Effectiveness of bundled interventions in reducing surgical site infections in elective caesarean sections and caesarean hysterectomies in a tertiary care centre

Background: Surgical site infections are the most common and easily preventable infections complicating surgeries. CDC recommends certain bundle interventions for the prevention of SSIs. Hence the present study was undertaken to see the effectiveness and feasibility of the bundle interventions in the elective caesarean sections and caesarean hysterectomies.Methods: A total of 600 patients were taken. Bundled interventions were applied in 278 caesarean sections and 26 caesarean hysterectomies. Routine care was implemented in 262 caesarean sections and 34 caesarean hysterectomies. Rate of SSI, risk factors associated and treatment outcomes were studied.Results: 8 out of 304 cases of the bundled intervention group developed SSI, giving a rate of 2.6%. 52 cases out of 296 in the routine care group developed SSI, the SSI rate being 17.5%. Anemia and diabetes were the most common risk factors.Conclusions: Adherence to bundled interventions can significantly and easily reduce the incidence of SSI

Burden of anemia and its associated factors among pregnant women of Vindhya region: prospective observational study

Background: Anemia is major public health problem. It is especially prevalent in women of reproductive age, particularly during pregnancy. It affects both developed and developing countries. According to the National Family Health Survey, anemia is prevalent in approximately 53.1% of non-pregnant and 50.1% of pregnant women. Objective of this study was to study the prevalence of anemia in pregnant women of Vindhya region and also various degree of anemia and factors associated.Methods: All pregnant women attending the outdoor and indoor of the obstetrics and gynecology department of, GMH. Rewa, taken for calculation of prevalence of anaemia and among them 510 pregnant women were selected who were satisfying inclusion and exclusion criteria for studying association factors. Study period was 1 year. Haemoglobin estimation done by sahlis haemoglobinometer.Results: Prevalence of anaemia figures 81%, Out of them, 38.05% mild, 33.26% moderate and 7.80% of women were severely anemic. Maximum number of women were housewives 71.1%. Anaemia was found more commonly among those who are either taking iron prophylaxis irregularly or not taking. High prevalence was noted among those pregnant women who had <4 antenatal visits i.e., 54.51%.Conclusions: Considering the high prevalence of anaemia in Vindhya region, extensive efforts should be made not only to correct anaemia, but to prevent anaemia. Various programmes for anaemia control should be executed more resourcefully to overcome it. Strong reinforcement of government scheme should be done at Anganwadi, CH, PHC to ensure prevention as well as early detection of anaemia

Detecting Sentiments from Movie Reviews by Integrating Reviewers Own Prejudice

Presently, sentiment analysis algorithms are widely used to extract positive or negative feedback scores of various objects on the basis of the text/reviews. But, an individual may have a certain degree of biasness towards a certain product/company and hence may not objectively review the object. We try to combat this biasness problem by incorporating the positive and negative bias component in the existing sentiment score of the object. This paper proposes several algorithms for a new system of implementing individual bias in the corpus of data i.e. movie reviews in this case. Each review comment has an unadjusted sentiment score associated with it. This unadjusted score is refined to give an adjusted score using the positive and negative bias score. The bias score is calculated using certain parameters, the weightage of which has been determined by conducting a survey. We lay emphasis on the degree of biasness an individual has towards or against the review parameters for the movie reviews corpus namely actor, director and genre. We equip the system with the capability to handle various scenarios like positive inclination of the user, negative inclination of the user, presence of both positive and negative inclination of the user and neutral attitude of the user by implementing the formulae we developed

A prospective study to evaluate the role of routine early third trimester ultrasound in the diagnosis of intrauterine growth restriction and prediction of adverse perinatal outcome using color Doppler

Background: Intrauterine growth restriction (IUGR) is a major and silent cause of perinatal morbidity and mortality. Rate of IUGR in developing countries is 6 times higher than that of developed countries. 14 to 20 million infants are affected with IUGR in developing countries annually. The highest incidence is found in south central Asia (33%) and India (21%). Aim of study was to evaluate the role of early 3rd trimester ultrasound in diagnosis and role of color Doppler in prediction of adverse perinatal outcome in IUGR.Methods: A prospective case-control study was conducted on 720 women admitted in GMH Rewa for one year. 360 antenatal cases diagnosed as IUGR on ultrasound were taken as study group, same number of non IUGR cases were taken as control. Study cases were followed with Doppler. The umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and cerebro-placental ratio were calculated and the results were analysed.Results: Inferences drawn from the study were: rate of caesarean section was significantly higher (31%) in study group, perinatal outcome was poor in more number of cases (10.8%) in study group than the control group (3.4%), and the sensitivity and specificity of cerebroplacental ratio was more reliable indicator in comparison to that of UA PI and MCA PI in prediction of adverse perinatal outcome.Conclusions: Looking at the high burden of IUGR cases in our country and its adverse effects on perinatal outcome, if early third trimester ultrasound is made mandatory for all pregnant women, most of the IUGR cases can be detected and managed timely and perinatal outcome can be significantly improved

A retrospective analysis of maternal deaths over a period of five years at a tertiary care hospital of central India

Background: Maternal mortality is one of the important indicators used for the measurement of maternal health. The present study was conducted to analyse the maternal deaths over a period of five years in a tertiary care centre, GMH Rewa, Madhya Pradesh.Methods: A retrospective observational   study was conducted in department of Obstetrics and Gynaecology, Shyam Shah Medical College and associated Gandhi Memorial Hospital, Rewa. The case records of all maternal deaths between January 3013 to December 2017 were collected from hospital medical records and studied. Data were analyzed statistically.Results: There were 214 maternal deaths from January 3013 to December 2017.The average maternal mortality ratio over a period of five years was 471.5 per one lac live births. Majority of maternal deaths were from toxaemia 33.2%, haemorrhage 26.2%, anaemia 16.3% and sepsis 12.6%.Conclusions: The present study highlights the importance of early antenatal registration of all pregnancies and regular follow up of cases by trained staff. Active management of high-risk groups by frequent antenatal visits, fluid and component transfusions, aggressive management of infection and closer monitoring of women in labor. Higher fertility and unwanted pregnancies should be reduced through family welfare services and easy availability of Medical termination of pregnancy services to be ensured. Analysis of every maternal death through maternal death audit should be carried out.

