This study evaluated perineal outcomes in primi-gravidas after restrictive use of episiotomy in Nepal. The episiotomy rate was 22% and the majority (43.2%) experienced first degree tears. Only one woman (1.4%) experienced a third degree tear, with no long-term complications. Having a baby weighing 2.5kg or more significantly increased mean tear length and nearly doubled the risk of a second or third degree tear. The restrictive episiotomy protocol was successfully implemented with no significant complications observed.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gesta...AI Publications
Preterm labor is a regular occurrence in pregnancy; an estimated 15 million babies are born prematurely each year, with the number increasing. This was a prospective study of pregnant women who came to the Maternity Teaching Hospital in Erbil, Kurdistan Province, Iraq, for an outpatient clinic. On a manageable sample of 150 singleton pregnancies. In this study, one hundred fifty singleton asymptomatic pregnancies encountered the inclusion criteria during the study period, 69 primi gravid, 81 multi gravid. The correlation between the cervical length at 20–24 weeks and preterm delivery was moderately poor (r =0.715), and this correlation was highly significant (P < 0.001). In another word, a better correlation was found between preterm delivery and cervical length at 20–24 weeks than at 10–14 weeks in the prediction of preterm delivery. This study also points towards the importance of serial ultrasound scans to detect those who are at higher risk. There was no statistically significant effect of age, parity. Finally, the findings revealed that trans vaginal ultrasound is more accurate at 20-24weeks than 10-14weeks gestation for prediction of preterm labor, it can be used routinely to prevent preterm birth.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gesta...AI Publications
Preterm labor is a regular occurrence in pregnancy; an estimated 15 million babies are born prematurely each year, with the number increasing. This was a prospective study of pregnant women who came to the Maternity Teaching Hospital in Erbil, Kurdistan Province, Iraq, for an outpatient clinic. On a manageable sample of 150 singleton pregnancies. In this study, one hundred fifty singleton asymptomatic pregnancies encountered the inclusion criteria during the study period, 69 primi gravid, 81 multi gravid. The correlation between the cervical length at 20–24 weeks and preterm delivery was moderately poor (r =0.715), and this correlation was highly significant (P < 0.001). In another word, a better correlation was found between preterm delivery and cervical length at 20–24 weeks than at 10–14 weeks in the prediction of preterm delivery. This study also points towards the importance of serial ultrasound scans to detect those who are at higher risk. There was no statistically significant effect of age, parity. Finally, the findings revealed that trans vaginal ultrasound is more accurate at 20-24weeks than 10-14weeks gestation for prediction of preterm labor, it can be used routinely to prevent preterm birth.
Neonatal and Obstetric Risk Assessment (NORA) Pregnancy Cohort Study in Singa...Premier Publishers
The Neonatal and Obstetric Risk Assessment (NORA) pregnancy cohort study was set up to assess clinical, biochemical and biophysical markers for risk assessment and prediction of the outcomes early in pregnancy. A total of 3271 patients who were in KK Women’s and Children’s Hospital between September 2010 and October 2014 were screened and 1013 patients consented to participate in the study. Women were followed at 18 to 22 weeks, 28 to 32 weeks and 34 weeks and above, till their postnatal discharge from the hospital. Finally, 926 patients remained for studying the outcome. In NORA study, we established locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters. Higher serum progesterone levels at 28–32 weeks of pregnancy were observed in women who had preterm deliveries compared with women with term deliveries in the cohort. We also found that extracellular vesicle (EV) biomarkers enhanced the predictive robustness of an existing pre-eclampsia (PE) biomarker sufficiently to justify PE screening in a low-risk general obstetric population. We plan to further conduct a range of serial assessments from the biosamples which will provide a comprehensive and valuable information of the dynamics of maternal conditions and fetal development during pregnancy.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Study of Incidence and Etiology of Prolapse at Rural Based Teaching Hospitaltheijes
In our country as large number of woman deliver at home, usually conducted by untrained dias, incidence of prolapse is higher. The etiology of prolapse was discussed by ARETAEUS, a Greek physician who believed procedentiato be result of weakness of ligaments of the uterus. There are multiple etiological factors in the developed of prolapse. Diagnosis of prolapse at the earliest will help to reduce the complications of prolapse as well as continue child bearing function of the young woman.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
Clinical study of Eclampsia and outcome in a tertiary care centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
Estimation of Fetal Size and Weight using Various Formulasijtsrd
Birth weight is an important factor in delivery management. Antenatal ultrasound has turned out to be one of the clinicians most vital devices for surveying fetal age, growth and prosperity. Contrasted Physical examination of the pregnant uterus is the most precise strategy for evaluating fetal size and growth along with the utilization of ultrasound imaging and estimating of the different fetal parameters. Objective To evaluates the antenatal assessments of fetal weight in pregnancies by using Johnsons formula, Hadlocks formula and Ultrasonography. Comparison of these different methods with the actual birth weight of these babies after delivered. Material and methods Two hundred singleton term pregnancies within 48 hours were randomly selected to participate in this prospective cohort study. Variables included such as abdominal circumference, Biparietal diameter, and Femur length. Parameters to obtain estimated fetal weight Results The mean birth weight of Hadlock formula is closest to the mean of actual birth weight. In the study population, more primigravida delivered babies with very low birth weight and more multigravida delivered babies of birth weight 3500 gms. Johnsons and ultrasound Hadlocks formula had a marked tendency to overestimate the fetal weight. Error was within 350 Gms in 84.7 , 70.8 and 84 of cases by Dares, Johnsons and ultrasound Hadlocks formula. Dr. Pushpamala Ramaiah | Dr. Lamiaa Ahmed Elsayed | Dr. Grace Lindsey | Dr. Ayman Johargy ""Estimation of Fetal Size and Weight using Various Formulas"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23231.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/23231/estimation-of-fetal-size-and-weight-using-various-formulas/dr-pushpamala-ramaiah
Aim: To predict the probability of stone free status calculated by CROES nomogram and to test the accuracy of our fi tted regression model to predict outcomes of PCNL. Methods: From July 2018 to May 2019, data of 100 patients underwent PCNL procedure for renal stones at Urology department at Menoufi a University was collected and postoperative results were compared to the preoperative predicted stone free status. The CROES nomogram was applied to the data of all cases using its scale to calculate the total score and corresponding percent of stone free status after the procedure. We used binary logistic regression to test whether the six factors in the study can predict the PCNL outcome. We compared the calculated probabilities of stone free by our fitted regression model to the traditional method using the whole 6 parameters on the scale of nomogram.
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i.e. 90% of them in the fallopian tube. Ectopic pregnancy affects 11 in 1000 pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of pregnancy. In a 20-year longitudinal study on ectopic pregnancy in a defined
population of women aged 15e39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased
from 5.8 during 1960e4 to 11.1 during 1975e9. The mean annual incidence of ectopic pregnancy per 1000 women
increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed
conceptions increased with increasing age of the women and were 4.1 in the teenage group, 6.9 in women aged
20e29 years, and 12.9 in women aged 30e39.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
Clinical study of Eclampsia and outcome in a tertiary care centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
Estimation of Fetal Size and Weight using Various Formulasijtsrd
Birth weight is an important factor in delivery management. Antenatal ultrasound has turned out to be one of the clinicians most vital devices for surveying fetal age, growth and prosperity. Contrasted Physical examination of the pregnant uterus is the most precise strategy for evaluating fetal size and growth along with the utilization of ultrasound imaging and estimating of the different fetal parameters. Objective To evaluates the antenatal assessments of fetal weight in pregnancies by using Johnsons formula, Hadlocks formula and Ultrasonography. Comparison of these different methods with the actual birth weight of these babies after delivered. Material and methods Two hundred singleton term pregnancies within 48 hours were randomly selected to participate in this prospective cohort study. Variables included such as abdominal circumference, Biparietal diameter, and Femur length. Parameters to obtain estimated fetal weight Results The mean birth weight of Hadlock formula is closest to the mean of actual birth weight. In the study population, more primigravida delivered babies with very low birth weight and more multigravida delivered babies of birth weight 3500 gms. Johnsons and ultrasound Hadlocks formula had a marked tendency to overestimate the fetal weight. Error was within 350 Gms in 84.7 , 70.8 and 84 of cases by Dares, Johnsons and ultrasound Hadlocks formula. Dr. Pushpamala Ramaiah | Dr. Lamiaa Ahmed Elsayed | Dr. Grace Lindsey | Dr. Ayman Johargy ""Estimation of Fetal Size and Weight using Various Formulas"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23231.pdf
Paper URL: https://www.ijtsrd.com/medicine/nursing/23231/estimation-of-fetal-size-and-weight-using-various-formulas/dr-pushpamala-ramaiah
Aim: To predict the probability of stone free status calculated by CROES nomogram and to test the accuracy of our fi tted regression model to predict outcomes of PCNL. Methods: From July 2018 to May 2019, data of 100 patients underwent PCNL procedure for renal stones at Urology department at Menoufi a University was collected and postoperative results were compared to the preoperative predicted stone free status. The CROES nomogram was applied to the data of all cases using its scale to calculate the total score and corresponding percent of stone free status after the procedure. We used binary logistic regression to test whether the six factors in the study can predict the PCNL outcome. We compared the calculated probabilities of stone free by our fitted regression model to the traditional method using the whole 6 parameters on the scale of nomogram.
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i.e. 90% of them in the fallopian tube. Ectopic pregnancy affects 11 in 1000 pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of pregnancy. In a 20-year longitudinal study on ectopic pregnancy in a defined
population of women aged 15e39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased
from 5.8 during 1960e4 to 11.1 during 1975e9. The mean annual incidence of ectopic pregnancy per 1000 women
increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed
conceptions increased with increasing age of the women and were 4.1 in the teenage group, 6.9 in women aged
20e29 years, and 12.9 in women aged 30e39.
Fetal anterior neck teratomas are tumors which arise from the
three blastomericl ayers - ectoderm, endoderm and mesoderm. It occurs when the totipotent germ cells are out of control of primary organizers [1,2]. Th e histologic features may include cystic and solid areas with organoid patterns and it may include mature or immature cells [1]. Even though the most common area of occurrence is at sacrococcgeal area it can also occur in other body parts [1,3]. In this case report we presented one of the rare place of teratoma - anterior fetal neck teratoma.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Indications and Outcomes of Emergency Caesarean Section at St Paul’s HospitalMedical College, Addis Ababa, Ethiopia 2017: (Afoul Month Retrospective Cohort Study) by Bizuneh Ayano in Womens Health Journal
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
Pati ent Sati sfacti on in Electi ve Major Surgery for Benign
perineal outcome after restrictive use of episiotomy
1. JNMA I Vol 48 I No. 4 I Issue I176 I Oct-Dec, 2009 269
Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas
Joshi A,1
Acharya R2
1
Department of General Practice, Tansen Mission Hospital, Palpa,
2
Department of General Practice and
Emergency Department, TUTH, Maharjgunj, Kathmandu, Nepal.
ABSTRACT
Introduction: Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations.
Principles of evidence based medicine raises questions on the utility of routine episiotomy.
Methods: A prospective observational study was conducted in primi gravidas coming to Tansen
Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive
use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and
complications. Risk factors associated with significant degrees of perineal tear was investigated.
Results: The episiotomy rate during the time of study was only 22%. Among those included in the
study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear.
Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing
2.5 kg increases the mean tear length significantly (P=0.019) and increases the risk of having second
or third degree of tear by almost two times (Relative Risk=1.95). No clinically significant complications
were observed in any of the women after the delivery.
Conclusions: This study provides some evidence that the principle of restrictive use of episiotomy
with a total episiotomy rate being around 20% can be carried out successfully even in an under-
resourced setting of our country.
Key Words: episiotomy, perineal tear, primi gravida, vaginal delivery
INTRODUCTION
The surgical enlargement of the vaginal orifice by
an incision of the perineum during the last part of
the second stage of labour or delivery started about
250 years back; a process which was later termed
as ‘episiotomy’.
1
Correspondence:
Dr. Arbin Joshi
Department of General Practice
Tansen Mission Hospital
Palpa, Nepal.
Email: joshi_arbin@yahoo.com
Phone: 9841286978
ORIGINAL ARTICLE J Nepal Med Assoc 2009;48(176):269-8
2. JNMA I Vol 48 I No. 4 I Issue I176 I Oct-Dec, 2009270
Episiotomy was first reported to be done in 1741.
2
Obstetricians came to favor episiotomy after a publication
by Pomeroy in 1918.
3
Figures about the worldwide use
of episiotomy are not well known. Hospital episiotomy
rates in the recent years ranged from approximately 20
- 73% in US,
4
26 to 67% in UK
5
and 39% in Jordan.
6
In a meta-analysis, the prevalence of episiotomy in
selective groups of all the studies performed fluctuated
around 30%.
7
The purpose of the current study is to evaluate the
perineal tear regarding its length, degree and complications
and to evaluate the risk factors associated with the
severe degrees of second and third degree perineal tear.
METHODS
A prospective observational study conducted among
primi gravidas coming to Tansen Mission Hospital for
delivery between August and November, 2005. Among
410 deliveries, only 74 satisfied the inclusion criteria.
All the primi gravidas, irrespective of their age, in 36 to
42 weeks of the gestational period with a single fetus
in cephalic presentation, not falling under popular criteria
of high risk pregnancy and who had not had any obstetrical
procedures like pudendal block, assisted delivery and
episiotomy were included in the study. High risk cases
such as multiple pregnancy, malpresentation, malposition,
hypertensive disease of pregnancy, mother having
systemic disease, previous cesarean section; bad obstetric
history and prolonged rupture of membrane were excluded
from the study.
Informed consent was taken from the women or from
the closest relatives. Decision for the episiotomy was
left to the doctor or midwife conducting the delivery.
The perineal tear after the delivery was assessed regarding
its number, length and degree by the principal investigator
and the person conducting the delivery. At last the
questionnaire was completed with other necessary
information. On the day of discharge the tear was again
re-evaluated by the investigator and follow up dates were
given.
RESULTS
Total of 410 deliveries took place during the study period,
among which 91 (22%) had episiotomies and 74 (18%)
satisfied the inclusion criteria and were included in the
study.
Birth weight of the babies born to these mothers ranged
from 2 to 3.75 kgs with majority of the babies (56.8%)
weighing in between 2.5 to 2.9 kgs and 23% of babies
weighing below 2.5 kgs. Syntocinon induction was done
in 43.2% of the cases and majority of the mothers
(56.7%) were in the gestational age of 38.1 to 40 weeks
of age. 59.4% of the cases had tears lesser than second
degree (Figure 1).
Length of the tear had positive correlation with weight
of the baby, head circumference of the baby and
gestational age (Correlation coefficient being 0.183,
0.171 and 0.58 respectively). Whereas, length of the
tear had low negative correlation with the second stage
of labour duration (Correlation coefficient = 0.166).
Mean tear length in patients with babies’ birth weight
less than 2.5 kgs is statistically different than mean tear
length in those with babies’ weight more than or equal
to 2.5 kgs (P=0.019). Birth of the babies weighing more
than 2.5 kgs increases the risk of having significant
second and third degree tear by almost two fold (Relative
Risk=1.95). Head circumference of the baby and duration
of second stage of labour does not seem to affect the
mean tear length significantly.
Table 1. Descriptive Statistics
Variables Mean SD
Age in years 20.7 2.9
Total length of tear in cms 3.2 2.4
Weight of the baby in gms 2723.2 3 5 1 . 2
Head circumferences in cms 32.1 1.5
Second stage of labour in mins 36.2 20.9
Gestational age in weeks 39.1 1.3
(n=74)
39.2%
1.4% 16.2%
43.2%
intact
1st degree
2nd degree
3rd degree
4th degree
Figure 1. Types of tear
Joshi et al. Perineal Outcome after Restrictive Use of Episiotomy in Primi-gravidas
3. JNMA I Vol 48 I No. 4 I Issue I176 I Oct-Dec, 2009 271
4
3.5
3
2.5
2
1.5
1
0.5
0
Mean tear Length in cms.
2
Mean tear Length in cms.
3.5
Birth Weight
<2.5 kgs.
(n=17)
Birth Weight
>2.5 kgs.
(n=57)
p=0.019
Figure 2. Comparison between the mean tear lengths
Joshi et al. Perineal Outcome after Restrictive Use of Episiotomy in Primi-gravidas
Regarding complications, none of the mothers had clinically
significant complications related with the episiotomy. Only
24 mothers could be followed up after six weeks and only
ten mothers could be followed up after ten weeks. All of
them had no long term complications.
DISCUSSION
In the context of Nepal, Family Health Division, Department
of Health Services has published clinical protocols on
Reproductive Health on 1999.
8
It has clearly stated that
the routine use of episiotomy should not be practiced; as
it has been proved that episiotomy is a form of care ‘likely
to be harmful’. Despite these facts, episiotomy remains a
common practice performed in all the hospitals including
the central hospitals of Nepal. In one of the central hospital
of Nepal, episiotomy rate of 49.3% was found in the year
1999.
9
In the hospital where this study was performed,
the episiotomy rate, before the protocol of restrictive use
of episiotomy was adopted, was 91% in primi gravidas in
the year 2001. In a review article Malla et al
10
concluded
that there is an urgent need to restrict the use of episiotomy
in vaginal delivery in Nepal.
Among 74 women, about 60% got either no detectable
perineal tear or only first degree tear (Figure 1). As all
episiotomies imply a second degree perineal tear as suggested
by Lede,
11
we can assume that those 60% got away with
lesser degrees of tear than an episiotomy, saving the
suturing time, suture material and most importantly
discomfort to the mother at the time of suturing. A huge
meta-analysis
7
including six randomized controlled trials
also concluded that restrictive use of episiotomy is associated
with reduced risk of posterior perineal trauma, need for
suturing perineal trauma and healing complications. The
percentage of the primiparous women in this study who
had no detectable tear or an intact perineum is quite high
(16.2% vs 6.6%) compared to a study done by
Samuelsson
12
in 2883 primiparous women. Lower birth
weight of the babies born in this study (average birth weight
being 2.7 kgs) could be the reason.
As compared to various other studies conducted in different
parts of the world,
4,6,13,14
rate of third degree perineal tear
in this study (1.34%), seems to be in the acceptable range.
One of the biggest retrospective studies
14
about risk factors
of third degree tear done in Netherlands, which included
284,783 vaginal deliveries stated an overall rate of third
degree perineal tear to be 1.94%. Shihadeh commented
that one of the reasons for third degree perineal tear in
primi gravidass is birth weight of the baby being more than
4 kgs. We cannot make any comment in this fact because
we didn’t have any baby born with more than 4 kgs but
we can definitely comment from the results of this study
that birth weight of more than 2.5 kgs is associated with
longer perineal tear (3.55 cm vs 2 cm, P=0.019) but not
with the greater degrees of tears. In fact, with this study
we were unable to determine the causative factors for the
greater degrees of tear as there was only one third degree
perineal tear and none of the factors were shown to
significantly increase the severe degrees (second or third)
of tear. However, birth weight of more than or equal to
2500 gms increased the risk of having significant 2
nd
and
3
rd
degrees of tear by 2.72 times (Relative risk 1.95, Odds
ratio 2.72). Similarly, head circumference of more than or
equal to 32 cms increased the risk by 1.31 times only
(Relative risk 1.13, Odds ratio 1.31).
A prospective study done in University of Trieste, Italy by
Pregazzi
15
in 2002, involving 218 primiparae concluded
that immediate postpartum perineal examination is not a
good predictor of stress incontinence and pelvic floor
weakness. Still, in this study we couldn’t find any serious
complications on perineal examination on the next day of
delivery. Among the few who followed up after six and
ten weeks, none of the mothers had any serious
complications except pain.
In five years of follow up of 38 women who had disruption
of the anal sphincter, Ghessing
13
in 1998 concluded that
34%, among the 57% who had complications, had flatulence
incontinence and rest were incontinent of either liquid or
solid stool. The woman who had third degree perineal tear
in this study, in the short follow up on ten weeks, didn’t
show any signs of incontinence.
This study definitely had a poor follow up. The reason could
be poor economical condition of the patients of this region
and difficult geographical and political situation of Nepal.
Nepali custom of going to the parent’s home soon after
giving birth to a baby could be another reason for losing
4. JNMA I Vol 48 I No. 4 I Issue I176 I Oct-Dec, 2009272
mothers in follow up. The follow up date was deliberately
coincided with the date of first and second DPT vaccination
so that they don’t have to travel to the hospital just for
the follow up for this study. Still, the poor follow up might
be because of the wide availability of the vaccines in the
villages. The duration of the follow up was also not long,
as we had to finish the study in a limited period of time.
Apart from this, there were lots of other limitations of this
study. It was a small scale study. There were no control
groups for comparison. Sample size was not calculated
statistically so we are not sure whether the sample was
adequate or not.
The results of the study apply equally to developed and
developing countries. The policy of restrictive use of
episiotomy holds more significance in the context of our
country in the sense that the mean birth weight of the
babies born to under-nourished Nepali mothers are very
low and as this study shows significant correlation between
the birth weight of the baby and the laceration length,
episiotomy seems to be an unnecessary intervention.
CONCLUSIONS
The principles of evidence-based care are more important
nowhere than in the process of birth. We need to turn
our research efforts for analysis of obstetric techniques
that help maintain the integrity of the perineum during
childbirth. Considering the strength of the evidence and
the common occurrence of the procedure, decreasing
episiotomy rates can be seen as a litmus test for the
application of evidence-based reproductive health care.
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Joshi et al. Perineal Outcome after Restrictive Use of Episiotomy in Primi-gravidas