Role of vitamin D in reducing the risk of preterm labour

Background: Although vitamin D insufficiency is increasingly recognized as a health problem across the world, inadequate vitamin D status appears to be particularly prevalent in certain populations such as the elderly and pregnant women. With respect to the latter, impaired vitamin D status during gestation is associated with adverse outcomes in pregnancy such as preterm birth and poor neonatal outcome.Methods: A total of 100 healthy, pregnant women in Sawangi, Meghe, Wardha, were recruited in 2012. Of these, 50 were randomised to receive either 2000 IU (study group) of vitamin D3 per day from 12-16 weeks of gestation of pregnancy. The remaining 50 pregnant women, who formed the control group were not supplemented with any drug. 25-hydroxyvitamin D [25(OH)D] in maternal blood was measured by chemiluminescence immunoassay, at recruitment and at the time of delivery and a serum 25(OH)D level <30 nmol/l was defined as deficiency.Results: Patients had deficiency of vitamin D at baseline (80.00%) was converted into sufficient level (76.00%) in cases after vitamin D supplementation. It was statistically significant at 5% level as P value <0.05 and there was also evidence in reduction of preterm birth.Conclusions: Maternal vitamin D deficiency is associated with significant increase risk for premature birth with P = 0.001. Maternal serum vitamin D sufficiency can be achieved by supplementing pregnant women with 2000 IU vitamin D supplements

Correlation of non stress test with fetal outcome in term pregnancy (37-42 Weeks)

Background: The main purpose of the various antepartum surveillance techniques is to detect fetal distress so as to prevent fetal death. Traditionally, obstetricians tended to classify pregnant women as “low” and “high” risk. Although many well-organized methods are available for managing the high-risk group, we need more ef­ficient methods for identifying pregnant women in distress in the low-risk group. The idea of taking this study using NST as a tool for routine antepartum fetal surveillance is we will be trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers. The objective of this study was to evaluate the correlation of the Non Stress Test with fetal outcome in pregnancies from 37-42 weeks of gestation.Methods: This was a prospective longitudinal study at Acharya Vinoba Bhave Rural Hospital Sawangi (Meghe) Wardha and Dept. of Obstetrics and Gynaecology Unit from August 2011- July 2013. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST for 20 minutes.Results: The incidence of reactive test was 85% and that of Non reactive NST was 15% .As the gestational age advances the incidence of NR NST is more. Postdatism (gestation &gt;40 weeks) is found to be an important factor for NR NST. Mode of delivery was related to results of Non stress Test in terms of maximum vaginal delivery in Reactive groups, Operative deliveries which occurred in the Reactive groups were also due to indications other than fetal distress. Caesarean section rate is slightly higher in non reactive NST. The individual parameters of poor fetal outcome like meconium stained liquor, Apgar score &lt;7 at 5 minutes had increased incidences in the non reactive group.Conclusion: Routine electronic monitoring is accepted in high risk women, but normal pregnancies too require some reliable objective assessment to optimize the outcome. This study suggests that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as meconium-staining of liquor and poor Apgar score increases with a non reactive strip. However large randomized controlled trials are necessary to assess normal pregnancies to incorporate NST to monitor normal pregnancies

Laparoscopy and hysteroscopy in patients of infertility in a rural set up

Background: Infertility is a life crisis. The number of couples seeking medical help for infertility is increasing dramatically. The incidence of infertility in any community varies between 5-15%.  This problem is compounded by the trend towards delayed child bearing to achieve socio-economic, educational and professional goals and the rapidly diminishing availability of adoptable infants. These couples are relatively well informed. Diagnostic laparoscopy & hysteroscopy have emerged as an accurate method of assessing, evaluating and treating infertility. Direct visualization of the abdominal and pelvic organs in laparoscopy allows a definitive diagnosis to be made in many conditions where clinical examination and less invasive techniques such as ultrasound and HSG fail to identify the problem.Methods: A prospective study conducted in Department of Obstetrics and Gynaecology, JNMC, AVBRH, and DMIMS. 60 women with H/O infertility for ≥ 1 year were enrolled and subjected to diagnostic tests. Cases with diagnosed tubal blockage, active lower genital tract infection, suspected pregnancy, tuberculosis and high risk medical disorders were excluded.Results: Endometriosis 32%, ovarian disorder (22%), Intra uterine synechiae and cervical stenosis together 14%, tubal block (6%) tubal pathology (delayed spill) (18%).Conclusions: Laparoscopy and hysteroscopy detects pelvic pathology which can appear to be normal on other imaging modalities and provides direct visualization as well as treatment of the diseased condition. Laparoscopy and hysteroscopy combined together are valuable technique for complete assessment of female factors of infertility patient and should be used early in the diagnostic work up in cases of infertility

Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas

Background: The objective was to assess the sensitivity and specificity of pap smear and colposcopy and to study the socio demographic parameters of women with unhealthy cervix. Methods: This was a prospective observational study conducted from August 2011 – August 2013 in the Department of Obstetrics and Gynaecology. Pap smear was performed by the conventional method and colposcopy was done for all 200 sexually active women who came with complaints of discharge per vagina, inter menstrual or post coital bleeding. Colposcopy results were analysed. Final correlation of pap smear and colposcopy were based on histopathology.Results: There were 200 samples that were suitable for statistical analysis. The sensitivity of colposcopy was 79.37%, specificity 81.02%, positive predictive value 65.79%, negative predictive value 89.52% respectively and accuracy was 80.5%. Pap smear had a sensitivity of 25.4%, specificity of 99.27%, positive predictive value of 94.12%, negative predictive value of 74.32%, and accuracy of 76.0% respectively.Conclusions: Pap smear had a poorer sensitivity compared to Colposcopy but a better specificity than colposcopy. Hence it may be better to utilise both tests as they complement each other in screening of premalignant lesions of cervix

Prevalence of gestational diabetes mellitus, its associated risk factors and pregnancy outcomes at a rural setup in Central India

Background: Gestational diabetes mellitus (GDM) is characterised by carbohydrate intolerance of varying severity with onset or first recognition during pregnancy. GDM is an important public health problem in India.Method: The present study was carried out in 300 antenatal women. Fasting blood glucose was measured after which they were given 75 g oral glucose and plasma glucose was estimated at 2 h. Patients with plasma glucose >140 mg/dl were labelled as GDM. Thus WHO criteria were used for diagnosing GDM. Data was collected from all subjects on demographic characteristics, socioeconomic status, education level, parity, family history of diabetes and/or hypertension, BMI, etc. and pregnancy outcome was studied.Results: Prevalence of GDM was found to be 8.33%. Gestational diabetes mellitus was found to be significantly associated with age, parity, BMI, socioeconomic status, education level and was also found to be associated with adverse pregnancy outcomes.Conclusion: GDM adversely affects maternal and fetal outcomes and its prevalence is steadily rising. Appropriate interventions are required for its control

Study of various gynaecological problems and reproductive health awareness amongst adolescents at a rural setup in central India

Background: Adolescent problems are increasing over the years and need special consideration. We, as health care providers, need to focus on young people as investing in their health today will reap rich rewards tomorrow.Methods: All the adolescents presenting with various gynaecological problems were evaluated by detailed history taking and thorough clinical examination after taking an informed consent and explaining them our objective. After examination, adolescent girls were given education by means of slide show about menstruation, care during menses, nutritional diet and prevention of anaemia.Results: Majority of adolescents had regular menstrual pattern. Oligomenorrhoea was the most prevalent abnormality of menstrual pattern in these adolescents. 15.58% adolescents had presented with breast problems like mastalgia, lump in breast, etc. Majority of adolescents studied were aware of the physical signs of puberty (77.25%) and HIV (74.14%). But very few adolescents were aware of the physiology involved in menstruation. Around half of all the adolescents were seen to follow proper menstrual hygiene.Conclusions: Healthy adolescence, the need of the hour

