Maternal mortality in a tertiary care hospital: a 3-year retrospective study

Background: Systematic review to determine the epidemiological aspects and causes of maternal mortality there by exploring possibility of intervention and implementing Evidence-based health policies and programmes to prevent future maternal death. Aims and objectives of the study were to calculate the maternal mortality rate in our hospital, to assess the epidemiological aspects of maternal mortality, to assess the type of delay and causes of maternal mortality and to suggest ways to reduce the MMR.Methods: This is a 3-year retrospective study from January 2017 to December 2019 that will be conducted in the department of obstetrics and gynaecology, The Apollo medical college and District hospital, Chittoor a tertiary care teaching hospital situated in the southernmost part of Andhra Pradesh state in India. It gets a large number of referrals from PHCs, CHCs, and maternity homes as well as from hospitals across Chittoor district. Epidemiological data will be collected from the hospital register. Maternal mortality ratio, epidemiological factors and causes affecting maternal mortality are assessed.Results: MMR in present study was 66 per 1,00,000 live births. Women in the age group of 20 to 30 years (85.72%), illiteracy (57.16%) and low socioeconomic status (100%) were risk factors for maternal mortality. Obstetric haemorrhage (57.16%) is most common cause whereas type 1 and type 2 delays are most common contributing factors for maternal mortality.Conclusions: Early identification and management of pregnancy complication, strengthening of existing Emergency obstetric care (EmOC) facilities, easy transport and appropriate referral linkages are keys to reduce maternal mortality to further extent

Profile and compliance of recipients of injection depot medroxy progesterone acetate as a contraceptive method in the government tertiary care hospital in Mandya, South Karnataka, India

Background: The advanced contraceptive devices available nowadays have minimal side effects and utmost efficacy. The use of safe and effective contraception is the need of the hour in India. Inj. Depot medroxy progesterone (DMPA) has been found to provide effective, long acting and reversible contraception in lactating mother and post-abortal patients. Objective of this study was to describe the profile of women utilizing inj. DMPA as a contraceptive, to determine its compliance and to assess the factors affecting discontinuation of inj. DMPA (Anthara) at the government tertiary care institute in Mandya.Methods: The present study was a record-based study of 18 months (January 2018 to June 2019). The records of 266 women who utilized inj. DMPA as contraception in our institution was analysed.Results: It was observed that out of 266 women 48.5% were from age group of 21-25 years and 64.3% were primipara. Most of the women who initiated inj. DMPA (Anthara) were in the lactational period (56.0%). Most common side effect was irregular bleeding (54.8%). Discontinuation rate was 55.6% after first injection and 16.9% after second injection and gradually reduced with subsequent injections. The most common reason for discontinuation was irregular spotting per vagina (53.9%).Conclusions: Inj. DMPA is a safe, effective, long acting contraceptive taken once in three months. Many women in early reproductive age and lactational period are using inj. DMPA (Anthara) for contraception because of its convenience of dosing and is easily made available at government health care centres free of cost and has no effect on lactation. Discontinuation rate can be reduced by proper counselling

Incidence and risk factors associated with ectopic pregnancy: a prospective study

Background: Increased incidence of ectopic pregnancy and its impact on women’s fertility in recent years need significant attention.Methods: A two years prospective study from January 2018 to December 2019 conducted to determine incidence, association of risk factors with ectopic pregnancy and find the most common risk factor of ectopic pregnancy in department of obstetrics and Gynaecology, a tertiary care Hospital in Pune.Results: During the study period 100 patients were diagnosed to have ectopic pregnancy. Incidence was 5.29 per 1000 births. Majority were in the age group of 20-24 years (42%), multiparous (59%) and belong to low socioeconomic state (62%). In majority of the patients (22%) no risk factors was found. Among the patients who had risk factors, the main risk factors for ectopic pregnancy were history of history of pelvic inflammatory disease (20%), previous tubal/abdominal surgery (12%), history of Infertility (10%), previous termination of pregnancy (10%), contraception with mirena IUS or IUCD in situ (8%) and a history of prior ectopic pregnancy (4%).Conclusions: In majority (78%) of patients risk factors for ectopic pregnancy was present and pelvic inflammatory disease was found to be a major risk factor for ectopic pregnancy

Comparative analysis of hysteroscopy versus suction evacuation in the management of retained product of conception

