Risk of uterine rupture after the partographic \u27alert\u27 line is crossed--an additional dimension in the quest towards safe motherhood in labour following caesarean section

To determine if prolonged active phase of labour is associated with increased risk of uterine scar rupture in labour following previous lower segment caesarean section, a retrospective cohort study (1988-91) was done to analyse active phase partographs of 236 patients undergoing trial of labour following caesarean section, 7 (3%) of whom had scar rupture. After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate alert . A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of alert line), B (0-1 h after alert line), C (1-2 h after alert line), D (2-3 h after alert line) and EF (\u3e 3 h after alert line). The relative risk of uterine scar rupture was calculated for different partographic time zones. The relative risk of uterine scar rupture was 10.5 (95% confidence interval 1.3-85.5, p = 0.01) at 1 hour after crossing the alert line; 8.0 (95% confidence interval 1.6-40.3, p = 0.009) at 2 hours after crossing the alert line; and 7.0 (95% confidence interval 1.6-29, p = 0.02) at 3 hours after crossing the alert line. In women undergoing trial of labour following caesarean section, prolonged active phase of labour is associated with increased risk of uterine rupture. A zonal partogram may be helpful in assessing this risk in actively labouring women who cross the partographic alert line

Diversified farming systems for changing climate and consumerism

When we think about environmental degradation and climate change, the first things that come to our mind are cars and factories, but not how we grow, consume and dispose of. If we collectively put these things together, we account for nearly one-third of the human-induced climate change. That certainly put agriculture at the crossroads of system-level transformation towards healthy food, people, and the planet. Such food-system transformation requires a paradigm shift towards nature-friendly nutrition-rich diverse fruits and vegetables, and it should constitute at least 30-50% of our food plate from the current average of less than 10%. The only way left for us is to return to an ecological intensification with feedback loops that inter-links vital elements of complex agroecological transition within the planetary boundary limits. Farming in harmony with nature, carbon-neutral, enrich micro-hydrology and restore biodiversity to co-benefits the people and the planet. The context-specific regenerative agriculture practices that are ecologically sustainable and economically viable found to be best fit models for smallholder farmers and home gardeners. It is based on the sound ecological philosophy of production follows structure, composition and functions, and where ecosystem services and well being become default returns on their own. The recent advances in digital augmentation with ICTs enabled citizen science to provide powerful tools to aid the integration of frontier technology with indigenous knowledge. This leads to an ideal agro-ecosystem integrated with diverse crops, multi-purpose tree species, animals, and peoples in collective action to restore broken food systems and combat climate chang

Audit changes clinical practice! impact on rate of justification of hysterectomy indication

After performing a baseline audit in 1986-89, an ongoing quality assurance process was initiated in January, 1990 and all hysterectomies performed over the next 2 year period were analyzed. Hysterectomy indications were divided into two groups: one in which the uterine specimen was expected to show pathology and another in which no pathology was expected. The hysterectomy was considered justified in the former if the pathology report verified the indication or showed a significant alternate pathology. In the latter, validation criteria showing documentation of certain prerequisite diagnostic procedures performed before reverting to hysterectomy, were used to ascertain justification. The overall rate of justification in the ongoing audit was 96%, being 97% for the group where hysterectomy indication was potentially confirmable by pathologic study and 93% for the one where it was not. Comparison with baseline analysis showed that the justification rates were higher for all indications not potentially confirmable by pathologic study (93% vs 89%, p \u3c 0.05), for recurrent uterine bleeding (90% vs 83%, p \u3c 0.05) and for leiomyoma (97% vs 95%, p \u3c 0.05). The improvement was associated with less frequent use of multiple indications in the ongoing study (10% vs 16%, p \u3c 0.05). The justification rates for hysterectomy indication can be improved by prospective audit and by avoiding use of multiple indications

Critical appraisal of endometriosis management for pain and subfertility

Objective: To critically appraise current best available management of pain and subfertility ascribable to endometriosis.Methods: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis.Discussion: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence.Conclusion: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required

Maternal risk factors associated with low birth weight in Karachi: A case-control study

To evaluate maternal risk factors associated with low birth weight (LBW) among women aged 15-35 years, we carried out a hospital-based, case-control study on 262 cases (mothers of neonates weighing \u3c or = 2.5 kg) and 262 controls (mothers of neonates weighing \u3e 2.5 kg). Odds of delivering a low-birth-weight baby decreased with increase in maternal haemoglobin [odds ratio (OR): 0.701; 95% confidence interval (CI): 0.62-0.79]. Odds were greater among mothers not using iron supplements during pregnancy (OR: 2.88; 95% CI: 1.83-4.54). Mothers of LBW babies had lower haemoglobin levels before delivery

Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks, In 482 cases the GCT was abnormal (plasma glucose value was \u3e140 mg% 2 hours after 75g glucose challenge). Of these, 292 had one or more abnormal critical values at a 75g -3 hour oral glucose tolerance test (GTT) and they were treated to maintain euglycaemia. The rest (n=190) had no evidence of glucose intolerance with no abnormal values at the GTT. The subjects were divided into 3 groups based on GCT values; A, randomly selected subjects with a normal GCT (n=1000); B, those with abnormal GCT but normal GTT (n=190); and C, those with abnormal GTT (n=292). The variables studied were age, gravidity, parity, gestational age at delivery, pre-eclampsia, birth-weight and mode of delivery. The incidence of pre-eclampsia and caesarian birth varied, being the lowest in Group A (3.9% and 11.9% respectively) and then rising through group B (6.3% and 16.3% respectively) to the highest in Group C (12.6% and 26.0% respectively; test of linear trend, p\u3c0.05). For macrosomia, the incidence increased from Group A to B but there was a drop in Group C. The incidence of macrosomia was significantly higher for Group B as compared to A or C (9.5% and 3.3%,