A retrospective analysis of outcome of pregnancy with acute renal failure during a period of one year at Geetanjali medical college & hospitals, Udaipur, Rajasthan, India

Background: Acute kidney injury (AKI) is a life threatening complication of pregnancy. Pregnancy related Acute Renal Failure is usually a consequence of obstetric complication like pregnancy induced hypertension, pre eclampsia, eclampsia, septic abortion, HELLP, antepartum hemorrhage, and puerperal sepsis.Methods: ARF was diagnosed when there was a history of sudden oliguria (urinary output 0.5mg/dl/day from baseline. All patients with obstetrical ARF, antepartum as well as postpartum, were included in this study.Results: From 256 patients, 15 patients (5.8%) had pregnancy related ARF. Maternal outcome was assessed according to grading of AKI. The causes of ARF were pre eclampsia and eclampsia (40%), HELLP (13.33%), APH (13.33%), PPH (20%) and puerperal sepsis (6.66%). Maternal mortality was 13.33%. Neonatal outcome, amongst 14 patients, was noted and analyzed. Intrauterine deaths amongst them were 4/14 (28.57%). Amongst 10 neonates which were admitted in neonatal ICU, 6/10 (60%) survived and 4/10 (40%) of them died.Conclusions: Multidisciplinary services at tertiary level may reduce mortality due to Pregnancy related Acute Renal Failure. Most common etiological factor was pre eclampsia and eclampsia. Disappearance of illegal abortion, improvement in ANC with effective management of complicated pregnancy, the facility for safe early elective delivery whenever indicated, the improvement in resuscitation of obstetric hemorrhage and increased preparation of hospital birth had all contributed to the prevention of this devastating complication of pregnancy

A randomized controlled trial to compare effects of different volume and concentration of lidocaine for preventing propofol injection pain in adults

Background: Pain on propofol injection is an unwanted effect which can lead to decreased patient satisfaction. Although many studies have shown that pre-treatment with lidocaine injection is effective in this pain, nevertheless, very few studies have been done  on different concentration and volume of lidocaine, effective of reducing pain significantly. Objective of the current study was to assess and compare the efficacy of intravenous lidocaine with  0.4% and 2% concentration in reducing the incidence and severity of propofol injection pain.Methods: A total of 126 American Society of Anesthesiologist grade I and II patients with age ≥18 years, scheduled for an elective surgery, were enrolled in the study. Patients were randomized into two equal groups of 63 each. Group A (n = 63) received pretreatment with 0.4% lidocaine and group B (n = 63) received 2% lidocaine. Propofol injection pain was measured by using Numeric Rating Scale (NRS) and Withdrawl Response Scale (WRS). Unpaired t test, ANOVA and Chi square test were used for statistical analysis.Results: A statistically significant decrease in the pain was recorded in group A (0.4% lidocaine) as compared to group B (2% lidocaine). Using NRS scale, 12% of patients in group A as compared to 33% patients of group B, experienced pain (p =0.02); while using WRS, 8% patients of group A as compared to 27% group B patients experienced pain (p= 0.04).Conclusions: The pain on injection of propofol is significantly decreased by the use of 0.4% lidocaine in comparison with 2% Lidocaine

Assessment of the efficacy of glyceryl trinitrate patch as a tocolytic

Background: Preterm labor is defined as onset of delivery after the age of gestational viability (20-28 weeks) and prior to 37 weeks. Preterm birth complicated 5-10% of all births and accounts for 75% of perinatal deaths. Several drugs are now available to delay delivery in spontaneous preterm labour. Delaying the delivery for at least 24-48 hr for lung maturity of fetus is the primary goal. Glyceryl trinitrate has less maternal side effects.Methods: The study included 100 women who were admitted in view of preterm labour with gestational age between 28-36 weeks and were given trans dermal nitroglycerin therapy for arrest of preterm labour.Results: The efficacy of nitroglycerine patch to arrest preterm labour was studied. 88 patients were successfully progressed for more than 48 hours with minimum prolongation of 3 days and maximum prolongation of 65 days and average prolongation of 26 days of pregnancy.Conclusions: Glyceryl trinitrate patch as a tocolytic is very effective. This drug has a good patient acceptability and compliance due to its minimal side effects, low cost and simple dosage schedule

Premature ovarian failure incidence, risk factors and its relation to BMI and infertility

