A study of fetomaternal outcome in cases of severe anemia in labor at a tertiary care center

Background: In India, the prevalence of anemia is high because of fewer intakes of iron, folic acid and food sources that prevent iron absorption, coupled with poor bioavailability of iron is the major factor responsible for prevalence of anemia. More than iron deficiency, zinc, vitamin B12 and folate deficiency was highly prevalent due to ascariasis infestation. Methods: This study was carried out in the department of obstetrics and gynaecology at PDU medical college and hospital Rajkot, Gujarat from May 2021 to April 2022. Results: The study was conducted on 83 cases, the prevalence rate of severe anemia in the study population of PDU Medical College Rajkot was found to be 1.6% during this study period. 57.83% of cases delivered before term. Most of the patients 85.54% in the study group suffered from iron deficiency anemia. Most of the patients 49.40% were managed by transfusion of 2-pint PCV. Most common complications associated with anemia in pregnancy are atonic PPH, pulmonary oedema and surgical site infections in this study. A 67.46% of new-borns were of <2.5kg birthweight. High number of new-borns 39.75% with moderately abnormal APGAR scores were delivered. In this study, 75 patients were delivered vaginally, 5 instrumental deliveries were conducted to cut short the second stage of labor, 3 patients underwent LSCS due to major degree placentae previa and foetal distress. Conclusions: Severe anemia during labor affect the maternal and foetal outcome to a large extent. The major step in improving these outcomes is prevention of anemia which could be done at pre-pregnancy stages of a woman’s life, measures such as food fortification, deworming, mass haemoglobin screening among adolescent girls helps in this cause

Rupture uterus: a retrospective analytical study

Background: Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed (WHO 2005). Objective of present study was to find out risk factors, management, related complications and associated maternal morbidity and mortality with rupture uterus.Methods: A retrospective analytical study was performed at Department of Obstetrics and Gynecology, PDU Medical College, Rajkot, Gujarat, India over a period of 3 years during 2014-2016. Evaluation of maternal age, parity, SE status, booking status, obstetric risk factors, duration of hospital stay, causes of rupture uterus, Management, intra-op and post-operative complications, maternal morbidity and mortality was done.Results: Total 29 cases of rupture uterus were found during study period. Most of them belong to age group of 21-30 (77.17%), Primipara (41.3%), Lower socioeconomic status (86.2%) and unbooked (65.52%) cases. Most common cause of rupture uterus was prolonged obstructed labor (51.72%) while scarred uterus (41.73%), transverse lie (3.44%) and injudicious use of oxytocin (3.44%) were others. In 16 cases obstetric Hysterectomy (55.17%) was performed while in 13 cases repair (44.82%) was done. We have found 2 cases of maternal death (6.89%) while study period with rupture uterus.Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis

Collaborating to Compete: Blood Profiling Atlas in Cancer (BloodPAC) Consortium

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136731/1/cpt666.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136731/2/cpt666_am.pd

Genome-Wide Linkage in a Highly Consanguineous Pedigree Reveals Two Novel Loci on Chromosome 7 for Non-Syndromic Familial Premature Ovarian Failure

BACKGROUND: The human condition known as Premature Ovarian Failure (POF) is characterized by loss of ovarian function before the age of 40. A majority of POF cases are sporadic, but 10-15% are familial, suggesting a genetic origin of the disease. Although several causal mutations have been identified, the etiology of POF is still unknown for about 90% of the patients.¦METHODOLOGY/PRINCIPAL FINDINGS: We report a genome-wide linkage and homozygosity analysis in one large consanguineous Middle-Eastern POF-affected family presenting an autosomal recessive pattern of inheritance. We identified two regions with a LOD(max) of 3.26 on chromosome 7p21.1-15.3 and 7q21.3-22.2, which are supported as candidate regions by homozygosity mapping. Sequencing of the coding exons and known regulatory sequences of three candidate genes (DLX5, DLX6 and DSS1) included within the largest region did not reveal any causal mutations.¦CONCLUSIONS/SIGNIFICANCE: We detect two novel POF-associated loci on human chromosome 7, opening the way to the identification of new genes involved in the control of ovarian development and function

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Study of fetomaternal outcome in second stage caesarean section

