Objectives: Evidence based medicine (EBM) has transformed the way healthcare is delivered all over the world. It combines individual clinical expertise with best available research evidence so that the patients get a high standard of care. The growth of information technology has provided us with tools which enable us to scrutinise vast amounts of data within a very short amount of time. EBM is a lifelong learning process and is an effort to make the most effective use of medical knowledge for best outcomes in terms of patient benefit and safety. It is important to understand the basic concepts of EBM and practice as well as propagate evidence based healthcare in Obstetrics and Gynaecology.
Conclusion: Obstetricians and Gynaecologists need to be able to access and critically appraise the latest evidence in their area of expertise and apply it in clinical practice to provide best outcomes to women under their care.
Evidence, Based, Medicine, Obstetrics, GynaecologyObjectives: Critical evaluation of iron sucrose (Malhotra, FOGSI Focus 9–11, 2009) in terms of efficacy, safety, and feasibility at rural setup for the treatment of anemia of pregnancy (Raja et al., Rawal Med J 28: 40–3, 2003) along with any reduction in blood transfusion rate at peripartum period of 37 weeks to 48 h within delivery.
Methods: In a prospective cohort study conducted in Department of Obstetrics and Gynaecology, during the year 2008 AVBRH-Wardha, 256 consecutive women of irondeficient anemia (IDA) treated with intravenous iron sucrose were studied for feasibility, safety, and efficacy of drug. Blood transfusion rates were compared for the years 2007 and 2008 in cases of antenatal women from37 weeks onward up to 48 h post delivery.Results were analyzed by Z-test.
Results: Mean rises in Hb g% were 1.1 ± 0.2, 2.3 ± 0.8, and 3.0 ± 0.4 after 1, 2, and 3 weeks, respectively. Decline in rate of blood transfusion among total anemic women at peripartum period was 9.36 %.
Conclusion: Iron sucrose therapy is very much relevant in rural scenario.
Anemia, Iron sucrose, Rural hospital, PregnancyObjectives: To determine the current prevalence of four major sexually transmitted infections (STIs: HIV, Hepatitis B, Herpes simplex virus 2, and Syphilis) in asymptomatic pregnant women.
Methods: This is a prospective study of 500 consecutive, apparently healthy asymptomatic pregnant women who were attending the antenatal clinic. The information regarding their socio-demographic and behavioral characteristics and obstetric performance was recorded. The blood samples was collected after obtaining their informed written consent from those who were tested for the HIV antibodies (NACO guidelines), HBsAg (ELISA test), HSV2-IgM (ELISA test), and Syphilis (VDRL and TPHA tests).
Results: The overall prevalence of one or the other four STIs studied was 4.8 % with the highest prevalence of HBV (2.4 %), followed by HSV-2 (2 %), and HIV (0.4 %). No woman tested positive for syphilis and multiple infections. All the infections were more common in illiterate, multigravida, monogamous women of low socio-economic status. High-risk sexual behavior of the husbands, history of STIs in husbands, and blood transfusions were the other factors associated with the prevalence of these infections.
Conclusions: The relatively high prevalence of HBV and HSV-2 infections in asymptomatic pregnant women suggests that there is need of screening for HBV and HSV-2 infections along with the pre-existing screening for HIV and Syphilis and universal immunization of HBV high-risk infants.
Asymptomatic pregnant women, HSV-2, HBV, HIV, SyphilisObjective: This prospective randomized controlled study was carried out with the purpose of assessing the efficacy of sublingual misoprostol in decreasing intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
Methods: One hundred seventy-four women undergoing elective or emergency cesarean delivery were assigned randomly to receive either 400 lg misoprostol or placebo sublingually at the time of cord clamping. An intravenous infusion of 20 units of oxytocin was started in all women at the same time. The primary outcome measures were intraoperative blood loss, need for additional uterotonic agents, and perioperative hemoglobin (Hb) fall.
Results: The maternal demographic factors, indications for cesarean delivery, and high-risk factors were similar between the two groups. Mean intraoperative blood loss was significantly less in misoprostol group as compared with placebo group (595 ± 108 vs. 651 ± 118 ml, P = 0.025). Fewer women needed additional uterotonic agents in misoprostol group (22.2 vs. 42.8 %; P = 0.0035; RR 0.52, 95 % CI 0.33–0.82). Perioperative Hb fall was significantly less in misoprostol group (0.87 ± 0.29 vs. 1.01 ± 0.26 g, P = 0.0018).
Conclusion: Sublingual misoprostol decreases intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
Sublingual misoprostol, Blood loss, Cesarean deliveryObjectives: To study the maternal mortality and the complications leading to maternal death.
Methods: A retrospective study of hospital records and death summaries of all maternal deaths over the period from January 2000 to August 2009 was carried out.
Results: There were a total of 80 maternal deaths out of 88,443 live births giving maternal mortality rate (MMR) of 90.45 per 100,000 live births. Unbooked and late referral accounted for 77.5 % of maternal deaths. The majority of the deaths was in 30–40-year age group and around term. Hemorrhage was the commonest cause of death (52.5 %), followed by sepsis (13.75 %) and pregnancy-induced hypertension including eclampsia (10 %).
