Reinforcing the vast difference between the outcomes of spontaneous versus induced miscarriages

Background: Information on incidence of spontaneous and induced abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancies. In this study, we analyzed in detail the presentation, complications of abortions and procedure associated complications of spontaneous and induced miscarriages.Methods: The study was prospectively conducted on 200 patients from IPD of MGM Medical College, Indore over a period of two years and under the guidance of population council of India. The patients were divided into 2 groups of 100 patients each under spontaneous and induced miscarriages.Results: After matching the parity, age of mothers, gestational age at presentation and socioeconomic status the results were analyzed.  45% women presented with incomplete abortion followed by inevitable (20), missed (12) and complete abortion (19) in the spontaneous abortion group. In induced abortion group majority of women presented with failure of contraception, natural method use being the most common method of contraception. Young women preferred medical abortion while multiparous women went for surgical evacuation.  Minor and tolerable side effects like mild bleeding pain nausea etc. were seen in medically supervised group of induced miscarriage. Major and life threatening complications were seen in the spontaneous abortion group like heavy bleeding, hypovolumic shock, septic abortion, foul smelling vaginal discharge, bowel injury and also one mortality was seen in the spontaneous abortion group.Conclusions: While appreciable progress has been made in legalizing and improving MTP services, the unmet needs continue to grow. Efforts should be made to make safe abortion facilities available to majority of population. At the same time awareness should be spread so that seeking abortion does not become an alternative to contraception

A cross sectional study to compare effects of mechanical dilatation and sublingual misoprostol on induction of labor in a tertiary level government hospital

Background: To compare sublingual misoprostol versus mechanical dilatation of the cervix with Foley’ catheter in induction of labor, the need for other method of augmentation of labor like oxytocin infusion, to find out maternal outcome and perinatal outcome and to find out rate of caesarean section in both the groups.Methods: The study was carried out in the department of obstetrics and gynaecology, M.Y. Hospital Indore, on pregnancies with an indication for induction of labor either with mechanical dilatation or with misoprostol. Two groups are made each of 100 cases. One group is induced with Foley’ catheter and other with 25 mcg misoprostol sublingually. Both groups are compared on the basis of age, parity, indication of induction, duration of cervical ripening and delivery, need of oxytocin augmentation. Maternal and foetal outcomes are also compared.Results: Most of the cases in both groups were primigravida, belong to 20-25 year of age group. Most cases were induced for postdatism followed by PIH. Induction delivery interval was short in cases received misoprostol. Also misoprostol group required less oxytocin augmentation, and has significant low rate of caesarean section. There was no significant difference in both cases in terms of maternal and foetal complications.Conclusions: Misoprostol is very safe and effective drug for induction of labour. It has property of collagenous remodelling of cervix along with stimulation of uterine contraction. Hence its induction-delivery interval is short with little requirement of oxytocin augmentation. Rate of failed induction is also low

Correlation of body mass index and age of menopause in women attending medicine and gynaecology department of a tertiary care centre

Background: Menopause is a physiological change that every woman experiences in her life. Some find it extremely troublesome and for some it is a gradual change .Multiple factors determine the age at which menopause occurs, also deciding the course of menopause. How do height, weight and body mass index affect the same is the basis of this research.Methods: 500 women who underwent natural menopause were examined to assess their height and weight. The body mass index was henceforth calculated. The results were statistically analysed using Pearson correlation.Results: The age of menopause varied with the increasing height, weight and BMI. Though no statistical significance was found in between height and age of menopause, there was a definite correlation between weight and BMI of the women.Conclusions: Time long obesity and higher BMI is known for being associated with many diseases like hypertension, diabetes, metabolic syndrome etc. This study indicates how it affects the physiologic change i.e. menopause also. Women with higher BMI tend to have higher age of attaining menopause

The retina in hypertensive disorders of pregnancy: a study of the prevalence and association with severity of disease in a tertiary referral centre in India

Background: Hypertensive disorders of pregnancy remains to be a major cause of maternal and fetal morbidity and mortality. The retina offers the unique opportunity to directly observe changes in the vasculature due to preeclampsia. Fundoscopy can be used to prognosticate and assess the severity of disease and offer an optimum time of delivery to improve fetomaternal outcome. There are limited number of studies from northern India assessing the relationship between hypertensive disorders of pregnancy and retinopathy. This study was undertaken to bridge this gap.Methods: This was an observational cohort study undertaken in a tertiary hospital, 225 patients of preeclampsia coming to the department were identified and a structured proforma used to gather relevant information. All patients underwent fundoscopy and were classified into groups on the basis of fundal grade observed. The groups were compared in terms of clinicodemographic variables. Appropriate statistical tests were applied.Results: A total 68% patients had retinal changes of which the most common grade was grade 1 There was a significant rise in the mean systolic and diastolic blood pressure with increasing grade of fundal change. The (p-value 0.001). 65.5% of patients of preeclampsia without severe features (i.e. mild cases) had no retinopathy. None of these patients had grade 3 or 4 changes. In the patients of preeclampsia with severe features, 88.9% cases had varying degrees of retinopathy.Conclusions: As severity of preeclampsia increases, incidence of retinopathy also increases. Fundoscopy is a useful diagnostic aid and should be done to optimize fetomaternal outcome

