A retrospective study of teenage pregnancy in a tertiary care hospital

Background: The objective of the study was to evaluate the maternal and fetal outcome of teenage pregnancy and find the effect of antenatal care on these teen mothers.Methods: A retrospective case study was performed over a period of three years. Data was retrieved from the hospital record. All teenage mothers (aged less than 19 years) delivering in the hospital were taken as cases. Consecutive two deliveries in the age group of 20 to 30 years meeting the inclusion and exclusion criteria were taken as control group. Various aspects of pregnancy outcome was recorded and analyzed. Results: The incidence of teenage pregnancy over the three years of study period was 4.33%. The occurrence of hypertensive disorders 32(9.4%) vs 36 (5.3%), p value < 0.01; IUGR 23 (6.7%) vs 11 (1.6%), p value < 0.01; preterm delivery 38 (11.2%) vs 18 (2.6%) p value < 0.01; and full term normal delivery 258 (75.9%) vs 563 (82.7%), (p value < 0.01 in the study group and control group respectively. Low birth weight babies 140 (41.2%) vs 63 (9.3%), p value < 0.01 and NICU admission 20 (5.8%) vs 9 (1.3%), p value < 0.01; were significantly higher in the study group. The comparison of various pregnancy outcomes according to the booking status of the teenage mothers finds significant improvement in most of the parameters in those who received adequate antenatal care.Conclusion: The pregnancy outcome of teenage mothers is poorer in comparison to 20 to 30 years age group in most of the parameters. Adequate antenatal care reduces the incidence of adverse pregnancy outcome significantly in the teen mothers

An observational study of parenteral paracetamol vis a vis tramadol as labour analgesics

Background: Labour although a physiological process, is associated with severe, excruciating pain. The delivery of the infant into the arms of a conscious and a pain free mother is one of the most exciting and rewarding moments in medicine ……..Moir. Labour analgesia plays an important role in making the process of labour comfortable for the mother. Drugs like paracetamol and tramadol with advantages of easy availability, being inexpensive and with no special technique of administration are a boon for labour analgesia. Our study aims to evaluate the efficacy of these two drugs as labour analgesics.Methods: Sixty cases in active labour fulfilling inclusion and exclusion criteria were selected for this study. All primigravidae at term gestation with singleton pregnancy having vertex presentation with no associated obstetric/ medical/surgical risk factors in spontaneous labour were selected. There were thirty patients who received Paracetamol as labour analgesic and thirty were in the tramadol group. It was an observational study.Results: The study revealed that paracetamol had a significant analgesic effect compared to tramadol at the fourth and the fifth hour of administration. However, the overall analgesic effect of both the drugs had no statistically significant difference. Maternal side effects and neonatal distress were less with paracetamol.Conclusions: This study showed that paracetamol had a better side effect profile for both mother and neonate along with a comparable, if not better, analgesic effect vis a vis tramadol

A re-look into intra-operative impediments and post-operative morbidities in repeat caesarean section

Background: Repeat caesarean sections are known to be a cause of significant morbidity in both intra and post-operative period. The challenges faced by the surgeon may include adhesions, difficulty in delivery of foetus, visceral injury and bleeding. The post-operative recovery may be marred by problems such as post-partum haemorrhage, febrile morbidity, wound infections and the after effects of intra-operative visceral injury. It is these issues that often make repeat caesarean section a cause for concern and delay the recovery of the mother. Methods: At random, hundred ante-natal patients visiting the obstetric OPD, meeting the inclusion criteria of previous caesarean section and planned for repeat caesarean section were selected and all the data were collected and tabulated. Results: After careful analysis of the data, it is observed that the intra-operative findings of adhesions, placenta praevia and excessive blood loss were encountered in relook caesarean sections. Similarly post operative morbidity in the form of wound infection and fever were observed in the same study population. Conclusions: If we are more vigilant and restrict the number of primary caesarean sections to evidence based appropriate indications, we may be successful in reducing the number of repeat caesarean sections and thereby mitigating the subsequent hardships for the mother

The study of role of HbA1c as a predictor of gestational diabetes mellitus

Background: India is the diabetic capital of the world and gestational diabetes mellitus contributes to a significant number of cases. Gestational diabetes mellitus is a common medical complication of pregnancy and may lead to serious consequences. Because of these reasons, it was felt that if there was a biomarker for predicting carbohydrate intolerance in pregnancy, it could help in earlier intervention and mitigate the consequences related to it. Hence, for this purpose, the role of HbA1c was studied as a predictor of gestational diabetes mellitus.Methods: This was a cross sectional study. Five hundred antenatal cases were considered for this study. All antenatal patients before 18 weeks of gestation attending antenatal clinic for the first time were selected and these patients were subjected to HbA1c followed by diabetes in pregnancy study group of India (DIPSI) test between 24-28 weeks and the results were analyzed to find any correlation between the two.Results: The main objective of the present study was to find whether HbA1c can be used as a predictor of gestational diabetes mellitus. In this study out of 500 women screened, 60 women turned out to have gestational diabetes mellitus. When comparing DIPSI positivity with various levels of HbA1c, it was found that maximum number of DIPSI positive patients (93.33%), had raised HbA1c levels.Conclusions: Maximum number of DIPSI positive cases had HbA1c level between 5.5 to 6 and this association was found to be statistically significant and a positive correlation was established between the two

Comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy performed for benign gynaecological conditions

Background: Hysterectomy is a common surgical procedure frequently performed in the day-to-day practice of gynaecology. Non-descent vaginal hysterectomy (NDVH), which is an art of gynaecological surgeons, has established its place in the realm of gynaecological surgeries. Total laparoscopic hysterectomy (TLH) has a steep learning curve, requires modernized OT set-up including special endoscopic instruments and may not be available in all centres. Non-decent vaginal hysterectomy is a viable alternative in such a scenario. Hence these two surgeries have been compared in this study.Methods: A total 40 patients undergoing hysterectomy for various benign indications, were included for the study. They were divided into two groups of 20 each. One group underwent TLH and the other NDVH. Demographic profile and other perioperative events were compared and statistically analysed.  Results: NDVH group experienced more pain and required a greater number of analgesic doses. The intraoperative blood loss was more in NDVH group and duration of surgery was significantly higher in NDVH group. Rest of the parameters were by and large comparable. The incidence of bladder injury was more in the TLH group as compared to NDVH group.Conclusions: Both NDVH and TLH have their pros and cons. In a given case the final decision will depend on a number of variables like human, financial and medical

A study of the prevalence of group B streptococci in the third trimester of pregnancy

Background: Group B Streptococci (GBS) is an important cause of early onset neonatal sepsis and the maternal colonization of this organism is a key factor in the occurrence of GBS associated morbidity and mortality in the newborns. Timely recognition of its presence in the genital tract of a pregnant women and intrapartum antibiotic prophylaxis can significantly bring down the burden of the disease in neonates. A cross sectional study was conducted on  antenatal women during 35-37weeks of gestation to evaluate the prevalence of Group B Streptococci in third trimester of pregnancy and explore the feasibility of including GBS screening in the routine antenatal investigation protocol.Methods: 200 antenatal women satisfying the exclusion/inclusion criteria were recruited for the study. Vaginal and perianal swabs were collected using sterile swab sticks and inoculated using the specified media. Beta hemolysis and typical colonies were looked for under microscope. Positive cases were subjected to intrapartum antibiotic prophylaxis and the neonates were observed for 72 hours to look for any signs of sepsis.Results: It was found that 2% of the women screened were positive for GBS .While none of the newborns of the 4 positive cases showed any signs of sepsis.Conclusions: Prophylactic intrapartum prophylaxis against GBS has shown to decrease the chances of neonatal sepsis but more detailed and robust studies are required before incorporating routine screening in our antenatal care system

A study of evaluation of unhealthy cervix by various diagnostic modalities

Background: This study was carried out to evaluate cases of unhealthy cervix by using Pap (Papanicolaou) smear, colposcopy and cervical biopsy and to arrive at a definitive diagnosis. It correlated the findings of Pap smear, colposcopy and histopathology. It is important to strictly implement the screening program and spread awareness of the disease symptoms and its management to reduce the overall incidence of morbidity and mortality reported due to cervical cancer.Methods: A total 120 patients satisfying the inclusion/exclusion criteria were recruited for the study and informed consent was taken from all the participants. Pap smear was taken for all the cases. Then cases were subjected to colposcopy followed by biopsy. All the findings were correlated and analyzed. The findings of Pap smear and colposcopy were correlated with the gold standard of histopathology.Results: The sensitivity and specificity of Pap smear and colposcopy with respect to cervical biopsy were 53.1% and 98.7%, 87.87% and 72.72% respectively. Colposcopy had higher sensitivity and lower specificity than Pap smear for screening of cancer cervix.Conclusions: Cervical cancer is one of the preventable and highly curable conditions when diagnosed in the precancerous stage. The incidence of deaths resulting from cervical cancer can be brought down with adequate cervical cancer screening. Colposcopy and colposcopy directed biopsy should be done along with Pap smear in screening for early detection of cervical cancer since the accuracy of detection of cervical abnormalities is higher when these two methods are used complementarily

A comparative study of early and delayed cord clamping in term deliveries

Background: Timing of clamping of the umbilical cord has always been a debatable issue. Early cord clamping (ECC) is defined as clamping of the cord within 30 seconds of delivery of the baby and delayed cord clamping (DCC) is defined as clamping of the cord between 30 to 120 seconds of delivery. Delayed cord clamping, despite some limitations, is said to be beneficial to the neonate.  A comparative study between ECC and DCC was carried out on a select group of term pregnant women without any high-risk factor and delivering at term. Aim of the study was to compare the effects of early versus delayed cord clamping on neonates and mothers. The focus was on the neonatal haemoglobin levels and adverse effects, if any on neonates and mothers in the two groups.Methods: 100 women satisfying the inclusion/exclusion criteria were recruited for the study. They were randomly divided into two groups of 50 each. Group A underwent early cord clamping and Group B delayed cord clamping. Mothers were observed for 1 hour post-delivery for any evidence of post-partum haemorrhage. Neonates were observed for any sign of tachypnea and blood sample was sent after 72 hours of delivery for analyzing Hb, hematocrit and bilirubin of the neonate.Results: The results revealed that neonates with DCC had a higher mean Hb level of 15.02 vis-à-vis the ECC group Hb of 11.69G/dl and the difference was statistically significant. Similarly mean hematocrit of DCC group was 48.67 while the ECC group mean was 42.36, the difference again was statistically significant. There was no significant side effects or complications in both mother and newborn babies.Conclusions: It was concluded that delayed cord clamping should be practiced in otherwise non high-risk deliveries

A study of comparison of efficacy and side effects of intravenous paracetamol and intravenous diclofenac as a postoperative analgesic

BBackground: A postoperative patient suffers from pain the best relief of which is a clinician’s duty. Till date very few studies have been conducted for comparison of paracetamol and diclofenac as analgesics. As a result a comparative study between Paracetamol and Diclofenac was carried out. The aim of the study was to compare the efficacy and side effects of intravenous Paracetamol and intravenous Diclofenac in patients undergoing major abdominal open surgeries in obstetrics and gynaecology. The study was conducted to assess the postoperative visual analogue pain scores (VAS) and total analgesic requirement in the first 24 hours and also to study the total requirement of additional analgesics despite administration of either Paracetamol or Diclofenac in postoperative period.Methods: 100 patients satisfying the inclusion/exclusion criteria were recruited for the study. They were divided into two groups of 50 each. Group A was given IV Paracetamol 6 hourly for 48 hours starting 2 hours after surgery. Group B was given IV Diclofenac 8 hourly for 48 hours starting 2 hours after surgery. Patients were assessed for pain relief by visual analogue scale (VAS) of zero to ten after 6 hours, 12 hours, 24 hours and 48 hours of surgery by asking the patient to point the position on the 100 mm scale.Results: The results revealed that when we compared the VAS scores between the 2 Groups at different time intervals, it showed that at 24 hours and 48 hours VAS score in the Diclofenac Group was significantly less than the Paracetamol Group. The main side effects were nausea and vomiting in both the groups. There was more nausea and vomiting in Diclofenac group compared to Paracetamol group.Conclusions: It was concluded that at 24 hour and 48 hour pain reduction was more in the Diclofenac group as compared to Paracetamol group, but the side effects were more in the Diclofenac group compared to Paracetamol group