Background: Premature ovarian failure (POF) is cessation in the normal functioning of the ovaries in women younger than age 40 years. It is estimated to affect1% of women younger than 40 years and 0.1% of those under 30 years. Premature ovarian failure is a common cause of infertility in women.Methods: Patient attending outpatient Department of Obstetrics and Gynecology with age less than 40 years and complaint of menstrual disturbances, symptoms of menopause were enrolled for the study for duration of 1year. This study is planned to calculate the incidence, risk factors, relation to BMI and infertility in patients attending outpatient department at Geetanjali medical college and hospital, Udaipur for all enrolled patient coming with complaints of menstrual disturbances. FSH levels were send for all the patients and those with FSH level more than 20 at day 2/3 for menstruating women and random FSH level for amenorrhea patient more than 20 were classified in to study group and all those women with FSH less than 20 are taken as control group.Results: Present study strongly suggests that simple laboratory test FSH and symptoms of missed and irregularity of menstrual cycle help in early and prompt diagnosis of premature ovarian failure. And early diagnosis helps in avoiding unnecessary medications and helps in improving long term morbidity.Conclusions: Disturbances in menstrual cycle like amenorrhea and infrequent cycles are the symptoms which are associated with premature ovarian failure after ruling out pregnancy and other hormonal and structural causes

Oligohydramnios and its perinatal outcome

Background: Oligohydramnios is one of the major causes of perinatal morbidity and mortality. The sonographic diagnosis of oligohydramnios is usually based on an AFI≤5 cm or on a single deepest pocket of amniotic fluid≤2 cm3. Our study was aimed to study the perinatal outcome in oligohydramnios. Aim and objective were to study obstetric risk factors associated with oligohydramnios and maternal outcome in the form of mode of delivery, and to assess neonatal complications in terms of APGAR score at birth, NICU admission rates, meconium stained liquor and still birth rates.Methods: It was an Observational, Prospective, clinical study of 100 pregnant patients diagnosed with oligohydramnios by ultrasound, carried out in Geetanjali medical college and hospital, Udaipur for period of from January 2020-August 2020. The study was conducted after ethical clearance and with informed consent. Detailed history on demographic profile, medical illness, obstetric history and antenatal complication if any in the present pregnancy; general examination, obstetric examination and bimanual examination were performed meticulously.Results: In our study 53% cases of oligohydramnios were associated with some of the risk factors like PIH (29%), IUGR (22%), fetal anomaly (1%), systemic maternal disease (1%) and 47% of the cases were Idiopathic. LSCS was done in 85.71% cases with AFI<5 cm. Low birth weight was found in 51.43% cases with AFI<5 cm. NICU admission was required for 28.57% cases with AFI<5 cm.Conclusions: AFI is an important and convenient screening test for prediction of perinatal outcome. In presence of oligohydramnios, the risk of fetal distress, operative delivery, low Apgar score, low birth weight, perinatal morbidity and mortality are more. Hence early detection of oligohydramnios, associated antenatal risk factors and timely management can improve the maternal and fetal outcome

Asymptomatic bacteriuria in pregnancy and its relation to perinatal outcome

Background: Asymptomatic bacteriuria is one of the cause for adverse perinatal outcome. Pregnant women are at high risk for UTIs. Women exposed to antepartum urinary tract infection had increased incidence of delivering infants with low birth weights, premature infants, preterm infants with low birth weights, than those who were not exposed. Women exposed to antepartum urinary tract infection were also more likely to experience premature labor, hypertension or preeclampsia and anemia.Methods: Antenatal women attending Geetanjali medical college and hospital, Udaipur, OPD department were screened for asymptomatic bacteriuria and followed up till delivery. Two groups were made one with asymptomatic bacteriuria positive and treated and other with non-asymptomatic bacteriuria patients. Both groups were followed uptill delivery to note their adverse perinatal outcomes. Odds ratios (OR’s) and 95% test based confidence intervals (CI’s) were computed between two groups to note their perinatal and maternal outcomes.Results: Prevalence of asymptomatic bacteriuria was 12.27%. Mean gestational age at which women presented was 14-26 weeks. No incidence of pyelonephritis was found. No significant adverse perinatal outcome was noted amongst patients treated for asymptomatic bacteriuria.Conclusions: Early screening and treatment of ASB when implemented helps in reducing adverse maternal outcome

Evaluation of Integrated Childhood Development Services (ICDS) program implementation in an urban slum of Delhi, India

