Rising trend of caesarean section in a tertiary hospital over half decade: a retrospective study

Background: Cesarean section (CS) rates are increasing worldwide; however, it can lead to significant increase in maternal and infant morbidity and mortality. This study aimed to determine the rates and trend of cesarean sections in Jammu (Jammu and Kashmir), India.Methods: This was a retrospective hospital record-based study done in patients who were admitted in Government Medical College Jammu (Jammu and Kashmir) India in the Department of Obstetrics and Gynecology during the study period from Jan 2012 to Dec 2017 and data of CS was collected. The trends and indications for CS over the 5-year period were analyzed with SPSS 12.0 software.Results: During the study period, annual number of deliveries in GMC Jammu increased from 14592 (2012) to 20417 (2017). CS rates increased from 4817 (33.01%) to 8378 (41.03%) with a hike of 8.02%. Commonest indication for CS was post CS pregnancies (25.43%-34.24%) followed by non-progress of labor (NPOL), fetal distress, breech presentation, antepartum hemorrhage, cephalo-pelvic disproportion (CPD) and severe pregnancy induced hypertension (PIH).Conclusions: This study indicates that rapid socio-economic changes and the outlook towards medical intervention by the women, families and society are largely responsible for rising trend of CS. Other factors that have been reported for this are fear of pain; concerns about genital modifications after vaginal delivery; misconception that CS is safer for the baby; fear of medical litigation and lower tolerance to any complications or outcomes other than the perfect baby are responsible for the current high incidence of caesarean section in many states and urban centres with post cesarean pregnancy being the largest contributor. From doctors point of view, it is a defensive medicine to have better outcome

Association between serum zinc level and simple febrile seizures in children: a hospital-based study

Background: Febrile seizures are the most common cause of convulsions in children and a frequent cause of emergency hospital admissions. There are different hypothesis about neurotransmitters and trace element (such as zinc) changes in cerebrospinal fluid and serum, which can have a role in pathogenesis of febrile convulsions. Hence we want to study this association in our set up. Objectives was to study the association between serum zinc levels and febrile seizures in childern in our set up.Methods: This hospital based, prospective case control study was done in SKIMS Soura Srinagar, Kashmir (J and K), India for one-year period from August 2015 to July 2016. A total of 100 children aged 6 months to 6 years admitted in the hospital presenting with febrile seizures after fulfilling our inclusion and exclusion criteria were enrolled for the study. Informed consent was taken from their attendants and classified into 2 groups of 50 each. Patients with history of simple febrile seizures were taken as cases and those with fever without seizures as controls. A detailed history was taken, and complete physical examination was done on the patients and recorded on a precoded and pretested proforma. Blood was collected within 12 hours of admission and serum zinc levels were estimated. For statistical analysis, SPSS 17 program using t-test was employed. Chi-square test was performed to compare proportion between 2 or more discrete variables. P<0.05 was considered statistically significant.Results: Out of 100 children enrolled, male to female ratio was 1.63:1. Majority of the children were between 6 to 12 months (36%). The clinical presentation comprised of mainly non localized fevers majority of which had clinical evidence to suggest viral etiology (60%), followed by ARI (20%), ASOM (10%), UTI (6%) and bronchiolitis (4%). Mean serum zinc level in cases was 30.96±7.93ugm/dl and in controls it was 35.95±9.25ugm/dl. Serum zinc level was found significantly low in cases of simple febrile seizures as compared to controls (P<0.05).Conclusions: This study reveals that there is positive correlation between low serum zinc levels and febrile convulsions