Emergency peripartum hysterectomy: a 3 year review at a tertiary care hospital in Vindhya region of India

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate

Histopathological evaluation of endometrium and its clinical correlation in patients of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a very common, challenging gynaecological problem in all age group women. Neoplastic lesions are responsible for very less number of cases but they should be diagnosed early. Endometrial biopsy is necessary for histopathological diagnosis of endometrial lesions and to rule out any malignancy. In present study, we evaluated histopathological pattern of endometrium and different clinical parameters in AUB patients.Methods: A retrospective observational study done in Obstetrics and Gynecology department of SSMC Rewa, Madhya Pradesh in 2 year from 1st October 2017 to 30th September 2019. AUB patients who fulfilled inclusion criteria were included in study. All data were collected from department records in predesigned proforma and statistically analyzed by statistical package for the Social sciences (SPSS) version 20.Results: Total 366 AUB patients were included in study; most frequent clinical presentation was HMB (56%). Mostly patient’s age ranged from 24-84 years, belonged to 41-50 years age group (44%), multiparous (78%), and premenopausal (53%). On histopathological evaluation of endometrium most commonly nonneoplastic lesions (75%) were seen, out of which proliferative phase endometrium was most frequent. Neoplastic lesions were seen in 25% cases. Out of which benign lesions were noted in 7%, premalignant in 17.3% and malignant in 1% (all in >45 year patients).Conclusions: Endometrial biopsy should be done in all AUB patients >45 years and in selected premenopausal in order to get early diagnosis, to rule out malignancy and to help in management. Endometrial biopsy should be considered as first diagnostic modality

Hysteroscopic evaluation of uterine cavity in cases of infertility and its correlation with transvaginal ultrasound and hysterosalpingography

Background: Infertility is defined as one year of unprotected intercourse without pregnancy. This study was taken up to evaluate the diagnostic accuracy of hysteroscopy in comparison with hysterosalpingography and vaginal ultrasound in the evaluation of the uterine cavity as first line study in the infertile patient.Methods: A Prospective and comparative study was carried out in the department of Obstetrics and Gynaecology, S.S. Medical College and associated Gandhi Memorial Hospital, Rewa, MP, India in a period of 13 months from August 2014 to September 2015 conducted on 60 subjects.Results: 60 patients were evaluated with diagnosis of primary and secondary infertility. Hysteroscopy showed alterations in 65%, predominantly uterine synechiae, chronic endometritis and endometrial polyp. Hysterosalpingography reported a sensitivity of 90% and a specificity of 100%, with a positive predictive value of 100% and a negative predictive value of 66.6%. The agreement between the two methods was moderate. The transvaginal ultrasound reported a sensitivity of 51.21% and a specificity of 100%, the agreement between these two procedures was moderate. There were no complications during hysteroscopy.Conclusions: We believe that transvaginal ultrasound, hysterosalpingography and hysteroscopy are complementary in the evaluation of the infertile patient but Hysteroscopy can diagnose small intrauterine lesions much more precisely, (compared with HSG and even TVS) and treat them simultaneously. Thus we consider routine hysteroscopy should be included in the evaluation of the infertile couple.

Epidemiological study of congenital malformations at birth in a tertiary health centre in central India

Background: The proposed study was carried out to determine incidence of congenital malformations, incidence of CM in live and still births, risk factors attributable, maternal and perinatal outcome, to frame the recommendations for early detection and prevention of CM.Methods: Prospective observational study. The cases selected from those attending the antenatal O.P.D. and those admitted in wards of Obs and Gynae Dept., GMH who delivered congenitally malformed baby dated from August 2013-July 2014. A detailed history, examination, relevant investigations was done.Results: Out of 9014 deliveries, 110 babies had CM. The incidence of CMs was found to be 1.22%. Maximum number (24.55%) of CM s were of CNS, most common was NTD (Anencephaly). Incidence of CMs was more in still births, mothers of age >40 yrs and <20 yrs, of illiterate, educated <8 std., house wives, rural areas, unbooked and multigravida. Most CM fetuses were delivered prematurely (67.27%). CVS and CNS systems were more commonly involved in consanguinous married couples. CM was associated with drug intake, 1.82% on antiepileptics, 1.82% on antihypertensives, 3.64% on oral hypoglycaemics,0.91% on NSAID,6.36% on unspecified drugs. 12.73% CMs were seen in passive smokers, 6.36% consumed alcohol, 17.27% pan/gutka intake. Majority were delivered by vaginal route, maximum fetuses (82.73%) were in vertex presentation, maximum (67.27%) CMs were in male babies.Conclusions: Many malformations arise because of the interplay of genetic, environmental and multifactorial factors. The stress imposed may be reduced considerably by understanding the causes of the malformations and adopting the management strategies outlined for the prevention or reduction of CM