Changing trends in cesarean section: from 1950 to 2020

Caesarean section (C.S) is a part of the standard care in modern obstetrics. The indications for a caesarean section as an alternative to vaginal delivery have evolved over the centuries. Its practicality, disponibility, and apparent safety have placed caesarean section, a first-line procedure in many clinical scenarios. The awareness of perinatal mortality and morbidity associated with safety of caesarean, expert anaesthesia, potent antibiotics, blood transfusion facilities and better neonatal care have increased incidence of caesarean section very fast. Thus, there is fast, steady and definite rise in incidence of caesarean section everywhere. But the question is ‘Is a rising caesarean section rate is inevitable?’. Studies carried out to understand CS deliveries has adopted different framework. The issue treats elements of ethics in the medical profession, gender issues, choices of women, the quality of institutional services, etc. The findings of retrospective studies have suggested that the caesarean section rate could be reduced in certain categories. In this study, we discuss the various ways in which it can be achieved

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause)

Study of obstetric and perinatal outcome of twin pregnancy

Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies

Real-time feedback control system for ADITYA-U horizontal plasma position stabilisation

The ADITYA-U tokamak (R-0 = 0.75 m, a = 0.25 m) is designed to shape plasma column in both single and double null diverter configurations. It is quite well known that sustaining a shaped plasma in tokamak requires very good plasma column position control, both horizontal and vertical. An FPGA-based proportional-integral-derivative (PID) control system has been designed and operated to achieve horizontal plasma position control in ADITYA-U tokamak. The complete system has been rigorously tested with sample signals before implementing to the ADITYA-U plasma discharges. The control system is integrated and time-synchronized with the plasma discharge operation of ADITYA -U. Furthermore, the system has been trained to take appropriate actions during the disruption or plasma failure in the tokamak operation. Detailed experimental results have been obtained by the operation of the digital PID controller. The complete design, installation, operation, tuning of the system along with all the relevant testing and operating experience of the digital PID controller for real-time horizontal plasma position control is presented in the paper.SP