Sanjivani wanjari - Academia.edu (original) (raw)
Papers by Sanjivani wanjari
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Induction of labour is defined as use of external means for artificially stimulating the uterus b... more Induction of labour is defined as use of external means for artificially stimulating the uterus before the spontaneous onset of labour pains. Labour induction ensures delivery of the fetus at an optimum time when delivery is more beneficial for the fetus, than the risks involved in continuing the pregnancy. Almost 25 % of labours are induced for some reason or another. Post term pregnancy-NICE guidelines recommend that IOL should be considered for women beyond 41weeks of pregnancy.
Journal of pharmaceutical research international, Jul 15, 2021
Overall the rate of induced labours has increased and almost 25% of women undergo labour inductio... more Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop's score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley's catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley's catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy. Prostaglandins PGE1 & PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.
Global journal of medical research, May 7, 2020
Background: Critical Thinking is a human cognitive process which is characterized by a purposeful... more Background: Critical Thinking is a human cognitive process which is characterized by a purposeful self-regulatory judgement. Acquiring critical thinking is a question of practice. Clinical competence depends upon critical thinking skills and problem solving abilities. This will be possible when postgraduate students are taught to use critical thinking skills in order to make sound clinical judgments. Aim: To study the utility of "Critical Self Thinking Inventory for Clinical Examination" (CSTI-CE) for assessment of critical thinking skills during OSLER in postgraduate students of Department of Obstetrics & Gynaecology.
Background –Labour can be induced for various indications. This is done when it appears that bene... more Background –Labour can be induced for various indications. This is done when it appears that benefits of induction outweigh its risk. Bishop score is the gold standard that is used to determine whether labour can be induced. However, the assessment of the cervix with digital examination is subjective and less reproducible. Elastography is an upcoming modality which is an ultrasound-based imaging technique used for assessing elasticity of tissues. It is based on the premise that softer tissues get more compressed than harder tissues when pressure is applied with ultrasound probe. Thereafter colour mapping is done depending on the gradient values of strain. Aim to assess whether elastography findings of uterine cervix can be used to predict successful induction of labour.
The Journal of Obstetrics and Gynecology of India, Feb 2, 2023
Purpose of the Study The unmet need for contraception in the postpartum period is a major challen... more Purpose of the Study The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions. Methods The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6 months. The case recruitment lasted for 3 months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6 months. The follow-up of patients was at 6 weeks and 6 months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care. Results and Conclusion There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6 weeks and 6 months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6 months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.
Journal of Evidence Based Medicine and Healthcare, 2014
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Induction of labour is defined as use of external means for artificially stimulating the uterus b... more Induction of labour is defined as use of external means for artificially stimulating the uterus before the spontaneous onset of labour pains. Labour induction ensures delivery of the fetus at an optimum time when delivery is more beneficial for the fetus, than the risks involved in continuing the pregnancy. Almost 25 % of labours are induced for some reason or another. Post term pregnancy-NICE guidelines recommend that IOL should be considered for women beyond 41weeks of pregnancy.
INTRODUCTION Thrombocytopenia, defined as a platelet count of <1.50 Lacs/cumm, is a common hem... more INTRODUCTION Thrombocytopenia, defined as a platelet count of <1.50 Lacs/cumm, is a common hematologic abnormality during pregnancy, with an incidence of 6.6%. [1] It occurs four times more frequently in pregnancy than in the non-pregnant women population. A low platelet count is often an incidental finding, however it may indicate a coexisting systemic or gestational disorder. Intervention may become necessary in a few cases due to reduce risk to the mother and foetus. The causes of thrombocytopenia in pregnancy are diverse, and the clinical features vary widely. Timely analysis of the cause and appropriate therapy should effectively improve the prognosis of pregnancies. Thrombocytopenia in pregnancy can be classified as mild with a platelets count of 11.5 lacs/cumm, moderate at 50,000 to 1 lacs/cumm and severe at less than 50,000/cumm. Signs of thrombocytopenia usually occurs when platelet counts are less than 50,000/cumm, like petechiae, nose bleeds, haematuria, GI bleeding. G...
INTRODUCTION Modern obstetrics is concerned with the health and well being of both mother and unb... more INTRODUCTION Modern obstetrics is concerned with the health and well being of both mother and unborn child. Recognition of a foetus at risk for death or damage in utero, quantifying the risk, balancing the foetal risk against the risk of neonatal complications from immaturity and determining the optimal time and mode of interventions are the cornerstones of modern perinatal medicine. [1] Alterations in amniotic fluid volume, especially decreased amniotic fluid volume (olighohydraminios) have classically been considered as an indicator of poor perinatal outcome. [2,3] The semiquantitative method of calculating an amniotic fluid index (AFI) by using ultrasound to measure the sum of the deepest pockets of amniotic fluid in the 4 quardants of the maternal abdomen is the most common method of quantifying amniotic fluid volume. [2,3]
Overall the rate of induced labours has increased and almost 25% of women undergo labour inductio... more Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can resul...
Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indicat... more Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indications have emerged over time for both maternal and foetal indications and this has resulted in a dramatic rise in caesarean section rate in the last several years. Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate. Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%). Other leading indications were foetal distress (9.36%), CPD (...
Recent Developments in Medicine and Medical Research Vol. 10
Recent Developments in Medicine and Medical Research Vol. 8
Journal of Pharmaceutical Research International
Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of ... more Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of spontaneous postmenopausal rupture of uterus caused by pyometra. This can be associated with high morbidity if generalized peritonitis and sepsis occurs. The symptoms will be like acute abdomen similar to that caused by ruptured bowel or gastric perforation. In case of postmenopausal rupture like ours, gynaecological symptoms are very less. Hence the diagnosis becomes difficult and challenging. Here we report a rare case of uterine rupture that occurred in a postmenopausal woman because of pyometra. The patient landed up in the surgical department as case of acute abdomen. Definitive diagnosis was made at the time of laparotomy only when exploration was done and gynaecologist called.
International Journal of Infertility & Fetal Medicine
Aim: To highlight an uncommon complication of blood transfusion, which can be detected early base... more Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO 2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Global Journal of Medical Research
Background:Critical Thinking is a human cognitive process which is characterized by a purposeful ... more Background:Critical Thinking is a human cognitive process which is characterized by a purposeful self-regulatory judgement. Acquiring critical thinking is a question of practice. Clinical competence depends upon critical thinking skills and problem solving abilities. This will be possible when postgraduate students are taught to use critical thinking skills in order to make sound clinical judgments. Aim: To study the utility of “Critical Self Thinking Inventory for Clinical Examination” (CSTI-CE) for assessment of critical thinking skills during OSLER in post-graduate students of Department of Obstetrics & Gynaecology.
Journal of Education Technology in Health Sciences
Introduction: Traditional procedural training with heavier focus on factual knowledge and lower a... more Introduction: Traditional procedural training with heavier focus on factual knowledge and lower attentions to skill training can lead to graduates with poor procedural competence. DOPS-Direct observation of procedural skills is one of the means of assessing clinical performance by direct observation by the assessor. Performance using DOPS is structured and continuous. Materials and Methods: Study design-Prospective interventional study was conducted in the department of obstetrics and gynaecology at JNMC Wardha. Sample size-12 first year postgraduate students, were assessed with the help of 3 DOPS encounters and 2 procedures were observed for each student. The assessment of the postgraduate students was taken during the normal course of the student's work. Results: The scores of 1 st , 2 nd and 3 rd DOPS was compared to see if there is an improvement of the students. Two DOPS assessments were taken. First was on suturing techniques (skill 1) and second on urinary catheterization (skill 2). The mean DOPS scores in 'skill 1' group were 3.91 in first encounter A1, 6.50 in second encounter A2, and 7.25 in third encounter A3. In the 'skill 2' group the mean DOPS scores were 4.50 in first encounter B1, 6.75 in second encounter B2 and 7.33 in third encounter B3. There was a gross improvement in scores in the third encounter as compared to the first encounter. Conclusion: Observing, assessing and providing feedback to students enhanced the quality of the skills. The DOPS assessments done repeatedly helped to improve the clinical skills of post graduate students.
Evaluation of Anaemia in Pregnant Women, Oct 14, 2014
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2014
Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indicat... more Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indications have emerged over time for both maternal and foetal indications and this has resulted in a dramatic rise in caesarean section rate in the last several years. Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate. Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%). Other leading indications were foetal distress (9.36%), CPD (7.69%), PROM (7.31%), postdate pregnancy (6.62%), hypertensive disorders of pregnancy (6.0%). Conclusions: Some of the measures that can reduce caesarean section rate can be 1) reduction in primary caesarean sections 2) giving the option of VBAC to women with one prior caesarean section 3) use of foetal heart tracings and scalp blood sampling for foetal monitoring 4) judicious use of oxytocin and plotting of the partogram for every labour.
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Induction of labour is defined as use of external means for artificially stimulating the uterus b... more Induction of labour is defined as use of external means for artificially stimulating the uterus before the spontaneous onset of labour pains. Labour induction ensures delivery of the fetus at an optimum time when delivery is more beneficial for the fetus, than the risks involved in continuing the pregnancy. Almost 25 % of labours are induced for some reason or another. Post term pregnancy-NICE guidelines recommend that IOL should be considered for women beyond 41weeks of pregnancy.
