Clinical study on ectopic pregnancy

Background: Ectopic pregnancy is a life-threatening emergency which is one of the important cause of maternal morbidity and mortality in early pregnancy. Ectopic pregnancy must be suspected in any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding. It is of great importance to diagnose the condition early to prevent complications. The aim of the study is to review all cases of ectopic pregnancy and determine the incidence, high risk factors, types of clinical presentation and mode of management in a tertiary care hospital. Methods: A retrospective study conducted on 108 patients of ectopic pregnancy admitted at obstetrics and gynaecology department, civil hospital Ahmedabad from January 2021 to June 2022. Results: In this study 108 patients, diagnosed with ectopic pregnancy observed during the study period, with an incidence of 1.09%. Majority of women were aged 20-30 years (45.3%) and multiparous (59.25%). The 66.6% cases were ruptured ectopic. The most common risk factors were pelvic inflammatory disease (16.7%), past history of infertility (14.8%) and IUCD (12.03%). Lower abdominal pain was seen in 98 (90.74%) patients and pallor was seen in 84 (77.78%). Majority of patients had tubal ectopic pregnancies. Most common mode of treatment was unilateral salpingectomy (79.62%). Conclusions: Ectopic pregnancy is leading cause of maternal mortality in first trimester. Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy

A Zigbee Technology for Lighting Control Application

Zigbee is wireless communication technology and IEEE 802.15.4 standards for data communication. There are zigbee standards provides network security and application sup port services operating on top of the IEEE 802.15.4 medium access control and physical layer wireless standards and it employs a group of technologies to enable scalable, self - organizations,self - healing networks that can mange various data traffic pattern s. The Zigbee is low - cost, low - power consumption, wireless mesh networking standards and It is designed around low power consumption allowing batteries to essentially last forever. Zigbee is use for monitoring and control applications. This paper presents a zigbee device types, its traffic varities, stucture and use in home automation and the lighting control application

Comparative study of non-descent vaginal hysterectomy with abdominal hysterectomy

Background: Hysterectomy is one of the most common operation performed in Obstetrics and Gynecology next to caesarean section. Due to its advantages vaginal hysterectomy are more and more performed now. Only drawback is lack of expertise. Present study focuses on comparison between outcomes in abdominal versus vaginal hysterectomy and to determine which route of hysterectomy is superior, safer and effective.Methods: The study is a prospective study conducted in the department of obstetrics and Gynecology. Civil hospital, Ahmedabad between the period of Jan 2016 to 2017. Of 100 patients. Fifty patients who underwent hysterectomy by vaginal route are taken as study group A, and the remaining 50 patients who underwent by the abdominal route are taken as study group B.Results: Majority of women undergoing hysterectomy were in age group of 30-50 years; postmenopausal age group women were less;13 NDVH and 5 in AH. Majority of the women were multipara in both age groups. Menorrhagia was found to be major indication with 42 in NDVH and 40 in AH. There is much significant difference in the postoperative pain in both groups with less in NDVH group. There is not much significant difference in blood loss in both the groups. Postoperative complications were more with AH.Conclusions: Thus, it can be concluded that NDVH is feasible, safe and provide more patient comfort without increasing the duration of surgery and other post-operative complications

Study of maternal and perinatal outcome in post-dated pregnancy

Background: It has been reported that in a pregnancy which has crossed the expected date of delivery, there is an increased risk of oligohydramnios, meconium stained amniotic fluid, macrosomia, fetal postmaturity syndrome, and cesarean delivery, all of which endanger the baby as well as the mother. The present study focus to investigate maternal and perinatal outcome in postdated pregnancies.Methods: The prospective observational study included primigravida and multigravida beyond 40 weeks of gestation admitted from September 2019 to September 2020 in obstetrics and gynaecology department B. J. medical college, civil hospital, Ahmedabad.Results: Out of 100 patients, majority were primigravida 62%, meconium stained liquor with fetal distress was the most common indication for LSCS 23.5 %, fetal distress was the most common fetal complications, rate of NICU admission was 33.33% between 41 weeks 1 day to 42 weeks, rate of induced labour was 71.43% between 41 weeks 1 day to 42 weeks. 88% patients were between 40 weeks 1 day to 41 weeks.Conclusions: Prolonged pregnancy was associated with remarkable risk of perinatal complications like fetal distress, meconium aspiration syndrome, IUGR, obstetric complications like oligohydramnios, perineal tear, atonic PPH and shoulder dystocia. The adverse outcome can be reduced by making accurate gestational age and diagnosis of postterm gestation as well as identifiable and management of risk factors. Considering the maternal and neonatal morbidity associated with prolonged pregnancy, pregnancy should not be permitted to go postterm

Maternal and perinatal outcome in multifetal gestation

Background: Multifetal gestation is a high-risk pregnancy associated with increased maternal and fetal complications. The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). The present study aims to investigate maternal and perinatal outcome in multifetal gestation.Methods: The prospective study was carried in the department of obstetrics and gynaecology, B. J. medical college, civil hospital, Ahmedabad from August 2019 to July 2020. All cases of multifetal pregnancy either admitted from antenatal clinics or from labor room as emergency cases were included in the study.Results: Out of total 7786 births during this period, 103 were twin pregnancies and 3 were triplets. The incidence was 1 in 73.5 births. Maternal complications observed were anaemia in 27.3% patients, preterm deliveries in 58% patients, PROM in 20.7% patients, hypertensive disorders of pregnancy in 13.2% patients, APH in 1.8% patients and PPH in 4.7% patients. No maternal mortality occurred. Fetal complications like gross congenital anomalies in 6.13% cases, single fetal demise in 8.49%, growth discordance in 7.53%, fetal growth restriction in 5.18% cases and 82% babies were low birth weight. Still birth rate was 8.01% and perinatal mortality rate was 12.3%.Conclusions: Early detection of high-risk cases, timely referral, frequent antenatal visits and early hospitalization with optimum obstetrics care and intensive neonatal care set up are necessary to improve maternal and perinatal outcomes

