Ultrasonographic detection of nuchal cord: required or not

Background: Nuchal cord is defined as an umbilical cord that passes 360 around the neck. From a long time nuchal cord is considered as one of the cause for birth asphyxia and neonatal complications. For ultrasonographic detection of nuchal cord and use of colour Doppler for the same is emphasized a lot in literature. On the other side studies are there that don’t support the ultrasonographic detection of nuchal cord. Practically also on one sides it makes the attendants more anxious and results in unnecessary caesarean section as well as results in malpractice also. This study was conducted to assess the requirement of nuchal cord detection at any phase of gestation.Methods: This is a retrospective study conducted in the department of obstetrics & gynecology in a rural tertiary health care centre in one year duration. All the patients having nuchal cord at the time of delivery or caesarean section were included in the study. The case reports were analysed retrospectively for neonatal outcome and progress of labour.  Results: The incidence of nuchal cord was 6.63%, irrespective of number of loops. The incidence of single loop was 5.32% double loop was 1.14% three loop was 0.17%. One patient had four loops of cord around neck and one patient had true knot in the cord but neonatal outcome was absolutely normal in both patients. The profile of patients was discussed in Table 1. A total of 85% patients were less than 30 year age group with literacy level of 65% and 55% patients were primigravida.20 patients developed prolonged labour, 13 patients among these responded to oxytocin and delivered normally and rest 07 underwent lower segment caesarean section for non-progress of labour or fetal distress. The duration of labour was found prolonged in patients w and triple nuchal cords. 53 (27.60%) fetus had unfavourable APGAR at birth, among these 20 had single tight loop of cord around neck, recovered soon as the cord was clamped and cut. Among rest 33 fetus 03 had three loops of cord around neck, 07 had two tight loops of cord around neck, in rest 23 fetus loops of cord were present besides that other factors like prematurity (11), severe preeclampsia (06), chorioamnionits (02) , antepartum hemorrhage (04) were also present, may be responsible for fetal distress.Conclusions: Routine ultrasonographic nuchal cord detection is not required and should not alter obstetric management of the patient.

Hurdles in starting laparoscopy in a rural medical college: our experience

Background: Although laparoscopy surgery has certain proved advantages over open surgery like less scarring, less postoperative pain, early return to work etc. but has a long learning curve. The pressure of feeling we are behind as a surgeon if we don’t embrace laparoscopy made us to take it on. With this paper we want to share our experiences i.e. beginner problem we faced, efforts and modification we adopted and current status of our journey. The aim of the study was to highlight the difficulties in starting laparoscopic surgeries and how to overcome them.Methods: This is a retrospective study of all laparoscopic procedures performed in our newly established government medical college in rural India was started from 2013.Results: We have performed cases of 27 diagnostic laparoscopy, 10 cases of laparoscopic ovarian cystectomy, 09 cases of ectopic pregnancy and cases of LAVH and 05 cases of TLH. Over a period of about two years out of total only 8 cases were performed in first year of study. It was our technical deficiency, nonavailability of mentor, anesthetists’ reluctance for general anaesthesia due to prolonged duration of surgery and administrative pressure of long waiting list. To overcome these problems we underwent lap training with experts, attended CMEs, conferences and convinced anesthetists and administration for these surgeries. We also selected and trained our O.T. staff about technical demands of laparoscopy.Conclusions: Start by doing what is necessary; then do whats possible and suddenly you are doing impossible. However conversion to open surgery should be kept at low threshold rather than landing yourself and patient in complications

Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases

Introduction of near peer assisted learning approach in teaching proper hand scrub technique among undergraduate students

Introduction: In near peer assisted learning (NPAL)tutor is of the same level of education as with one to two years senior but within the same broad grade. Literature suggests that it fosters qualities like leadership, self-confidence and mentoring in tutors with simultaneous provision of a cordial learning environment to tutees. With this study we introduced NPAL in our newly established institute and assessed its feasibility, student’s perception, future applicability.Method: After having ethical clearance from institution, the students and faculty of Department of Obstetrics and Gynaecology were sensitized. The interns posted in labor room were designated as tutors and maternity students were included as tutees. The surgical hand scrub was the topic of teaching. The faculty taught interns and assessed, then interns taught maternity students and they were assessed by faculty members. The interns were again assessed by faculty. Afterwards both these interns and maternity students supposed to work together in labor room, the feedback was taken from all with a structured questionnaire using Likert scale.Result: The results were encouraging from all the corners, the tutors, tutees and faculty agreed that NPAL is a better method of teaching strongly enhancing the learning of tutors and their communication skills and develops positive attitude towards teaching as a part of their profession. The tutees found a cordial learning environment with a cognitive congruence with their tutors and felt very comfortable while working with them. Faculty also showed a positive attitude towards NPAL.Conclusion: NPAL is a good adjunct to standard teaching but could not substitute standard teaching

Tuberculosis masquerading carcinoma cervix and carcinoma endometrium: 2 case reports

Tuberculosis is a common infection in developing countries but genital tuberculosis is less common, confused with malignancy and difficult to diagnose at times. We present 2 cases of genital tuberculosis where a clinical diagnosis of malignancy was made and tuberculosis surprised us once again. This case report is intended to emphasize to suspect tuberculosis in young patients on the basis of history and examination to be later supported by investigations.

To compare intrapartum cardiotocographic (CTG) recording with conventional intermittent fetal heart auscultation during labor

Standard evaluation of fetal well-being during labor includes the periodic assessment of the fetal heart rate (FHR), its pattern and response to intrapartum stimuli and events. Effective methods of evaluation and meaningful interpretation of FHR data range from non-invasive techniques like Intermittent Auscultation, continuous electronic fetal heart rate (FHR) monitoring to invasive techniques of fetal blood gas analysis and fetal ECG

Experience of hysteroscopy in a rural tertiary care center of Haryana, India

Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33%  for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort

Impact of driver's advanced reaction time in car-following model with optimal velocity deviation under V2X environment

The vehicle-to-everything (V2X) technology has made a significant advancement in the field of intelligent transportation in recent years. When operating a vehicle in a V2X environment, the driver can get real-time updates on the motion of nearby vehicles. In a real-world traffic situation, there is always some deviation between the actual and anticipated traffic information, and this deviation will undoubtedly have a significant effect on traffic flow. Drivers always maintain the flow of traffic by taking some time to assess and decide how the drivers in front of them are behaving behind the car in the traffic system. As a result, by taking into account the driver's advanced reaction time and optimal deviation in a V2X environment, a novel car-following model is developed and the effects of these parameters on the traffic flow are examined. In order to determine the stability requirements for the new model, the linear and nonlinear stability of the proposed model is examined using the perturbation methods. Studies have found that when the driver's reaction time and the velocity deviation are optimized, it can reduce the amplitude of the stability curve, thus enlarging the area of more stable motion. Also, the numerical simulation supports the theoretical research by showing that the new model may effectively reduce traffic congestion and improve the stability of traffic flow as the influence of these factors on the traffic flow increases

Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases