Does Character Count: Moral Self-fashioning in the Swadhyaya and Chinmaya Mission Movements

Swadhyaya and the Chinmaya Mission are two rapidly growing modern Indian religious movements that have developed a contemporary discourse on the moral self--a theory and practice centered on the cultivation of an ideal human being--deeply grounded in the religious traditions of India. This discourse stands in stark contrast to conceptions of modern secular self-identity that lie at the heart of theories of modernization. Yet, it is nevertheless the case that religion is indeed only one among many competing sources of morality and authority in modernity, as modernization theorists predicted. This project asks the critical question of what makes a religious discourse on self-fashioning so remarkably appealing to the millions of Swadhyaya and Chinmaya Mission participants in modern Indian society. Based on one year of ethnographic fieldwork conducted in Mumbai, India from February 2012--May 2013, this dissertation draws attention to the everyday lived practice and lived experiences of religion and ethics among followers. I demonstrate that the particular teachings of the two movements, rooted in the Hindu scriptures, provide new ways of understanding and perceiving the self, the other, and human existence that act both as a source for ethical being as well as a guide for practical living. I show that the appeal of the two movements lies in the specific ways in which their particular discourse and praxis facilitate the transformation of the self and argue that the appeal of theistic sources in modernity cannot simply be understood in terms of a religious impulse inherent to humanity or as a matter of belief or non-belief. In contrast to abstract theoretical accounts of a modern secular self-identity, this dissertation demonstrates how the modern self understood, fashioned and experienced in relation to the teachings and practices of Swadhyaya and the Chinmaya Mission challenges some of the key markers associated with modern self-identity, including self-sufficient humanism and individualism

Study on fetomaternal outcome in antepartum haemorrhage

Background: Any bleeding from or into the genital tract after the period of viability, but before the birth of the baby is termed as antepartum haemorrhage (APH).Methods: 110 cases of bleeding per vaginal (pv) after 28 weeks of gestation were studied retrospectively from August 2018 to June 2019 and were grouped as placenta previa, placental abruption and indeterminate.Results: 35.45% cases were of placenta previa, 53.63% cases were of placental abruption and 10.90% cases were of indeterminate. Majority were delivered by lower segment caesarean section (LSCS) and most of the cases required blood transfusion.Conclusions: APH cannot reliably be predicted .It is major cause of maternal and perinatal mortality and morbidity. Multidisciplinary approach and senior input is necessary in making decision about timing and mode of delivery. Presently increase in use of ultrasonography (USG) for placental localisation and to diagnose abruption, improved obstetrical and anesthetic facilities, increase in use in blood products to correct anemia and advanced neonatal care facilities, all of these have played important role in decreasing perinatal as well as maternal mortality and morbidit

A study on diagnosis and management of arteriovenous malformation of uterus

Background: Arteriovenous malformation is abnormal connection between an organ’s arterial and venous circulation. In acquired AVM, history of uterine procedure seems inevitable. Their clinical feature is usually vaginal bleeding. It is diagnosed by 2-D ultrasonography combined with colour doppler. Most of the time they resolve spontaneously; however, if left untreated, uterine artery embolization or hysterectomy comes in hand. The purpose of this study was to evaluate the role of TVUS and colour doppler in the diagnosis and follow-up of treated cases of uterine AVM. This study also aims to evaluate different modalities to manage uterine AVM.Methods: This was a retrospective study done at tertiary care centre from January 2018 to December 2019 to assess the presentation, treatment, and clinical pictures of patients with uterine AVM that were diagnosed with TVUS. Authors reviewed both (1) clinical data (2) ultrasound data of patients. The diagnostic criteria were “subjective” with a rich vascular network in the myometrium with the use of colour Doppler images and “objective” with a high PSV of 20 cm/sec in the vascular web.Results: Thirteen patients met the diagnostic criteria mentioned above. Out of that 100% presented with on and off bleeding per vaginum. Recent and remote history of uterine procedures were in found in 84.6% (n=11) of cases. UAE was done in 53.8% (n=7) cases. Thirty-three (33%) (n=5) cases spontaneously resolved when closely monitored with serial imaging and serum beta- HCG levels. Hysterectomy was needed in 7.4% (n=1) of patients of AVM.Conclusions: Uterine AVM occurred after unsuccessful pregnancies or uterine procedures. Triage of patients for expectant treatment, hormonal treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the AVM, appears to be a good predictor of outcome

A clinical study on fetomaternal outcome in jaundice with pregnancy

Background: Jaundice in pregnancy and pregnancy in women with preexisting liver disease is not very uncommon. However it takes a major toll on health of both mother and fetus, due to increased morbidity and mortality for both mother and fetus, categorizing pregnancy as a high risk one. The distribution of jaundice in pregnancy varies throughout the world, but is seen more in developing countries. The course and outcome of liver disorder in pregnancy is altered due to various hemodynamic, hormonal and immunological changes unique to pregnancy. The hepatic functions during pregnancy are affected by increase in serum estrogen and progesterone levels.Methods: This was a prospective study of 70 cases of pregnancy with jaundice admitted in the department of obstetrics and gynecology at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India. The duration of study was from June 2015 to December 2018. During this period 70 patients were admitted with jaundice in pregnancy. Patients were analyzed with regards to socio demographic profile, investigations, maternal and perinatal outcome.Results: The incidence of pregnancy with jaundice in present study was 0.32%. Most common cause identified was viral hepatitis in 27 cases (38.57%) out of which 23(32.85%) cases being hepatitis E. Followed by HELLP syndrome, pre eclempsia, eclempsia in 24(34.28%) cases. 13(18.57%) cases were belonged to cholestatic jaundice of pregnancy. Rest 6(8.56%) cases belonged to malaria, portal hypertension due to liver disease etc. Out of total 70 patients 53(75.71%) women from rural area, 54(77.13%) patients were from age group of 20-29years.Maximum patients were multigravida i.e. 28 (40%) and 66(94.28%) women coming from lower middle and lower socio economic class. There were 9 maternal deaths, 5 due to DIC. Total vaginal deliveries were 40, 24 patients underwent LSCS, 4 patients had abortion, and 2 expired undelivered. Most common complication was DIC in 16(22.85%) cases and thrombocytopenia in 14(31.67%) cases. 30(42.85%) babies were LBW and 18(25.7%) babies were IUGR.Conclusions: Prompt diagnosis and accurate evaluation and multidisciplinary approach of management in pregnancy with jaundice at a tertiary care center with good NICU is helpful in reducing maternal and perinatal mortality and morbidity

Fetomaternal outcome in patients with diabetes mellitus in pregnancy

Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome

A retrospective analysis of ectopic pregnancies in tertiary care hospital of Western India: two year study

Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality

Maternal and fetal outcome in cases of eclampsia

Background: Eclampsia refers to occurrence of generalized tonic clonic convulsions (GTCS) followed by confusion or coma during pregnancy or puerperium in patients with preeclampsia excluding other neurological conditions. Purpose of this study was to evaluate the risk factors, management protocols and determine maternal and perinatal morbidity and mortality in patients of eclampsia.Methods: This is retrospective study of 180 cases of eclampsia carried out from June 2017 to December 2019 including all the antepartum, intrapartum and postpartum cases at tertiary care centre. Immediate management was focused to control the convulsion and lower the blood pressure followed by NST and USG foetus with Doppler study.Results: In this study, 72.2% cases reported antepartum eclampsia while 27.8% cases were postpartum and overall incidence was 0.91% of total deliveries conducted during the study period. Incidence was higher in primigravida (74.4%) and below 25 years age (68.8%). Magnesium sulphate was effective in 94.4% cases. Study reports 63 normal vaginal delivery, 5 assisted vaginal delivery, 110 caesarean section and 2 women expired undelivered. There were 10 maternal deaths.Conclusions: Time interval between eclamptic seizures and initiation of therapy is an important prognostic factor affecting maternal and perinatal outcome. Public awareness regarding the importance of regular antenatal visits can help in reducing chances of development of eclampsia. Even though various drugs and methods have been tried for the treatment of eclampsia, the definitive management is the delivery of foetus after control of convulsion, hypertension and should be managed at tertiary care hospital

Significance of 2 dimensional-echocardiography in hypertensive disorders of pregnancy: a study in tertiary care centre, Ahmedabad, Western India

Background: Echocardiography is a safe, non-invasive technique to assess cardiac structure and function in pregnancy. Understanding the structure and function of the heart in hypertensive women is important in terms of timely diagnosis, better management and good prognosis. This study will focus on the importance and feasibility of Echocardiography as a routine investigation tool in hypertensive disorders of pregnancy.Methods: This is a retrospective study of 150 cases of hypertension in pregnancy conducted at the Obstetrics and Gynaecology department of a tertiary care centre in the year June 2019-July 2020. Data was analysed in terms of complications seen in women who had structural and functional abnormalities in the echocardiographic scan in comparison to those hypertensive women who had a normal scan.  The important Echocardiographic parameters were compared amongst cases of hypertension and their impact on fetomaternal outcome was discussed.Results: In this study conducted amongst 150 pregnant women suffering from different forms of hypertensive disorders  presenting in our institute for routine workup in the year 2019-2020, 12(8%) had chronic hypertension, 75(50%) had gestational hypertension, whereas 63(42%) had pre- eclampsia. The incidence of structural valvular lesions in these categories as 2%, 3.34% and 4% respectively. Deranged echocardiographic parameters like decreased Left Ventricular Ejection Fraction in 10%, decreased stroke volume in 28.6% and increased Left Ventricular mass in 26.6% are seen more in cases of pre-eclampsia compared to gestational hypertension and chronic hypertension.Conclusions: Echocardiography is a valuable tool to stratify risk and can guide management in gestational hypertension, chronic hypertension and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes. Preeclampsia has a greater impact on the heart than gestational hypertension, and changes are most pronounced in early onset, severe disease. Studying the cardiac structure and function in early trimesters can bring about better maternal and fetal outcome

Effect of early maternal newborn skin to skin contact in labour room on third stage of labour and success at breastfeeding

Background: Immediate postpartum period and birth pose many challenges for the mother and the new-born. Initiation of early skin to skin contact in the labour room can be beneficial to both of them.Methods: Randomized control trial conducted over a period of 7 months in a tertiary care centre enrolling 400 laboring women.200 in the control group were given routine care. In the 200women in the study group, the newborn was given immediate skin to skin contact by placing him/her on the mother’s chest.Results: Duration of third stage of labour was less than 10 minutes in 95%women of study group compared to 56% women in the control group(p<0.01). Placenta was expulsed as a whole in 98% cases in the study group compared to 81% in the control group. Successful breastfeeding was observed in 88% women in study group compared to 54%in the control group(p<0.01). Breastfeeding was initiated within 30 minutes of birth in 96%women in the study group compared to 41% in the control group.Conclusions: Uterus could contract faster with the complete expulsion of placenta and shortening of the third stage of labour with early skin to skin contact. The newborn showed early initiation, success at breastfeeding and longer first breastfeeding with early skin to skin contact

Changing trends in fetomaternal outcome in COVID-19 in pregnancy

Background: This study is to provide an overview of the clinical course and outcome of COVID in pregnancy in both first wave and second wave, to study about different parameters affected significantly in both waves.Methods: This is a retrospective comparative study that was conducted by dividing the patients into group 1 and group 2. Group 1 was treated in 2020 (wave 1) whereas group 2 in 2021 (wave 2). A laboratory confirmed positive cases of COVID-19 infection in pregnant women were included. All the patients were further categorized into mild, moderate and severe subgroups according to the ICMR criteria. Results: The study of the first (2020) and second (2021) wave of COVID-19. In group 1 and group 2, there were a total of 359 cases and 145 cases respectively. In group 1, there were 54/359 (15.04%) moderate cases and in group 2 there were 17/145 (11.72%) moderate cases. While there were 101/359 (28.13%) and 106/145 (73.10%) severe cases in group 1 and group 2 respectively. Most of severe cases of second group associated with breathlessness, tachypnoea and fall in oxygen saturation level ended with mechanical ventilation by O2 mask (7.54%), NRBM (8.49%), HFNC (14.15%), BIPAP (12.26%), invasive ventilation (22.64%). Conclusions: The results of study show that hospitalized patients in the second wave were younger, required hospitalization, and had higher mortality rates