Implications of socio-economic factors on contraceptive choices among women in North East India: a perspective

Background: Socio economic status plays a vital role in determining the awareness and conscious decision making of a woman pertaining to contraceptive use. Family planning has been recognized as one of the most cost-effective solutions for achieving gender equality and equity by empowering women with knowledge and in making reproductive choices by accessing contraceptive methods. Methods: A cross sectional study was conducted on 1000 married women of reproductive age group in the Department of Obstetrics and Gynaecology, NEIGRIHMS, Shillong, Meghalaya, from April 2021 to April 2022. NEIGRIHMS being a tertiary referral centre caters to patients from the entire North Eastern Region of India. A validated questionnaire was used for sociodemographic information, knowledge, awareness and attitude towards different contraceptive methods. Results: Out of 1000 married women, 82.5% women were aware about contraceptive methods, 67.5% women had knowledge on the different types of contraceptive methods available and only 370 (37.04%) of the participants are using at least one type of contraceptive methods and of these, 280 (28%) women preferred condom. Bivariate analysis revealed that factors such as current age, economic status and occupation, were seen to influence the utilization of contraceptive methods among women. Conclusions: While it is noteworthy to see the efforts made by the Government towards achieving the various health targets but sincerer and dedicated efforts are needed to ensure increased awareness about the importance of family planning

The matrilineal society of Meghalaya: trends of family planning and its implications on maternal health

Background: The key health indicators pertaining to maternal health are TFR, contraceptive usage and MMR. As per the NFHS V, the use of any contraceptive method is 27.4% and total fertility rate is 2.9 in Meghalaya, which reflects on the poor performance of the state towards achieving the goals set by the National Health Policy 2017. The current MMR of Meghalaya is 211/1 lakh live birth, one of the highest amongst the Indian states. The two most important causes of maternal mortality in Meghalaya are post-partum haemorrhage and anaemia- both avoidable causes of maternal mortality related to higher order pregnancies and lack of adequate spacing between two consecutive pregnancies, thereby increasing the importance of contraceptive use. The aim of the study was to identify factors associated with poor uptake of contraceptive measures and their implications on maternal health in a matrilineal society. Methods: A cross sectional study was conducted in the department of obstetrics and gynaecology, NEIGRIHMS where 200 patients, indigenous to Meghalaya, were recruited over a period of one year and were interviewed using a validated questionnaire pertaining to family planning practices. Results: Factors such as number of live births, religion and residence were seen to influence the utilization of contraceptive methods. Conclusions: There is still a wide gap to be filled- more sincere and dedicated efforts are needed to empower women to make informed decisions by   increasing awareness about the importance of family planning and its implications on maternal health

Sheehan’s syndrome: a case report

Sheehans syndrome or necrosis of pituitary gland is a rare complication of postpartum haemorrhage, initially described in 1937. Sheehans syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. We present a case of young lady with this syndrome who presented with classical symptoms of hypopituitarism within 1 year of her delivery which was complicated by postpartum haemorrhage

Analysis of the prevalence, etiology, and risk factors of stillbirth from a teaching institute of North Eastern India- a retrospective study

Background: Stillbirth rate is considered a health index. The worldwide stillbirth rate is 18.4/1000 total birth. This study was aimed to evaluate the prevalence and risk factors of intrauterine fetal death in pregnant women in one of the teaching centers in Northeastern India.Methods: This was a retrospective study. All cases of intrauterine fetal death admitted in the department of obstetrics gynecology of our institute were included over two and half years. Information was gathered from the medical records of the patients and data were analyzed.Results: During two and half year’s period, the total number of deliveries was 2696 and the total numbers of stillbirths were 96, hence the stillbirth rate was 35.6/1000. 93 (96.87%) were antenatal stillbirths and 3 (3.12%) were intrapartum stillbirths. 82 (85.41%) women were unbooked. 85 (90.4%) belonged to low socioeconomic status. 67 (69.79%) were preterm. Maximum 39 (40.62%) belonged to 28-35 weeks of gestational age. The most common cause of Intrauterine death (IUD) was antepartum hemorrhage (17.7%). 14 (14.5%) were abruption and 3 were placenta previa. The second most common cause (14.5%) was the hypertensive disorder of pregnancy.Conclusions: The stillbirth rate in our institute is higher than the national average. The most common causes of IUD were antepartum hemorrhage, preeclampsia, prematurity, and malpresentation which can be diagnosed and managed by increasing uptake of antenatal care which will lead to timely identification and proper management of maternal and fetal complications eventually reducing the preventable stillbirths

