Does prophylactic tranexamic acid reduce blood loss in Indian women following vaginal delivery?

Background: Postpartum hemorrhage (PPH) accounts for 25% to 33% of obstetric deaths every year. Anemia is a cause and consequence of PPH. Despite intense efforts to prevent anemia, many Indian women labour with low hemoglobin levels. Tranexamic acid (TXA), an antifibrinolytic, have been demonstrated to reduce blood loss and transfusion requirements in various surgeries including cesarean section. Objectives were to study the efficacy of TXA in effectively reducing blood loss in Indian women following vaginal delivery.Methods: This randomized, double-blind, placebo-controlled study was conducted on 200 patients scheduled for vaginal delivery. In addition to oxytocin 10 units, group T received TXA 15 mg/kg and group P received normal saline administered over 5 minutes. Estimated blood loss, Hemoglobin deficit, need for additional uterotonics, need for blood transfusion, incidence of PPH and adverse events were noted.Results: The fall in hemoglobin was significantly higher in group P (p<0.00001). Estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P compared to group T (p<0.00001). The incidence of PPH was lower in group T (2.8% versus 11.3%). There were no significant difference in the need for supplementary uterotonics (9.9% versus 15.5%) and the incidence of blood transfusion (2.8% versus 8.5%). No adverse maternal and fetal outcomes were noted.Conclusions: To reduce blood loss following vaginal delivery, TXA may be safely recommended as standard adjunct to Oxytocin for regular management of third stage of labour, especially in developing countries like India

A rare case of caesarean scar ectopic pregnancy: a case report

Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality

Pressure effects on the magnetic structure in La0.5Ca0.5-xSrxMnO3 (0.1 -< x -< 0.4) manganites

The effect of high pressure (0 - 8 GPa) on the magnetic structure of polycrystalline samples of La0.5Ca0.5-xSrxMnO3 (0.1 -< x -< 0.4) manganites at 5 K is investigated using neutron diffraction technique. Application of pressure is found to modify the previously reported magnetic structure, observed under ambient conditions, in these compounds [I. Dhiman et al., Phys. Rev. B 77, 094440 (2008)]. In x = 0.1 composition, at 4.6(2) GPa and beyond, A-type antiferromagnetic structure is found to coexist with CE-type antiferromagnetic phase, observed at ambient pressure, with TN ~ 150 K. For x = 0.3 sample, as a function of pressure the CE-type phase is fully suppressed at 2.3(1) GPa and A-type antiferromagnetic phase is favored. Further Sr doping at x = 0.4, the A-type antiferromagnetic phase is observed at ambient pressure and for T < TN (~ 250K). This phase is retained in the studied pressure range. However, the magnetic moment progressively reduces with increasing pressure, indicating the suppression of A-type antiferromagnetic phase. The present study brings out the fragile nature of the CE-type antiferromagnetic state in half doped manganites as a function of pressure and disorder \sigma 2. We observe that pressure required for destabilizing the CE-type antiferromagnetic state is reduced with increasing disorder \sigma 2. External pressure and changing A-site ionic radii have analogous effect on the magnetic structure.Comment: 9 pages, 6 figures, 1 table, To appear in Physical Review

Prevalence of metabolic syndrome in women with polycystic ovarian syndrome: an observational study in a tertiary care centre in Pondicherry, India

Background: Polycystic Ovarian Syndrome (PCOS) is a multifactorial, polygenic and multisystem endocrine disorder affecting women in reproductive age. PCOS diagnosis is based on 2003 Rotterdam criteria It has been noted that hyperinsulinemia is a central factor in the pathogenesis of PCOS. Many studies show evidence of a critical link between PCOS and Metabolic Syndrome (MBS).Methods: It was a hospital - based observational study done over a period of one year with a sample size of 177.An observational study was done in patients satisfying the inclusion and exclusion criteria. After taking informed and written consent, history was obtained from the patient to know the age, socioeconomic status, present and past clinical history, menstrual and obstetric history, personal and family history and any other history as deemed necessary. Patient was clinically assessed to know the height, weight, body mass index.Results: The prevalence of MBS was 37.2%. The commonest age group was between 25- 35 years.There is no statistical association between educational qualification, economic status and the prevalence of MBS and There no significant association between the presence of acne, androgenic aloepecia and the presence of PCOS.While the presence of increased waist circumference > 88cms, USG findings consistent with PCOS, high blood pressure > 130/85 mm of Hg, elevated FBS > 110 mg/dl, low HDL <50 mg/dl were statistically significant.Conclusions: The results can be used to formulate a screening policy for metabolic syndrome, particularly in the low resource settings of developing countries

Evaluation and identification of resistance to powdery mildew in Indian wheat varieties under artificially created epiphytotic

Wheat production is globally weighed down by several biotic factors of which rusts and powdery mildew are the most important. Powdery mildew, caused by Blumeria graminis f. sp. tritici, is becoming a disease of major importance in the North Western Plains Zone and Northern Hills Zone of the country. In the present context ofclimate variability, diseases like powdery mildew can assume greater importance in wheat breeding programs. Importance of basic studies on powdery mildew is the need of hour. A set of 370 Indian bread wheat, durum, dicoccum and triticale varieties were screened using mixture of natural occurring pathotypes from four locations(viz., Karnal, Ludhiana, Dhaulakuan and Yamunanagar) under polyhouse conditions. Data were recorded on the severity of infection based on 0-9 scale. Out of 370, only 23 varieties (Amrut, DDK 1025, DWR 1006, DWR 195, GW 1139, HD 4672, HD 4530, HD 2278, HD 1981, DDK 1001, HI 8627, Jay, TL 2942, DT 46, K 8020, DDK 1029, K 9107, K 816, Lok 1, MACS 6145, DDK 1009, NP 111 and NP 200) had shown immune reaction (0) whereas 150, 83 and 114 varieties have shown resistance (1-3), moderately susceptible (4-6) and highly susceptible (&gt;6) response respectively against powdery mildew. Data indicated that there is an urgent need to broaden the genetic base of wheat by identifying and introgressing new sources of powdery mildew resistance. With limited sources of PM resistance available, above identified genotypes can be further used and characterized for resistance breeding programs in India

