or scientific era even though women are working equally or one step ahead of men, in family planning decision they are still lagging behind. Postpartum period is very crucial for a woman especially for many of those belonging to the villages as this may be the only time she comes in contact with a health personnel and in a mood to listen health advice. Keeping this in mind, this crucial period was considered as opportunity to test the issue of awareness regarding contraception.Methods: We conducted a cross-sectional study in the department of obstetrics and gynecology of Govt medical college and hospital, Aurangabad between August 2016 to December 2016. A total 720 post-partum women were interrogated and counselled regarding various methods of contraception.Results: Only 55.69% were aware about various methods of contraception. Awareness was maximum for Sterilisation (91%) followed by Intrauterine contraceptive device (81%) and Oral contraceptive pills (41%). Women knew about contraception from health care system (45%) and mass media (36%). After counselling 97% patients ready to use.Conclusions: There is lack of awareness regarding contraception. Contraceptive services are to be strengthened by intergrating with antenatal sevices

Awareness regarding Janani Shishu Suraksha Karyakram among pregnant women of Marathwada, Maharashtra, India

Background: Government of India has launched “Janani Shishu Suraksha Karyakram” on 1st July 2011, to assure free and cashless services (including free transport) to all pregnant women and sick neonates accessing public health institutions.  The objective of the study was to find out level of awareness regarding JSSK entitlement in pregnant women and to examine the association between different socio-demographic factors and awareness level.Methods: This was a cross sectional study was conducted in the Department of Obstetrics and Gynaecology. Govt. Medical College and Hospital, Aurangabad involving 1000 pregnant women attending antenatal clinic between September 2015 to March 2016. Questionnaire was given to assess the awareness about JSSK entitlements and if it was known to them, then the source of information was noted. Information regarding socio-demographic characteristics was noted. The study subject was considered as aware of the scheme, if she had heard about the scheme and had knowledge about certain key points of the scheme. One point each was given to all the correctly answered questions and mean was calculated. Subjects whose correctly answered questions were more than the mean value were considered to have good awareness level. Analysis was done usingSPSS version 20. Chi-square test for association between awareness level and different socio-demographic factors. Significance level was considered at p value <0.05.Results: Among 1000 antenatal women, good awareness level regarding JSSK entitlements was seen in only 472 (47.2%) study subjects. Maximum awareness regarding JSSK entitlements was noted to be for Free vaginal delivery in 869 (86.90%) followed by free drugs and consumables to mother (73.4%) and free treatment for sick infants 662 (66.2%) and least awareness was noted for free drop back of sick infant from health facility to home (9%) and free caesarean section (9.6%). Not even a single woman answered all the 17 entitlements correctly. Only 13 (1.3%) women were able to answer 16 questions correctly. Advancing age, increasing level of education, member of nuclear family, increasing number of conception (gravidity) and advanced gestational age are significantly associated with the level of awareness. However, religion, socioeconomic status and occupation did not have any statistical significant association with the level of awareness regarding various entitlements of JSSK in antenatal women. Regarding the source of information, the most common source of information was from health personnel, followed by friends and family. None of the women reported that Radio, TV, Newspaper had contributed as a source of information.Conclusions: Awareness level of JSSK entitlements in the pregnant women in our study is low. Maximum awareness was noticed for the provision of free vaginal delivery whereas awareness for provisions like free caesarean section, free drop back facility to home, free provision of blood is very low. Further efforts are needed to increase the overall awareness of various entitlements of JSSK among pregnant women to increase the utilization of the benefits of the scheme and thus indirectly helping in reducing MMR and IMR

Study of efficacy of compression suture in the surgical management of atonic PPH

Background: Study was conducted to analysis efficacy of compression suture in the surgical management of Atonic PPH. It’s prospectively carried out with 60 cases required compression suture in managing Atonic PPH. Atonic uterus is preventable cause of maternal mortality and morbidity constituting 80% PPH cases.Methods: Prospective study carried out at tertiary care center for studying efficacy of compression suture in the surgical management of atonic PPH for one year, started after approval from ethical committee.Results: Compression suture is effective in managing atonic PPH. out of 60 cases, 4 patient's required obstetric hysterectomy as a last resort to control Atonic PPH. Uterus was conserved in 93.3% of cases.Conclusions: Development of compression suture technique has proved to be effective in the control of massive Atonic PPH not responding to medical management is an alternative to hysterectomy when timely applied. It proves to be valuable addition for surgical treatment of PPH and for saving uteri after medical management of PPH failed. Authors can adopt compression suture as a mid-step before resorting to uterine devascularisation or hysterectomy when medical line of management fails. Resident doctors in teaching institutes must be well trained in this technique

