A comparative study of high dose vs low dose oxytocin in the augmentation of labour

Background: Augmentation of labour is a practice that aims to increase the duration, frequency, and intensity of uterine contractions in order to decrease the duration of labour and reduce adverse events of maternal and fetal outcomes associated with prolonged labour. Although oxytocin is the most commonly used drug for the augmentation of labour, there is no universally accepted dosage regimen as various studies have used different regimens of oxytocin as low dose and high dose, leading to clinical heterogeneity. Hence this study was taken up to study the advantages, disadvantages and complications of a widely accepted regime for this study.Methods: 100 patients in active labour, with inadequate uterine contractions were selected. The patients were randomly selected, allotting alternate cases for high dose and low dose oxytocin. The patients were monitored through the course of labour and compared in terms of augmentation-delivery interval, mode of delivery, maternal and fetal outcome. The findings were tabulated and statistically analyzed.Results: Majority of the patients delivered vaginally in both groups (78% of high dose and 90% of low dose group). The mean augmentation-delivery interval was 7.20 and 7.45 hours for high dose and low dose group respectively. 12% patients in high dose group experienced maternal complications, while none were encountered in low doe group. 12% neonates from high dose group and 14% from low dose group required admission to the NICU.Conclusions: It was concluded with moderate certainty that high dose regimen of oxytocin resulted in reduction in the duration of labour, but cesarean rate, maternal and fetal complications were more. It was concluded that neither regimen has got an absolute advantage or disadvantage over the other.

An observational study of parenteral paracetamol vis a vis tramadol as labour analgesics

Background: Labour although a physiological process, is associated with severe, excruciating pain. The delivery of the infant into the arms of a conscious and a pain free mother is one of the most exciting and rewarding moments in medicine ……..Moir. Labour analgesia plays an important role in making the process of labour comfortable for the mother. Drugs like paracetamol and tramadol with advantages of easy availability, being inexpensive and with no special technique of administration are a boon for labour analgesia. Our study aims to evaluate the efficacy of these two drugs as labour analgesics.Methods: Sixty cases in active labour fulfilling inclusion and exclusion criteria were selected for this study. All primigravidae at term gestation with singleton pregnancy having vertex presentation with no associated obstetric/ medical/surgical risk factors in spontaneous labour were selected. There were thirty patients who received Paracetamol as labour analgesic and thirty were in the tramadol group. It was an observational study.Results: The study revealed that paracetamol had a significant analgesic effect compared to tramadol at the fourth and the fifth hour of administration. However, the overall analgesic effect of both the drugs had no statistically significant difference. Maternal side effects and neonatal distress were less with paracetamol.Conclusions: This study showed that paracetamol had a better side effect profile for both mother and neonate along with a comparable, if not better, analgesic effect vis a vis tramadol

A re-look into intra-operative impediments and post-operative morbidities in repeat caesarean section

Background: Repeat caesarean sections are known to be a cause of significant morbidity in both intra and post-operative period. The challenges faced by the surgeon may include adhesions, difficulty in delivery of foetus, visceral injury and bleeding. The post-operative recovery may be marred by problems such as post-partum haemorrhage, febrile morbidity, wound infections and the after effects of intra-operative visceral injury. It is these issues that often make repeat caesarean section a cause for concern and delay the recovery of the mother. Methods: At random, hundred ante-natal patients visiting the obstetric OPD, meeting the inclusion criteria of previous caesarean section and planned for repeat caesarean section were selected and all the data were collected and tabulated. Results: After careful analysis of the data, it is observed that the intra-operative findings of adhesions, placenta praevia and excessive blood loss were encountered in relook caesarean sections. Similarly post operative morbidity in the form of wound infection and fever were observed in the same study population. Conclusions: If we are more vigilant and restrict the number of primary caesarean sections to evidence based appropriate indications, we may be successful in reducing the number of repeat caesarean sections and thereby mitigating the subsequent hardships for the mother

Retinal ganglion cell repopulation for vision restoration in optic neuropathy: a roadmap from the RReSTORe Consortium

Abstract Retinal ganglion cell (RGC) death in glaucoma and other optic neuropathies results in irreversible vision loss due to the mammalian central nervous system’s limited regenerative capacity. RGC repopulation is a promising therapeutic approach to reverse vision loss from optic neuropathies if the newly introduced neurons can reestablish functional retinal and thalamic circuits. In theory, RGCs might be repopulated through the transplantation of stem cell-derived neurons or via the induction of endogenous transdifferentiation. The RGC Repopulation, Stem Cell Transplantation, and Optic Nerve Regeneration (RReSTORe) Consortium was established to address the challenges associated with the therapeutic repair of the visual pathway in optic neuropathy. In 2022, the RReSTORe Consortium initiated ongoing international collaborative discussions to advance the RGC repopulation field and has identified five critical areas of focus: (1) RGC development and differentiation, (2) Transplantation methods and models, (3) RGC survival, maturation, and host interactions, (4) Inner retinal wiring, and (5) Eye-to-brain connectivity. Here, we discuss the most pertinent questions and challenges that exist on the path to clinical translation and suggest experimental directions to propel this work going forward. Using these five subtopic discussion groups (SDGs) as a framework, we suggest multidisciplinary approaches to restore the diseased visual pathway by leveraging groundbreaking insights from developmental neuroscience, stem cell biology, molecular biology, optical imaging, animal models of optic neuropathy, immunology & immunotolerance, neuropathology & neuroprotection, materials science & biomedical engineering, and regenerative neuroscience. While significant hurdles remain, the RReSTORe Consortium’s efforts provide a comprehensive roadmap for advancing the RGC repopulation field and hold potential for transformative progress in restoring vision in patients suffering from optic neuropathies