Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate

ANTIMICROBIAL ACTIVITY OF AQUEOUS AND ETHANOLIC LEAF EXTRACTS OF ANACARDIUM OCCIDENTALE

Objective: The objective of this study was to evaluate the antimicrobial activity of leaves of Anacardium occidentale (A. occidentale) against microorganisms including multidrug-resistant (MDR) bacteria. Methods: Agar well diffusion method was employed to demonstrate the antimicrobial activity of leaves A. occidentale. Ethanol and aqueous extracts of the leaves were used against microorganisms, which included American type culture collection strains of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa and the clinical isolates of Streptococcus pneumoniae, Candida albicans, MDR Escherichia coli, and MDR Klebsiella pneumoniae. Results: The ethanolic extract of leaves of A. occidentale showed significant antimicrobial activity. Aqueous extract had mild antifungal activity. Conclusion: Ethanolic extract of leaves of A. occidentale could be a good source for the antibacterials to combat MDR bacterial infections. Further studies are necessary for these potent plant extracts to evaluate the in vivo efficacy and toxicity

Sonographic assessment of fetal head deflexion using occiput: spine angle measured during first stage of labour and its role in predicting the mode of delivery among nulliparous women

Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71).  The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery

TG‐69: Radiographic film for megavoltage beam dosimetry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134818/1/mp6779.pd

Adenomatoid Odontogenic Tumor of the Mandible - A Case Report and Review of Literature

Adenomatoid odontogenic tumor (AOT) is a relatively uncommon odontogenic neoplasm, first described by Steensland in 1905. Adenomatoid odontogenic tumor accounts for about 3-7 % of all odontogenic tumors. Predominantly found in young female patients, located more often in the maxillary anterior region, associated with an unerupted permanent tooth, mainly in the second decade. There are three variants: follicular, extra follicular & extra osseous. Irrespective of the type they show similar histological appearance with gland like structures, calcifying areas and amyloid like material. We present a case of follicular adenomatoid odontogenic tumor of the mandible, in a 23-year-old female patient associated with, unerupted lower left permanent canine