Thyroid disorders in antenatal women in a rural hospital in central India

Background: Thyroid disorders are one of the most common endocrine disorders in pregnancy. Thyroid disorders are known to be associated with abnormal maternal and fetal outcomes and are often overlooked in pregnant women because of nonspecific symptoms and hypermetabolic state of pregnancy.Methods: 514 women between 12 to 18 weeks of pregnancy from October 2013 to September 2015were recruited in the study. Serum thyroid-stimulating hormone (TSH) testing was done. Free T4 and free T3 were tested in subjects with a deranged TSH value. Subjects were followed up till delivery, and maternal and fetal complications arising out of thyroid dysfunction were studied.Results: The occurrence of subclinical hypothyroidism was 9.54%, overt hypothyroidism was 2.34% and hyperthyroidism was 0.58%.  When compared to subjects with euthyroidism, anemia and preterm delivery were the most significant maternal complications in subjects with hypothyroidism (p=0.0001 and 0.0001, respectively) whereas miscarriage, IUD/stillbirth, LBW and intrauterine growth restriction were significant fetal complications observed in subjects with hypothyroidism, with p<0.0001, p=0.002, 0.025, 0.009 respectively. NICU admissions were 2.58 times more in subjects with thyroid disorders as compared to euthyroid subjects.Conclusions: The occurrence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening for thyroid dysfunction is recommended to prevent adverse fetal and maternal outcomes. Serum TSH is a sufficient and cost-effective screening tool.

Clinical study of post operative wound infections in obstetrics and gynaecological surgeries in a tertiary care set up

Background: The study was performed with the aim to find out the incidence of post-operative wound infection among the elective and emergency obstetrics and gynaecological abdominal surgeries in the Dept. of OBGY, A.V.B.R.H., Sawangi (Meghe), Wardha with the objectives to identify the risk factors and most common causative micro-organism and to study the preventive aspects.Methods: This prospective observational study was carried out in the Dept. of Obstetrics and Gynaecology at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, India from August 2011 to August 2013.Results: During this period a total of 3475 patients underwent major abdominal surgeries, out of which 213 cases develop post operative wound infections with rate being 6.12%.The rate was found to be higher among the emergency obstetric case (51.17%) with the common risk factors being anaemia, advanced age and diabetes among gynaecological surgeries and prolonged rupture of membranes and previous LSCS and multiparity among obstetric cases. The common causative organism was found to be E. coli (36.15%).Conclusion: The merit of this study was to start the active surveillance of surgical site infections based on standard definitions and methods to be maintained by cooperation of infection control practitioners and surgical team. Identification of risk factors for surgical site infections to encourage the development of recommendations for prevention of SSI in order to achieve the setting goal to reduce the SSI.

Thyroid disorders in antenatal women in a rural hospital in central India

Background: Thyroid disorders are one of the most common endocrine disorders in pregnancy. Thyroid disorders are known to be associated with abnormal maternal and fetal outcomes and are often overlooked in pregnant women because of nonspecific symptoms and hypermetabolic state of pregnancy.Methods: 514 women between 12 to 18 weeks of pregnancy from October 2013 to September 2015were recruited in the study. Serum thyroid-stimulating hormone (TSH) testing was done. Free T4 and free T3 were tested in subjects with a deranged TSH value. Subjects were followed up till delivery, and maternal and fetal complications arising out of thyroid dysfunction were studied.Results: The occurrence of subclinical hypothyroidism was 9.54%, overt hypothyroidism was 2.34% and hyperthyroidism was 0.58%.  When compared to subjects with euthyroidism, anemia and preterm delivery were the most significant maternal complications in subjects with hypothyroidism (p=0.0001 and 0.0001, respectively) whereas miscarriage, IUD/stillbirth, LBW and intrauterine growth restriction were significant fetal complications observed in subjects with hypothyroidism, with p&lt;0.0001, p=0.002, 0.025, 0.009 respectively. NICU admissions were 2.58 times more in subjects with thyroid disorders as compared to euthyroid subjects.Conclusions: The occurrence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening for thyroid dysfunction is recommended to prevent adverse fetal and maternal outcomes. Serum TSH is a sufficient and cost-effective screening tool.