Study of caesarean section at tertiary care centre: a retrospective study

Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%,  and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup

Frequency of urinary tract infections among pregnant women receiving antenatal care in a tertiary care centre: hospital based cross-sectional study

Background: Urinary tract infections (UTI) are one of the most frequent human bacterial infections, causing substantial morbidity and mortality, with nearly 150 million cases globally per year. The prevalence of UTI (including both asymptomatic bacteriuria and symptomatic infection) in pregnant women in India is reported to range from 3% to 24%. This infection must be adequately diagnosed and efficient treatment must be initiated to prevent maternal and perinatal morbidity.Methods: This was a hospital based cross sectional study. 625 ante natal women recruited during first visit attending antenatal care outpatient department (ANC OPD). We tested their clean catch mid-stream urine sample for routine, microscopic and culture sensitivity test.Results: Out of 625 antenatal women frequency of urinary tract infection was 16.2%. 17% women were symptomatic having one or more symptoms indicative of urinary tract infection and 83% women were asymptomatic. Among symptomatic women, 92.5% women showed culture positivity for one or more bacteria whereas in asymptomatic women, culture was positive in 10.8%. E. coli followed by Klebsiella were the most common isolate identified in both symptomatic and asymptomatic women. On antibiotic sensitivity testing, we found good overall sensitivity of bacteria to commonly used antibiotics such as nitrofurantoin, and norfloxacin but resistant to ampicillin was observed in all women. UTI adversely affects the mother like pyelonephritis, preterm labour and preterm baby and its complications.Conclusions: It is important to identify presence of UTI during pregnancy by doing urine routine and culture sensitivity test in all antenatal women and administration of appropriate antibiotic to affected women so as to reduce the morbidity both in mother and baby