Critical analysis of surgical difficulties and postoperative morbidities of caesarean deliveries: a rural teaching hospital experiences in silk city, South India

Background: Caesarean section is the delivery of a fetus through a surgical incision on the uterine wall after 28 weeks of gestation. Objectives of present study were to determine the caesarean section rate, to analyse surgical difficulties and post-operative morbidites in caesarean deliveries and to formulate modalities to reduce morbidity and to ensure safe motherhood.Methods: Retrospective analysis of caesarean deliveries in Shri Sathya Sai Medical College and Research Institute, Ammapettai from January 2015-2017. Total number of delivery in these two year were 494.Total vaginal delivery-210, Total caesarean delivery-284. Case records of women who had cesarean deliveries were analysed for intra operative complications and post-operative morbidity within the period of their hospital stay.Results: Total no of deliveries in 2 years were 494. Vaginal delivery was 210 (42.5%). Total caesarean section is 57.5% (n=284). Primary caesarean section rate 33.1% (n=94) and secondary cesarean section rate 66.9% (n=190). 60% of our subjects were un-booked emergency admissions. Majority were between 21-30 years. Youngest is 16yr old with imminent eclampsia, oldest 35yr with previous 3 LSCS with central placenta previa. Non-closure of peritoneum in previous caesarean has increased the risk of adhesions, plastered rectus muscle and bladder adhesion which caused difficulty in reaching lower segment in 62 women. In present study, vertical incision was put on uterus in 4 cases due to adhesions. Difficulty in entering uterine cavity, extension of uterine angle due to thick lower segment and excessive bleeding was seen in cases of repeat caesarean section. Scar dehiscence has increased due to single layer closure of uterus. Scar dehiscence was noted in 41 cases. Bladder injury in 3 cases, adherent placenta over the scar was seen in 5 cases.Conclusions: Caesarean section rate is increasing. Intraoperative complications and postoperative morbidity is comparatively less in primary caesarean section. More than one morbidity was seen in 60% women who had repeat section. With the growing rate of cesarean deliveries worldwide, women should be counselled that the repeat cesarean are bound with surgical difficulties and complications. If available, it’s imperative to take the senior obstetricians help for better surgical outcome. Anticipation of complications, early decision and active intervention reduces morbidity and prevent mortality as most of the women report for admissions late in labour

Effect of Naturopathic modalities in the management of recurrent Urinary Tract Infection

Now a days recurrent UTI is on common infection among the people, more common in women, particularly in child bearing age. The current research aims at providing a cost effective, long standing treatment protocol for the management of recurrent UTI and also for minimizing the recurrence of symptoms for a longer duration.. The objective of the study is to assess the effect of naturopathic modalities in the signs, symptoms and microscopical features of recurrent urinary tract infection. The study was a before and after Quasi – experimental or Non- randomized design. Data from an individual case sheet Proforma specifying demographical data, general history, clinical history related to urinary tract infection, physical examinations, laboratory investigation, data related with treatment and its response were collected. A consultation and examination was performed to grade the signs and symptoms. Grading was done before and after treatment. Routine blood investigation including erythrocyte sedimentation rate (ESR) and data related to presence of pus cells in urine were also collected. The naturopathic modalities including hot hip bath, abdominal hot compress, juice therapy and diet control is found to be therapeutically very effective in reducing the symptoms of urinary tract infection. Juice therapy used in the study has diuretic and anti-inflammatory properties and provide good results

Feto-maternal outcome in patients with peripartum cardiomyopathy: a 5-year study in a tertiary care hospital in Kolar district