Reinforcing the vast difference between the outcomes of spontaneous versus induced miscarriages

Background: Information on incidence of spontaneous and induced abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancies. In this study, we analyzed in detail the presentation, complications of abortions and procedure associated complications of spontaneous and induced miscarriages.Methods: The study was prospectively conducted on 200 patients from IPD of MGM Medical College, Indore over a period of two years and under the guidance of population council of India. The patients were divided into 2 groups of 100 patients each under spontaneous and induced miscarriages.Results: After matching the parity, age of mothers, gestational age at presentation and socioeconomic status the results were analyzed.  45% women presented with incomplete abortion followed by inevitable (20), missed (12) and complete abortion (19) in the spontaneous abortion group. In induced abortion group majority of women presented with failure of contraception, natural method use being the most common method of contraception. Young women preferred medical abortion while multiparous women went for surgical evacuation.  Minor and tolerable side effects like mild bleeding pain nausea etc. were seen in medically supervised group of induced miscarriage. Major and life threatening complications were seen in the spontaneous abortion group like heavy bleeding, hypovolumic shock, septic abortion, foul smelling vaginal discharge, bowel injury and also one mortality was seen in the spontaneous abortion group.Conclusions: While appreciable progress has been made in legalizing and improving MTP services, the unmet needs continue to grow. Efforts should be made to make safe abortion facilities available to majority of population. At the same time awareness should be spread so that seeking abortion does not become an alternative to contraception

Importance of Universal screening for thyroid disorders in first trimester of pregnancy

Objective: To determine the importance of screening for Thyriod disorders in the first trimester of pregnancy. Materials and Methods: The Study was conducted on 305 patients which were were randomly selected and screened on OPD basis by TSH levels (cut off level 0.10-2.50 mIU/ml). Results: In the 305 women screened mean age was 24.46 years, mean gestational age was 9.09 weeks, 89.83% were euthyroid, 9.8%were hypothyroid, 0.32% were hyperthyroid. Incidence of hypothyroidism in high risk population was 20.58% and in normal population was 6.7%. There was significant association of thyroid disorders with high risk factors (P < 0.001). In hypothyroid women 46% had adverse perinatal outcomes and 53.33% had normal outcomes. This shows statistically significant association abnormal TSH values with adverse pregnancy outcomes (P < 0.001). In abnormal perinatal outcomes 6.2% women had Caesarean section out of them 73.68% were euthyroid, 26.31% were hypothyroid 1.9% had preterm labour, out of them 50% were euthyroid, 50% were hypothyroid. Out of 2.2% spontaneous abortions 28.5% were in euthyroid group while 71.4% were in hypothyroid group. There was 1 term stillbirth in hypothyroid group.This study showed significant association between abnormal thyroid stimulating hormone (TSH) values and adverse perinatal outcomes (P < 0.001). Conclusion: There is significant correlation between risk factors and hypothyroidism. So high risk screening is mandatory in early pregnancy. But if we screen only high risk population we would miss 4.6% cases which could have been diagnosed and treated earlier. Therefore it is important to screen all pregnant women in the first trimester, it should be made mandatory

A cross sectional study to compare effects of mechanical dilatation and sublingual misoprostol on induction of labor in a tertiary level government hospital

Background: To compare sublingual misoprostol versus mechanical dilatation of the cervix with Foley’ catheter in induction of labor, the need for other method of augmentation of labor like oxytocin infusion, to find out maternal outcome and perinatal outcome and to find out rate of caesarean section in both the groups.Methods: The study was carried out in the department of obstetrics and gynaecology, M.Y. Hospital Indore, on pregnancies with an indication for induction of labor either with mechanical dilatation or with misoprostol. Two groups are made each of 100 cases. One group is induced with Foley’ catheter and other with 25 mcg misoprostol sublingually. Both groups are compared on the basis of age, parity, indication of induction, duration of cervical ripening and delivery, need of oxytocin augmentation. Maternal and foetal outcomes are also compared.Results: Most of the cases in both groups were primigravida, belong to 20-25 year of age group. Most cases were induced for postdatism followed by PIH. Induction delivery interval was short in cases received misoprostol. Also misoprostol group required less oxytocin augmentation, and has significant low rate of caesarean section. There was no significant difference in both cases in terms of maternal and foetal complications.Conclusions: Misoprostol is very safe and effective drug for induction of labour. It has property of collagenous remodelling of cervix along with stimulation of uterine contraction. Hence its induction-delivery interval is short with little requirement of oxytocin augmentation. Rate of failed induction is also low

Cross-cultural adaptation of motivational interviewing for use in rural Nepal.

BackgroundMotivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person's behaviors.MethodsWe developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment.ResultsParticipants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not "allow" it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone's motivations and align those with the patient's needs.ConclusionsMI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient's autonomy and their role as a member of a complex social fabric to facilitate behavior change