Background: The Integrated Childhood Development Services (ICDS) scheme is India’s foremost program imparting comprehensive and cost-effective services to meet the multi-dimensional needs of children. Following a populist approach, the program has now increased its umbrella coverage to reproductive age, pregnant and lactating women. The impact of such development and existing program performance remain debatable due to the paucity of evaluation research.Methods: A mix-methods descriptive case study was done using adapted ICDS monitoring tool in a pre-identified slum. The slum was purposely chosen for its intensive habitation of the poor and marginalized population. Primary data were collected through personalized interviews with program staff, health functionaries, and community representatives. Secondary data were collected from records available at Anganwadi centre (AWC). The data were triangulated and analyzed with results being expressed in narrative, simple proportions and percentages.Results: The mean coverage of ICDS services was 58.3%. Maximum coverage recorded for Supplementary Nutrition (SN) and minimal for Nutrition and Health Education (NHE). SN, immunization, Pre-school education (PSE) and growth monitoring (0-3 years) were regularly held. Maternal and child health services were unsatisfactory. Poor community perception reported for AWC and ICDS services with exception of SN.Conclusions: Present case study unveils poor infrastructure, coverage and community participation for ICDS services. Immunisation and referral networking is often dysfunctional reflecting the need for enhanced intersectoral cooperation. Adapted tools could serve as an effective strategy for evaluating and facilitating need-based improvements

Effect of pregnancy on the auditory and visual reaction time

Background: The auditory and visual pathways are complex multi-synaptic neuronal circuits prone to alteration in conductivity under the influence of various neuro-hormonal modulators. The female sex steroids have shown significant effect on these circuits during different phases on menstrual cycle and pregnancy.Methods: The present study was designed with an aim to find out the auditory and visual reaction time variations during different trimesters of pregnancy. The healthy non pregnant women, in premenstrual phase were grouped as controls (Group NP; n=30) whereas the cases were further divided into 3 groups depending on the duration of pregnancy as Groups T1,T2and T3 with 30 volunteers in each.Results: The ART and VRT were measured using RTM-608 (Medicaid) in the Obstetrics and Gynaecology department of our hospital. The observations were recorded and analysed using one way ANOVA and post hoc Tukey test. A significant increase (p<0.001) in reaction time of both the auditory and visual pathways has been observed in Group T1 as compared to Group non-pregnant. Whereas Group T2 and T3 had shown not much difference of ART and non-significant increase of VRT when compared to Group NP. The increased reaction time could be attributed to the raised HCG levels during 1st trimester, modulating the neuronal conductivity during that period.Conclusions: However, the non-significantly increased or similar reaction time in Group T2and T3could be attributed to increased levels of estrogen and progesterone. Hence, these hormones have neuromodulatory effect on the neuronal excitability, plasticity and excitability, though the direct effect of HCG needs further exploration

Relationship between anxiety, depression and quality of life in medical student with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting 5-10% of women worldwide. It has clinical, hormonal and psychological manifestation like anxiety, depression and low self-esteem. Aim was to evaluate prevalence of anxiety, depression, and quality of life in medical students with PCOS. Objectives were to study the prevalence of anxiety, depression among medical students suffering from PCOS; and to evaluate quality of life (QoL) in students with PCOS and its association with anxiety, depression and quality of life.Methods: The cross sectional study was conducted among 70 medical students at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, from February 2019 – June 2020. Students were screened and selected as per the Rotterdam’s 2003 criteria after informed consent. Mental health assessment done by using Hamilton depression rating scale for depression, Hamilton anxiety rating scale for anxiety, and using 36-item short form survey for QoL.Results: Twenty five (35.7%) students suffered from anxiety while 20 (28.5%) had depressive disorders. Forty five (64%) patient both anxiety and depression. These students had significant psychological morbidity and poor QoL.Conclusions: Psychological morbidity with PCOS is undertreated and need to be addressed and treated in time so as to turn these students into a responsible happy adult

Asymptomatic bacteriuria and antibacterial susceptibility during pregnancy

Background: Urinary tract infections are more common in women than in men and still more in pregnant women because of anatomical and physiological changes during pregnancy. Incidence of asymptomatic bacteriuria is 2-10% globally and it is still more in developing countries. Untreated asymptomatic bacteriuria can lead to many prenatal and maternal complications; hence early detection and treatment is of considerable importance.Methods: Total 220 pregnant women at their first visit were screened during one year. Midstream urine samples were inoculated and results were interpreted after 24-48 hours.Results: Incidence of asymptomatic bacteriuria was 12.27%. E. coli was the commonest pathogen detected and Nitrofurantoin was found to be effective against commonest pathogens.Conclusions: Ectopic pregnancy can have varied presentations and misdiagnosis can be seen in Surgical, Medical and Gynaecology Universal screening of aymptomatic bacteriuria is recommended because of its high prevalence and prenatal and maternal complications, if left untreated. Nitrofurantoin can be advocated because of its low cost and high effectiveness where culture is not possible because of inadequate resources.