Conclusions: Hemorrhage, sepsis, and pregnancy-induced hypertension including eclampsia were found to be the direct major causes of death. Anemia and cardiac disease were other indirect causes of deaths.
Maternal mortality, Postpartum hemorrhage, Sepsis, Eclampsia, AnemiaIntroduction: Premature rupture of membrane is managed either expectantly or actively. The purpose of the study was to assess the effectiveness of early labor induction with cervical prostaglandin E2 versus expectant management in women with term premature rupture of membrane.
Material and Methods: Singleton pregnancy cases with cephalic presentation reported between 37 and 41 weeks of pregnancy with PROM of \6 h and cervical dilatation \3 cm were studied over a period of 2 years. Out of 100 patients studied, half of them were managed by expectant protocol and the other half by early induction within 6 h of PROM with intracervical gel. Main outcomes measured were PROM–delivery interval, mode of delivery, neonatal and maternal morbidity, and period of maternal and/or neonatal hospitalization. Chi-square test was used to compare frequencies between two groups. Differences between means of other measurement were compared by independent t test.
Results: PROM–delivery interval was 22 h in expectant group, while in early induction group, it was 13 h (p value\0.001). Rate of cesarean section remained almost same in both groups. Increases in maternal–neonatal infection rate and hospital stay were noted in expectant group; however, this was not statistically significant.
Conclusion: Immediate labor induction with prostaglandin in cases of term PROM shortens delivery interval and maternal hospital stay with reduction in maternal–neonatal sepsis.
Premature rupture of membrane, Term PROM, Induction, Expectant managementObjective: To evaluate the clinical, laboratory, and diagnostic features in women with abdominal tuberculosis that resembled advanced ovarian malignancy.
Methods: A retrospective review of women with abdominal tuberculosis who were managed at GCRI Ahmedabad from 1996 to 2001 was undertaken.
Results: Fifteen patients (3.06 %) with suspected ovarian cancer cases, finally diagnosed as abdominal tuberculosis over a 6-year period (1996–2001), are analyzed. During this period, 492 patients were operated for suspected ovarian malignancy. Pre-operatively, ultrasound-guided biopsies were inconclusive in 14 cases and hence, exploratory laparotomy was planned. They underwent laparotomy and biopsy for final diagnosis. Frozen sections—of peritoneal/ omental biopsies in 11 cases and ovarian tumour in three cases—were indicative of tuberculosis in all the 14 cases.
Conclusion: The data of this study indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intra-operatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.
Abdominal tuberculosis, CA-125, Adenosine deaminase, GranulomasObjectives: To study the various factors affecting the success rate of tubal recanalization and the reasons for failure of the procedure.
Methods: A retrospective study was conducted during 2000–2007 @ KIMS, Hubli.
Results: Of the 25 subjects who underwent tubal recanalization, 44 % of women conceived and they were [35 years of age. Laparoscopically sterilized patients had better chances of conception (50 %) following reversal than those who were sterilized by Pomeroy’s method (30 %). With post-reversal tubal length of [4 cm, pregnancy rate was 50 %. Isthumus–Isthumus and Isthumus– Ampullary anastomosis have 50 % success rates.
Conclusion: Tubal recanalization by microsurgical technique is one of the methods to solve infertility after sterilization.
Sterilization, Tubal recanalization, Microsurgical techniqueObjectives: The study of health status of grass-root level health care providers may help us understand the delivery gaps from the programmatic point of view.
Methods: A detailed interview of 313 Anganwadi workers (AWW) was taken in a predesigned, pretested questionnaire, and their clinical examination and Pap smear study were arranged at New Civil Hospital, Surat during November 2007–April 2008. All AWWs were accompanied for follow up and examination. Data were analyzed using Epi-Info Software.
Results: Mean age of menarche and menopause was 14.3 and 44 years, respectively. Among 73 women having menopause, 53 (72. 6%) had natural menopause. On taking history, only 9.5 % gave positive findings, while 42.3 % had positive clinical signs on examination. Inflammation was reported in 43.4 % Pap smear, while 2.8 % had cervical dysplasia of varying grades.
Conclusions: All women should be advised to undergo complete pelvic examination including Pap Smear for the detection of gynecological morbidity.
Anganwadiworkers, Reproductive morbidity, Pap smearObjectives: (1) To compare the efficacy of Pap smear and HPV PCR for detection of CIN; and (2) To study the distribution of HPV genotypes.
Methods: One hundred women presenting at the female Outpatient Department with unhealthy cervices were subjected to a detailed history, clinical examination, Pap smear, HPV DNA PCR test, and colposcopic-directed biopsy (where indicated).
Results: This study has shown that there is a strong association of HPV infection with higher grades of CIN (100 % in patients with CIN 2, CIN 3, and CIS). The detection of CIN by HPV PCR was more accurate than by Pap smear. The most prevalent HPV genotype found in our study was HPV 16.
Conclusion: The advent ofHPVtesting has opened the doors for more accurate cervical cancer surveillance strategies than Pap smear. Early detection and treatment of CIN will considerably reduce the incidence of cervical cancer.
Cervical intraepithelial neoplasia, Cancer cervix, Human Papillomavirus, Polymerase chain reaction