Objectives: To know the outcome of mode of delivery - elective repeat cesarean section (CS) and trial for vaginal delivery in women with prior one cesarean section.
Methods: A prospective study was carried out on 385 women with previous one lower segment cesarean section (LSCS) from 1st January 2005 to 31st December 2006. Women with recurrent indications for CS or those having non recurrent indications with any complicating factors in present pregnancy were taken for elective LSCS. Those women with previous one LSCS for the non recurrent indications were given a trial for vaginal delivery. Case selection for trial of vaginal delivery was done as per ACOG guidelines. Statistical analysis was done by t test.
Results: Out of the 197 women in the trial group, 72.1% delivered vaginally and 27.9% required emergency repeat LSCS. There was no statistically significant difference in maternal and perinatal morbidity rates in elective CS versus trial of vaginal delivery groups.
Conclusion: With proper selection, appropriate timing and close supervision; trial of vaginal delivery eliminates the need for a large proportion of repeat cesarean operations. Individualized approach seems to be the best.
Objectives: To study the changing trends in indications and technics of cesarean section in various parts of India. Methods: A clinical survey was carried out amongst 253 obstetricians from all over India selected at random regarding their practices of cesarean section in terms of indications and technics.
Results: Result showed that previous cesarean section, severe pregnancy induced hypertension, failed induction of labor and infertility treated cases are now increasing amongst the indications for cesarean section. In technics, single layer closure (41.11% doctors) and nonsuturing of peritoneum, visceral or both, (35.96% doctors) are now increasing among obstetricians. Polyglycolic acid sutures (vicryl, centicryl, dexon) are replacing catgut for uterine closure.
Conclusion: Being a common major surgery any changes in technic for better surgical result are always welcome. Changes in indications are mainly due to litigation fear and better neonatal facilities.
Objectives: The antenatal screening of HIV in all women is becoming an integral part of routine antenatal check up in India, by prevention of parent to child transmission (PPTCT) program. Aims: To analyze the response to implementation of PPTCT program in a peripheral hospital and to study the involvement of husbands for counseling and testing.
Methods: Data of 4372 women attending the antenatal clinic from January 2005 to December 2005 was analyzed. Data of husband counseling and testing was also analyzed.
Results: Acceptability of the test after pretest counseling is 99%. Women attended post test counseling and collected reports in 58.6%. Sero prevalence of HIV was 0.73% of which 62.5% came for post test counseling and 46.8% patients got nevirapine. Only 10% of the husbands of total antenatal cases came for counseling of which 65% got tested.
Conclusion: The acceptability of test after pretest counseling is satisfactory but the follow up for post test counseling and % of sero positive women getting nevirapine is to be improved. There is need to enhance male involvement to make husband friendly antenatal clinic.
Objective: To compare the blood loss and time between spontaneous delivery and manual removal of the placenta during caesarean section.
Methods: We prospectively randomized and compared outcomes of 100 gravid women with manual (n=50) or spontaneous (n=50) placental delivery at cesarean section. Operative blood loss was measured directly.
Results: Blood loss measured after placental delivery at cesarean was greater in the manually delivered group (100.9±22.5 mL) than in the spontaneously delivered group (55.11±21.07 mL, P<0.001). The mean interval between delivery of the newborn and the placenta was longer in spontaneous delivery group (62.02 vs 50.5 seconds) but the mean duration of the operation was similar.
Conclusion: Spontaneous delivery of placenta as compared to manual expression reduces significantly the blood loss without increasing the operating time. Blood loss following delivery of the placenta at cesarean section was significantly less after spontaneous expulsion of the placenta as compared to manual expression of the placenta.
placental delivery, spontaneous, manualObjectives: To evaluate cervical length assessment by transvaginal sonography at 22-24 weeks for predicting women at risk of preterm delivery.
Methods: Cervical assessment by transvaginal sonography was done in 115 low risk asymptomatic women at 22-24 weeks of gestation. The length of cervix and status of internal os were recorded. The period of gestation at delivery in these patients was then correlated with sonography findings. The gestations at delivery in women with cervical length more or equal to 30 mm (Group A, n=96) were compared with that in women with cervical length less than 30 mm (Group B, n=19). The statistical analysis was done using Chi square test.
Results: The mean cervical length in the study population was 36.43±7.98 mm with no significant difference between primigravidas and multigravidas. There was definite positive correlation between cervical length at 22-24 weeks and period of gestation at delivery. The average gestation at delivery in group A women was 38.03 weeks as compared to 32.72 weeks in group B women (P<0.005).
Conclusion: Endovaginal ultrasonographic examination of cervix is simple, sensitive and cost effective method of assessing risk of preterm delivery.