Journal of pharmaceutical research international, Jul 15, 2021
Overall the rate of induced labours has increased and almost 25% of women undergo labour inductio... more Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop's score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley's catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley's catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy. Prostaglandins PGE1 & PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.
Global journal of medical research, May 7, 2020
Background: Critical Thinking is a human cognitive process which is characterized by a purposeful... more Background: Critical Thinking is a human cognitive process which is characterized by a purposeful self-regulatory judgement. Acquiring critical thinking is a question of practice. Clinical competence depends upon critical thinking skills and problem solving abilities. This will be possible when postgraduate students are taught to use critical thinking skills in order to make sound clinical judgments. Aim: To study the utility of "Critical Self Thinking Inventory for Clinical Examination" (CSTI-CE) for assessment of critical thinking skills during OSLER in postgraduate students of Department of Obstetrics & Gynaecology.
Background –Labour can be induced for various indications. This is done when it appears that bene... more Background –Labour can be induced for various indications. This is done when it appears that benefits of induction outweigh its risk. Bishop score is the gold standard that is used to determine whether labour can be induced. However, the assessment of the cervix with digital examination is subjective and less reproducible. Elastography is an upcoming modality which is an ultrasound-based imaging technique used for assessing elasticity of tissues. It is based on the premise that softer tissues get more compressed than harder tissues when pressure is applied with ultrasound probe. Thereafter colour mapping is done depending on the gradient values of strain. Aim to assess whether elastography findings of uterine cervix can be used to predict successful induction of labour.
The Journal of Obstetrics and Gynecology of India, Feb 2, 2023
Purpose of the Study The unmet need for contraception in the postpartum period is a major challen... more Purpose of the Study The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions. Methods The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6 months. The case recruitment lasted for 3 months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6 months. The follow-up of patients was at 6 weeks and 6 months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care. Results and Conclusion There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6 weeks and 6 months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6 months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.
Journal of Evidence Based Medicine and Healthcare, 2014
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Induction of labour is defined as use of external means for artificially stimulating the uterus b... more Induction of labour is defined as use of external means for artificially stimulating the uterus before the spontaneous onset of labour pains. Labour induction ensures delivery of the fetus at an optimum time when delivery is more beneficial for the fetus, than the risks involved in continuing the pregnancy. Almost 25 % of labours are induced for some reason or another. Post term pregnancy-NICE guidelines recommend that IOL should be considered for women beyond 41weeks of pregnancy.
INTRODUCTION Thrombocytopenia, defined as a platelet count of <1.50 Lacs/cumm, is a common hem... more INTRODUCTION Thrombocytopenia, defined as a platelet count of <1.50 Lacs/cumm, is a common hematologic abnormality during pregnancy, with an incidence of 6.6%. [1] It occurs four times more frequently in pregnancy than in the non-pregnant women population. A low platelet count is often an incidental finding, however it may indicate a coexisting systemic or gestational disorder. Intervention may become necessary in a few cases due to reduce risk to the mother and foetus. The causes of thrombocytopenia in pregnancy are diverse, and the clinical features vary widely. Timely analysis of the cause and appropriate therapy should effectively improve the prognosis of pregnancies. Thrombocytopenia in pregnancy can be classified as mild with a platelets count of 11.5 lacs/cumm, moderate at 50,000 to 1 lacs/cumm and severe at less than 50,000/cumm. Signs of thrombocytopenia usually occurs when platelet counts are less than 50,000/cumm, like petechiae, nose bleeds, haematuria, GI bleeding. G...
INTRODUCTION Modern obstetrics is concerned with the health and well being of both mother and unb... more INTRODUCTION Modern obstetrics is concerned with the health and well being of both mother and unborn child. Recognition of a foetus at risk for death or damage in utero, quantifying the risk, balancing the foetal risk against the risk of neonatal complications from immaturity and determining the optimal time and mode of interventions are the cornerstones of modern perinatal medicine. [1] Alterations in amniotic fluid volume, especially decreased amniotic fluid volume (olighohydraminios) have classically been considered as an indicator of poor perinatal outcome. [2,3] The semiquantitative method of calculating an amniotic fluid index (AFI) by using ultrasound to measure the sum of the deepest pockets of amniotic fluid in the 4 quardants of the maternal abdomen is the most common method of quantifying amniotic fluid volume. [2,3]
Overall the rate of induced labours has increased and almost 25% of women undergo labour inductio... more Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can resul...
Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indicat... more Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indications have emerged over time for both maternal and foetal indications and this has resulted in a dramatic rise in caesarean section rate in the last several years. Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate. Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%). Other leading indications were foetal distress (9.36%), CPD (...
Recent Developments in Medicine and Medical Research Vol. 10
Recent Developments in Medicine and Medical Research Vol. 8
Journal of Pharmaceutical Research International
Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of ... more Rupture of uterus occurring spontaneously is a rare occurrence. Here we are presenting a case of spontaneous postmenopausal rupture of uterus caused by pyometra. This can be associated with high morbidity if generalized peritonitis and sepsis occurs. The symptoms will be like acute abdomen similar to that caused by ruptured bowel or gastric perforation. In case of postmenopausal rupture like ours, gynaecological symptoms are very less. Hence the diagnosis becomes difficult and challenging. Here we report a rare case of uterine rupture that occurred in a postmenopausal woman because of pyometra. The patient landed up in the surgical department as case of acute abdomen. Definitive diagnosis was made at the time of laparotomy only when exploration was done and gynaecologist called.
International Journal of Infertility & Fetal Medicine
Aim: To highlight an uncommon complication of blood transfusion, which can be detected early base... more Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO 2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Global Journal of Medical Research
Background:Critical Thinking is a human cognitive process which is characterized by a purposeful ... more Background:Critical Thinking is a human cognitive process which is characterized by a purposeful self-regulatory judgement. Acquiring critical thinking is a question of practice. Clinical competence depends upon critical thinking skills and problem solving abilities. This will be possible when postgraduate students are taught to use critical thinking skills in order to make sound clinical judgments. Aim: To study the utility of “Critical Self Thinking Inventory for Clinical Examination” (CSTI-CE) for assessment of critical thinking skills during OSLER in post-graduate students of Department of Obstetrics & Gynaecology.
Journal of Education Technology in Health Sciences
Introduction: Traditional procedural training with heavier focus on factual knowledge and lower a... more Introduction: Traditional procedural training with heavier focus on factual knowledge and lower attentions to skill training can lead to graduates with poor procedural competence. DOPS-Direct observation of procedural skills is one of the means of assessing clinical performance by direct observation by the assessor. Performance using DOPS is structured and continuous. Materials and Methods: Study design-Prospective interventional study was conducted in the department of obstetrics and gynaecology at JNMC Wardha. Sample size-12 first year postgraduate students, were assessed with the help of 3 DOPS encounters and 2 procedures were observed for each student. The assessment of the postgraduate students was taken during the normal course of the student's work. Results: The scores of 1 st , 2 nd and 3 rd DOPS was compared to see if there is an improvement of the students. Two DOPS assessments were taken. First was on suturing techniques (skill 1) and second on urinary catheterization (skill 2). The mean DOPS scores in 'skill 1' group were 3.91 in first encounter A1, 6.50 in second encounter A2, and 7.25 in third encounter A3. In the 'skill 2' group the mean DOPS scores were 4.50 in first encounter B1, 6.75 in second encounter B2 and 7.33 in third encounter B3. There was a gross improvement in scores in the third encounter as compared to the first encounter. Conclusion: Observing, assessing and providing feedback to students enhanced the quality of the skills. The DOPS assessments done repeatedly helped to improve the clinical skills of post graduate students.
Evaluation of Anaemia in Pregnant Women, Oct 14, 2014
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2014
Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indicat... more Background: Caesarean section is the most commonly performed surgery in obstetrics. Newer indications have emerged over time for both maternal and foetal indications and this has resulted in a dramatic rise in caesarean section rate in the last several years. Methods: A one year observational study was done in a large government hospital receiving a large number of patients from urban as well as rural areas and also referrals from the periphery. An attempt was made to find out the caesarean section rate and to evaluate the indications that lead to a rise in caesarean section rate. Results: During the one year study period, there were total 14568 deliveries, out of which 5508 were caesarean sections giving a caesarean section rate of 37.8%. Repeat caesarean section after one prior caesarean delivery was the leading contributor of caesarean section rate and accounted for one in three caesarean sections carried out (32.80%). Other leading indications were foetal distress (9.36%), CPD (7.69%), PROM (7.31%), postdate pregnancy (6.62%), hypertensive disorders of pregnancy (6.0%). Conclusions: Some of the measures that can reduce caesarean section rate can be 1) reduction in primary caesarean sections 2) giving the option of VBAC to women with one prior caesarean section 3) use of foetal heart tracings and scalp blood sampling for foetal monitoring 4) judicious use of oxytocin and plotting of the partogram for every labour.