Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors and Prevention Strategies

Background and Aims: Stillbirth is one of the most common adverse outcomes of pregnancy, accounting for half of all perinatal mortality. Each year approximately 4 million stillbirths are reported, with 97% occurring in developing countries. The objective of the present study was to evaluate the stillbirth rate, exploring the risk factors and causes of stillbirth and suggest policies to reduce it. Settings and Design: A retrospective study of stillbirth among all deliveries over 5 years at North Bengal Medical College, a referral tertiary care teaching hospital in a rural background. The stillbirth rate and its trend were defined and the probable causes and risk factors were identified. Results: Stillbirth rate is 59.76/1000 live births, and Perinatal Mortality 98.65/1000 births. Of the still births, 59.72% were fresh and 40.27% were macerated. Among the causes of stillbirths, poor antenatal attendance and low socioeconomic status were important; other risk factors included prematurity, PIH, birth asphyxia, poor intrapartum care including prolonged and obstructed labour. In 23% cases, the cause remained unexplained. Conclusion: In addition to poor antenatal care, low socioeconomic condition, poor referral service, suboptimal intrapartum care in health facilities including tertiary centre were mainly responsible for majority of still births which could have been prevented. We speculate that upgrading the existing health system performance, particularly high quality intrapartum care by skilled health personnel, will reduce stillbirths substantially in our institut

An Eight-year Study Report on Arsenic Contamination in Groundwater and Health Effects in Eruani Village, Bangladesh and an Approach for Its Mitigation

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace

Vaginal leiomyoma

Leiomyomas are common benign tumors in the uterus. However, vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. Here, we report a case of a 38-year-old multigravida who presented with lower abdominal pain and vaginal bleeding. A physical examination and ultrasonography were performed, and a diagnosis of cervical fibroid was made. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Although a rare tumor, vaginal leiomyomas may present with a variety of clinical features and may be mistaken preoperatively for cervical fibroid. Removal of tumor by vaginal route, wherever possible, with subsequent histopathological examination appears to be the optimum management plan

An Atypical Case of Pelvic Leiomyomatosis Peritonealis Disseminata

An exceptional case of Leiomyomatosis peritonealis disseminata which occurred in a perimenopausal woman was mistaken for ovarian malignancy at laparotomy as it had extensive involvement of the pelvic peritoneum without a trace of leiomyoma in uterus and cervix

Groundwater Arsenic Contamination in the Ganga River Basin: A Future Health Danger

This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 µg/L), and in food materials (up to 3947 µg/kg), all exceeding the World Health Organization’s standards for drinking water, the United Nations Food and Agricultural Organization’s standard for irrigation water (100 µg/L), and the Chinese Ministry of Health’s standard for food in South Asia (0.15 mg/kg), respectively. Several individuals demonstrated dermal, neurological, reproductive, cognitive, and cancerous effects; many children have been diagnosed with a range of arsenicosis symptoms, and numerous arsenic-induced deaths of youthful victims are reported in the GRB. Victims of arsenic exposure face critical social challenges in the form of social isolation and hatred by their respective communities. Reluctance to establish arsenic standards and unsustainable arsenic mitigation programs have aggravated the arsenic calamity in the GRB and put millions of lives in danger. This alarming situation resembles a ticking time bomb. We feel that after 29 years of arsenic research in the GRB, we have seen the tip of the iceberg with respect to the actual magnitude of the catastrophe; thus, a reduced arsenic standard for drinking water, testing all available drinking water sources, and sustainable and cost-effective arsenic mitigation programs that include the participation of the people are urgently needed

Groundwater arsenic contamination in Ganga-Meghna-Brahmaputra plain, its health effects and an approach for mitigation

The authors’ survey of the Ganga–Meghna–Brahmaputra (GMB) plain (area 569,749 km2; population >500 million) over the past 20 years and analysis of more than 220,000 hand tube-well water samples revealed groundwater arsenic contamination in the floodplains of the Ganga–Brahmaputra river (Uttar Pradesh, Bihar, Jharkhand, West Bengal, and Assam) in India and the Padma–Meghna–Brahmaputra river in Bangladesh. On average, 50 % of the water samples contain arsenic above the World Health Organization guideline value of 10 μg/L in India and Bangladesh. More than 100 million people in the GMB plain are potentially at risk. The authors’ medical team screened around 155,000 people from the affected villages and registered 16,000 patients with different types of arsenical skin lesions. Arsenic neuropathy and adverse pregnancy outcomes have been recorded. Infants and children drinking arsenic-contaminated water are believed to be at high risk. About 45,000 biological samples analyzed from arsenic-affected villages of the GMB plain revealed an elevated level of arsenic present in patients as well as non-patients, indicating that many are sub-clinically affected. In West Bengal and Bangladesh, there are huge surface water in rivers, wetlands, and flooded river basins. In the arsenic-affected GMB plain, the crisis is not over water scarcity but about managing the available water resources.

An Eight-year Study Report on Arsenic Contamination in Groundwater and Health Effects in Eruani Village, Bangladesh and an Approach for Its Mitigation

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace