ASSESSMENT OF INDICATIONS OF LOWER SEGMENT CESAREAN SECTION AT TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

Background: Cesarean section (CS) is one of the most common and widely performed surgical procedures in obstetrics in India and Worldwide. It is mainly evolved as a lifesaving procedure for mother and fetus during the difficult delivery. To study, various indications for the lower segment CS at our tertiary care center were the objective of the present study. Methods: This is a descriptive, retrospective study of all the patients who were underwent CS in the Department of Obstetrics and Gynecology, Jhalawar Medical College, Jhalawar from January 1, 2021, to March 31, 2021 for the duration of 3 months. Data of patients who delivered by C-Section in our hospital during the defined study period were recorded and a statistical analysis was done for various indications of the lower segment CS (LSCS). Results: The total numbers of women delivered by CS over the study period were 806 among these 339 (42.05%) patients were primiparous and 467 (57.95%) were multiparous. 550 (68.23%) cases were from age group 20–25 years and 153 (18.98%) were had age group 26–30 years, 20 (2.48%) were from age group below 19 years, and 76 (10.29%) patients were above 31 years age. The previous LSCS was the leading indication to the LSCS (31.14%) followed fetal distress (13.88%), malpresentation 95 (11.78%) (including breech presentation in maximum women (86), transverse and oblique lie (9 each), and face presentation (3)) (11.78%), meconium stained liquor with fetal distress 60 (7.44%), severe oligohydramnios 48 (5.95%), non-progress of labor 32 (3.97%), cephalopelvic disproportion 23 (2.85%), pre-eclampsia 20 (2.48%), obstructed labor 19 (2.35%), big baby 19 (2.35%), pregnancy-induced hypertension 18 (2.23%), maternal request and post-dated pregnancy 15 (1.86%) each, gestational hypertension and eclampsia 11 (1.36%) each, placenta previa 10 (1.24%), induction failure 8 (0.99%), and intrauterine growth retardation and antepartum hemorrhage 7 (0.86%) and 14 (1.73%). Patients had other indications such as Abruptio placentae, gestational diabetes, twin pregnancy, uterine rupture, and deep transverse arrest. Conclusions: In this study, CS rate (40.68%) is found to be higher as compared to other studies and the WHO guidelines. CSs rate is high probably because Jhalawar Medical College, Jhalawar acts as a government tertiary care center. The previous LSCS was a common indication in 31.14% of mothers in present study. Besides, previous LSCS, fetal distress, malpresentation (Breech presentation/transverse lie, oblique lie, and face presentation) MSL with fetal distress, and severe oligohydramnios were the common indications for LSCS, which are seen in the present study

STUDY OF EFFECTS OF SPONTANEOUS DELIVERY OF PLACENTA VERSUS MANUAL REMOVAL OF PLACENTA DURING CESAREAN SECTION AT TERTIARY CARE CENTRE

Objectives: The aim of the study was to compare the effects of manual removal of placenta and spontaneous delivery of placenta during cesarean section. Methods: This was a hospital-based prospective comparative study conducted in the Department of Obstetrics and Gynecology, Jhalawar Medical College, Jhalawar. 400 antenatal women at term and singleton pregnancy posted for cesarean section from October 2018 to September 2019 for 1 year duration. The study populations were divided into two groups (200 each). Group A in whom placenta deliver spontaneously and Group B in whom placenta was removed manually. Comparison was done in term of blood loss, fever, endometritis, and delayed complications. Results: The manual removal of placenta associated with greater blood loss (p<0.0001, statistically significant), the greater fall in hemoglobin (p<0.0001, statistically significant). Manual removal of placenta was associated with leukocytosis (p=0.0009), higher incidence of fever, post-operative uterine tenderness, and sub involution of uterus (p<0.05 statistically significant). This is reflected by increased incidence of endometritis with manual removal (p=0.001, Significant). The overall time taken between delivery of baby to delivery of placenta was significantly lesser in manual removal method (p<0.0001). Conclusion: Manual method seems to decrease the time interval between delivery of baby and that of placenta. Manual removal of placenta does more harm than benefit by increasing the incidence of fall in hemoglobin and delayed complication

Study of placentation and maternal and fetal outcomes in cases of 2 or more caesarean sections

Background: The CS epidemic is a reason for immediate concern and there is increase in repeat CS as well these days. The secondary increase in repeat CS delivery has been associated with increase in CS complications particularly increase in complications associated with abnormal placentation.Methods: It is a Prospective observational study which was conducted at a tertiary care centre over a period of 18 months with a sample size of 60 patients. Patients with two or more previous CS irrespective of parity index, gestational age, previous vaginal delivery or vaginal birth after CS, associated medical or surgical problems were included in the study. Intra-partum, postpartum complications, abnormal placentation, maternal and perinatal outcomes associated with previous 2 CS were studied. Any case less than 2 CS were excluded.Results: In this study, radiologically, 50 patients had no abnormality. 7 patients had placenta previa, 2 patients had placenta percreta and 1 patient had placenta previa with placenta accreta. These included abnormal placentation diagnosed radiologically by ultrasonography, colour Doppler or MRI. Intra-operatively, 49 patients had normal placentation. 6 patients had placenta previa without any evidence of placental adherence, 3 patients were placenta percreta. 1 patient had placenta previa with placenta percreta and 1 had placenta previa with placenta increta. Statistically significant differences p <.05 was observed in group of normal and abnormal placentation, with respect to type of anesthesia spinal/GA, uterine incision(pfannensteil versus midline and classical), bladder injury, intraoperative blood loss, uterine and internal iliac artery ligation, obstetric hysterectomy, placenta kept in situ, surgical site infections, neonatal resuscitation required and NICU admissions.Conclusions: The incidences of abnormal placentation have increased with the rise in previous two CS Also the maternal and perinatal morbidity and mortality increases with history of previous two CS

Obstetric and neonatal outcome in pregnancies complicated by hemolysis elevated liver enzymes low platelet count syndrome at a tertiary care centre in India

Background: The hemolysis elevated liver enzymes low platelet count (HELLP) syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count occurring in 0.4 to 0.7% of all pregnancies and in 10-12% of cases with severe preeclampsia. This present study will throw some light on occurrence, diagnosis, complications, treatment, mode of delivery and the neonatal outcome.Methods: A prospective observational study was conducted in the department of Obstetrics and Gynecology at Seth G.S. Medical College and KEM hospital which is a tertiary care centre in Mumbai in the state of Maharashtra India from September 2013 to December 2014 after the approval of institutional ethics committee. The inclusion criteria were only those patients in whom HELLP syndrome was diagnosed on the basis of blood investigations, laboratory parameters and clinical picture. All those patients who did not fulfill the diagnostic criteria for HELLP syndrome were excluded.Results: In our study, according to the Mississippi classification, 15% belonged to class 1, 62% to class 2 and 23% to class 3. The peak age of incidence was 21-30 years (78%) and majority were primigravida (57%). Majority (91%) presented with headache and the other associated complains were epigastric pain, nausea, vomiting and blurring of vision. Only 32% patients presented at term (>37 weeks), 65% patients were at 28-36 weeks of gestation and 3% had very early onset HELLP syndrome. Majority (65%) had severe hypertension (BP>160/110 mm of Hg) with albuminuria of grade +3 to +4. Majority (83%) of the patients were given injection MgSO4 either for prophylaxis or treatment of eclampsia. 65% patients delivered vaginally. 70% were live births, out of which 8% died in the early neonatal period. Severe maternal complications such as eclampsia, hematuria, acute kidney injury, abruption placentae, severe anemia and DIC were seen in 63% patients. 57% of patients were transfused with blood and blood products and 7% required intensive care management.Conclusions: A multidisciplinary approach is of utmost importance along with early diagnosis and prompt treatment to prevent the cataclysmic deterioration of patients with HELLP syndrome

Demographics and follow up of post partum intra-uterine copper device in tertiary hospital in Delhi, India

Background: Increasing unintended pregnancies in post partum females in our country warrants urgent attention towards prevalence and efficacy of contraceptives used. This study was done to determine the prevalence of PPIUCD and its follow up in patients attending tertiary hospital in New Delhi, India.Methods: Prospective study was carried in Department of Obstetrics and Gynecology, Dr. RML Hospital, New Delhi, India over a period of 1 year from July 2017 to July 2018. The awareness and prevalence of PPIUCD was assessed. At 6 week follow-up visit, women with PPIUCD were asked for symptoms of unusual vaginal discharge, irregular or heavy bleeding per vagina, and any expulsions if noticed. All the data was recorded and assessed.Results: Out of 1478 deliveries, 1372 were eligible for PPIUCD. 335 patients got PPIUCD inserted. 295 patients were followed as 40 patients were lost to follow up. 79.3% women did not have any complaints. 11.8%, 1% and 7.4% women had only heavy menstrual bleeding, only lower abdominal pain and both symptoms respectively. Spontaneous expulsion rate was noted in one patient (0.3%) at 6 weeks. IUCD removal was done in 4 patients who had complaints of pain and heavy menstrual bleeding not conservatively managed.Conclusions: PPIUCD insertion is a safe, convenient and effective method of contraception. The benefits of contraception immediately after delivery outweigh disadvantage of complications. Antenatal counseling and follow up in hospitals need to be strengthened to increase awareness and acceptability of PPIUCD