Objectives: To know the outcome of mode of delivery - elective repeat cesarean section (CS) and trial for vaginal delivery in women with prior one cesarean section.
Methods: A prospective study was carried out on 385 women with previous one lower segment cesarean section (LSCS) from 1st January 2005 to 31st December 2006. Women with recurrent indications for CS or those having non recurrent indications with any complicating factors in present pregnancy were taken for elective LSCS. Those women with previous one LSCS for the non recurrent indications were given a trial for vaginal delivery. Case selection for trial of vaginal delivery was done as per ACOG guidelines. Statistical analysis was done by t test.
Results: Out of the 197 women in the trial group, 72.1% delivered vaginally and 27.9% required emergency repeat LSCS. There was no statistically significant difference in maternal and perinatal morbidity rates in elective CS versus trial of vaginal delivery groups.
Conclusion: With proper selection, appropriate timing and close supervision; trial of vaginal delivery eliminates the need for a large proportion of repeat cesarean operations. Individualized approach seems to be the best.
Objectives: To study the seroprevalence of antitoxoplasma antibodies in normal non pregnant, normal pregnant and in women with history of abortions according to age, living conditions, history of association with animals, dietary habits, period of gestation and frequency of abortion whether sporadic or habitual.
Methods: The study was conducted in the Department of Microbiology, attached to Dr. S. N. Medical College, Jodhpur in Rajasthan. It included 50 non pregnant (control group I) 50 normal pregnant (control group II) and 500 women (study group) having history of abortion. Standardized quantitative ELISA test was performed for Toxo IgG and Toxo IgM antibodies to Toxoplasma gondii (T. gondii) in sera of subjects included in the study.
Results: Seroprevalence of toxoplasmosis was more in women with history of abortion. Overall seropositivity of Toxo IgM was maximum in the age group of 15-25 years (6.25%), whereas seroprevalence of Toxo IgM increased with age and was maximum (16.67%) in the age group 26-35 years in study group. There was increased prevalence of toxoplasma antibodies in both rural and urban population but percentage of Toxo IgM antibody was increased in normal pregnant (100%) and in study group females (28.57%) among rural population. There was increased prevalence of Toxo IgG and IgM antibodies in both control and study group females having association with animals such as cat and dogs. In the study group, in women having association with animals like cats and dogs, there was increased percentage of both Toxo IgG (38.10%) and Toxo IgM antibody (14.29%) as compared to those in normal pregnant control group - Toxo IgG (9.09%) and Toxo IgM (6.82%). Maximum prevalence of toxoplasma was also seen in study group women who were non vegetarians -Toxo IgG (50%) and Toxo IgM (14.29%). The prevalence in the study group was more in second trimester of pregnancy and with history of habitual abortion -IgG (28.29%) and Toxo IgM (18.75).
Conclusion: It can be concluded that all subjects with bad obstetric history should be screened for toxoplasmosis and if found positive should be treated to prevent fetal losses.
Objectives: To compare the efficacy of newer drug cabergoline with estrogen-androgen combination in lactation inhibition and suppression.
Methods: In a tertiary care teaching hospital, 196 postpartum women in need of inhibition or suppression of lactation were randomly divided into Group A (100 women who were given tablet cabergoline orally) and Group B (96 women who were given estrogen-androgen combination intramuscularly). Both groups were followed till complete cessation of milk expulsion. Number of days and extra doses of drug required were recorded and statistically analyzed on SPSS version 10 of windows 2000.
Results: The mean number of days required was significantly less (0.73+0.963) in Group A, (p value=0.001). Extra doses of drug were needed less often in Group A (p value=0.017).
Conclusion: Cabergoline is more effective drug for prevention and suppression of lactation with added advantage of oral route and easy dosage schedule.
Objectives: To find out any possible relationship between the presence of thyroid antibody (antiTPO-Ab) in early antenatal period and the development of thyroid dysfunction at post partum period.
Methods: Sixty three women of 16 to 18 weeks of pregnancy were screened and studied. The women were followed up till the sixth post partum month. Statistical analysis was done by Fisher’s Exact test and Mann-Whitney U test.
Results: Anti TPO-antibody positivity in antenatal women is 9.52%. TPO antibody positive women when compared with negative women showed significant differences in the development of post partum thyroid dysfunction (33.33% vs. 1.75%, P=0.022), mean serum TSH level (2.7 vs 1.72, P=0.01) and history of miscarriages (66.67% vs 14.03%, P=0.01).
Conclusions: The risk of development post partum thyroid dysfunction increases significantly in women with positive TPO antibody and mean serum TSH level >2mU/1 measured in 16 to 18 weeks of pregnancy. Screening of women with other immunological disorders or history of miscarriage can be done during antenatal period.
