Study of feto-maternal outcome in referred obstetric cases in tertiary care center in Rajasthan: a cross sectional study

Background: Pregnant women are at high risk for life threatening complications throughout the pregnancy and during delivery as well. Most of these complications are unpredictable with routine clinical examination. Skilled medical interventions such as blood transfusion, caesarean delivery, expert surgical team, medicines etc. are required to prevent these complications. Emergency obstetric referral should be carried out to avoid maternal and fetal morbidity and mortality. Aims and objectives of current study were to investigate the pattern of referral in tertiary care center and fetomaternal outcome in referred cases.Methods: This is a observational study conducted in the department of obstetrics and gynaecology, at a tertiary care hospital. Patients are referred from nearby PHCs, CHCs, SDHs and private hospitals. All referred antenatal and intra-natal patients to our center of >24 weeks of gestational age were studied.Results: Majority of them 43% women were of 21-25 year of age, 35% women were of 26-30 year of age group. Out of 76 delivered women, 55% underwent caesarean section and 36.84% were delivered normally. PPH seen in 6.66% patients, maternal deaths reported 2.5%, septicaemia 1.6%, wound gaping in 3.33%, puerperal pyrexia in 5% of patients. 77% neonates were shifted to mother-side, whereas 18% were admitted to NICU.Conclusions: Referral system is an important part of health care system. By providing good antenatal care, availability of blood products, well organized referral center, timely identification and referral of high-risk patients, skilled birth attendants at time of child birth all will help in reducing feto-maternal morbidity and mortality and will help in achieving goal of ideal MMR and NMR.

Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass

Study of predicting perinatal outcome in patients with oligohydraminos at term pregnancy

Background: Amniotic fluid plays a major role in the fetal growth and development. It provides the fetus with a protective low resistance environment suitable for growth and development, a cushion against the constricting confines of the gravid uterus, allowing the fetus room for the movement and growth and protecting it from external trauma. The abnormalities of the fluid volume can interfere directly with the fetal development or may be an indirect sign of underlying disorder such as fetal hypoxia, neural tube defect or gastrointestinal obstruction. Aim of this study was to determine whether an amniotic fluid level of 5cm or less can be predictor of adverse perinatal outcome in terms of fetal distress, birth weight, APGAR score and neonatal morbidity and mortality. Methods: Amniotic fluid index (AFI) was determined with a b-mode real time scanner with linear transducer operated at 3.5 MHz. AFI estimation done by four quadrant technique in supine position. The summation of measurement from each quadrant represented the amniotic fluid index in centimeters of each patient. Fetal outcome was assessed with respect to birth weight and gestational age; Apgar score at one and five minutes; any other neonatal complications intrapartum or postpartum during stay in hospital and maturity of baby - condition at the time of discharge of mother and baby. Results: The labor was induced in 28% women with AFI <5cm, out of which 19 women delivered vaginally and 9 women underwent LSCS for failure of induction. The mean birth weight was 2.61 kg in our study. Maximum number of babies i.e. 57% were with birth weight between 2.1-2.5 kg. The APGR score at 5 min was 9 in 71% cases and 8 in 21% cases. The mean APGR score at 5 min was 8.63. Conclusions: AFI can be used as an adjunct for fetal surveillance along with other methods to identify high risks foetuses to improve the perinatal outcome

An observational study of uterine rupture at a tertiary care center

Background: Uterine rupture is one of the most dangerous obstetric emergency situation carrying an increased risk of maternal and perinatal morbidity and mortality. This catastrophic complication occurs most often in women attempting a vaginal birth after a prior LSCS. Aim was to determine the incidence, etiology, management, maternal and fetal outcome. Recommend strategy for its prevention to reduce the incidence of maternal and fetal morbidity and mortality.Methods: This prospective observational study was conducted over a period of 1 year. Total 51 cases who were diagnosed with rupture were included in the study. Emergency laparotomy after pre-operative resuscitation done. Hysterectomy or repair of rupture site was done depending on the condition of the patient, parity, presence or absence of infection.Results: Maximum patients of uterine rupture belonged to 37-40 weeks of GA. Inter-delivery interval <18-24 week were more vulnerable. Patients with previous caesarean section was more than without section. Maximum cases presented with signs of shock. Maternal death rate was 11.63%, whereas perinatal death rate was 82.35%.Conclusions:Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors are: history of prior caesarean section, grand multiparity, obstructed labor, and fetal malpresentations. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse feto-maternal complications.

An observational study to assess feto-maternal outcome in severely ill COVID-19 positive pregnant females admitted at dedicated COVID care center of southern Rajasthan

Background: COVID-19 infection is caused by corona virus SARS-COV2. the aim of the study is to assess feto-maternal outcome in severely ill covid positive pregnant females.Methods: An observational study was conducted at dedicated covid care center, RNT medical college Udaipur from Jan 2021 to May 2021 among pregnant females. In this study out of 236 total covid positive pregnant patients, 54 patients which could not maintain oxygen saturation, according to NIH criteria were included in our study.Results: Out of 54 pregnant women, 24 women delivered with 2 twin pregnancies. Out of this 67% underwent cesarean section and 33% were delivered by vaginal route. Postpartum hemorrhage seen in 29% of patients. Maternal death reported in 39% of patients. Out of 54 patients 38 patients were admitted in ICU. Invasive ventilation received by 26% of patients while oxygen received by non-invasive ventilation (15%), Bains (18%) rest by NRBM and venturi mask (41%). Remdesivir were given in 26 (48%) patients.Conclusions: Our study suggests there may be increased risk of adverse pregnancy outcome for mother and fetus. COVID-19 in pregnancy was associated with risks of pre-eclampsia, stillbirth, preterm birth, PPH. Similar to general population comorbidities do play a role in the outcome of disease in pregnancy. Further studies are needed for effective strategies to prevent adverse outcomes in pregnant females with COVID-19.

Schiff Bases and Their Metal Complexes: Synthesis, Structural Characteristics and Applications

The development of Schiff base was a major step forward in the area of coordination chemistry. Schiff bases, a class of organic compounds, carry the imine or azomethine (>C=N–) functional group. Schiff bases played an influencing role in the development of coordination chemistry and were a key point in the development of inorganic, bioinorganic chemistry and optical materials. Schiff bases, widely used in inorganic, organic, and analytical chemistry, account for a significant portion of the more commonly employed classes of organic molecules. The ability of Schiff base ligands to form stable metal complexes with a wide range of transition and other metal ions makes them extremely useful. Condensation of a primary amine with an aldehyde or ketone yields a Schiff bases. In this chapter, we focused on introducing Schiff bases, classified them and their metal complexes, and discussed several synthesis methods, including conventional and green approaches. This chapter also elaborated on the industries’ applications, such as the food industry, agrochemical industry, dye industry, analytical chemistry, catalysis, energy storage, environmental, chemo-sensing, bio-sensing, and biomedical applications of novel Schiff bases and their metal complexes

Quantitative estimation of serum 25(OH) D and associated risk factors of vitamin D deficiency among pregnant women attending a tertiary care hospital in Udaipur, Rajasthan

Introduction: Insufficiency of vitamin D is now known globally and is exceptionally common in temperate and tropical countries. Due to its several negative maternal and fetal health consequences, vitamin D insufficiency in pregnancy is a growing concern worldwide. Methods: A cross-sectional study was conducted at a tertiary medical hospital for one year. A sample of 280 pregnant women attending antenatal clinic (ANC) were enrolled using a random sampling technique. A standard questionnaire was designed to collect socio-demographic details and the sun exposure of participants. To analyse dietary habits and consumption of vitamin D-rich foods, a food frequency questionnaire (FFQ) was used. Serum samples were obtained and analyzed for and calcium levels. Results: High prevalence of maternal vitamin D insufficiency 122 (43.57%) and deficiency 92 (32.85%) observed. Most 263 (94%) participants had adequate serum calcium levels (> 8.5 mg/dL). Younger participants (< 25 yrs.) had low mean vitamin D (17.61±13.89 ng/mL), adequate calcium (9.52±0.70 mg/dL) levels. Rural residence, multigravida, advanced trimester, poor education, joint family, unemployment, and lower socioeconomic status were found associated with vitamin D insufficiency. Conclusion: In the present study a high prevalence of maternal vitamin D deficiency was observed. The burden of Vitamin D inadequacy (76.39%) reflects poor nutritional status and health risks for mothers and fetuses. Sociodemographic factors (Residence, Education, Family, and Socioeconomic status) were linked to this micronutrient deficiency. There is a need for further community-based nutritional research on sociodemographic, biological, and nutritional determinants for in-depth understanding

Regular Antenatal Care Visits Predict Good Knowledge Among Post-natal Mothers Regarding Entitlements of Health Programs in Western India

Janani-Shishu Suraksha Karyakram (JSSK) and Janani Suraksha Yojana (JSY) were launched with the objective of increasing institutional deliveries. But, its knowledge among the post-natal mothers is not known. This research evaluated the knowledge of two national health programs among post-natal mothers and found out the predictors of good knowledge about the entitlements of these programs. A cross-sectional study was conducted on a sample of consecutively recruited 339 post-natal mothers who had delivered in a tertiary care hospital of western India. Data were collected from November 2016 to February 2017 by interview method using a questionnaire with questions about knowledge regarding the entitlements of JSSK and JSY. Multivariable analysis was carried out for predictors of good knowledge. Among the 339 post-natal mothers, 30% had a good knowledge regarding JSSK. Only 24% had heard about JSSK; 54% knew regarding free transport to the place of delivery; only 22% and 13%, respectively knew about free inter-facility transport in case of complications for pregnant women and sick infants, while 96% knew regarding free drop-back facility. Only one-fourth of the mothers knew regarding monetary benefit under JSY, while 28% of them had actually received the benefit. The number of antenatal care visits, having an occupation and belonging to Hindu religion significantly predicts good knowledge among postnatal mothers regarding JSSK. Knowledge among the post-natal mothers regarding the entitlements of JSSK and JSY is less while comparing with published literature and needs improvement. Regular ante-natal care (ANC) visits might improve their knowledge of these programs. There is a need to create awareness among hospital staff for the provision of reimbursement of costs incurred by post-natal mothers. There is also a need to carry out demand generation activities among mothers regarding the entitlements of JSSK and JSY

Understanding Environmental and Social Reasons Towards Abnormal Menstruation Cycle in Indian Women

The human female reproductive system is by far the most complex biological system, abnormal menstruation cycles is directly associated with type 2 diabetes and they have shown to be associated with cardiovascular disorders as well. The underlying reasons for abnormal menstruation cycle in Indian women is just not stress, birth control pills and or disease symptoms but signs of social and environmental factors are clearly evident now in form or traditional societal practices. This paper aims to understand the abnormal behavior of the menstruation cycle in Indian women

Measurement of t(t)over-bar normalised multi-differential cross sections in pp collisions at root s=13 TeV, and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

Peer reviewe