Clinical study of Misgav Ladach technique of caesarean section

Background: In the last decades caesarean section rates increased in many countries becoming the most performed intraperitoneal surgical procedure. The operative technique performed is made chiefly on the basis of the individual experience and preference of operators, the characteristics of patients, timing and urgency of intervention. Present study was undertaken to assess the benefits of the Misgav Ladach caesarean section technique in tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative morbidity.Methods: Prospective surgical interventional study conducted in department of obstetrics and gynecology in tertiary care institute.Results: The duration of surgery, blood loss and post-operative complications were significantly less in the Misgav Ladach technique of LSCS.Conclusions: The choice of the Caesarean section technique is strictly linked to the individual experience and confidence of the surgical team. Misgav-Ladach technique proved to be associated to less complications, moreover, since its shorter operating time; it is to prefer in all that cases a prompt operation is required

Comparative study of immediate post placental vaginal versus intra caesarean insertion of copper T380A

Background: The study was carried out to compare modes of PPIUCD that is safety, removal and expulsion rates of immediate post placental vaginal versus intracaesarean insertion of copper T380A.Methods: This was an interventional study conducted from January 2015 to December 2016 in Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Aurangabad. This study involved participants who accepted PPIUCD in antenatal period and delivered in Government Medical College and Hospital, Aurangabad. Copper T380A was inserted vaginally after taking consent in 50 postpartum mothers within 10 minutes of normal vaginal delivery and 50 women who were undergoing caesarean section for obstetric indications who accepted copper T380A from contraceptive basket. Chorioamnionitis, prolonged premature rupture of membranes, unresolved postpartum hemorrhage, major medical disorder and participants who were lost to follow up were excluded. Antibiotic cover was given for 5 days. Participants were followed up either personally or telephonically at 6 weeks, 6 months or earlier if they had any complaints.Results: Among 50 post placental vaginally copper T380A inserted participants, 6(12%) had menstrual disturbance and pain abdomen each. One participant (2%) had infection vaginitis. Among 50 intracaesarean copper T380A inserted participants, 3 (6%) had menstrual disturbance and pain abdomen each. 6 (12%) had missing strings. Missing strings which was seen only in intracaesarean group was statistically significant when compared to post placental vaginal group. Expulsion was seen only in post placental vaginally copper T380A inserted participants (4 out of 50). There was no statistically significant difference in expulsion & removal rates of both the groups.Conclusions: Both modes of PPIUCD insertion were equally safe for participants except for missing strings which was seen more in intracaesarean group and was statistically significant

Placenta accreta in a referred post hysterotomy case: a bold step into the unknown

Placenta accreta spectrum encompasses a range of pathological adherence of placenta and causes significant maternal and neonatal morbidity and mortality. With the increase in the number of cesarean deliveries over the last few decades, there has been an 8 fold increase in the incidence of placenta accreta. The single most important risk factor reported in about half the cases of PAS disorders is placenta previa. Management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta. We discuss a rare case of a patient who underwent hysterotomy in an outside hospital and was referred to our tertiary care centre as atonic PPH. Undiagnosed antenatally and at the time of hysterotomy, she was diagnosed as a case of placenta accreta on exploration at our institute and was surgically managed

Placenta percreta - an audacious experience

Maternal and fetal morbidity and mortality from placenta accreta are considerable and are associated with high demands on health resources. There is abnormally firm attachment of placenta to the uterine wall with the absence of deciduas basalis and incomplete development of Nitabuch’s layer. The reported incidence of placenta accreta has increased from approximately 0.8% in 1980s to 3 per 1000 in the last decade, occurring more frequently in future deliveries after caesarean section. Management of patients with a morbidly adherent placenta (placenta accreta, increta, or percreta) varies widely. Although the impact of a morbidly adherent placenta on pregnancy outcomes is well-described, no randomized trials have examined the management of pregnancies complicated by this disorder. As a result, recommendations for its management are based on case series and reports, personal experience, expert opinion, and good clinical judgement. We report a case of placenta percreta that was successfully managed by planned caesarean hysterectomy with prophylactic ligation of bilateral anterior division of internal iliac artery