Background: RPOC can occur due to spontaneous or induced abortion followed by incomplete or partial expulsion of product of conception. Suction evacuation is currently the standard surgical treatment, but operative hysteroscopy has the advantage over Suction evacuation allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications.Methods: Comparative retrospective study of 80 patients who presented with RPOC during the period of 6 months. Hysteroscopy was done in 40 patients and Suction evacuation in remaining 40 patients. Data regarding anaesthesia required, mean time taken for procedure and post procedure hospital stay, complication due to the procedure and post-operative outcome were collected to compared,Results: In hysteroscopy group none of patients required anaesthesia and even though mean time taken for the procedure is 2 minutes more in hysteroscopy group without statistical significant difference (P 0.672), the post procedure hospital stay is less compared to suction evacuation group. Complication due to procedure was seen in 5 (12.5%) patients in hysteroscopy group which is less compared to 13 (32.5%) patients in suction evacuation group. Mean number of days of pain requiring analgesia and Sick leave applied was also less in hysteroscopy group (1 day and 2 days respectively) group compared to suction evacuation group (9 days and 7 days respectively)Conclusions: Lesser rates of intra and post-operative complications with hysteroscopy makes the procedure ‘safe’ to the patients and ‘effective’ as it ensures complete evacuation of the uterine cavity under direct vision and reduce the need for repeat procedure

Comparison of maternal outcome in patients treated with methyldopa and labetalol in the management of hypertensive disorders of pregnancy

Background: To compare the maternal outcome in patients treated with methyldopa and labetalol in the management of moderate to severe hypertensive disorders of pregnancy (HDP).Methods: The present study is Prospective parallel group comparative study on 200 out-patients and inpatients selected between January 2013 to December 2013 from OPD and antenatal ward of Obstetrics and Gynaecology department, of tertiary care teaching hospital, Regional Institute of Medical Sciences, Imphal. 100 patients each were distributed to methyldopa group and labetalol group respectively.Results: There was statistically significant reduction in the mean systolic BP + Standard deviation / Diastolic BP + Standard deviation and Mean arterial pressure (MAP) in Labetalol group (from 156.84 + 5.75/100.20 + 6.02 mmHg and 119.08 + 4.07 to 133.76 + 3.50/85.14 + 3.98 mmHg and 101.35 + 2.94) compared to Methyldopa group (from 156.00 + 6.581/100.96 + 6.896mmHg and 119.30 + 4.86 to 137.20 + 2.36/89.02 + 2.38mmHg and 105.08 + 1.78). Risk of adverse effects was less in Labetalol group (12%) but complication during pregnancy was more in Methyldopa group (51%). Number of spontaneous onset of labour and vaginal mode of delivery was more in Labetalol group.Conclusions: The present study shows that primiparity, residing in rural area, with low income group and overweight are at high risk of developing Hypertensive Disorders of Pregnancy. Labetalol is the better drug in controlling blood pressure with less adverse effects and maternal complication

Prevalence of gynecological diseases in postmenopausal women in tertiary care hospital in Chengalpattu district

Background: Menopause is a biological event characterized by the complexity of factors. On an average one-third of the women’s life consists of the post-menopause years, and health care programs for women do not address concerns beyond reproductive ages. The aim of this study was to describe the magnitude of menopause-related symptoms, the pattern of health care seeking, and associated factors. To assess the prevalence of gynecological disease in post-menopausal women.Methods: This cross-sectional study was done in Karpaga Vinayaga Institute of Medical Sciences and Research Center - obstetrics and gynecology OPD. Over a period, months in the year 2019. Stages of reproductive aging workshop (STRAW) revised criteria and nomenclature are used for the ascertainment of menopause and inclusion of the women in the study. It provided a comprehensive basis for staging since there were more complexities on ascertainment of menopause explained. The STRAW criteria are considered as the gold standard for assessing menopausal stages.Results: A total of 600 participants were included in the study. The proportion of women who had at least one menopause-related symptom was 95.95 (95% CI 93.73-97.54) and 58.3% of women had severe symptoms. Severities of symptoms in psychological, physical, vasomotor, and sexual domains were 56.7%, 70.5%, 49.3%, and 10.2% respectively. Premature menopause (p<0.016), induced nature of menopause (p<0.031), dyslipidemia (p<0.006) and other medical condition (p<0.003) were associated with severity of menopausal related symptoms.Conclusions: A high proportion of women are affected by menopause-related symptoms. Care seeking for all symptoms is not uniform, indicative of a lack of knowledge about the treatable nature of many of these symptoms. Sensitization of both women and the health care system may serve to address this issue of menopause-related symptoms and the possibility of treatment for these

