Sociodemographic determinants of medical termination of pregnancy along with contraceptive practices

Background: Though the most common reasons for medical termination of pregnancy (MTP) is unwanted pregnancy due to nonuse of contraceptives by the women of reproductive age group and other are pregnancy before marriage or due to rape. Several studies indicate that most abortions are sought to limit family size or space the next pregnancy. There is need to study relation of MTP with contraceptive practices.Methods: The present cross-sectional study was conducted at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, to study socio-demographic factors associated with medical termination of pregnancy and its relation with contraceptive practices. Total 1840 women seeking care for medical termination of pregnancy were interviewed after their informed consent during period of January 2015 to December 2017. A detailed history regarding age, religion, income, marital status, parity, history of previous MTP, indications for MTP, use of contraception, gestational age was taken.Results: Statistical analysis-chi square test of significance for qualitative data using SPSS software version 24.0. The proportion of women coming for MTP due to nonuse of contraceptives was 86% the other indications for MTP were medical condition (9%) and contraceptive failure (5%). The factors like age, religion, education and socioeconomic status were significantly associated with MTP.Conclusions: There is need to counsel women of reproductive age group that MTP is not a way to control unwanted birth

Factors influencing the likelihood of vacuum delivery success

Background: Instrumental or assisted vaginal birth is commonly used to expedite birth, for the benefit of either mother, baby or both. Objective of present study was to evaluate risk factors for unsuccessful vacuum delivery when variability between individual accoucheurs is taken into account.Methods: We conducted a retrospective cohort study of attempted 687 vacuum deliveries over a 10-year period (2008–2017 inclusive) in a tertiary care center at Smt. Kashibai Navale Medical College and General Hospital, Narhe to account for inter-accoucheur variability, we matched unsuccessful deliveries (cases) with successful deliveries (controls) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful vacuum deliveries.Results: During the study period of 10 years, there were 29861 deliveries, of which 19831 (66.4%) were vaginal deliveries. 8802 (29.47%) were cesarean deliveries and 1228 (4.1%) were instrumental deliveries. Among instrumental deliveries, 687 (56%) were vacuum deliveries and 541 (44%) were forceps deliveries. Six hundred and eighty-seven ventouse deliveries of vertex presenting, single, term infants were attempted, of which 38 were unsuccessful (5.5%). Increased birth weight (OR=1.11 p<0.001), second-stage duration (OR=1.01 p<0.001), rotational delivery (OR=1.52 p<0.05) and use of ventouse versus forceps (OR=1.33 p<0.05) were associated with unsuccessful outcome. When inter-accoucheur variability was controlled for, instrument selection and decision to rotate were no longer associated with vacuum delivery success. More senior accoucheurs had higher rates of unsuccessful deliveries (12% v. 5%, p<0.05), but undertook more complicated cases. Cesarean delivery in the second stage without prior attempt at ventouse delivery was associated with higher birth weight (OR=1.07 p<0.001), increased maternal age (OR=1.03 p<0.01), and epidural analgesia (OR=1.46 p<0.001).Conclusions: Careful selection of cases and adequate training of post graduate students during residency under direct supervision of senior experienced obstetrician can reduce the rate of failed vacuum delivery and related complications Results suggest that birth weight and head position are the most important factors in successful vacuum delivery, whereas the influence of patient selection and rotational delivery appear to be operator-dependent. Risk factors for lack of vacuum delivery success are distinct from risk factors for requiring vacuum delivery, and these should not be conflated in clinical practice

Intrauterine fetal demise: a retrospective study in tertiary care center in India

Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age 30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management

Our experience of nifedipine as a tocolytic agent in preterm labor (24 weeks to 36 weeks 6 days)

Background: Preterm birth is defined as birth between the age of viability and 37 completed weeks of gestation. The aim of this study is to evaluate the safety and efficacy of nifedipine, a calcium channel blocker, as a tocolytic in prolonging duration of pregnancy in case of preterm labor.Methods: This is a retrospective analytical study conducted in Department of Obstetrics and Gynaecology, SKNMC and GH, Pune, India conducted over a period of one year from June 2014 to May 2015. All uncomplicated, singleton preterm labor cases were given Cap. Nifedipine as tocolytic and Inj. Betamethasone for enhancing fetal lung maturity. Maternal parameters studied were Gravida and Parity, previous history of preterm labor, gestational age at delivery, mode of delivery, side effects. Neonatal parameters studied were weight at birth, APGAR score at birth, complications at birth, NICU admissions, mortality.Results: Out of total 4478 deliveries from June 2014 to May 2015, 252 women with preterm labor were treated with nifedipine. 214 out of 252 delivered at term with overall success rate of 84.92%. Out of remaining 38 cases, 36 cases delivered as preterm normal deliveries and 2 required Caesarean section. No major side effects observed in mothers receiving nifedipine. As regards neonatal outcome, 12 babies required NICU admission and mortality was of 2.Conclusions: Nifedipine is safe and effective in prolonging preterm labor and has minimal maternal and neonatal side effects. It eliminates the need for intensive maternal monitoring as required in case of betamimetics

Comparative study of programmed labor and traditional management of labor

Background: Prolongation of labor leads to dehydration, ketoacidosis, infection, fetal asphyxia. Programmed labor aims at reducing the duration of labor, labor pain and incidence of cesarean section with improved maternal and neonatal outcome.Aims and Objectives:1)       To evaluate the effect of programmed labor on duration of labor.2)       To assess efficacy of analgesics in reducing pain of labor.3)       To find out maternal and neonatal complications.4)       To study impact of programmed labor on LSCS rates.Methods: Prospective randomized study of primigravida in active labor (after 4 cm cervical dilatation) for which 100 women were selected for programmed labor (cases) and 100 women were selected for traditional management of labor (controls). Cases were subjected to interventions to improve uterine contractions (ARM, Dinoprostone tablets, and Oxytocin drip), to facilitate cervical dilatation (Inj. Drotaverine), to relieve labor pains (Inj. Pentazocine & Diazepam). All labors were monitored by partogram.Results: Programmed labor reduced duration of first and second stage of labor. There was faster cervical dilatation (1.8 cm/hour against 1.2 cm/hour). Majority of the patients had better pain relief. There was no impact on LSCS ratesConclusions: Programmed labor significantly reduced duration of labor with good pain relief without compromising maternal and fetal/neonatal safety. But it had no impact on LSCS rates

ISEC2006-99116 Overview of Solar Air Drying Systems in India and His Vision of Future Developments

ABSTRACT :-Solar Air Drying is one of the oldest method of food preservation. For several thousand years people have been preserving grapes, herbs, Potato&apos;s, corn, milk, fruits, vegetables, spices, meat and fish by drying. Until canning was developed at the end of the 18 th century, drying was virtually the only method of food preservation. It is still the most widely used method. Solar Drying is an excellent way to preserve food and solar food dryers are an appropriate food preservation technology for a sustainable world. This technology makes it possible to dehydrate and preserve food professionally without compromising on quality, color, texture, enzymes, vitamins, taste and nutritional values of foods in the process. Food scientists have found that by reducing the moisture content of food to between 10 and 20%, bacteria, yeast, mold and enzymes are all prevented from spoiling it. India is blessed with an abundance of sunlight, water and biomass. Vigorous efforts during the past two decades are now bearing fruit as people in all walks of life are more aware of the benefits of renewable energy, especially solar energy in villages and in urban or semi-urban centers of India. Industries that can benefit from application of solar energy to heat air are Food, Textiles, Dairies, Pharma and Chemical. This paper reviews the present scenario of Solar Air Dryer and strategies for future developments in India