Caesarean section on demand: a hospital-based study

Background: The aim of the study was to find out the reasons behind healthy women preferring cesarean section (CS) in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at ASCOMS, Jammu (Jammu and Kashmir), India a tertiary level teaching hospital. All women who underwent caesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period (9 months) were 889. There were 636 (71.54%) vaginal deliveries and 253 (28.46%) CSs. Among 253 CSs, 25 (9.88%) had maternal request as their indication. Majority 13 (52%) of them were in the age group of 20 - 25 years. Multigravida opted for CS more than primigravida (17 versus 8). Most 10 (40%) of them were Graduates and 15 (60%) were working. Majority of them 13 (52%) were in class II socioeconomic status of Kuppuswamy’s scale. The various reasons for women requesting cesarean delivery were refusal of vaginal birth after cesarean section (VBAC), simultaneous tubectomy, painless delivery, prolonged infertility, afraid of neonatal outcome and astrological concerns.Conclusions: Most of the women who opted for cesarean delivery in our study was for preventable reasons like painless labor, previous negative birth experience and simultaneous tubectomy which would have been avoided by prior counseling starting from antenatal period and by providing labor analgesia. Proper education of the patient and personal involvement of the treating obstetrician in counselling the patient and her supporters can reduce cesarean delivery for maternal request

Knowledge, attitude and practice of family planning among women of reproductive age group attending outpatient department in a tertiary centre of Northern India

Background: India with 1.35 billion people is the second most populated country in the world next to China. Total fertility rate of India is 2.2 and the current total fertility rate of Jammu and Kashmir is 1.7 which is still lagging behind various states. This study was conducted to investigate the knowledge, attitude and practices of contraception in women of reproductive age in this set up.Methods: The present cross-sectional study was carried out in patients attending OPD (outpatient department) of Obstetrics and Gynecology at ASCOMS, Jammu, Jammu and Kashmir, India from 1st September 2017 to 31st August 2018. 200 married women aged between 18-49 years were included in this study. Socio-demographic characteristics of the women, their knowledge, attitude and practices on contraception were evaluated with the help of predesigned questionnaire.Results: Out of 200 women, maximum respondents belong to age group of 21-25 years (75.6%). Most of the contraceptive non-users belongs to age below 20 years (62.5%). Majority of respondents were Hindu (70.37%), maximum studied up to secondary level education (84.61%), 70.30% were housewives and 56.58% belongs to middle class. In 45% of respondents, media was the main source of information. Preferred spacing method was condom in 85% of cases. 68% women had knowledge of female sterilization. According to most women, family planning methods are meant for limitations of birth (43%) and 36% meant for spacing of birth. 80% women had positive attitude towards contraceptive usage. 50% experienced side effects with the use of contraceptives. The most common side effect was menstrual irregularities in 25% of cases. Most common reason for not using contraceptive methods among non-respondents were lack of knowledge in 50% of cases.Conclusions: The study showed that inspite of having good knowledge, utilization of contraceptives were less because of large family norm, religious myth, cultural and political barriers. Ignorance regarding use and side effects of various contraceptive methods is another reason for inadequate practice of family planning methods

Risk factors and outcome of Klebsiella pneumonia sepsis among newborns in Northern India

Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respiratory distress (70.8%), shock (70.8%), fever (37.5%) or hypothermia (58.3%), apnea (29.2%) and abdominal distension (33.3%). Most common perinatal risk factor was prolonged labor (&gt;24 h) seen in 79.2% of cases. C-reactive protein (CRP) level was positive in 95% of the cases. The mortality was 25%. KP strains were sensitive to colistin, polymyxin B, cotrimoxazole and tetracyclines.Conclusions: The clinical manifestations of neonatal sepsis caused by KP are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care

Overcrowding and possible solutions for a busy gynecological emergency department: a hospital-based setting

