Analysis of awareness, acceptance, safety and continuation rate of post-placental and intra-caesarean insertion of intrauterine contraceptive device

Background: Intrauterine contraceptive device (IUCD) is an effective form of long acting reversible contraception. This study was done to determine the level of acceptance among Indian women according to their socio-demographic profile and continuation rate of post-placental and intra-caesarean insertion of intrauterine contraceptive device (PPIUCD).Methods: A prospective longitudinal study was conducted in the Department of Obstetrics and Gynecology at RNT Medical College, Udaipur, Rajasthan, India from August 2014 to December 2014. CuT 380A was inserted within 10 minutes of delivery of placenta in 100 counseled women who fulfilled the Medical Eligibility Criteria. They were followed up for 6 months.Results: Total women counseled were 316, out of which 100 accepted and 216 declined the PPIUCD. Expulsion rate was 2%, bleeding (3%), missing strings (8%), pain abdomen (3%), removal rate (6%). Continuation rate was 92%. There was no case of pelvic infection,   perforation or pregnancy with the CuT in situ in the entire followed up period.Conclusions: PPIUCD was demonstrably safe, effective and high retention rate (92%).The expulsion rate was not very high (2%). Awareness of PPIUCD among Indian women was very poor. Myths and misconception among community, limited access to skilled service providers and poor awareness among people were the reasons for low acceptance levels. Increasing awareness of benefits of PPIUCD will surely ensure the change in the acceptanc

Role of SR vacuum cannula as novel technique for atonic PPH management study at Pannadhay Rajkiya Mahila Chikitsalaya and RNT Medical College, Udaipur

Background: Postpartum hemorrhage is a major obstetrical emergency and one of the important but preventable causes of maternal morbidity and mortality. It is often sudden, frequently unpredictable and catastrophic. In this study SR vacuum cannula will be applied to create negative pressure inside the uterine cavity with a specially designed uterine cannula, which is a simple, safe and cost-effective technique. The aim and objective of the study was to analyse the incidence, effectiveness of suction cannula in management of atonic PPH after failure of medical management over tamponade and the maternal outcome after suction technique.Methods: This observational study was conducted in Department of Obstetrics and Gynecology, RNT Medical College and Panna Dhay Rajkiya Mahila Chikitsalaya, Udaipur, Rajasthan. Patients requiring PPH management admitted to the obstetrics ward between August 2019 – December 2020. The Uterine Vacuum Retraction System consists of SR Suction cannula to control PPH after vaginal delivery. SR suction cannula for atonic PPH at caesarean delivery and High vacuum suction machine was used.Results: In majority of the patients bleeding was stopped within three minutes. 60 women (50%) bleeding was stopped within 3 minutes, in 38 women (31.7%) bleeding was stopped between 3-4 minutes and in 22 women (18.3%) bleeding was stopped >4 minutes. In 75 (62.5%) women negative pressure was applied only once, in 20 (16.7%) was applied two times and 25 women (20.8%) negative pressure was applied three times to stop bleeding. Blood collected in bottle after SR Cannula Application ranged from 100-150 ml.Conclusions: Vacuum suction cannulas should be made part and parcel of normal delivery tray to facilitate quick application. This simple and cost-effective technique takes very little time to organize and can stop bleeding within 3 minutes in atonic PPH as shown in this study

Correlation between second trimester beta human chorionic gonadotropin levels and pregnancy outcome in high risk group

Background: Current obstetric practice uses second trimester maternal serum levels of alpha fetoprotein, beta human chorionic gonadotropin (b hCG), unconjugated estradiol as a screening tool for fetal aneuploidy. Given the obvious role of placenta in determining the maternal serum levels of these hormones, we evaluate their role as predictors of placental dysfunction as manifested by pregnancy outcome.Methods: This prospective study was done in department of obstetrics and gynecology, RNT Medical College, Udaipur, Rajasthan on 150 patients attending the antenatal OPD and those admitted between 16 to 20 weeks of pregnancy. Mid-trimester serum b hCG levels was obtained in these patients. They were followed up till delivery or abortion to see for development of any obstetrical complication.Results: Out of 100 cases in study group, 17% cases had level of serum b hCG >2 MOM and 83% cases had 2 MOM and 92% cases had < 2 MOM. Out of 17 cases in study group with high level of serum b hCG, 82.35% and 0% out of 4 cases in control group, developed PIH. Out of 17 cases with high level of b hCG in study group, 58.85% and 25% out of 4 cases in control group, developed IUGR.Conclusions: Women with bad obstetric history and unexplained elevation of serum b hCG during second trimester are at an increased risk for PIH and IUGR

Ultrasonographic assessment of strength of previous cesarean scar during pregnancy

Background: Management of a woman who has undergone a previous cesarean section, has always been a controversial topic, with the inability to precisely confirm the integrity of the scarred lower uterine segment (LUS) being the indication of repeat cesarean section. The objective of this study is to evaluate the accuracy of ultrasonography (USG) in determining the LUS thickness in women with previous cesarean section (CS) and to assess its usefulness in predicting the risk of uterine rupture during a trial of vaginal birth.Methods: A prospective study was conducted on 100 women between 37 to 40 weeks of gestation with a previous CS and 100 primigravidae women serving as control. Thickness of LUS was measured by transabdominal USG. The decision for mode of delivery was based purely on obstetric ground. Patients undergoing CS were considered for analysis.Results: Mean LUS thickness was higher in the control group. Seventy-one patients of control group underwent repeat CS, in which 47 (66.1%) had normal intraoperative finding. 24 (33.7%) had abnormal LUS intraoperatively (LUS thinning). Of these, 20 (28.6%) showed abnormal LUS on USG (<5mm), but 4(5.6%) had normal ultrasonographic finding. Sensitivity, specificity, positive and negative predictive value of ultrasonographic evaluation were found to be 100%, 83.3%, 92% and 100% respectively.Conclusions: Prenatal scar assessment by USG is useful in evaluation of previous cesarean scar and in most cases a near accurate evaluation was possible.

Knowledge, attitudes and practices related to cervical cancer screening in adult women: a hospital based cross-sectional study

Background: The Pap smear is a reliable, inexpensive and effective screening test for cervical cancer; the second most common cancer among women worldwide. We aimed to determine women’s knowledge, attitudes and practice towards Pap smear and barriers for the screening in a public hospital.Methods: It was a hospital based cross sectional study on 300 women who were interviewed face-to-face with a structured questionnaire regarding their socio demographic features (8 questions), knowledge (20 questions), attitudes (7 statements) and practice (undertook test or not) towards Pap smear.Results: A total of 320 women were approached for interview of which 300 responded of which 33.33% had heard of cervical cancer. At least one symptom and one risk factor were known to 13.33% and 20% participants. Only 31.33% participants had heard, and 6.67% actually underwent screening test, however, 76.25% of the participants expressed a favourable attitude for screening.Conclusions: Education level influences attitude towards screening and actual practice depends on age, income, and marital status. This study shows that despite the fact that women had suboptimal level of knowledge regarding cervical cancer, their attitude is favourable for screening. The knowledge and practice of women was inadequate and needs to be promoted.

Consanguinity Mapping of Congenital Heart Disease in a South Indian Population

Parental consanguinity is a risk factor for congenital heart disease (CHD) worldwide, suggesting that a recessive inheritance model may contribute substantially to CHD. In Bangalore, India, uncle-niece and first cousin marriages are common, presenting the opportunity for an international study involving consanguinity mapping of structural CHD. We sought to explore the recessive model of CHD by conducting a genome-wide linkage analysis utilizing high-density oligonucleotide microarrays and enrolling 83 CHD probands born to unaffected consanguineous parents. exons did not reveal causative mutations in Indian probands. In addition, genotyping of the linked allele (G) in 325 U.S. CHD cases revealed neither genotypic nor allele frequency differences in varied CHD cases compared to 605 non-CHD controls. may harbor recessive mutations leading to CHD in the Indian population. Further research involving large multinational cohorts of patients with specific subtypes of CHD is needed to attempt replication of the observed linkage peak on chromosome 14. In addition, we anticipate that a targeted re-sequencing approach may complement linkage analysis in future studies of recessive mutation detection in CHD

Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery

<p>Abstract</p> <p>Background</p> <p>The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia.</p> <p>Methods/Design</p> <p>The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS) monitoring (Aspect medical, Newton, MA). The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment.</p> <p>Discussion</p> <p>The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three.</p> <p>Trial registration</p> <p><b>This trial is registered at </b>Clinicaltrials.gov <b>#</b>: NTC00433251</p

Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis

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Williams syndrome and Ebstein’s anomaly: A rare association

We report a rare case of Williams syndrome associated with Ebstein’s anomaly of the tricuspid valve. To our knowledge, such an association has never been reported