Blood transfusion needs among obstetric patients in a tertiary care hospital: a prospective observational study

Background: Pregnancy possess a special challenge as immune responses in pregnant and non-pregnant states are different. The objectives of this study were to analyze the various indications for blood and blood component transfusion in obstetric patients. To study the prevalence and indications for blood transfusion among obstetric patients. To evaluate the various risk factors among these women. To study the role of antenatal visits in patients requiring blood transfusionMethods: A prospective observational study will be undertaken over a period of one year from July 2018 to June 2019 in Department of Obstetrics and Gynecology at SSIMS and RC, Davangere. This study was conducted on pregnant women and immediate postpartum patients (up to 7 days after delivery) admitted in Department of Obstetrics and Gynecology and requiring blood and blood component therapy. Statistical analysis will be performed using Chi square test and Student’s t test.Results: During study period out of 5486 patients 543 patients required blood transfusion. The incidence of blood transfusion is 9.89%. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, incomplete abortion, complete abortion and hydatidiform mole. Anemia in pregnancy was the most common indication and was observed in 217 cases (39.96%) followed by postpartum hemorrhage, which was seen in 117 cases (21.54%). The incidence of transfusion reactions was 5.34% in our study.Conclusions: A proper knowledge of blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. Regular Antenatal checkups should be given more importance in order to maximize the hemoglobin level at the time of delivery and to screen out the high-risk patients. Active management of the third stage of labor is required to minimize the blood loss. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion

A clinical study of prevalence of gestational diabetes mellitus and associated risk factors at a tertiary care centre in Karnataka, India

Background: Women with GDM are at increased risk for adverse obstetric and perinatal outcome .This study was undertaken to evaluate the prevalence of GDM using Diabetes in pregnancy study group India (DIPSI) criteria and associated risk factors in pregnant women.Methods: Universal screening for GDM was done in 200 pregnant women with estimated gestational age between 14 -18 weeks. They were given 75 gm oral glucose irrespective of meals. Diagnosis of GDM was made if 2 hr plasma glucose was ≥140, If plasma glucose is <140 then the test is repeated at 24-28 weeks. If normal, then the test is repeated at 32 weeks. If plasma glucose is <140 mg at 32 weeks, then they are classified as non –GDM group. Prevalence of risk factors like age ≥25, BMI ≥25, family history of DM, bad obstetric history, history of GDM and macrosomia were studied in GDM and non GDM group and results are statistically analysed.Results: The prevalence in this study was 11.5%. The prevalence was more in women with advanced age, high BMI, positive family history of DM, past history of GDM and macrosomia.Conclusions: The prevalence of GDM was found to be 11.5 % and its association with risk factors found to be significant. DIPSI diagnostic procedure is a simple, cost effective and evidence based test

Assessment of gestational diabetes mellitus development in correlation with elevated first trimester serum uric acid levels

Background: More than 10% of pregnancies in the world are affected with gestational diabetes mellitus (GDM), making it a prevalent pregnancy complication. The goal of this research was to examine whether or not higher serum uric acid levels in the first trimester of pregnancy are associated with an increased risk of developing GDM.Methods: The study was conducted on 56 first-trimester pregnant females at risk of GDM attending the outpatient clinic of the S. S. institute of medical sciences, Davanagere. All cases underwent estimation of uric acid levels &lt;15 weeks, 24 to 28 weeks, and oral glucose challenge test (OGCT) at 24 to 28 weeks.Results: In our study, among 56 pregnant women, 17 (30.3%) developed GDM. Of these 12 women (70.6%) with GDM had higher uric acid levels and 5 women (29.4%) with GDM had normal uric acid levels. Uric acid levels were higher in women with a higher BMI.Conclusions: GDM development is significantly correlated with elevated serum uric acid levels in the first trimester. Early interventions by dietary and exercise regimes in these patients can reduce the maternal and neonatal complications

Rhino cerebral mucormycosis: a report of two cases and review of literature.

Mucormycosis is caused by fungi of the order Mucorales and is one of the fulminant and fatal mycotic infections known to human beings with a high mortality rate. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. It is commonly reported in immunocompromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant, and immunosuppressive therapy. Mucormycosis is on the rise with an increase in incidence of Diabetes mellitus and HIV infection leading to immunocompromised status of the patient. Here in, reporting two cases of rhinocerebral mucormycosis in two uncontrolled diabetic patients with deep palatal perforation in one case and this is a rare and late occurrence. Both the patients were successfully treated with a combination of surgical debridement and systemic amphotericin B administration. By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers and cellulitis

Which is better for pfannensteil skin incision closure in caesarean section? Interrupted mattress suture or continuous subcuticular suture