Background: Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first 5 months postpartum. PPCM remains a diagnosis of exclusion. There have been numerous proposed causes including hormonal abnormalities, inflammation, viral pathogens, autoimmune response, and genetic predisposition. Aim of study was to study the clinical profile, risk factors, and the management along with obstetric and perinatal outcome, in women with peripartum cardiomyopathy.Methods: This retrospective observational study was conducted on the antenatal women of age group of 18 years to 40 years, admitted in the labour ward of R. L. Jalapa hospital who presented with heart failure in last month of pregnancy till 5 months postpartum, without previously having a heart disease over the 5 year period, January 20 15 to December 2019.Results: Majority of the patients (15/18) presented with complaints of exertional dyspnoea. Mean LVEF at the time of diagnosis was 38.39%. There were 5 (27%) maternal mortality and all of them had global hypokinesia on echocardiography and presented in NYHA class III and IV. Two (11%) out of eighteen patients had intrauterine death, and all the patients who had IUFD belonged to class IV. Four babies (22.22%) had intrauterine growth restriction.Conclusions: The present study came to conclusion that in rural tertiary center, maternal outcome and prognosis was poor as patients presenting to us were majority of them in cardiogenic shock and lower LVEF in terminal stages. The associated risk factors were preeclampsia, anemia and multiple gestation which could also contribute to the poor prognosis which was noticed in the study. Early recognition of the disease is of paramount importance as the clinical manifestations can conceal and can lead to high morbidity and mortality especially within 3 months postpartum

Diversity of Endophytic Actinomycetes From Wheat and Its Potential as Plant Growth Promoting and Biocontrol Agents

A total of 35 endophytic actinomycetes strains was isolated from the roots, stems and leaves tissues of healthy wheat plants and identified as Streptomyces sp. (24), Actinopolyspora sp. (3), Nocardia sp. (4), Saccharopolyspora sp. (2) Pseudonocardia (1) and Micromonospora sp. (1). Seventeen endophytic actinomycetes isolate showed abilities to solubilize phosphate and produce IAA in the range of 5 to 42mg/100ml and 18-42µg/ml respectively. Nineteen isolates produced catechol-type of siderophore ranging between 1.3-20.32µg/ml. Also, hydroxamate-type siderophore produced by 9 isolates in the range of 13.33-50.66µg/ml. Maximum catechol-type of siderophore production was observed in Streptomyces roseosporus W9 (20.32µg/ml) which was also displaying maximum antagonistic activity against ten different pathogenic fungi. The results indicated that internal tissues of healthy wheat plants exhibited endophytic actinomycetes diversity not only in terms of different types of isolates but also in terms of functional diversity

A comparative study of maternal outcome between vacuum extraction and outlet forceps delivery

Background: Instrumental delivery is an art that is fading and may disappear in the near future as more and more obstetricians are resorting to caesarean sections. Instrumental vaginal deliveries comprise the use of vacuum assisted devices and /or forceps to assist in delivering a fetus, offering the alternative to accomplish vaginal delivery in properly selected cases thereby reducing maternal morbidity in terms of blood loss and increase hospital stay which is a consequence of cesarean sections. The objective of the present study is to compare the maternal morbidity with vacuum and outlet forceps delivery.Methods: A prospective comparative study was conducted in women delivering at department of obstetrics and gynaecology, in SDUMC, R L Jalappa Hospital, Kolar from March 2016 - March 2017 for a period of one year. A minimum of 180 patients were taken up for study. 90 women delivered by outlet forceps delivery and 90 women by vacuum delivery. Cases which require instrumental vaginal delivery and fulfilling the inclusion criteria for forceps or vacuum were taken up for the study, after taking informed consent. Maternal outcomes including episiotomy wound and extension, perineal tear, post-partum hemorrhage, hospital stay was analyzed and compared.Results: Mostly forceps and vacuum were applied for age group of 26-30 years and primigravida, which showed a statistical significance. Extension of episiotomy was more with forceps that is 21.1% and with vacuum being 4.4%. This difference was statistically significant. Postpartum hemorrhage was also more common in forceps group that is 13.3%compared to vacuum 11.1% but the difference was not statistically significant. The need for blood transfusion was seen more in cases of forceps that is 11.1% cases whereas in vacuum i.e. 6.7% cases but was not statistically significant.Conclusions: With the expertise and appropriate decision on the indication and meticulous handling of the instrument whether outlet forceps or vacuum, especially in a tertiary care centre, the maternal outcome is equally good with both the instruments

Study on knowledge and experience about emergency contraception at a tertiary care centre family planning clinic

Background: Unintended pregnancies and unsafe abortions are the major reproductive health challenges faced by women of developing countries. According to WHO 42 million induced abortions occur annually and out of which 20 million are performed in unsafe condition and by unskilled providers.Methods: It is a questionnaire-based study planned to be conducted in the family planning clinic of Department Of Obstetrics and Gynaecology, at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Statistical analysis is done by percentage analysis, paired T test or Wilckoxer signed rank test and Mcnemer test.Results: This is a questionnaire-based study conducted on 300 urban educated women seeking termination of pregnancy. Among 300 women studied majority were in the age group of 21-30 years i.e. 174 women (58%). Among 300 women studied about 126 women who had some knowledge about EC and Medias (like TV, radio and magazine) constitutes the major source of knowledge i.e. 60 women (47.6%) then Doctors and nurse i.e. 36 women (28.5%) and other sources like friends, relative and Teachers i.e. 30 women (23.8%). Knowledge about the side effects of EC was very limited in present study, i.e. 30 women (23.8%) were unaware of side effects, 60 women (47.6%) were aware of minor side effects like nausea, vomiting and pain abdomen, and only 36 women (28.5%) were aware of hormonal side effects like menstrual irregularity.Conclusions: From present study it is shown that even among urban educated women knowledge about emergency contraception is very limited. For the proper use of emergency contraception, women should have basic knowledge about fertility and contraception. According to present study only 23.8% of urban educated women have knowledge about safe and unsafe period only (42.8%) had knowledge about timing of use of Emergency contraception

The study of antiphospholipid antibodies in recurrent pregnancy loss

Background: Around 15% of clinically recognised pregnancies in women less than 35 years old result in spontaneous miscarriage. However recurrent pregnancy loss (RPL) is encountered in 5% of couples with two or more losses and in around 1–2% of couples with three or more losses. In view of the increasing burden of recurrent pregnancy loss in the society and in view of Anti-phospholipid syndrome being one of the undisputed treatable cause for recurrent pregnancy loss, this study aims to evaluate the significance of the antibody profiles of APS in relation to RPL in OBG dept of VIMS and RC.Methods: Patients coming to the Obstetric and Gynaecology department of Vydehi Institute of Medical Sciences and Research Centre, Bangalore, from December 1st 2014 to June 30th 2016. A detailed history of patients was taken based on set questionnaires. Detailed general and gynaecological examination findings were taken. Routine blood investigations were sent along with investigations for aPLAs which included: - Lupus Anticoagulant (LA) - Anti Cardiolipin Antibody (ACA) - Anti β2 glycoprotein 1 (Anti-β2GP1Ab). Final results are statistically evaluated.Results: A total of 56 patients of recurrent miscarriage with two or more prior pregnancy losses were considered. Out of the 56 patients, 23 patients were excluded as per the exclusion criteria and 33 patients were included in the present study. The mean age of the study group was 24.63 years (Range: 20-32 years). Overall, seven patients (21.21%) were seen to have positive antiphospholipid antibody titers amongst the 33 patients, with repeat testing done after 12 weeks to confirm the positivity. Five patients (15.15%) were positive for ACA antibody. Four (12.12%) patients were positive for LA and B2GP1 each. Two patients (6.06%) were positive for both LA and ACA antibodies. Two patients (6.06%) were positive for LA and B2GP1 antibodies and two other (6.06%) patients were positive for ACA and Anti-β2GP1Ab. There was a statistically significant association noticed between ACA positivity and POG at 1st pregnancy loss. However, the overall association of APLA positivity and POG at pregnancy loss was not statistically significant.Conclusions: There was a significant difference of POG at first pregnancy loss in ACA positive patients as compared to the ACA negative patients. However, when all the APLA positive patients were considered the difference was not statistically significant

