An audit of extra-uterine pregnancy in a tertiary care facility in Northern India

Background: Ectopic pregnancy is the most frequent lethal gynaecological predicament, befalling worldwide in all strata of reproductive women. It remains the leading cause of pregnancy-related first trimester deaths. Though prompt diagnosis has furthered a decline in associated morbidity, an upsurge has been seen in its prevalence owing to a rise in predisposing risk factors. The objectives of this study were to identify incidence, risk factors, and outcome in patients presenting with ectopic pregnancy in a tertiary care hospital.Methods: This two-year retrospective study was conducted in Department of Obstetrics and Gynecology in Vardhaman Mahavir Medical College and Safdarjung hospital, on patients presenting with a diagnosis of ectopic pregnancy (either ruptured or un-ruptured). The primary outcome was incidence of ectopic pregnancy. Secondary outcomes noted were demographic characteristics, predisposing risk factors, clinical presentation and management course in hospital. Data was recorded on a predesigned proforma and deciphered later.Results: Incidence of ectopic pregnancy was 0.82%. Significant causative factors were previous history of PID (29.28%), TB (21.4%), previous pelvic surgeries (18.57%) and preceding ectopic pregnancy (12.14%).Conclusions: Increase awareness and knowledge of risk factors amenable to modification and features will aid early diagnosis of extra-uterine pregnancy, besides planning conservative treatment if possible, and devising effective risk-reduction strategies

Analgesic efficacy of intravenous paracetamol versus intravenous tramadol after caesarean section: a single blind randomized controlled study

Background: Caesarean section is one of the commonest surgeries performed in obstetrics. Adequate management of postoperative pain leads to early mobilization and proper newborn care. The purpose of this study was to compare the analgesic efficacy and side effect profile of Paracetamol versus Tramadol in women undergoing caesarian section.Methods: A single-blind randomized controlled interventional study was conducted in Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi over a period of six months from May 2015 to Oct 2015. 100 women undergoing caesarean section under spinal anaesthesia were divided in two groups (50 in each group) using computer generated randomization. One group received Intravenous Paracetamol 1000 mg and another group Intravenous Tramadol 50 mg. The drugs were given 8 hourly for 24 hours. The primary outcome measures were the degree of pain relief during the entire observation period by doing visual analogue scale (VAS) scoring and need of rescue analgesia if any (administered if the VAS score >6); secondary outcome measures were side effects on mother and baby.Results: The pain scores were low in both groups across various time interval except at 6 hours in Paracetamol group (p=0.673) and at 8 hours in Tramadol group (p=0.194). Requirement for rescue analgesia was comparable in both the groups (16% vs. 10%, p = 0.372). However maternal side effects were more in Tramadol group (8% vs. 34%, p = 0.001).Conclusions: Both Paracetamol and Tramadol achieve satisfactory pain control after caesarean section but Tramadol causes significant side effects in mother compared to paracetamol

Maternal anaemia and its severity: an independent risk factor for preterm delivery and adverse neonatal outcome

Background: This study was done to evaluate the effect of maternal anaemia and its severity on gestational age and neonatal outcome.Methods: This was a retrospective study, conducted in Vardhman Mahavir medical college and Safdarjang hospital, New Delhi between April 2012 to March 2013. Cases were divided in three groups i.e. non anaemic, mild to moderately anaemic and severely anaemic (according to WHO classification). A total of 1050 woman (350 in each group) were recruited for study. The following outcome measures were used: preterm delivery (<37 weeks), birth weight, APGAR score, admission of baby in neonatal intensive care unit and early neonatal death. Data was analyzed by Chi-square test. A P value of or less than 0.05 was considered as significant.Results: The risk of preterm delivery, low birth weight, poor APGAR score and admission of baby in neonatal intensive care unit was more in anaemic group and it increased with severity of anaemia which was statistically significant. The increase in risk of early neonatal death was not significant in mild/moderate anaemic group (P value 0.326) while it was statistically significant in severely anaemic group (P value 0.004).Conclusions: Anaemia in pregnancy has a recognizable association with prematurity, low birth weight and poor neonatal outcome.

Comparative evaluation of postpartum versus post MTP insertion of intrauterine contraceptive device

Background: This study was planned to evaluate acceptability, safety and continuation rate of postpartum intrauterine contraceptive device (PPIUCD) and to compare it with well accepted post MTP IUCD in Indian population.Methods: This was a prospective study conducted in VMMC and Safdarjang Hospital, New Delhi, India. Copper T 380-A was inserted in 100 woman in postpartum period and in 100 woman in post MTP period. Follow up done at 6 weeks, 3 months and 6 months. Safety was assessed in terms of expulsion, IUCD failure/pregnancy rate, perforation, removal of IUCD, visibility of strings and various complain at each visit. Continuation rate along with their level of satisfaction was compared at the end of 6 months. SPSS software, Chi-square test and student T test were used for analyzing the results. P value ≤0.05 considered as significant.Results: Acceptance of post MTP IUCD was more than PPIUCD. There was statistically no significant difference in expulsion rate, removal of IUCD and various complaints. There was no case of perforation in either group. Non visibility of strings was major cause of concern and apprehension in PPIUCD group. Only one case of pregnancy was reported in PPIUCD group while no failure was reported in post MTP group. Continuation rate and level of satisfaction were comparable in both groups.Conclusions: PPIUCD is equally safe and effective as post MTP IUCD.

Correlation of lipid profile of infertile men with abnormal semen parameters

Background: Male’s inability to impregnate a fertile female is referred as male factor infertility. It accounts for 40-50% of infertile couples and affects almost 7% of all men. Male comorbidities and conditions, which negatively affect men’s health, have been repeatedly associated with impaired reproductive functioning. Cholesterol is the main substrate for steroid synthesis and it plays crucial role in formation of sperm plasma membrane and thus in spermatogenesis, highlighting the role of serum lipids in male fecundity. Purpose of the study is to evaluate correlation lipid profile of male partners with abnormal semen parameters in infertile couples. Methods: A cross sectional study was carried out in the infertility clinic of a tertiary care hospital for over 18 months and 151 infertile men with abnormal semen parameters (as per WHO 2010 criteria) were enrolled. Evaluation of lipid profile was done and its relationship with abnormal semen parameters was analyzed. Results: Significant positive correlation was seen between LDL and Triglyceride with sperm concentration and total sperm count. However, significant negative correlation was seen between Triglyceride and sperm motility and TMSC. Total and progressive motility was found to be significantly associated with total cholesterol (p&lt;0.05). Infertile men having higher total cholesterol were found to have better total and progressive motility compared to men with less total cholesterol. Conclusions: Our findings demonstrated that lipid profile has significant correlation with semen parameters, specifically sperm concentration, count and motility

Analysing Breast Cancer using Convolution Neural Network

Technological development of Soft Computing and Artificial Intelligence contributed a lot towards disease diagnosis in medical science. For providing solutions to the biological inspired problems in medical domain like Breast Cancer (BC) soft computing methods can give the flexible information. As per 2020 about 2 million women were detected with Breast Cancer (BC) creating most common malignancy among women worldwide. This rises both incidence and mortality has occurred during the past three decades due to evolving risk factors, improved cancer registries, and earlier diagnosis. There is a large number of risk factors for BC, some of which can be changed and others cannot. Eighty percent of people diagnosed with BC nowadays are over the age of fifty. Molecular subtype and developmental stage are both important in determining the likelihood of survival. When it comes to clinical presentation, behaviour and shape, invasive BC span a broad spectrum of tumours. In this paper, Convolution Neural Network (CNN) used to recognize the BC tumor because it is another sort of neural network that can discover key information in both image and time series data. By applying CNN on the 2023 RSNA (Radiological Society for North America) Screening Mammography Breast Cancer data we analysed how best CNN algorithm is for identifying breast cancer with accuracy and also tried to analyse at what age Breast Cancer is mostly occurred in women

Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury

Introduction: Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, not all deliveries are done tertiary care. Even not all are registered one if delivery is conducted at a hospital setup. The majority of patients are being managed by available obstetrician at local places. Early diagnosis and timely management of complications related to pregnancy are very important to avoid PRAKI. We aim to study maternal risk factors and fetomaternal outcome in PRAKI. Materials and Methods: A prospective study is conducted between 2021 and 2022 in the Department of Obstetrics and Gynaecology, VMMC, and Safdarjung Hospital, New Delhi. For antenatal and delivered women up to 6 weeks, 50 patients were recruited according to KDIGO (Kidney Disease International Global Outcomes) criteria. Patients were followed with CBC, serum electrolytes, serial KFT, urine input/output monitoring, and USG-KUB. Dialysis was done if indicated. Complete renal recovery was considered if S.Cr ≤1.0 mg/dl within 6 weeks of diagnosis of AKI. For statistical significance, a P value of less than 0.05 was considered. Results: The majority of patients were unbooked, 21–25 years of age, and belonged to lower socioeconomic status (54%). Risk factors were: preeclampsia (28%), puerperal sepsis (24%), PPH (20%), abruption (14%), pyelonephritis (4%), acute gastroenteritis (4%), gestational hypertension with superimposed preeclampsia (2%), antepartum eclampsia (2%), and thrombotic microangiopathy (2%). Hemodialysis is required in 23 (46%). Complete renal recovery was seen in 40 (80%) and partial renal recovery in 3 (6%). Maternal mortality was 14% and causes were: puerperal sepsis (57%), preeclampsia with severe features with MODS (29%), and antepartum eclampsia with hepatorenal failure (14%). Fetal outcome: 76% live birth, 24% intrauterine death, and 16% early neonatal death. Conclusion: Most common risk factors for PRAKI are preeclampsia followed by puerperal sepsis and PPH where all are preventable causes