Placental abruption at 18 weeks of gestation: a rare case report

Placental abruption is one of several notable obstetrical entities that may be complicated by massive and sometimes torrential hemorrhage. Hypovolemic shock is caused by maternal blood loss. Delayed or incomplete treatment of hypovolemia with severe placental abruption can cause acute kidney injury, disseminated intravascular coagulation. Placental abruption is most commonly seen after 24 weeks of pregnancy and it is very rare before 20 weeks of pregnancy. Here, we report a case of life-threatening placental abruption at 18 weeks of gestation.

Trend in Infant and Young Child Feeding practices during 2005 – 2015 in India

Background: Optimal infant and young child feeding (IYCF) practices during first 2 years of life is the key to ensuring optimal growth and development of the infant. Improving IYCF practices have an important role in reducing morbidity and mortality amongst under 5 children in India. Material & Methods: The secondary data from National Family Health Survey (NFHS)-3 and NFHS- 4 was analyzed. Objective: To assess the trend in IYCF practices during 2005 – 2015 for 13 selected states of India. Results: It was found that over a decade, there has been an improvement in early initiation of breast feeding and exclusive breastfeeding for 6 months amongst infant in 11 out of 13 states. However, a reduction in the timely initiation of complementary feeding amongst children in the age group of 6-8 months has been observed in 9 out of 13 states. Conclusion: There is a need to strengthen the efforts to further improve the IYCF practices in India for reducing high rates of undernutrition in the country

Comparative evaluation of laparoscopic hysterectomy and non-descent vaginal hysterectomy in women with benign gynaecological disease

Background: Hysterectomy is one of the most frequently performed gynaecological operative procedure all over world, second most to caesarean section in United States. The aim of study was to compare the intraoperative and postoperative complications in patients undergoing non-descent vaginal hysterectomy (NDVH) and Laparoscopic hysterectomy (LH) for benign gynaecological disease.Methods: The prospective one-year study was conducted on 156 patients who required hysterectomy for benign gynaecological conditions. After applying inclusion and exclusion criteria, 75 patients assigned to Group A (NDVH) and 75 to Group B (LH) and both groups were compared.Results: On comparing the two groups there was statistically significant decrease in the duration of surgery (p<0.01, t = 11.65), pain score (p<0.01, t = 2.75) and blood transfusion requirement (p = 0.03, χ2 = 4.80) in group A, while blood loss (p = 0.73, t = 0.33), uterine volume (p = 0.15, t = 1.43), time taken to ambulate (p = 0.06 , t = 0.21), duration of hospital stay (p = 0.07, t = 1.80), conversion to laparotomy (p = 0.13, χ2 = 2.56), febrile morbidity (p = 0.27, χ2 = 1.34), infection (p = 0.42, χ2 = 1.11) and visceral injury was found statistically insignificant.Conclusions: Vaginal hysterectomy is an easier technique with shorter duration of surgery and with minimal infrastructure required and for fixed uterus or huge adnexal mass laparoscopic hysterectomy (LH) should be preferred

Assessment of nutritional status of elderly population living at high altitude regions of India utilizing Mini Nutritional Assessment (MNA) methodology

Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. There is lack of scientific evidence on the staus of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. Lack of scientific evidence exists on the status of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0. Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001). Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0.   Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001).   Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases

Morphological changes in placenta in cases of oligohydramnios

Background: There are gross and microscopic changes in placenta and umbilical cord in complicated pregnancies. The objective of this study was to study pathological (gross and microscopic) changes in placenta, membrane and umbilical cord in cases with oligohydramnios and to study relationship between changes in placenta, membranes and umbilical cord with severity of oligohydramnios.Methods: A total of 50 patients were selected and their placentas were collected after delivery and sent to pathology department in 10 % formalin for histopathological examination. Patients were divided into three groups and the results were compared. Statistical calculations were performed using the SPSS 16.0. In order to detect differences between subjects students t-test was used for continuous variables, while, for categorical variables, the X2 test was used. A p-value of less than 0.05 was considered statistically significant.Results: Atotal of 50 patients were studied for a period of one year and following observations were made, discoid shape placenta in 45 (90.0%), oval in 5 (10.0%), central attachment of umbilical cord in 16 cases (32.0%), eccentric in 33 (66.0%), marginal in 1 (2.0%) case following variables were compared and p value detected, placental maximum diameter (p <0.0001),placental minimum diameters (p = 0.041), mean of cord length (p <0.0001) placental weight (p = 0.273), placental thickness (p = 0.253), acute chorioamnionitis (p <0.0001), chronic chorioamnionitis (p<0.0001), focal squamous metaplasia (p <0.0001), bacterial colonies in subamnion (p <0.0001), meconium staining (p <0.0001), amnion nodosum (p < 0.0001), intra amniotic haemorrhage (p = 0.090), membranous deciduitis with chorioamnionitis (p = 0.081), focal haematoma (p = 0.010), acute inflammatory infiltrate in Wharton’s jelly (p = 0.012), single umbilical artery (p =0.010), intervillous fibrin deposition (p <0.0001), calcification (p<0.0001), chorangiosis (p <0.0001), syncytial knots (p <0.0001), avascular villi (p = 0.011), villous edema (p = 0.090) and infarct (p = 0.090).Conclusions: There are alterations in placental morphology associated with oligohydramnios hence placenta should be examined, which may be useful in predicting perinatal morbidity and mortality

Platelet count estimation: a prognostic index in pregnancy induced hypertension

Background: Hypertension in pregnancy is one of the serious complications of pregnancy with an incidence of 5% to 7% of all pregnancies, particularly in cases with preeclampsia and eclampsia. Though platelet count during pregnancy is within the normal non pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity of the disease process and duration of PIH syndrome.Methods: A prospective observational study was conducted on 200 pregnant women attending OPD Or Inpatients in the Department of Obstetrics and Gynecology, SMGS Hospital, GMC Jammu from November 2015 to October 2016. Pregnant women beyond 28 weeks gestation of pregnancy are included and divided into two groups i.e. the study and control group. Platelet counts will be done every 4 weeks in controls and weekly in subjects from 28 weeks till delivery.Results: The mean platelet count observed among cases of mild preecclampsia, severe preeclampsia and ecclampsia was 2.26, 1.63 and 0.99 lakh/mm3 respectively. The difference in mean platelet count among cases and controls was statistically significant. The association of platelet count with severity of different categories of PIH was analysed statistically and was highly significant.Conclusions: Platelet count is a very important investigation for the antenatal mother having PIH, as it is directly related to maternal and perinatal outcome. Routine and regular monitoring of platelet count can be included in the routine antenatal checkup among the pregnant women with PIH

Maternal haemoglobin and perinatal outcome in a tertiary care hospital in Jammu city, India

Background: Maternal anemia is a common problem worldwide. The objective of this study was to assess the prevalence of anemia in women attending a tertiary care centre in their third trimester of pregnancy and to study the relation of maternal hemoglobin with perinatal outcome.Methods: This study was conducted in the Department of Obstetrics and Gynecology, SMGS Hospital, Jammu for a period of one year from Nov. 2015 to Oct. 2016. A total of 767 women in their third trimester (>28 weeks) were enrolled and were followed till delivery. Their hemoglobin levels were noted and its association with adverse maternal and fetal outcomes was studied.Results: It was seen that out of 767 patients, 193 (25.16%) were non-anemic and 574 (74.83%) were anemic out of which 343 (44.71%) were mildly anemic, 160 (20.86%) had moderate anemia and 70 (9.12%) had severe anemia. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, CCF, mortality & blood transfusions in the anemic group as compared to the non-anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admissions, meconium stained liquor, low birth weight babies and APGAR scores <7/10 among the anemic group as compared to the non-anemic group.Conclusions: Maternal anemia is a significant risk factor for adverse maternal and perinatal outcome and its prevalence continues to be high especially in developing countries like India. So, correction of maternal anemia still remains one of the most important step towards better obstetrical care