Retrospective audit of genital prolapse management

Background: Pelvic organ prolapse is a descent of the pelvic organs into the vagina, frequently associated with local pelvic symptoms. Pelvic floor support is essential to maintain the normal anatomy. Recent studies of genital prolapse suggests that it is more important to improve the patient satisfaction and reduce complication than to achieve anatomical success. The purpose of the audit of genital prolapse management in this retrospective study is to know and understand the decision making, selection of patients for a particular surgery and to know and avoid the complications of genital prolapse management.Methods: This retrospective descriptive study was conducted at SVMCH and RC during the period of January 2020 to December 2021. The detailed analysis of the cases, symptomatology, surgical methods, complications and follow up were studied.Results: We managed 110 cases of genital prolapse. 35 patients had massive/ huge genital prolapse (POP Q Stage 4). 75.4%were found in the age group beyond 55 years, 66.3% were multiparous. 31% of the patients came with massive prolapse (POP Q-stage IV), 5% showed cervical elongation ,7% showed vault prolapse, Majority of our patients (63%) were managed by vaginal hysterectomy with pelvic floor repair. Followed by pessary, Fothergill’s surgery, Purandare’s surgery, Le forte’s, sacrospinal fixation, hysterosacropexy, pessary with thiersch stitch.Conclusions: The choice of management of genital prolapse has to be tailored according to the patients needs and pathology. The younger trainees have to be trained to get the skills of various surgeries of genital prolapse

A retrospective study of ectopic pregnancy

Background: Ectopic pregnancy is one of the common acute abdominal emergencies posing a serious threat to life. The overall incidence of ectopic pregnancy is on a steady increase over the last two decades. Yet the case fatality rate has come down due to early diagnosis and management. 95% of ectopic pregnancies occur in the fallopian tube, and rest 5% cumulatively in the ovary, cervix, peritoneal cavity and previous caesarean section scar. The present study was done to analyse the associated risk factors, clinical manifestations and management options of ectopic pregnancy.Methods: This retrospective observational cohort study was done in the Department of Obstetrics and Gynaecology, at Sri Venkateshwaraa Medical College, Hospital and Research Centre, Ariyur, Puducherry, between January 2018- November 2021. Data was collected from the case sheets, operative notes and a retrospective analysis of the cohort of patients with ectopic pregnancy was done.Results: This retrospective study was conducted from January 2018 to November 2021 involving a total of 50 cases. We found that majority of tubal gestation occurred in the age group 26-30 years 58.6% and 13.7% in the age group more than 30 years. Majority of patients 65.5% underwent U/L salpingectomy.10.34% underwent salpingo oophorectomy. Fimbrial expression was done for two patients. Two patients underwent fimbriectomy. Cornual stump excision was done in two patients. Hemoperitoneum was detected in 55.17% of cases.Conclusion: Ectopic gestation can become an obstetrical emergency and reproductive capacity hampering morbidity if not diagnosed and treated on time. However having a high vigilance and evaluating every woman in the reproductive age group who presents with the classical clinical triad of amenorrhea, pain abdomen and bleeding per vagina can help in curbing the incidence in future.

Retrospective study of post-operative care in pandemic in tertiary care centre

Background: COVID-19 pandemic has unfortunately changed the surgical interventions and the post-operative management worldwide. Most of the medical institutes in India had formulated their own protocols from the beginning of the pandemic in March 2020 to stop all elective surgical procedures as soon as possible. However emergencies and all types of obstetric as cases were not stopped as it was unavoidable conditions.Methods: This retrospective observational study was done in the department of obstetrics and gynaecology, at Sri Venkateshwaraa Medical College, Ariyur, Puducherry, during the period April 2020-December 2020. Data was collected from the case sheets and operative notes and retrospective analysis was done.Results: On analysing we have realised that LSCS rate was higher and induction for trial of labour was kept minimal. We had 3 infective morbidity in the form of wound infection and 1 patient was returned to the operation theatre for reexploration. Arranging the blood during the pandemic was also a tedious task.Conclusions: In the present era of pandemic, where the patient load is high, we can rely on post graduate students to look after the post-operative patients through effective communication with the available consultants

An unusual case of massive vaginal eversion complicated by obstructive uropathy

Pelvic organ prolapse is the descent of the pelvic organs (uterus or bladder or rectum) from their normal anatomical position, in varying combination, into or beyond the vagina as a result of failure of the ligamentous and fascial supports. Sometimes the resulting vaginal eversion or protrusion is so massive it may cause outflow obstruction of one or both ureters. Here authors present a case of a 62 year postmenopausal woman having massive vaginal eversion leading to obstructive uropathy and chronic renal insufficiency. The prolapse was corrected by Sacrohysteropexy

Obliterative le fort’s colpocleisis for acute kidney injury caused by pelvic organ prolapse in elderly woman

Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina, which sometimes causes hydronephrosis. Here authors report a case of an eighty five year old woman with a fourth degree uterine prolapse with obstructive uropathy. She was treated with a conservative surgery Le Fort’s colpocleisis. Following which the patient’s renal functions and symptoms improved. Hence authors conclude that colpocleisis can be considered as the option for elderly women who have completed the family with no desire to preserve the sexual function especially in women with co morbities where pelvic reconstructive surgeries pose a challenge