Impact of coronavirus on pregnant females in India: an observational study

Background: Coronavirus (COVID-19) has emerged as a rampant pandemic and the entire world is struggling against it. The entire nations are trying to device measure like national lockdowns, diverting resources towards fighting coronavirus, extensive media coverage, closing of elective services in hospitals. All this has influences the masses to a deep level. Coronavirus not only is morbid for the sick, but also the healthy pregnant females seeking health care and impacted them more mentally than physically.Methods: In this study 103 pregnant females from the entire nation of India were made to answer a well thought and made questionnaire which aimed at assessing the mental state and impact of coronavirus on the pregnant females.Results: Majority of the females answered that they felt anxious and were undergoing stress due to the coronavirus. They fear impending doom for the child and also are struggling a lot to seek apt healthcare for themselves and their children because of the ongoing pandemic.Conclusions: Coronavirus has not only affected people who are directly affected with the virus, but also who are still not affected but are mentally stressed because of it. National lockdown and alteration in the healthcare services are also stress- inducing for the pregnant females

Holt-Oram syndrome: a rare case report

Holt-Oram syndrome is an inherited disorder that causes abnormalities of the hands, arms and heart. The diagnosis can be established clinically. The diagnostic criteria have been validated with molecular testing. An upper-limb malformation involving the carpal bone(s) and, variably, the radial and/or thenar bones-An abnormal carpal bone, present in all affected individuals and identified by performing a posterior-anterior hand x-ray, may be the only evidence of disease. 24 years unbooked Hindu female G2P1+0 presented in OPD at term. Her USG examination showed-small deformed upper limbs with poorly appreciable upper limb skeleton. Induction of labour was done and patient delivered vaginally a female baby with deformed upper limbs. This case emphasizes the importance of proper history taking (family history), early diagnosis of such anomalies and proper counseling the parents

Study of TH 1 and TH 2 activity in women with threatened miscarriages

Background: Successful pregnancy is associated with T helper-type 2 (Th2) immunity and is helpful in maintaining pregnancy, while T helper type-1 (Th1) activity is responsible for deleterious effects.Methods: The study comprised of two groups: Group I- Threatened abortions in first trimester (n=60) subdivided in two groups: 1 N- one who continued pregnancy (n=38), and another, 1A- who aborted (n=22), and Group II- 40 pregnant women in first trimester who later delivered at term without any history of abortion in the past. Blood was collected and analyzed for IL-2 and IL-6 by ELISA kit.Results: Th1 activity (IL-2) was higher in threatened abortion group irrespective of whether continuing their pregnancy or aborting in comparison to control (p <0.001). On the other hand, Th2 activity (IL6) was decreased    (p <0.001) in both the groups of threatened abortions.Conclusions: The patients with threatened abortion have a definite increase in Th1 activity and decrease in Th2 activity whether aborting or continuing their pregnancy in comparison to normal pregnant women without any history of spontaneous abortion in the past

A rare case report on complete cervical agenesis with vaginal atresia and suspended didelphys uterus with hematometra and left haematosalpinx

Congenital uterine malformations are deviations from normal anatomy resulting due to defective fusion of Mullerian ducts or the paramesonephric ducts in the developing embryo. These anomalies may be isolated or in combination with urological abnormalities. The mean prevalence of female congenital malformations in general population is up to ⁓ 7%. Patients with these anomalies usually present during pubertal age due to absence of onset of menses, cyclical abdominal pain, or in reproductive age group as infertility or recurrent pregnancy loss depending upon the degree of malformation. Cervical agenesis is a rare Mullerian anomaly with an incidence of 1 in 80,000 females. It represents 3% of all uterine anomalies. It is rarely associated with a functioning uterus (4.8%). Cervical agenesis is often associated with vaginal atresia (less than 50%). It is important to classify these anomalies for easy diagnosis and plan appropriate preoperative treatment

Perceptions of Indian women on hysterectomy

Background: Women who undergo hysterectomy face a multitude of physical and psychosocial problems. The objective of the study was to assess the impact of pre-operative education on post-operative psychosocial health.Methods: It was an interventional research in 96 women who were randomly divided into two groups; one received pre-operative education about surgery and the other given routine preoperative advice. With the help of a questionnaire the perceptions of women on hysterectomy were assessed.Results: Post-operation, 47 of the intervened patients and all the patients of control group were satisfied with the surgery, statistically insignificant; fisher's exact of 1. For 20 intervened patients and 6 patients of control group were very acceptable with the fact that the uterus was no longer present in the body post-surgery, statistically significant; fisher's exact of 0.001. 45 of the intervened group were not feeling depressed whereas 19 patients of the control group were feeling depressed, statistically significant; fisher's exact of 0.0005.Conclusions: Thus, there was a positive impact of pre-operative education on perceptions about hysterectomy. Women who underwent hysterectomy after receiving preoperative education were content with the results of surgery. Resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

A study on knowledge attitude and practice of contraception in school going children in Wardha district in central India

Background: Adolescent sexuality is leading to adolescent pregnancy, unsafe abortion, Reproductive Tract Infections, Sexually transmitted infections. Therefore, studying knowledge, attitude and practice regarding this problem among school adolescents is an essential issue, which can support to overcome young people from sexual related problems.Methods: This study was cross sectional study conducted in Wardha district of Maharashtra among school going adolescents. Data was collected by the means of anonymous questionnaire after taking the informed consent.Results: In our study total 375 students were included in the study, amongst 192 were girls and 183 were boys. Majority of students belong to age group of 13-15 years. Nearly 50% of students were knowing about basic reproductive physiology. Amongst the total 375 participants, 184 (49%) students had ever heard about any of contraceptive method while 51 % of totally unaware. Among total students having knowledge of contraception, 38.7% knew about condoms, oral contraceptive pills as method of contraception were known to 88 students (23.5%) while knowledge of emergency contraception was very low. The knowledge of females was higher as compared to males regarding oral and emergency contraception. 15% of total adolescents accepted that they have used condom. The proportion of males using condoms was higher as compared to females.Conclusions: The adolescents need to be provided with correct knowledge for behavior change, to stop their undesirable practices for healthy life. There was an evident gap between knowledge and practices with respect to the sexual practices of youth which needs to be bridged.

Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute

Role of plasminogen activator inhibitor type 1 (PAI-1) in PCOS patient

Background: There has been few studies done demonstrating elevated level of PAI-1 in women with Polycystic Ovarian Syndrome (PCOS). PAI-1 has been associated with insulin resistance, obesity, anovulatory infertility, increased risk of cardiovascular disease in PCOS patient. The objective of the study was to find out the plasma level of PAI-1 in PCOS and compare with healthy age matched control. To correlate PAI-1 with various demographic, anthropometric, biochemical and hormonal parameters in PCOS patient and specific relation of PAI-1 with the insulin resistance, obesity, hyperandrogenemia.Methods: A prospective case control study was carried out in 50 patients having PCOS (fulfilling Rotterdam Criteria, 2003). 25 healthy age matched control were taken. Blood samples were taken for estimation of fasting glucose, fasting insulin, lipid profile, LH, FSH, Prolactin, Testosterone, insulin sensitive indices (HOMA-IR, glucose: insulin ratio). Plasma level of PAI-1 was estimated with Human ELISA invitorgen kit. The data were statistically analysed with SPSS 16.0 version (student T test, Pearson ranked correlation coefficient, linear regression analysis was applied) and PAI-1 was correlated with various parameters.Results: Mean level of PAI-1 was significantly raised in PCOS patient (893.36±234.97) pg/mL than in control (259.68±97.75) pg/mL (p<0.001). PAI-1 significantly correlated with insulin resistance, obesity; that is; PAI-1 significantly correlated with BMI (r=0.557; p<0.001), waist: hip ratio (r=0.550; p<0.001), fasting glucose (r=0.429; p=0.002), fasting insulin (r=0.357; p=0.001), triglyceride (r=0.492; p=0.000), LDL (r=0.604; p=0.001), HOMA-IR (r=0.467; p=0.001). On regression analysis LDL, fasting insulin, HOMA-IR altogether explained 54.9% of total variability of PAI-1.Conclusions: Plasma level of PAI-1 is elevated in PCOS patient and it is significantly correlated with insulin resistance and obesity

A study on delayed cord clamping and early skin-to-skin contact and its effects on neonatal outcome

Background: Previous study conducted against immediate tying and cutting of the umbilical cord and suggested waiting until the child had taken repeated breaths and the pulsation in the cord had ceased to prevent potential weakness in the child.  A comparative study between delayed cord clamping (DCC) and early cord clamping (ECC) was carried out on a select group of primigravida without any high-risk factor and delivering at term. The objective of the study was to identify the effects of delayed cord clamping and early skin to skin contact on new born infant’s physiological parameters (temperature, weight, SpO2= saturation of peripheral oxygen, Apgar score= appearance, pulse, grimace, activity, and respiration, Hb=haemoglobin level). Methods: Study sample consisted of 300 mothers and their new born after gaining mother’s acceptance. They were divided into 2 groups of 150 each. Group A underwent delayed cord clamping and early skin to skin contact and group B early cord clamping. Newborns monitored 24 hours for hypothermia, apnoea, oxygen needs. Results: The findings of the present study were equivalent among both groups regards the mean neonatal haematological parameters were comparable and slightly elevated hemoglobin level and weight status among late cord clamping compared to early cord clamping group with significant difference was observed at 24 hour later. Conclusions: This study was found that DCC does have a beneficial effect on temperature, Apgar score, SpO2, Hb level and weight status of new born. Therefore, it is believed that DCC and early skin to skin contact (ESSC) provides effective thermal control with a reduced risk of hypothermia

A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

Background: Worldwide CSR has been steadily increasing beyond recommended level of 15 %by WHO. High CSR have been reported in developed and developing countries. Reasons for increase in CSR are not obvious and somewhat complex. Thus, present study was undertaken to analyze various indications for CS performed at rural tertiary health care centre Sewagram, M.S.Methods: This was prospective study included all women who underwent CS from 1st January 2015 till 30th June 2016. Data was entered in MS excel sheet analyzed with percentage and chi square test using SPSS ver.17.Results: CSR was 36 .88% in present study. As per NICE guidelines CS were classified in four categories based on urgency, women were distributed in each category. Category I had 22.62%, category II -38.61%, category III - 28.37% and Category IV - 10.40% women. In CAT I common indication was foetal bradycardia (71.53%). In CAT II CS, common indication was non reassuring foetal status (38.82%).  Breech presentation (14.74%) and previous scar with doubtfull scar integrity (14.33) were next common indications. In CAT III (43.43%), IV (41.13%) previous LSCS with inadequate pelvis was the common indication. Confidential enquiry revealed that 26.17% (28/107), 20.3% (40/197), 23.17%, (35/151) and 8.3 % (5/60) of CAT I, II, III and IV CS had questionable indications.Conclusions: In this study, CSR was higher than WHO standard. Common indications in primipara was foetal distress while in multiparas primary indication previous LSC