Rising trends of caesarean section in modern obstetrics: analysis by Robson classification

Background: Rising caesarean section (CS) rates are a major public health concern worldwide. The main objective of our study was to analyse the CS rates according to Robson ten group classification system (TGCS).Methods: This was a retrospective study conducted in the department of obstetrics and gynaecology at Chettinad hospital and research institute, during a period of 5 years from May 2015 to April 2020. All the women who delivered by CS were included in the study. The data regarding parity, gestational age, onset of labour, number of foetuses and presentation was collected and classified according to Robson TGCS and analysed.Results: A total of 4199 women delivered during the study period. Out of 4199 women 2149 (51.18%) underwent CS. All the women who underwent caesarean section were classified according to Robson TGCS. Group 5 contributed the most (40.81%). Group 2 had the second highest contribution of 33.36%. Group 1 had 6.24%, group 3 and 4 contributed for 1.16% and 4.65% respectively. Group 6 and 7 had 2.84% and 1.68% respectively. Group 8 had 2.28%, group 9 had 0.23% and group 10 constituted 6.75%.Conclusion: As contribution of repeat CS is high among the overall CS rate it is important to reduce the primary CS rates. More analytical studies need to be done based on Robson TGCS to evaluate the indication of CS within each group

Bone health after menopause: effect of surgical menopaus on bone mineral density and osteoporosis

Background: Natural menopause or surgical menopause is associated with endocrinological changes and alteration in bone and mineral metabolism. Hence this study was conducted to assess the bone mineral density changes in women with surgical menopause. Methods: This is a prospective observational study conducted in the department of obstetrics and gynaecology at Sri Ramachandra medical college, which is a tertiary care teaching hospital. 60 women with surgical menopause were included in the study. BMD was assessed by dual energy X-ray absorptiometry at the lumbar spine and hip joint. All the data was entered in Microsoft excel spread sheet and analysed by using SPSS software.Results: Among 60 study subjects, 41 individuals had a normal BMD, 16 had osteopenia, and 3 were diagnosed with osteoporosis. Osteopenia and osteoporosis is significantly higher in patients who had undergone hysterectomy with removal of ovaries. Observations of osteopenia and osteoporosis were significantly higher with increasing number of years post hysterectomy.Conclusions: Prevalence of osteoporosis is high in patients who undergo hysterectomy. Oophorectomy is associated with postoperative bone loss. Targeted management strategies should include routine BMD assessment and hormone therapy improves management of bone health in this population. Further more studies are needed in large populations to test alternative treatments for post oophorectomy osteoporosis

Maternal and neonatal outcome in premature rupture of membranes: a retrospective study

Background: Premature rupture of membranes (PROM) is one of the most challenging and controversial obstetric dilemma which occur even in low risk pregnancies. This study was done to analyse the maternal and neonatal outcomes in PROM cases.Methods: This was a retrospective study conducted in the department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, during a period of 3 years from August 2017 to August 2020. All the women who admitted with PROM were included in the study. The data regarding parity, gestational age, number of fetuses, presentation, duration of PROM, PROM to delivery interval, mode of delivery, weight of the baby, NICU admission was collected from the hospital records and analysed.Results: A total of 115 cases of PROM were recorded. High incidence is found in the age group of 20-30 years. Among them 73.04% were admitted at term. 71.3% were primigravida. 58.26% of them delivered vaginally where as 41.74% delivered by LSCS. Majority of them admitted within 6 hours of PROM. Majority of them delivered within 12 hours of PROM. High APGAR scores in majority of the cases. Most of the babies had birth weight >2.5 kg. 16 babies were admitted in NICU. There was no maternal mortality in our study though we had one neonatal mortality.Conclusions: Careful identification of present or impending complications and individualizing the management based on gestational age and presence of complications holds good in optimising fetomaternal outcome in PROM.

Knowledge and Perception on Prevention of Hospital Acquired Infections (HAI) among Health Care Professionals in Tertiary Care Teaching Hospital

Hospital-acquired infections (HAIs) are infections which are absent at the time of admission and would have been acquired after hospitalization. The purpose of the study was to evaluate the knowledge and perception levels on preventing HAI among health care professionals in tertiary care setup. The semi-structured tool was used for data collection. Out of 367 health care professionals, 262 participants were included in the study. Data were analyzed with descriptive and inferential statistics. The mean level of knowledge and perception score on HAI was 19.58 ± 2.70 and 51.97 ± 5.62. There was a positive correlation among the level of knowledge with level of perception on the prevention of HAI (r=0.16) at p>0.01. The knowledge and perception level was significantly associated with few demographic variables such as following protocols of hand hygiene,trainings on HAI within last year and functioning infection control department in their institution at p = 0.001. Health care professionals have adequate knowledge and perception regarding the prevention of HAI. There should be emphasized refreshment and updates on the current trends on the prevention of HAI among the health care professionals through intensive education and conducting training courses