M-health for maternal health- bridging the gaps!!

This article reviews significance, potential and principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology, essentially deploying mobile technology. There are various benefits of such TM clinical applications. The consensus among patients and health care providers is that this technology is convenient to provide needed subspecialty medical care, even when it is not available locally. Such innovations are clinically successful, but economic and cost-effectiveness data are lacking

Managing dyspnea in pregnancy-an errand uphill: an experience from the critical care obstetric unit of a tertiary care facility in India

Background: The occurrence of dyspnea in a gravid woman induces the query in the treating obstetrician regarding its root cause being either underlying or new cardiac or pulmonary disease, or due to the pregnancy itself. Attainment to this conclusion requires grasp of the cardiopulmonary changes befalling during normal pregnancy, as well as detection of the ailment of dyspnea during antenatal period. Objective of present study was to find out the incidence and feto-maternal outcome of patients presenting with dyspnea in pregnancy and puerperium.Methods: This study was conducted in Department of Obstetrics and Gynaecology in Vardhaman Mahavir Medical College and Safdarjung hospital over a period of one year, wherein review of all women who had presented with a diagnosis of dyspnea in pregnancy and puerperium, and admitted and treated in the Critical care obstetric unit of the department was done. Thorough evaluation was done and case files were exhaustively reviewed, data was anonymously extracted, and outcomes analyzed. All causes of mortality were also recorded. The primary outcome was incidence of dyspnea in pregnancy. Secondary outcomes measured were socio-demographic variables, timing of presentation-antepartum=first trimester, second trimester, third trimester/postpartum7 days, causative factors for dyspnea, any other obstetric complications, mode of delivery, fetal outcome (fetus weight, Apgar score, need for NICU admission), need for ICU/HDU admission, duration and course in the hospital, mortality, and cause of death in case of mortality. Data recording was done on a predesigned proforma and deciphered at the end of study and analyzed.Results: Incidence of dyspnea was 1.97% of all admissions. Pulmonary edema following hypertensive disorders of pregnancy, was the leading cause. 28.5 % women succumbed to their illness. Majority were preterm births (88/112), requiring NICU admission.Conclusions: The clinician should be able to determine the underlying cause of dyspnea, differentiating it from physiologic progesterone-induced hyperventilation. Strategy of expeditious delivery during the third trimester is often warranted after weighing fetal outcome and maternal risk in such women

Descriptive audit of maternal sepsis in a tertiary care centre of North India

Background: Maternal sepsis is one of the leading causes of maternal mortality around the world. The aim of this study was to study the prevalence, clinical profile and fetomaternal outcome of maternal sepsis at a dedicated Obstetric critical care unit of a tertiary care centre of North India. It was retrospective study conducted in tertiary care centre in North IndiaMethods: Women diagnosed as sepsis or septic shock at any point in pregnancy and up to 6 weeks postpartum (irrespective of the source of infection) were included in the study. Demographic, clinical, microbiological and outcome data were recorded from the case sheets of all patients admitted in obstetrical critical care unit between January to December 2016. Outcome measures: Prevalence, bacterial organism, source of infection, mode of delivery, period of gestation, maternal and fetal outcome.Results: The prevalence of maternal sepsis was 16.5/10,000 live births. The number of maternal deaths attributable to sepsis were 35, making the maternal mortality ratio due to sepsis 128/100,000 live births. 87% of the cases were unbooked. 22% presented antenatally while 58% were postpartum and 20% were postabortal. Genital tract infection was most common source of infection. E. coli was the predominant organism in 28% followed by Methicillin resistant staphylococcus aureus in 12%. The mortality from sepsis was very high (78%). 54% of cases required mechanical ventilation and around 7% had to be shifted to intensive care unit for advanced life support and care. Sepsis was associated with preterm delivery and a high perinatal mortality rate.Conclusions: Early recognition of the severity of infection and prompt management by a multidisciplinary team of intensivists, anesthetists, neonatologists, obstetrician, midwives are the key to success. Vigilant infection control measures must be strictly practiced during all pregnancy events

