Vaginal infections and its relation to preterm labour, PPROM, PROM and its outcome

Background: Prematurity is the cause of 85% of neonatal morbidity and mortality. Recently, vaginal infection has been associated with increased risks for prematurity and premature rupture of membranes (PROM). Since preventive measures can prevent preterm labour and neonatal morbidity and mortality taking these facts into consideration the present study was undertaken to study the role of vaginal infection in preterm labour, PPROM, PROM.Methods: A prospective observational study was done in PESIMR, Kuppam, Andhra Pradesh.  The aim was to study the role of vaginal infections in preterm labour, preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM). Objectives of the study were to diagnose vaginal infection by taking high vaginal swab, to study the relation of vaginal infection and preterm labour, PPROM, PROM, to evaluate maternal morbidity, mortality and neonatal outcome. The another objective was to select an appropriate antibiotic therapy. The study was done on 80 patients of preterm labour, PPROM and PROM. Vaginal infection was confirmed by high vaginal swab and neonatal outcome was noted.Results: Out of 80, high vaginal swab had growth in 40 patients and 40 were sterile. CONS were the commonest isolated organism grown followed by candida. RDS was the commonest neonatal complication seen in mothers with vaginal infection who delivered prematurely, thus vaginal infection being a common cause of preterm labour, PPROM and PROM, timely detection and treatment is important to avoid prematurity, associated neonatal morbidity and mortality.Conclusions: study provides important data about microbiological correlate of threatened preterm, preterm labour, PROM, PPROM in our pregnant women and most of pathological isolates were sensitive to ampicillin, taxim and gentamicin

Prevalence of pelvic floor dysfunction in women attending obstetrics and gynaecology OPD at PES Institute of Medical Sciences asnd Research, Kuppam

Background: Millions of women are affected with pelvic floor dysfunction globally. But when the literature was reviewed, studies assessing the prevalence of PFD (pelvic floor dysfunction) and related factors were limited in India. Hence the present study was undertaken to assess the prevalence of PFD.Methods: 300 women aged 18-70years attending Obstetrics and Gynaecology OPD at Kuppam were interviewed and details like age, number of children, mode of delivery, BMI, education, occupation as primary outcome variables and type of pelvic floor dysfunction as explanatory variable were collected using a semi structured questionnaire. Frequency and proportions were calculated for quantitative variables and Chi-square test was used for comparison of categorical variables. p-value of 45 years old, 38 (65.52%) women had 2 or 3 children, and 12 (20.69%) women had ≥4 children. 47 (81.03%) had vaginal delivery. 37 (63.79%) subjects had no schooling and 13 (22.41%) were unskilled workers. 36 (62.07%) participants BMI ranged between 25 to 34.99. Age, education, occupation, number of children, mode of delivery, BMI were found to be associated with increased incidence of pelvic floor dysfunction.Conclusions: In conclusion the study assessed high prevalence of pelvic floor dysfunction associated with vaginal delivery, increased age, number of children and BMI

Enhancing contraceptive usage by immediate postpartum intra uterine contraceptive device insertion with evaluation of safety, acceptability and expulsion

Background: India’s population which crossed one billion in 2000 is projected to reach 1.53 billion by 2050 making India the most populous country in world. In India 65% of women have unmet need for family planning in the first post-partum year. PPIUCD is highly effective, safe, long-acting, coitus independent and rapidly reversible method of contraception with very few side effects.  Since there is tenfold increase in institutional deliveries due to maternity benefit schemes, postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated and these women would leave the hospital with contraceptive in place.Methods: The present study was a prospective study to assess the acceptance rate of PPIUCD insertion and evaluation of safety of Cu T 380A when inserted within ten minutes of placental expulsion in 100 women delivering at PESIMSR, Kuppam. A specially designed proforma was used to collect the data of women attending hospital between period June 2016 to June 2017.Results: Out of 486 patients who were counselled only 100 women (20.57%) accepted for PPIUCD insertion. The acceptance rate of PPIUCD is 20.57%. Of 100 women who had PPIUCD insertion, 91 were seen at follow up, 76 (78.12%) women were continuing with no complaints and only 15 (16.4%) women developed complications. PPIUCD was found to be safe as there was no reported case of perforation or failure during usage. The complications like expulsion was found to be 1.09%, infection 5.4%, pain abdomen 5.4%, bleeding 1.09% and missing strings 5.4%.Conclusions: PPIUCD was demonstrably safe, having no reported case of uterine perforation. Expulsion rates are low implying more retention rates, thus more effective. Public awareness regarding the concept and advantages of PPIUCD insertion can be improved by mass media approach and creating strategies and training programmes under Government policies