Background: Caesarean delivery is one of the most commonly performed operations in obstetrics. Postoperative comfort of the woman largely depends on the method of skin closure. Wound complications from caesarean delivery such as dehiscence or infection cause a significant emotional and economic burden in obstetric care. There are many methods and techniques for skin wound closure in caesarean section. Each technique has its own advantages and disadvantages. The aim and objective of this study was to compare the wound outcomes in Pfannensteil incisions closed with mattress sutures using nonabsorbable suture and subcuticular sutures using absorbable sutures in caesarean deliveries.Methods: It is a prospective observational study done on 216 consecutive pregnant women who were admitted to labor room for elective or emergency caesarean section. Patients undergoing caesarean section with Pfannensteil incision between February 2019 to October 2019 were included in this study. Among 216 women, 108 women had mattress sutures and 108 women had subcuticular sutures for skin wound closure. The primary outcome studied was wound complications including erythema, wound dehiscence, burst abdomen, infection and pain which was studied on postoperative day 3-7. The secondary outcome was assessed at 6 weeks follow-up in terms of pain, cosmetic appearance of scar and patient satisfaction about scar.Results: A total of 216 pregnant women undergoing caesarean section were studied who had similar baseline characteristics and risk factors. However, women with previous caesarean section were more in mattress group. The overall incidence of erythema, surgical site infection, wound dehiscence, resuturing and pain was more in mattress group and was statistically significant. During follow-up at 6 weeks, women with subcuticular sutures had cosmetically better scar and more satisfied with their scars than women with mattress sutures but the pain level was same in both groups.Conclusions: Authors conclude that compared to mattress sutures, subcuticular sutures cause significantly fewer wound complications and pain in postoperative period. Also, subcuticular sutures are associated with cosmetically appealing scars and higher patient satisfaction. But there was no difference in pain level at 6 weeks in both methods of skin closure

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

Exploring the adequacy of informed consent for caesarean section at a tertiary care center

Background: The objective was to study adequacy of valid informed consent in caesarean section and to quantify the proportion of patients who receive a proper informed consent before undergoing caesarean section.Methods: A cross-sectional questionnaire-based study involving 200 registered antenatal women undergoing caesarean section for various reasons both as elective or emergency basis, and data was analyzed.Results: Among the study group, 98.5% patients were informed about the said procedure in their own local language and consent was taken, in 3 (1.5%) patients informed consent was not taken. Detailed procedure was explained to only 29 patients (14.5%) whereas 171 patients (85.5%) had no clue about the detailed nature of the procedure. 193 patients (96.5%) were satisfied with the given informed patients; 7 patients (3.5%) were not satisfied.Conclusions: Women need consistent and adequate information for consent. Sessions should be held regarding the procedure, its risks and benefits; in this way patient will undergo the procedure with proper knowledge, awareness and confidence.

A comparative clinical study on Tagara-Devadaru Lepa with and without Prachhanna in the management of Indralupta with special reference to Alopecia Areata

Hair disorders causes negative impact towards individual and his/her quality of life. Indralupta is a disease in which hair is lost from some or all areas of the body, usually from scalp. It shows one or more round spot on the scalp . It arises from the vitiation of Tridosha and Rakta. Treatment advised is Siravedhana and topical application of herbal and mineral drugs. To avoid complications of Siravedhana, inthis study Prachhanna was preffered and Tagara-Devadaru chosen as drug for topical application at the site of Indralupta. In this study we had taken 40 Diagnosed patients of Indraluptaand were subjected to clinical trials. They were randomly assigned into two Groups namely Group A and Group B. Group A treated with Tagara-Devadaru Lepa, while subject under Group B treated by Prachhanna along with Tagara-Devadaru Lepa. The treatment modalities of TagaraDevadaru Lepa and Prachhanna with Tagara-Devadaru Lepa are equally efficacious in treating.On comparing the results of Group A and Group B, the conclusion were drawn.Both the methods of treatment are cost effective, easy to prepare and had no adverse effects

Red Fox Optimizer with Data-Science-Enabled Microarray Gene Expression Classification Model

Microarray data examination is a relatively new technology that intends to determine the proper treatment for various diseases and a precise medical diagnosis by analyzing a massive number of genes in various experimental conditions. The conventional data classification techniques suffer from overfitting and the high dimensionality of gene expression data. Therefore, the feature (gene) selection approach plays a vital role in handling a high dimensionality of data. Data science concepts can be widely employed in several data classification problems, and they identify different class labels. In this aspect, we developed a novel red fox optimizer with deep-learning-enabled microarray gene expression classification (RFODL-MGEC) model. The presented RFODL-MGEC model aims to improve classification performance by selecting appropriate features. The RFODL-MGEC model uses a novel red fox optimizer (RFO)-based feature selection approach for deriving an optimal subset of features. Moreover, the RFODL-MGEC model involves a bidirectional cascaded deep neural network (BCDNN) for data classification. The parameters involved in the BCDNN technique were tuned using the chaos game optimization (CGO) algorithm. Comprehensive experiments on benchmark datasets indicated that the RFODL-MGEC model accomplished superior results for subtype classifications. Therefore, the RFODL-MGEC model was found to be effective for the identification of various classes for high-dimensional and small-scale microarray data