Need of premarital care

Background: Marriage is considered a remarkable event in an individual’s life. It provides people with a sense of belonging, support, security and responsibility. We put so much of efforts to find a good match for our younger and loved ones but we forget to match the most important wealth of our life “Health”. This study aimed to know the knowledge, attitude and practice of the population through a structured questionnaire.Methods: A cross-sectional study was conducted using a self-administered questionnaire which was distributed to 110 males and 110 females attending Medicine and Gynae OPD at Safdarjung hospital, New Delhi. Participants were questioned according to the self administered questionnaire and their answers were evaluated.Results: Only 11% of males new of premarital counseling and none of the females were aware of premarital care. Contraception knowledge was also poor among females as 7% females new only I-Pill as the method of contraception. After knowing the importance of premarital counseling and screening 92% males and 52 % females agreed for premarital counseling and screening.Conclusions: Marriage provides people with a sense of belonging, support, security and responsibility. Premarital care nurtures it and fill its “Neev” with the goodness of health. Therefore, it is recommended that premarital care is important before every marriage for the happy and healthy family ahead

A hospital based retrospective study on hepatotropic viruses as a cause of acute viral hepatitis in children in Uttarakhand, India

Introduction: Acute viral hepatitis in children is a serious health problem throughout the world. Aims and Objective: To determine the profile of Hepatitis A, B, C and E as a cause of acute viral hepatitis in children in a tertiary care hospital of Uttarakhand, India. Material and Methods: In this retrospective study, data was collected from the records of paediatric patients who underwent testing for one or more of the hepatitis viruses. Serum samples were tested for Anti-HAV IgM and Anti-HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) and Hepatitis B surface antigen and Anti HCV antibodies by enhanced chemiluminiscence.  Results: Among total of 252 patients suffering from Acute Viral Hepatitis (AVH), males predominated over females with 72.2 % vs. 27.8 %. Hepatitis A virus (72.6 %) was found to be the leading cause of AVH in our hospital followed by HBV (16.7 %), HEV (9.5 %) and the least common was HCV (1.1 %). Co-infection was seen in only 2 cases i.e one as HAV-HEV (0.4%) and other as HAV- HBV (0.4%). Out of all the cases of AVH, 9.5 % were suffering from Acute Hepatic Failure. Hepatitis A virus was found to be the most common cause of acute hepatic failure (50 %), followed by Hepatitis B (37.5 %) and Hepatitis E (12.5 %).  Conclusions: Hepatotropic viruses are quite prevalent in children in our country. Thus to control faeco-orally transmitted viruses i.e Hepatitis A and hepatitis E, awareness about healthy hygienic practices should be emphasized upon. Also hepatitis A vaccination can be recommended to be included in national immunization schedule. To prevent parenterally transmitted viruses like Hepatitis B and hepatitis C, use of sterile needles and syringes while tattooing, ear piercing and avoiding injections through unregistered medical practitioners should be done. Vaccination for hepatitis B should be routinely done

Enlarged uterus through a natural orifice: worth an effort? A randomized controlled trial

Background: The objective was to compare the efficacy, safety and patient satisfaction of the Non-Descent Vaginal Hysterectomy (NDVH) with Total Abdominal Hysterectomy (TAH) in benign enlarged uterus.Methods: This was a prospective Randomized comparative study. A total of 60 subjects were randomly divided into VH and TAH groups (Group A, group B), by sealed opaque envelope, each comprising 30 subjects. Subjects having uterus of more than 12 weeks size requiring hysterectomy for benign pathology and non-prolapsed uterus were included in the study.  Corporal bisection, morcellation, myomectomy, coring and combination of these were used as debulking procedures.  Results: We could do all the VH successfully with no conversion to laparotomy and 100% success rate. The mean uterine size was 420.00 g ± 117.24 in group A and 454.33 g ± 52.50 in group B, mean operative time taken was more in group B as compared to group A, though not statistically significant (97 ± 4.46 min, 100 ± 7.27 min; P = 0.621).The mean blood loss, haemoglobin decrease and the Blood Transfusion was significantly lesser in VH group as compare to TAH group (251.13 ± 57.98 ml, 327.33 ± 58.54 ml; P = 0.000). There was no visceral injury in either group, though postoperative fever and wound infection were more in the TAH group than VH group.Conclusions: VH is safe and should be offered as the first surgical choice in women with uterine enlargement due to benign reasons and non-prolapsed uterus where feasible, and should be included in training program for residents and postgraduates trainees. It is definitely a surgical challenge worth the effort