Background: The objective of this study is to determine the trends of patients presenting in Obstetrics and Gynecology emergency department and to identify possible solutions.Methods: This retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the department of Gynecology and Obstetrics and comprised data of all patients presenting to the emergency department between 1st January 2018 to 31st December 2018.  Patients were assessed in terms of demographic features, presenting complaints, admission types (urgent, non-urgent), referral from other hospitals or coming from home. The total number of patients admitted and the number of patients sent home was also recorded.Results: A total of 1,46,366 patients were analyzed retrospectively. Out of which 63,004 (43.05%) were send home from the OPD while 83,362 (56.95%) presented to the emergency department. Of them, 49,383 (59.24%) were discharged straight away from the ED after emergency treatment and care while 339,79 (40.76%) were admitted. Out of 339,79 patients, 24,932 (73.37%) stayed in the emergency whereas 9047 (26.63%) admitted into different wards for elective procedures. Majority of the patients 26,098 (89.92%) came from home and 2927 patients (10.08%) were referred from other hospitals. Labour pains 7833 (31.42%) was the most common presentation. Trauma was the reason for admission in 112 (0.45%) patients out of 29025. 971 (3.89%) patients presented with gynecological problems. 4093 (14.10%) patients presented with non-urgent indications. Rest of all patients presented with indications which were categorized as urgent and were admitted. All data was analysed using SPSS version 20.Conclusions: To reduce the overcrowding in the emergency department and improve quality of obstetrics and gynecological services, Inpatients and Outpatient departments at primary and secondary care levels need to be strengthened. Patients with non-urgent problems should be provided adequate care at primary and secondary health care centers

Knowledge regarding prevention of hypothermia in newborns among mothers in Northern India

Background: Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. World Health Organization (WHO) recommends maintaining a warm chain and skin-to-skin care for thermo-protection of newborn children. Since little is known about practices related to newborn hypothermia, this study’s goal was to assess the knowledge of mothers of newborns especially LBW babies on prevention of hypothermia and to provide them the knowledge of cost-effective thermal protection measures.Methods: It was a cross-sectional study using pre-tested, pre-structured questionnaire. 108 postnatal mothers having LBW babies admitted in postnatal wards of Government Medical College, Jammu, Jammu and Kashmir, India were included in the study and analysed using SPSS version 20.Results: Out of 108 mothers, maximum mothers were of age less than 25 years (51%), 60% were from rural area, residing in nuclear family were 62%. Mothers attended hospital for confinement were 95% and 85% started breast feeding their babies. 45% had knowledge of keeping the baby warm by immediately wiping the baby and only 3% mothers had knowledge of Kangaroo Mother Care (KMC).Conclusions: Understanding and addressing community-based practices on hypothermia, prevention and management might help to improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermo-protection for their newborns could facilitate these practices. Those who fail to fully attend antenatal clinics should be targeted for newborn care education

Characteristics and transmission dynamics of COVID-19 in healthcare workers in a tertiary teaching hospital

Coronavirus disease-19 (COVID-19) transmission significantly affected Healthcare workers (HCWs) worldwide. As a result, they have paid a heavy toll to the COVID-19 outbreak. However, the literature on its transmission routes and risk factors in HCWs is limited. The aim. The authors seek to characterize and know the transmission dynamics of COVID-19 infection in the HCWs of our hospital. Methods: A cross-sectional descriptive study was conducted by the authors. Staff records and virology testing results were used to identify SARS-CoV-2 positive HCWs and study the demographic characteristics and transmission dynamics over one and a half years. Data were analyzed using SPSS software version 23. Results: A total of 169 healthcare workers were positive for SARS-CoV-2. 6 doctors were positive from non-clinical branches, and 17 were positive from clinical branches. One health worker also died of cardio-pulmonary compromise. 88.2 % of healthcare workers got infected while managing patient’s positive for COVID-19. The most frequent clinical manifestation was myalgias in 90.53 % of health workers, followed by arthralgia in 86.98 %. The least common symptoms were loss of taste/smell followed by radiographic changes, and only 19 (11.24 %) presented with shortness of breath. 79.88 % have taken self-medication to relieve COVID symptoms. Maximum number of health workers got infected from July to September. Conclusions: Universal masking, reinforcement of hand hygiene, PPE kits with medical masks, appropriate infection control measures and testing of both clinical and non-clinical staff were essential measures for reducing transmission amongst HCW