Comparison of safety, efficacy and perinatal outcome of isoxsuprine and nifedipine in women with preterm labour

Background: Over the last 50 years, extensive research has been conducted with the objective of preventing, predicting and optimizing the outcome of patients with preterm labour. Currently, the therapeutic foundation for treating preterm labour involves the use of tocolysis. An attempt is made to study the tocolytic effect of Isoxsuprine and nifedipine in suppression of preterm labour.Methods: This is a prospective study, carried out in the department of Obstetrics and Gynaecology of S S institute of medical sciences and research centre, Davangere, over a period of 15 months- from October 2014 to January 2016.Results: 60 antenatal cases with 28-36 weeks of gestation with painful intermittent uterine contractions were considered for the study. Subjects were randomly allotted into two groups - Group A (Isoxsuprine) and Group B (Nifedipine) 30 patients each. Main outcomes include prolongation of pregnancy, maternal side effects and neonatal outcome were compared. Baseline characteristics were well matched in both study groups. Mean prolongation of pregnancy was 31.68 days in Nifedipine and 27.54 days in Isoxsuprine group which was statistically significant. Success rate with Nifedipine was found to be 96% as compared to Isoxsuprine which was 75%. Maternal side effects like hypotension (13.33%) and tachycardia (6.66%) were common in Isoxsuprine group, while facial flushing was seen in16.66% patients in Nifedipine group. Neonatal outcome was similar in the both groups.Conclusions: Nifedipine is a safe and effective tocolytic agent than Isoxsuprine with less maternal complications

Evaluation of spot urinary albumin - creatinine ratio as a screening tool in the prediction of pre-eclampsia in early pregnancy: a pilot study

Background: Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in India. Objective of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 18-28 weeks of gestation can predict subsequent pre-eclampsia in asymptomatic pregnant women.Methods: A prospective observational study involving 50 registered antenatal cases visiting the obstetrics outpatient department between 18-28 weeks of singleton pregnancy with nil proteinuria upon dipstick measurement were included. ACR was determined from random single midstream urine sample. Statistical analysis was performed using Chi square test and Student’s t-test.Results: Of the study group, 10 patients had high ACR value, with 8(80%) developed pre-eclampsia and 2(20%) remained normotensive. ACR had a sensitivity of 80%, specificity 97.56%, positive predictive value of 88.89%, diagnostic accuracy of the test being 94.12%.Conclusions: The spot urinary protein creatinine ratio is a reliable predictor for pre-eclampsia in pregnancy

Obstetric emergencies during the COVID-19 lockdown period: a case series

Obstetric emergencies during COVID-19 pandemic pose an enormous challenge to the concerned obstetrician. Risk stratification during obstetric triage will guide in the initial assessment & planning of further management to reduce maternal and fetal morbidity and mortality rates. As the health system adapts to cope with this pandemic, special attention needs to be given to the several moral and ethical dilemmas that may occur during patient care

Art and craft of episiotomy

Background: Episiotomy is the most common obstetric surgical procedure performed in labor room. Mediolateral and Midline episiotomies are the most common types. Post-delivery suture angle is the most important determinant factor which predicts the risk of anal sphincter injuries. Mediolateral episiotomy has a significantly lower risk of OASIS rate when compared to midline episiotomies. Aim of the study was to know whether mediolateral episiotomies are actually mediolateral and does the angle of episiotomy influences the risk of anal sphincter injuries, maternal/fetal complications in the perinatal period.Methods: An observational study was conducted on 250 postpartum patients admitted to our hospital. Details of episiotomy in relation to incision angle, length, depth and post suturing angle were noted within two days of delivery.Results: Among the subjects included there were 40.8 % incisions were RMLE, average length was 3.32cms, average suture angle is 28.69 degree. OASIS was seen in 19.5% cases more so with midline episiotomies.Conclusions: Episiotomy is an essential, must to know skill. Compulsory ssupervised clinical teaching and use of skill lab training can prevent potential detrimental consequences

Clinical skill learning for tomorrow’s doctors - a step towards better obstetric care

Background: Female urethral catheterization is the most commonly performed procedure in obstetrics and gynecology, for the assessment of urinary output. Many times catheterization is done by junior colleagues with improper technique resulting in improper catheterization and urethral injury. It is a must to know skill for every graduating medical student to avoid devastating consequences of performing it poorly. The objectives of this study are to evaluate the effectiveness of four step method of skill learning of bladder catheterization in female patients by interns and demonstrate the competency in the proper insertion and removal of an indwelling urinary catheter and also the study aimed to determine the effectiveness of bladder simulator training for medical interns.Methods: A prospective, observational and skill imparting study done using a specially designed model, after ethical committee approval. 30 Interns were divided in to six groups of five each for skill learning. It was done with Kirkpatrik model using specially designed objective structured clinical examination forms and scoring sheets. Sample paired t test was used.Results: 80% of the interns could perform the skill with maximum scores.Conclusions: It is an innovative teaching learning method for incoming interns which will help them to improve knowledge and practice and finally reduce the risk of complications and injury.