Thoracopagus conjoined twin: an unusual presentation

Conjoined twins are among rare clinical conditions observed by obstetricians. Due to rare incidence of this condition there is general lack of knowledge among obstetricians, especially at primary care level which leads to missed diagnosis during antenatal period. The management of this condition is complex especially in cases where the diagnosis is not known before onset of labour. A 30 - year old Hindu lady was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Clinical examination revealed findings of ruptured uterus and foetal head of one baby and feet of second baby were outside the introitus. Emergency laparotomy was done which revealed conjoined twins. This article report clinical course of a thoracopagus conjoined twin. The relevant literature is also reviewed.

Abdominopelvic mass in postmenopausal female: a diagnostic dilemma

Abdominopelvic masses have varied presentations and pose a diagnostic challenge especially in postmenopausal women where a detailed evaluation is needed to rule out malignancy. Here we report a case of postmenopausal woman with diagnostic discrepancies in clinical findings, radiological investigations and histopathological observation

Role of levonorgestrel releasing intra-uterine system in the treatment of menorrhagia due to dysfunctional uterine bleeding and fibroid uterus

Background: This study was carried out to assess the clinical effectiveness of levonorgestrel releasing intrauterine device (LNG-IUS) in the treatment of menorrhagia due to either Dysfunctional Uterine Bleeding (DUB) or fibroid in Indian patients, and to assess patient satisfaction with this treatment modality.  Methods: Sixty women with menorrhagia, 30 due to fibroid and 30 due to DUB, meeting inclusion criteria, received LNG-IUS and were prospectively followed up for 9 months with periodic clinical assessments and transvaginal ultrasounds. Patient satisfaction was assessed on a five-point scale.Results: One patient in DUB group was lost to follow-up. In DUB patients, the treatment failure rate was only 3.4% (1 out of 29 patients). The median PBAC score reduced by 95% at 9 months. Fibroid patients also had an equally impressive 97.7% reduction of PBAC score at 9 months, although the failure rate was higher (23.3%; 7 out of 30). Majority of patients were either ‘very satisfied’ or ‘satisfied’ with the treatment, although this percentage was more in DUB (82.8%) than in the fibroid group (66.7%). Haemoglobin and serum ferritin levels significantly increased in both groups. No major side effect was noted.Conclusions: LNG-IUS is an excellent treatment modality for patients of DUB, with good patient satisfaction. It is also a useful treatment option in non-submucosal small fibroids for the symptoms of menorrhagia, can reduce uterine volume and can help avoid hysterectomy, but there is no effect on fibroid volume. Majority of patients are satisfied, although satisfaction rates are less than in DUB patients

Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey

Background: Partograph is an effective, but underutilized tool for monitoring labour. This study examined the influence of hospital policy on the knowledge, attitude, practice and skills of doctors towards partograph plotting.Methods: A cross-sectional survey among doctors posted in labour rooms of tertiary care public teaching hospitals of India was carried out, using self-administered questionnaire to assess knowledge, attitude and practice; and labour case scenarios were provided to assess partograph plotting skills. Chi-square test or Fisher’s exact test were employed to test the significance of association between knowledge, attitude, practice and skills of 150 doctors working in hospitals with (n=3) and without (n=2) policy of routine partograph plotting.Results: The majority of doctors in both groups had correct knowledge about different partograph components. However, doctors working in hospitals with a policy of partograph use, demonstrated significantly better skills using case scenarios for plotting partographs (p<0.01), and a positive attitude towards plotting partograph and its use as a decision support tool (p=0.000) as compared to doctors working in hospitals without a routine partograph plotting policy.Conclusions: Hospital policy of routine partograph plotting may positively influence utilization of partograph in tertiary care public hospitals in India