Background: The incidence of second stage caesarean section is more in developing countries. Caesarean sections done at full cervical dilatation with impacted fetal head are difficult and associated with an increased incidence of maternal and fetal complications.Methods: This was prospective observational study conducted at a tertiary teaching institute. All second stage caesarean sections performed between September 2017 to August 2018 were analysed in terms of incidence, indications of caesarean-section, intra-operative  and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 7270 deliveries. Out of this 1884 deliveries were done by caesarean section. Out of them 50 were 2nd stage caesarean sections contributing to 2.65% of total sections. Patwardhan method was used in 50% cases for deliveryof deeply engaged head. Intra-operative complications were higher in terms of atonic pph (8%), extension of uterine incision (16%), in 3 cases bladder injury was noticed. Obstetric hysterectomy was required  in 4% cases. 14% cases had postoperative febrile illness and 8% cases had wound infection. 44% babies required NICU admissions and neonatal death was 18%.Conclusions: Caesarean section in the 2nd stage of labour is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation

Manual vacuum aspiration in first trimester induced abortion: A randomized comparative prospective studies of 100 cases

Background: Induced abortion is one of the safest procedures for unwanted pregnancies in medical practice. Vacuum aspiration is the preferred method for uterine evacuation before 12 weeks of pregnancy. Objectives: To study the efficacy of manual vacuum aspiration (MVA) in o8 wk versus 8–12 wk of pregnancy. Materials and Methods: A randomized comparative prospective study was performed at the Department of Obstetrics and Gynaecology, P D U Medical College, Rajkot, over a period of January 2012 to June 2013. Totally, 100 subjects were enrolled in the study, which were further divided into two groups (o8 wk and 8–12 wk of pregnancy, 50 in each). MVA was performed in both the groups, and comparison was done in view to evaluate completeness of procedure, requirement of add-on procedure, and complications. Results: Of 50 subjects in each group, perforation was found in two cases in group A and one case in group B. Requirement of oxytocics noted in only one case in group B, whereas incomplete abortion noted in two cases in group A and three in group B. All complications were found statistically insignificant (P = 1) between both the groups. Conclusion: This study focused on the efficacy of MVA in higher weeks of gestations, which was equal in both the groups. Thus, MVA is a safe and an acceptable procedure up to 12 wk of pregnancy

Mapping scroll expander performance for organic working fluids using dimensionless parameters in N-s-D-s diagram

This paper presents an analysis of single-stage scroll expander performance for pure fluids and their zeotropic mixtures in supercritical conditions using dimensionless parameters, namely specific speed (N-s) and specific diameter (D-s). Scroll geometries with different aspect ratios were modeled for a range of expander inlet temperatures. The expander efficiency was modeled accounting for losses due to leakage, friction, and over- and under-expansion. The expander efficiency was plotted as a function of two dimensionless parameters to analyze the applicability domain of scroll expanders. For a particular expander inlet temperature (T-in), zeotropic mixtures result in more compact scroll geometries than pure fluids, leading to reduced losses and better expander efficiency. Any increase in T-in results in larger scrolls leading to higher leakage and thereby lower efficiency. At suitable operating conditions, an optimized scroll expander design can achieve expansion efficiency as high as 75%. Sub-optimal scroll designs for a given application lead to lower expansion efficiency due to over- or under-expansion losses

Rupture uterus: a retrospective analytical study

Background: Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed (WHO 2005). Objective of present study was to find out risk factors, management, related complications and associated maternal morbidity and mortality with rupture uterus.Methods: A retrospective analytical study was performed at Department of Obstetrics and Gynecology, PDU Medical College, Rajkot, Gujarat, India over a period of 3 years during 2014-2016. Evaluation of maternal age, parity, SE status, booking status, obstetric risk factors, duration of hospital stay, causes of rupture uterus, Management, intra-op and post-operative complications, maternal morbidity and mortality was done.Results: Total 29 cases of rupture uterus were found during study period. Most of them belong to age group of 21-30 (77.17%), Primipara (41.3%), Lower socioeconomic status (86.2%) and unbooked (65.52%) cases. Most common cause of rupture uterus was prolonged obstructed labor (51.72%) while scarred uterus (41.73%), transverse lie (3.44%) and injudicious use of oxytocin (3.44%) were others. In 16 cases obstetric Hysterectomy (55.17%) was performed while in 13 cases repair (44.82%) was done. We have found 2 cases of maternal death (6.89%) while study period with rupture uterus.Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis