A Comparative study between who modified Partogram and paperless partogram in the Effective management of labour

BACKGROUND: The partogram was designed with the aim to provide at a glance a pictorial representation of labour, in order to sensitise obstetric care providers to deviations in the normal process and course of labour. AIMS AND OBJECTIVES: To compare WHO modified Partograph and Paperless Partogram in the effective management of labour on the basis of 1. Labour crossing the Alert Line/ Alert ETD, 2. Labour crossing the Action Line/ Action ETD, 3. Rate of caesarean section, 4. Perinatal outcome, 5. Maternal complications. MATERIALS AND METHODS: This is an observational study which was conducted among 200 singleton pregnant women delivering at Institute of Social Obstetrics Kasturba Gandhi Hospital and Institute of Obstetrics and Gynaecology, Egmore. INCLUSION CRITERIA: • Any parturient irrespective of age and parity in established labour (1 contraction in 10 min or more frequently) with cephalic presentation, irrespective of whether the membranes are intact or ruptured. • Onset of labour has to be spontaneous (not induced) • The parturient must be atleast 4cm or more dilated at the point of inclusion. • Gestational maturity should be 37 completed weeks or more. EXCLUSION CRITERIA: • Induced labour, • Previous caesarean, • Multiple pregnancy, • Pregnancy Induced Hypertension, • Antepartum hemorrhage, • Presence of any severe complications. RESULTS: • Mean age is 24.09±3.85 and 25.23±3.82 respectively. • 64% primis and 57% primis were included in WHO and paperless partographs respectively. 36% multis in WHO and 43% multis in paperless group were included. • Mean gestational age in WHO and paperless was 38.13±1.02 and 37.87±1.07 respectively. All parameters were comparable in both the study groups. • Most of the subjects 61%and57% entered the study at 4cm dilatation in WHO and paperless respectively. • Alert ETD was crossed in 10% WHO group and 8% in paperless group. Action ETD was crossed in 3% WHO and 1% in paperless group. • In WHO partograph 66 women required more than 2 pervaginal examinations, and 4 of them even required 6PVs. In paperless partograph 87 required only 2 pervaginal examinations,none of them required more than 3PVs. • Oxytocin was used for augmentation in 39% of cases in WHO group, but only 16% cases required oxytocin in paperless group. Inspite of increased usage of oxytocin mean duration of active phase (234.87vs 215.79) was comparable in both the study groups. • 65% of subjects in paperless partograph had spontaneous vaginal delivery, where as in WHO partograph only 45% had spontaneous vaginal delivery, but the difference in the rate of instrumental delivery (3% and 4%) and csection (29% and 22%) were not statististically significant in both the study groups. • Admissions to NICU in both groups (28% and 24%) were similar in both groups

Evaluation of safety, efficacy, acceptance and expulsion of post placental intrauterine contraceptive device in a tertiary care centre

Background: Postpartum intrauterine device provides an effective temporary method of contraception for the woman who needs birth spacing rather than birth limitation and also a quasi-permanent family planning method. The aim of this study was to study the efficacy, acceptance, safety and complication of PPIUCD insertion.Method: This a retrospective analytical study done in a tertiary care teaching institute, Institute of Obstetrics and Gynaecology Egmore for a six-year period from January 2010 to December 2015 with a sample size of 81204. Outcomes measured were safety, efficacy, acceptance (patients and professionals) and complications.Results: For the study period of six years the total number of women delivered were 81204. A steady increase was noted in the insertion of PPIUCD from 2010 (1.98%) to 2015 (58%). 50.5% had insertion following caesarean section and 49.5% following vaginal delivery. Primipara had a higher rate of acceptance amounting to 74.74%. Most common complication reported was missing strings 9.25% and a greater part of the patients (83%) did not have any complaints.Conclusions: Enthusiasm and conviction on the part of the health care provider goes a long way in improving the acceptance rate of PPIUCD. It is an indispensable contraceptive tool for our country since our women most often do not return for postnatal contraceptive options

Evaluation of safety, efficacy, acceptance and expulsion of post placental intrauterine contraceptive device in a tertiary care centre

Background: Postpartum intrauterine device provides an effective temporary method of contraception for the woman who needs birth spacing rather than birth limitation and also a quasi-permanent family planning method. The aim of this study was to study the efficacy, acceptance, safety and complication of PPIUCD insertion.Method: This a retrospective analytical study done in a tertiary care teaching institute, Institute of Obstetrics and Gynaecology Egmore for a six-year period from January 2010 to December 2015 with a sample size of 81204. Outcomes measured were safety, efficacy, acceptance (patients and professionals) and complications.Results: For the study period of six years the total number of women delivered were 81204. A steady increase was noted in the insertion of PPIUCD from 2010 (1.98%) to 2015 (58%). 50.5% had insertion following caesarean section and 49.5% following vaginal delivery. Primipara had a higher rate of acceptance amounting to 74.74%. Most common complication reported was missing strings 9.25% and a greater part of the patients (83%) did not have any complaints.Conclusions: Enthusiasm and conviction on the part of the health care provider goes a long way in improving the acceptance rate of PPIUCD. It is an indispensable contraceptive tool for our country since our women most often do not return for postnatal contraceptive options