PREVALENCE OF HYPERTENSION AMONG ADULT POPULATION IN SLUMS OF WEST DELHI

Objective: The present study was conducted to assess the prevalence of hypertension in adult population residing in slums of West Delhi.Methods: A cross-sectional study was conducted among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured using digital machine (OMRON). The data obtained were analyzed for percent prevalence, mean, standard deviation, and median. Joint National Committee (JNC)on prevention, detection, evaluation, and treatment of high blood pressure (JNC)VI and JNC VII criteria were used to classify hypertension.Results: The overall prevalence of hypertension was 25.3%. The prevalence was higher (27.9%)in males than females (22.8%)and also in the age group 46-59 years (43.0%)as compared to 18-45 years (19.8%). The overall prevalence of prehypertension, Stage I and Stage II hypertension, respectively, was 35.2%, 16.1% and 9.2%.Conclusion: A one-fourth of the adult population is hypertensive. Early diagnosis and treatment are advisable, besides awareness about dietary and lifestyle modification

Isolated abdominal sarcoidosis presenting with hypercalcemic crisis: A rare case

Sarcoidosis is a granulomatous disease of unknown origin, with pulmonary findings in more than 90% of patients. Extrapulmonary involvement is common and all organs can be involved (especially lymph nodes, eyes, joints, and central nervous system) but it is rare to find an isolated extrapulmonary disease (< 10% of patients). Granulomatous inflammation of the spleen and the liver is common in patients with systemic sarcoidosis while hepatosplenomegaly is unusual and splenic involvement rare. We are describing a rare case of abdominal sarcoidosis presenting with the hypercalcemic crisis but no pulmonary involvement

Assessment of Status, Awareness, and Attitude Associated with Childhood Immunization in Delhi – NCR, India

Introduction: Immunization is a preventive measure that reduces the occurrence of diseases and child mortality rate. India has made significant progress in this area and continuous efforts are being made to promote a large-scale immunization process for several life-threatening diseases. Aim: Our study was aimed at finding out the immunization coverage and awareness, among mothers, in Delhi – NCR through a sample of 400 respondents. Materials and Methods: The study was conducted through questionnaire-cum-interview and snowball sampling method and included 400 respondents who were mothers having at least one child below 6 years of age. Results: We found that a large percentage of respondents (97.25%) had immunized their children for the recommended vaccines. Mother’s education and occupation were the major influencing forces, with educated and professionally working mothers fairing better, highlighting the importance of female literacy. The full immunization coverage for all five vaccines was 69.27%. Hospitals and doctors were the major sources of information (55.5%) about immunization and more than half of the respondents (55.25%) got their children immunized in government hospitals. Gender of child and economic status of the family were not significant factors affecting immunization. The major factors for not immunizing or delaying the immunization of children were lack of motivation and the busy routine of parents. Conclusion: Female literacy is a major factor influencing immunization success, it should be targeted and not only awareness campaigns but also incentive-based strategies should be employed to create awareness and encourage parents. Complete and timely vaccination of children can protect them from grave diseases and also stop outbreaks of many diseases

One-dimensional single-chain molecular magnet with a cross-linked &#960;–&#960; coordination network [{Co^II(&#916;)Co^II(&#923;)}(ox)₂(phen)₂]_n

A one-dimensional single-chain molecular magnet [{CoII(&#916;)CoII(&#923;)}(ox)2(phen)2]n with a cross-linked &#960;–&#960; coordination network has been synthesized hydrothermally and investigated for its structural and magnetic properties. Oxalate (ox) ligands bridge the paramagnetic CoII metal ions, whereas phenanthroline (phen) ligands exhibit &#960;–&#960; coordination networks. The compound has been thoroughly investigated using room-temperature X-ray and neutron diffraction, infrared spectroscopy, dc magnetization, and reverse Monte Carlo (RMC) simulation methods. Rietveld refinement of the powder X-ray and neutron diffraction patterns at room temperature confirms the single-phase formation of the compound in the monoclinic structure with a space group P21. Structural analysis reveals that the compound assembles in the form of a one-dimensional zigzag chain-like structure. Chains consist of two asymmetric &#916;- and &#923;-CoII ions and a &#960;–&#960; coordinating network bridged by ox and phen ligands, respectively. The chain lies in the crystallographic ac plane, infinite in length with the absence of interchain &#960;–&#960; overlap. dc magnetization data fitted over the high-temperature regime (T &#62; 5 K) using the Ising chain model reveals the one-dimensional magnetic nature of the compound with alternately spaced magnetic CoII sites with two different Landé g factors and exchange coupling constant values. Different Landé g factors (2.5 and 2.1) and negative exchange coupling constant values (−108 and −20 K) at two alternating CoII sites indicate a ferrimagnetic behavior of this chain compound. In the low-temperature regime (T &#60; 5 K) the compound exhibits spontaneous magnetization and hysteresis at 1.6 K, due to the occurrence of long-range three-dimensional (3-D) magnetic ordering. A prominent clustering of the C atoms around the Co atoms is ascertained by RMC analysis of diffuse scattering in the neutron diffraction pattern. The pair correlations distances between Co–Co, Co–C, Co–N, and Co–O atoms are found to be 5.0, 2.2, 2.5, and 2.4 &#197;, respectively, for the compound