Comparative study of gabapentin and isoflavone in menopausal vasomotor symptoms

Objective: This study was planned to compare the effects of gabapentin and isoflavones in menopausal vasomotor symptoms. Materials and Methods: This prospective comparative study was conducted on 100 patients with complaints of hot flashes, divided into two groups of 50 each. Group I received 900 mg of gabapentin and Group II received 60 mg of isoflavones daily for 3 months. The patients were interviewed to calculate hot flash, global and depression scores and were rescored after 2, 4, 8, and 12 weeks. The primary outcome measure was a change in the hot flash score from baseline. The secondary outcome was an improvement in sleep, depression, and lipid profile. Data were analyzed using Chi-square test and Student's t-test. Results: Both groups showed significant improvement in hot flash score at the end of 12 weeks (82% Group I, 74% Group II; P = 0.076). Statistically significant difference was seen at 12 weeks in sleep quality in favor of gabapentin (P = 0.011) and in depression in favor of isoflavones (0.026). Isoflavone had significant improvement in cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides profiles after 12 weeks (P < 0.001, 0.009, 0.024 and <0.001, respectively) as compared to gabapentin. Conclusion: Isoflavone and gabapentin are equally effective in the treatment of hot flashes; however, isoflavones have better response in patients who have associated with complaints of depression and gabapentin is better who have associated sleep disturbance

Sheehan's syndrome: a case report

Sheehans syndrome or necrosis of pituitary gland is a rare complication of postpartum haemorrhage, initially described in 1937. Sheehans syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. We present a case of young lady with this syndrome who presented with classical symptoms of hypopituitarism within 1 year of her delivery which was complicated by postpartum haemorrhage

Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation

Hypertensive disorders of pregnancy affect 5% to 10% of all pregnancies globally. The aim of treatment is to bring down blood pressure (BP) quickly and smoothly, which is safe for the mother and baby. The aim of our study was to study the efficacy and safety of intravenous labetalol and oral nifedipine in severe pregnancy-induced hypertension. Materials and Methods: It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. Results: In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. Conclusion: From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol

Analysis of Different Routes of Hysterectomy Based on a Prospective Algorithm and Their Complications in a Tertiary Care Institute

Introduction. Hysterectomy is the most common gynaecological operation worldwide. The objective of the study is to analyze the various routes of hysterectomy and its complications when the decision of route is based on using a prospective algorithm tree. Methodology. It is an observational study to analyze the route of hysterectomy based on using a prospective algorithm. The decision tree is based on pelvic pathology, uterine size, vaginal access, pelvic adhesion, competency of the surgeon, choice of the patient, and complication of different routes of hysterectomy. Data were collected from preoperative, intraoperative, and postoperative records. Demographic factors, indications, routes of hysterectomy, and complications were recorded and analyzed by using SPSS software version 22. Observation. Among the malignant or suspected malignant pathology groups, TAH was performed in 89 cases and TLH was performed in 3 cases. Among the benign disease groups, VH was performed in 137(38.2%) cases, TAH was performed in 118(32.9%) cases, and TLH was performed in 104 (28.9%) cases. Operative time and a number of blood transfusions were significantly less with VH (p value p-value<0.00001) compared to VH and TLH. Vaginal discharge was more with VH and TLH compared to TAH (p value −0.004) and wound infection was more in the abdominal route (p value 0.001). Conclusion. The abdominal route was the route of choice for surgery in malignancy or suspected malignant pathology. In benign pathology, VH was the most common and preferable route of surgery. Complications were found to be minimal with vaginal hysterectomy