A study of feto-maternal outcome in cases of gestational diabetes mellitus

Background: The aim of the study was to determine prevalence of gestational diabetes mellitus in the community, demographic parameters like age at diagnosis, parity, complications related to gestational diabetes mellitus, and plan the management of gestational diabetes mellitus and to reduce the maternal and perinatal morbidity and mortality. The objective of this study was to evaluate the risk factors and fetomaternal outcome in mothers with gestational diabetes mellitus. Methods: In this prospective cross sectional study we included 120 patients with gestational diabetes mellitus were studied for fetomaternal outcome. The study was conducted from January 2021 to June 2022 at department of obstetrics and gynecology, B. J. Medical College and Civil Hospital, Ahmedabad. Results: Total 120 cases of gestational diabetes mellitus were studied. It was observed that gestational diabetes mellitus were more common in elderly age group (54.16%), multigravida patients were most commonly involved (48.33%). Past history of gestational diabetes mellitus was present in 39.81% of cases, 68.34% of cases required insulin for glycemic control, 63.34% cases required delivery by Caesarean section, maternal complications like preeclampsia (20 cases), polyhydroamnious (44), uteroplacental insufficiency (10), macrosomia, sudden IUFD (7) and operative delivery were common outcome. 12 neonates developed respiratory distress syndrome, 17 developed hypoglycemia and 26 neonates required NICU admission, 12 neonates underwent perinatal mortality. Conclusions: Gestational diabetes mellitus has become a global public health burden. Early detection of gestational diabetes mellitus, timely referral, frequent antenatal visits, and management of the identified cases at tertiary care centers can lead to decreased maternal and feral morbidity and mortality

Management of post-partum haemorhage at tertiary care center

Background: In developing countries like India post-partum haemorrhage (PPH) contributes to 35% of all maternal deaths and 239 per 1,00,000 deaths. So, PPH is a high-risk condition which increases maternal morbidities and mortalities. Hence it mandates a multidisciplinary approach. Audit of misses and near misses helps to determine causes of maternal morbidity and mortality and identify gaps in care. Aim of the study was to study conservative and definitive management of PPH. Methods: A retrospective analysis of all patients who has undergone PPH and also cases who referred from outside with PPH in department of obstetrics and gynaecology at civil hospital Ahmedabad from January 2021 to January 2022. Results: Out of 6029 deliveries there were 171 cases of PPH (2.8%). Which of 150 cases (87.7%) managed by conservative management (uterine conserving) and 21 (12.3%) cases were required definitive management (hysterectomy) due to failure of conservative management. Out of all cases 78.8% cases of PPH were due to atonicity of uterus and 19.1% cases were due to traumatic cause. Early recourse to hysterectomy was recommended especially where bleeding is associated with morbidly adherent placenta. Conclusions: PPH is an important cause of morbidity and mortality. We now have more options for conservative management which can greatly reduce its sequelae and more importantly in patients with wider issues of reproductive health. But in case of intractable bleeding and non-responsive by conservative management definitive management (Hysterectomy) is life saving and last resource

Study of cardiac disease and its outcome in pregnancy

Background: Pregnancy comes as a temporary complication in the disease process of a patient with a cardiac lesion. It is the 4th common cause of maternal mortality and one of the most important non-obstetrical causes of maternal death. Previously most women with diagnosed heart disease were advised to avoid pregnancy and labor and termination was advised. But in modern obstetrical practice, pregnancy in a patient with a heart disease is no longer an unacceptable hazard. The objective of this study is to find out incidence of cardiac diseases in pregnancy, to evaluate their management and to find out maternal and fetal outcome in pregnancy with cardiac disease.Methods: This study is a prospective cohort study in which an analysis of maternal and fetal outcome in 30 cases of cardiac diseases in pregnancy was carried out in the department of Obstetrics and Gynaecology in our institute at Civil hospital Ahmadabad from 01/01/2017 to 31/12/2017.The study included all known case of RHD, CHD, or newly diagnosed case or surgically corrected case with prosthetic heart valves during current pregnancy.Results: Majority of women having pregnancy with cardiac disease were in the age group of 20-30 years. Majority of them were primigravida and suffered from rheumatic heart diseases with grade 1 NYHA severity. Majority of women got delivered by normal vaginal delivery with healthy fetal outcome. Most of the babies born to cardiac mother had their baby weight ranging between 2.0-2.5kg.Conclusions: The results of present study indicate that heart disease forms a considerable proportion of medical illness complicating pregnancy. Cardiac disease presents problems both to the obstetrician and as well as to the physician, cardiologist and to the neonatologist. But the majority of pregnancies complicated by heart disease are uneventful with a favorably good outcome for both the mother and the fetus