A two-year study of patterns and prevalence of congenital malformations

Background: India is undergoing an epidemiological transition; communicable diseases are on the decline due to better living conditions and healthcare delivery. On the other hand, the relative increase in the prevalence of non-communicable, chronic and genetic diseases threatens to be a public health problem in India like congenital malformations. Congenital malformations remain one of the least focused areas of disease surveillance in India compared with communicable and some chronic diseases. Thus, data on the magnitude of birth defects are essential to plan preventive strategies and organize methods of supportive care for affected individuals and families. The aim of this study is to study the incidence and prevalence of the birth defects and the patterns of congenital malformations in our institute and the various risk factors influencing the occurrence.Methods: A cross sectional study was conducted on all Ant natal patients and deliveries conducted in the institution for a period of two years from June 2015 to May 2017. Mediscan Systems extended a big hand in further confirmation of diagnosis. A detailed history was taken regarding the patients and husband’s age, parity, occupation, previous obstetric outcome, family history of birth defects and exposure to teratogens and environmental factors and intake of periconceptional folate. Data analysis was done with respect to age, parity, consanguinity, sex, previous defects.Results: CNS defects were the most recognisable malformations at birth. Pick up rate for CVS anomalies were low requiring expertise. As against the wide prevalence of cardiac defects across total population the reported prevalence is less as similar to rest of the studies done in many centres across the country. Target scan has halved the burden of birth defects.Conclusions: Congenital malformations though cannot be prevented totally but can be minimised and if detected early will reduce the mental agony in the mother and family. Prenatal counselling, periconceptional folate, anomaly scan, Prenatal diagnosis reduce the incidence of birth defects

Two-year comparative study on immediate versus delayed induction in term premature rupture of membranes

Background: Premature rupture of membranes (PROM) has an incidence of about 10% of all pregnancies and is a significant event as it can cause maternal complications, neonatal morbidity and mortality. Some believe that the expectant management of PROM at term does not increase the perinatal and maternal morbidity, and immediate induction of labour leads to an increased caesarean section rate. There are some authors who report a significant increase in the rates of neonatal, maternal infection and foetal distress if delivery occurs over 24 hours after PROM. Thus, a data is required to manage the cases of PROM to effect safe delivery for both mother and baby. The objective of the study was to compare the neonatal and maternal outcomes between immediate and delayed induction with PG E2 gel in term PROM.Methods: A hospital based study in women admitted to Obstetrics and Gynaecology Department at R.S.R.M Hospital with a sample of 400 patients in age group between 19- 35 years with gestational age between 37 and 41 weeks were selected for the study. All the 400 cases who presented with term PROM were admitted in labour room and history was elicited regarding age, menstrual and obstetric history with enquiry regarding the time of rupture of membranes, duration and amount of leaking with general, systemic and detailed obstetric examination.Results: The number of PG E2 gel needed for induction varied between the two groups. Around 45 patients in group 2 needed second dose of gel whereas only 32 patients required the second dose in the late induction group and 72 cases got into active labour. There was no difference in maternal and neonatal infectious morbidity between the two groups. This may be due to the use of prophylactic antibiotics. Neonatal outcome was equally good in both the groups.Conclusions: Delayed induction of labour in PROM after a waiting period of 12 hours stands as a reasonable option as it reduces the number of operative deliveries without compromising the maternal and neonatal outcome

A study on awareness and acceptance of contraceptive methods in postpartum women in a tertiary care institute

Background: Contraception is an important tool to reduce unwanted pregnancy and promote healthy living. The benefits of family planning program are recognized worldwide to improve health, social and economic status of families. The objective of the study is to estimate the prevalence of awareness for various contraceptive methods among postpartum women, to find the acceptance of different contraceptive methods and evaluate the factors affecting the same.Methods: The study is a cross-sectional observational study conducted among postpartum women who delivered in Narayana medical college hospital over a period of 1 year. The awareness, acceptance and reason or refusal for contraception was assessed. The data obtained was analyzed to generate graphs and tables.Results: A total of 61% women were aware of at least one method of contraception. 74% were using a contraceptive at the time of study. 39% were unaware of any contraceptive method. 49% preferred intrauterine contraceptive device. Main reason for non-acceptance of contraceptive was couple’s desire for a male child. Health professionals were the main source of imparting the knowledge of birth spacing.Conclusions: Regular antenatal counselling to all pregnant women must be done in every hospital in a village to tertiary care centres. Information should be provided about various contraceptive methods and patient should be able to choose a method of her own choice. A strong motivation is required to adopt a suitable method individualised to each woman