Study on acute transfusion related adverse reactions in surgery department

Background: Blood transfusion is a routine life- saving medical intervention which is generally regarded as safe when done appropriately. Without blood transfusion, many medical and surgical conditions like anemia, road traffic accidents, obstetric hemorrhage, cardiothoracic surgeries are nearly impossible to manage. However, this life-saving procedure is often associated with adverse effects ranging from minor chills and rigors to life-threatening anaphylaxis. Incidence of transfusion reactions is estimated at 0.001% -10%. The knowledge about the adverse transfusion reaction (ATRs) will help in early identification, management, and prevention of adverse transfusion reactions.Methods: Descriptive cross-sectional study done in 1047 patients, admitted and received at least one unit of whole blood and blood components in the surgery department, Government Medical College, Kottayam during the study period. Information regarding the issue of blood component collected from the transfusion medicine department and the details of the reactions were collected from the patients, and the transfusion reaction workups were done in the transfusion medicine department. The collected data was analysed using Microsoft Excel sheets.Results: The frequency of acute transfusion reaction in this study is 1%. The majority of the reactions were seen with a packed PRBC transfusion. Febrile non-hemolytic transfusion accounted for 54.64% followed by allergic reactions (36.36%) and Transfusion associated cardiac overload (9%).Conclusions: The frequency of ATR in our study was 1%. Febrile non-hemolytic transfusion (FNHTR) and allergic reactions were common patterns followed by transfusion associated cardiac overload (TACO) seen

Post Hysterectomy morbidity: a suburban teaching hospital experience in Kanchipuram, Tamil Nadu, South India

Background: Hysterectomy is the removal of uterus for benign uterine tumor and uterine descent in perimenopausal women. Post hysterectomy and follow up morbidity in rural women is studied over a period of 1 year. They were reviewed during hospital stay to identify morbidity and risk factors for prolonged hospital stay and formulate modalities to reduce morbidity. Risk factors assessed were fever, wound sepsis, anemia, previous post-operative adhesions and injury to other organs. Follow up was done at 4 weeks. 72% women were morbidity free. 46% women had more than one morbidity. The aim of this study is to analyse immediate and late post hysterectomy morbidity in a rural setup and to identify risk factors for prolonged hospitalization and formulate modalities to reduce morbidity and duration of hospital stay.Method: Perimenopausal women who underwent hysterectomy for benign uterine conditions and uterine descent were studied for post-operative morbidity at SSSMCRI over a period of one year. Post hysterectomy morbidity was clinically assessed from day one of surgery till discharge, for early and late morbidity. Abdominal skin incision smear, vault smear, urine culture and USG pelvis for collection of fluid was done in woman who developed fever. Follow-up morbidity was done at 4 weeks. Hysterectomy done for malignant conditions were excluded from the study.Results: In rural women, postoperative morbidity was assessed in 81 abdominal, 32 vaginal hysterectomy. Post-operative pain was felt by all 113 women for first 3 days. Fall of hemoglobin due to haemorrhage was seen in 43 (38%) women. 33 needed post-operative blood transfusion. Surgical site infection was seen in 13, needed re-suturing in 7. Fever was seen in 50 women (44%) due to UTI (E coli 13, Klebsiella 5). Pelvic fluid collection was seen in 9 with vault infection. We had one burst abdomen, one re-laparotomy, 3 bladder injuries. Prolonged hospital stay was seen in 41 women. 46% had more than one morbidity. Follow-up at 4 weeks, 72% were morbidity-free. Prolene granuloma 2, Stitch abscess 9, vaginal discharge 14, vault granuloma 3 were observed. Vaginal smear showed 9 Staphylococcus aureus and 5 bacterial vaginosis infection. 12 women had E. coli and 6 Klebsiella infection in urine culture.Conclusion: Pre-operative risk factors for post op morbidity like anemia, urinary and vaginal infection should be properly treated prior to surgery. Awareness of risk factors for morbidity, anticipation of complications due to size, site, nature of tumour and previous surgery adhesions, timely intervention by experienced surgeons and adequate blood transfusion will reduce morbidity and prolonged hospital stay