Lateral location of placenta on ultrasound as a predictive test for preeclampsia

Background: Hypertensive disorders represent the most common medical complication of pregnancy Pre-eclampsia complicates approximately 2-7% of pregnancies and is a major cause of maternal and perinatal morbidity This has led to the interest in screening. The placenta is located laterally in majority of patients with abnormal flow velocity waveforms. In the light of these observations, we designed a prospective study to find out whether the lateral location of placenta as seen by ultrasound at II and III trimester of gestation can be used to predict the development of preeclampsia.Methods: A prospective observational study was done in PESIMSR, Kuppam, Andhra Pradesh. The aim of the study was to find out whether placental laterality as determined by ultrasound can be used as a predictor of development of gestational hypertension, development of preeclampsia/eclampsia During the study period of November 2013 to November 2014, all antenatal women attending the OPD in II and III trimester without any medical disorders likeDM, HTN, renal disease, cardiac disease or smoking, who undergo ultrasound in II and III trimester were included. The location of the placenta was determined by real time ultrasound in II and III trimester. The placenta will be classified as central when it is equally distributed between the right and the left side of the uterus irrespective of anterior, posterior or fundal position. When 75% or more of the placental mass is to one side of the midline, it is classified as unilateral right or left placenta. subjects were followed upto delivery for development of gestational hypertension/ preeclampsia/eclampsia as per the ACOG criteria.Results: 66% patients in the lateral placenta group developed preeclampsia. Only 36%in the central group developed preeclampsia. The association of lateral placenta as a predictor of preeclampsia had a P value of <0.001 which is statistically significant. Incidence of preclampsia is more in primigravidas compared to multigravidas. Most of the pre eclamptics had their onset at 29 – 32 weeks of gestation.Conclusions: The study shows that placental position determined by ultrasonogram in II and III trimester of gestation is an excellent screening tool for the prediction of pre-eclampsia. The test is ideal because it is simple, non-invasive, cost effective and convenient to the women

Disengagement of the deeply engaged fetal head during caesarean section in advanced labor: patwardhan versus push extraction

Background: To compare the maternal and neonatal morbidities between the “Patwardhan” technique and the “Push” method for extraction of the foetus in second stage caesarean sections.Methods: Retrospective cohort study was done at PESIMSR, Kuppam, AP from MAY 2012 to APRIL 2015. Women with single fetus at term in anterior vertex position, with the head deeply impacted in pelvis and needing cesarean delivery where included in the study.  Group 1 consists of all cases in which extraction of fetus was done by Patwardhan technique and Group 2, in whom extraction of fetus was done by push method and extracted as vertex. Objective of the study was to assess selective complications like extension of the incision, injury to the surrounding structures, excessive bleeding, need for blood transfusion and the fetal outcome between the two groups.Results: Out of 98 cases reviewed, 46 belonged to group A (Patwardhan) and 52 belonged to group B (push). Patients in the push group had statistically significant higher rates of maternal morbidity in terms of uterine extension and other related complications. However; there were no differences in neonatal outcomes in both the groups.Conclusions: While complications are inherent in both methods, Patwardhan method of delivery of the fetus for second stage labour has been shown to confer considerable advantage in prevention of maternal morbidity over the push method in our institution. Our findings support the fact that the Patwardhan method could be a useful maneuver in intraoperative disengagement of fetal head, when encountered at second stage CS and it is our opinion that the Patwardhan manoeuvre can be practiced selectively as a primary technique.

Prevalence of teenage pregnancy and its obstetric and perinatal outcomes in a rural tertiary care hospital

Background: Teenage pregnancy has been reported as one of the leading causes of death in adolescent girls in both developed and developing countries. In developed countries teenage pregnancies are most common in unmarried girls whereas in developing countries like India where early marriages are more common, teenage pregnancies are seen mostly in married women.Methods: In this retrospective observational study, data between January 2018 and December 2019 was studied; data was evaluated using MS excel for statistical purpose. In the present study, only pregnant women less than 20 years were included.Results: Out of 6,028 pregnant women delivered during this period, 686 i.e. 11.3% age of women were less than 20 years, 609 (88.7%) had delivery at term and the remaining 77 (11.2%) women had preterm delivery. As per this study, incidence of hypertensive disorders were 12.24%, 5.5% were associated with anemia and most of them had vaginal delivery (65.01%) including induced and instrumental; cesarean section was 35.5%. In present study, 24.1% babies were of low birth weight and 3.49% of babies were intrauterine growth restricted (IUGR) babies.Conclusions: This study showed hypertensive disorders were the most common maternal complication and the incidence of vaginal delivery was higher compared to that of cesarean section, incidence of anaemia was less compared with other studies. Proper antenatal care, institutional delivery and postnatal care can reduce fetal and maternal complications in childbearing women in teenage age group.

Disengagement of the deeply engaged fetal head during caesarean section in advanced labor: patwardhan versus push extraction

Background: To compare the maternal and neonatal morbidities between the “Patwardhan” technique and the “Push” method for extraction of the foetus in second stage caesarean sections.Methods: Retrospective cohort study was done at PESIMSR, Kuppam, AP from MAY 2012 to APRIL 2015. Women with single fetus at term in anterior vertex position, with the head deeply impacted in pelvis and needing cesarean delivery where included in the study.  Group 1 consists of all cases in which extraction of fetus was done by Patwardhan technique and Group 2, in whom extraction of fetus was done by push method and extracted as vertex. Objective of the study was to assess selective complications like extension of the incision, injury to the surrounding structures, excessive bleeding, need for blood transfusion and the fetal outcome between the two groups.Results: Out of 98 cases reviewed, 46 belonged to group A (Patwardhan) and 52 belonged to group B (push). Patients in the push group had statistically significant higher rates of maternal morbidity in terms of uterine extension and other related complications. However; there were no differences in neonatal outcomes in both the groups.Conclusions: While complications are inherent in both methods, Patwardhan method of delivery of the fetus for second stage labour has been shown to confer considerable advantage in prevention of maternal morbidity over the push method in our institution. Our findings support the fact that the Patwardhan method could be a useful maneuver in intraoperative disengagement of fetal head, when encountered at second stage CS and it is our opinion that the Patwardhan manoeuvre can be practiced selectively as a primary technique.