A two-year study on postmenopausal bleeding at a tertiary institute

Background: The life expectancy of women shows an increase as a result of which women experience a long postmenopausal phase. Postmenopausal bleeding is a worrisome symptom occurring in 10 % of the women, making them seek a gynaecology opinion at the earliest. Women in developed countries have a predilection for developing endometrial cancer whereas cancer cervix still dominates in the developing countries. This prospective study was carried out on 75 women presenting with postmenopausal bleeding to the gynaecology clinic at a tertiary hospital set up. The study aimed to find the incidence of postmenopausal bleeding, age distribution, causes and different evaluation methods to confirm the diagnosis.Methods: The present study is a prospective study conducted on 75 postmenopausal women reporting with postmenopausal bleeding at the gynaecology clinic at a tertiary care hospital.              Results: Menopause was noted above 45 years in 84% of the patients and 16% were in 40-45 years age. Postmenopausal bleeding was observed in 50-60 years in 56% of women and 30% above 60 years. The medical problems associated were hypertension (20%), diabetes (11%), obesity (22%), hypothyroidism (4%). 53 women had benign causes while 22 had malignancy.Conclusions: Benign lesions of the genital tract are common causes of postmenopausal bleeding. Carcinoma cervix and endometrium classically present with postmenopausal bleed. Strong suspicion, thorough evaluation and early diagnosis improve the quality of life and reduce the morbidity and mortality

A two-year study of patterns and prevalence of congenital malformations

Background: India is undergoing an epidemiological transition; communicable diseases are on the decline due to better living conditions and healthcare delivery. On the other hand, the relative increase in the prevalence of non-communicable, chronic and genetic diseases threatens to be a public health problem in India like congenital malformations. Congenital malformations remain one of the least focused areas of disease surveillance in India compared with communicable and some chronic diseases. Thus, data on the magnitude of birth defects are essential to plan preventive strategies and organize methods of supportive care for affected individuals and families. The aim of this study is to study the incidence and prevalence of the birth defects and the patterns of congenital malformations in our institute and the various risk factors influencing the occurrence.Methods: A cross sectional study was conducted on all Ant natal patients and deliveries conducted in the institution for a period of two years from June 2015 to May 2017. Mediscan Systems extended a big hand in further confirmation of diagnosis. A detailed history was taken regarding the patients and husband’s age, parity, occupation, previous obstetric outcome, family history of birth defects and exposure to teratogens and environmental factors and intake of periconceptional folate. Data analysis was done with respect to age, parity, consanguinity, sex, previous defects.Results: CNS defects were the most recognisable malformations at birth. Pick up rate for CVS anomalies were low requiring expertise. As against the wide prevalence of cardiac defects across total population the reported prevalence is less as similar to rest of the studies done in many centres across the country. Target scan has halved the burden of birth defects.Conclusions: Congenital malformations though cannot be prevented totally but can be minimised and if detected early will reduce the mental agony in the mother and family. Prenatal counselling, periconceptional folate, anomaly scan, Prenatal diagnosis reduce the incidence of birth defects

Two-year comparative study on immediate versus delayed induction in term premature rupture of membranes

Background: Premature rupture of membranes (PROM) has an incidence of about 10% of all pregnancies and is a significant event as it can cause maternal complications, neonatal morbidity and mortality. Some believe that the expectant management of PROM at term does not increase the perinatal and maternal morbidity, and immediate induction of labour leads to an increased caesarean section rate. There are some authors who report a significant increase in the rates of neonatal, maternal infection and foetal distress if delivery occurs over 24 hours after PROM. Thus, a data is required to manage the cases of PROM to effect safe delivery for both mother and baby. The objective of the study was to compare the neonatal and maternal outcomes between immediate and delayed induction with PG E2 gel in term PROM.Methods: A hospital based study in women admitted to Obstetrics and Gynaecology Department at R.S.R.M Hospital with a sample of 400 patients in age group between 19- 35 years with gestational age between 37 and 41 weeks were selected for the study. All the 400 cases who presented with term PROM were admitted in labour room and history was elicited regarding age, menstrual and obstetric history with enquiry regarding the time of rupture of membranes, duration and amount of leaking with general, systemic and detailed obstetric examination.Results: The number of PG E2 gel needed for induction varied between the two groups. Around 45 patients in group 2 needed second dose of gel whereas only 32 patients required the second dose in the late induction group and 72 cases got into active labour. There was no difference in maternal and neonatal infectious morbidity between the two groups. This may be due to the use of prophylactic antibiotics. Neonatal outcome was equally good in both the groups.Conclusions: Delayed induction of labour in PROM after a waiting period of 12 hours stands as a reasonable option as it reduces the number of operative deliveries without compromising the maternal and neonatal outcome