Simulation and Synthesis of Efficient Majority Logic Fault Detector Using EG-LDPC Codes to Reduce Access Time for Memory Applications

This paper presents an error-detection method for Euclidean Geometry low density parity check codes with majority logic decoding methodology in VHDL language and the output is verified with the help of Xilinx12.1. Majority logic decodable codes are suitable for memory applications due to their capability to correct a large number of errors. However, they require a large decoding time that impacts memory performance. The proposed fault-detection method significantly reduces memory access time when there is no error in the data read. The technique uses the majority logic decoder itself to detect failures, which makes the area overhead minimal and keeps the extra power consumption low. Starting from the original design of the ML decoder introduced, the proposed ML Detector/Decoder (MLDD) has been implemented using the Euclidean Geometry low density parity check codes. The proposed improved majority logic detector/decoder to perform data error correction in simple way using additional error correction technique and also reducing the delay time by detecting the errors in parallel manner. Hence the decoding process uses less number of cycles which reduces the delay

Obstructive Sleep Apnea – Current Perpectives

Obstructive sleep apnea is a common sleep related breathing disorder. The demand for sleep medicine services has increased exponentially since the recognition of sleep apnea as a disease in the 1960s. The involvement of dentists in the treatment of sleep apnea has increased. It is important that dentists are aware of the problem of sleep disorders and the potential they have to help in their management

Mechanism of haematotoxicity induced by phenylhydrazine: a review

This work was carried out to show the effects of phenylhydrazine (PHZ) induced anaemic condition. Anaemic condition is defined as reduction in red blood cells (RBC) than normal number of red blood cells. The anti-anaemic activity can be studied using the changes in haematological parameters (PCV, RBC &amp; Haemoglobin) influenced by PHZ [(40mg/kg p.o.)] in rats. PHZ, a potent chemical that causes different effects on different tissues at several levels. Administration of PHZ causes haemolytic anaemia, genotoxic effects and rose in iron absorption in spleen, liver and duodenum &amp; causes change in iron metabolism. PHZ acts by activating immune response which triggers phagocytosis and also interfere with the binding of erythropoietin (EPO) receptors and further JAK-STAT pathway. PHZ also causes genotoxic effect by forming single strand DNA damage. In view of lipid peroxidation along with the formation of Thiobarbituric acid (TBA)-reactive malonyldialdehyde, it is recommend that PHZ induces anaemia as an outcome of peroxidation of&nbsp; RBC membrane lipids and this effect may be a upshot of the autoxidation of the drug and the interaction of membrane lipids and oxygen radical

A prospective randomised open labelled comparative study of anti inflammatory effects of topical 5% benzoyl peroxide gel vs topical 4% nicotinamide gel for grade I-II acne in a tertiary care hospital

Background: Acne vulgaris is a dermatological disorder characterised by formation of comedones and inflammatory lesions. The treatment of acne basically involves reduction of lesions. Benzoyl peroxide, in concentrations of 5%, 10%, and 20%, has been used effectively in the treatment of acne for more than 20 years. Nicotinamide/ Niacinamide is a newly-approved anti-acne drug with a potent anti-inflammatory effect. The present study assessed the efficacy of 5% Benzoyl peroxide gel in comparison to 4% Nicotinamide gel for topical treatment of mild to moderate acne vulgaris.Methods: In this study, the patients with mild to moderate acne vulgaris with inflammation were divided into two groups, group I was treated with topical 5% Benzoyl peroxide gel whereas topical Nicotinamide gel was given to the group II. Assessment of efficacy was done by total lesion counting according acne global severity index, the results were compared at the end of 2 weeks and 4 weeks with the baseline values.Results: At the end of this study, it was found that the reduction of inflammatory and total percentage of decrease in counts of lesions from baseline were highly significant in both the groups (p<0.001), between the groups, differences were statistically significant (p<0.001), therefore 5% Benzoyl peroxide gel has better efficacy than 4% Nicotinamide gel.Conclusions: Benzoyl peroxide is more efficacious than 4 % Nicotinamide gel in mild to moderate acne