Shrinivas Gadappa - Academia.edu (original) (raw)
Papers by Shrinivas Gadappa
New Indian journal of OBGYN, Aug 1, 2023
Objectives: To compare the effect of delayed cord clamping (DCC) versus physiological cord clampi... more Objectives: To compare the effect of delayed cord clamping (DCC) versus physiological cord clamping (PCC) on third stage of labour and fetal outcome. Methodology: This is arandomized controlled trial. Participants were randomly assigned to control group (DCC) receiving cord clamping after 1 minute of delivery of baby and the study group (PCC) receiving cord clamping after delivery of placenta. Maternal and early neonatal outcome was analyzed and compared between the two groups by appropriate statistical test. Result: Baseline maternal characteristics were comparable in both groups. The duration of third stage of labour was higher in PCC, but no significant increase in incidence of PPH, no need of additional uterotonic and no need for blood transfusion was observed. Average FHR was normal in both the groups with FHR at 1 minute higher in PCC group and FHR at 5 minutes higher in DCC group. The fetal temperature was comparable in both groups. The mean Apgar score was higher in PCC group than DCC. Fetal haemoglobin and hematocrit values were also higher in PCC group. Conclusion: PCC is safe, effective and cost-free intervention for neonatal health benefits and should be implemented in the term and pre term infants, even in resource poor settings, where it might offer a sustainable strategy to prevent transient tachypnia of new born (TTA), hypothermia and may prevent long term anemia in new born without increasing the maternal risk of third stage complication.
Zenodo (CERN European Organization for Nuclear Research), May 9, 2023
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, May 1, 2023
Objectives: To understand the phenomenon of labour room violence against women and HCP's perc... more Objectives: To understand the phenomenon of labour room violence against women and HCP's perceptions of behaviours constituting mistreatment in labour room, to study the factors responsible for mistreatment in labour rooms and to study the changes after training of RMC practices. Methods: This study analyses mixed-methods data obtained through systematic clinical observations and open-ended comments recorded by the observers to describe care and in -depth interview to capture HCPs perception of labour room violence. Findings: There are 7 major categories of disrespect and abuse that women encountered during childbirth in health facilities which are verbal abuse, non-consented clinical care, non-condential care (including denial of privacy), non-dignied care, discrimination based on specic patient attributes, abandonment or denial of care and detention in facilities.(1) According to the present study, these forms of mistreatment has been drastically reduced in our institute in addition to which good RMC practices are adopted, so that a woman can experience decent & ethical but an honourable start towards her motherhood. Conclusions: Training of HCPs to understand the concept of respectful maternity care, development of a handbook with standard operating protocols(14) for women in labour, introduction of different birthing positions as well as birth companions were described as key components to inculcating respectful maternity care. The programme was on going one, with respectful maternity care practices being passed on from older to newer staff through a system of continuous teaching and guidance on the job, hence institutionalising these new practices through constant engagement, supervision and incremental.
International journal of clinical obstetrics and gynaecology, Nov 1, 2017
The study was carried out to find out prevalence of abnormal glucose challenge test (GCT), using ... more The study was carried out to find out prevalence of abnormal glucose challenge test (GCT), using DIPSI guidelines by using venous as well as capillary glucometer test in pregnant women and also to study the risk factors along with feto-maternal outcome in diagnosed cases of abnormal GCT. Material & Methods: The present longitudinal study was conducted between June 2015 to May 2017 in GMCH, Aurangabad. A total of 700 pregnant women seeking antenatal care between 16-32 weeks gestation were enrolled for study. Selected women were subjected for 75gm oral glucose challenge test. Venous plasma glucose as well as capillary blood glucose values were estimated and compared. Abnormal glucose tolerance was diagnosed on the basis of 2 hour plasma glucose values more than 120 mg/dl. Prevalence of abnormal GCT & risk factors were studied. Women diagnosed and treated as per DIPSI guidelines and followed up for maternal and fetal outcome. Data collected was entered in Microsoft excel and analysed further using SPSS Software version 23 package. Results: Out of 700 antenatal women, 70 women were diagnosed as having abnormal GCT by venous plasma glucose. method. Abnormal GCT was seen in 10% of the screened participants. Statistically Significant association was found between abnormal GCT and age, BMI, gravidity, positive family history, history of previous fetal or early neonatal deaths. Sensitivity of capillary glucometer method was 100% and specificity was 99.68% when compared to venous laboratory method. Out of 70 cases diagnosed as abnormal GCT, 6 lost to follow up. In follow up of 64 women with abnormal GCT, 50 women were treated with medical nutritional therapy and 20 required MNT & insulin. 56 women delivered at term & 8 women had preterm delivery. Conclusion: In low resource settings where Venous plasma glucose is impossible, universal and timely screening of all pregnant women with 75 gm GCT with glucometer should be done to reduce adverse pregnancy outcome and for preventing type 2 DM. Creating awareness regarding risk factors and targeting this population for lifestyle modification is very essential in order to prevent fetal origin of adult onset diseases.
New Indian journal of OBGYN, Aug 1, 2023
Background: Adolescent is age between 11-19 years, where there are enormous physical, psychologic... more Background: Adolescent is age between 11-19 years, where there are enormous physical, psychological, sexual, emotional and behavioural changes. They constitute 22 % of population in India. Hence, their unique problems need to be addressed. Objectives: 1) To study gynaecological problems and their clinical profile in adolescent girls. 2) To evaluate treatment modalities of gynaecological problems in adolescent girls. 3) To evaluate reproductive health awareness among adolescent girls. Methods: Girls in the age group of 11 to 19 years attending gynaecology OPD or emergency were included in the study. First, the girl was interviewed keeping her privacy and dignity. A detailed history and examination were done emphasizing on pubertal events such as thelarche, pubarche, pregnancy and menarche. Investigations like hemogram, coagulograms, hormonal assays, and sonography were done wherever applicable. Results: 71.67% achieved menarche at 14-16 years of age. Most common gynaecological problems among the adolescent girls were menstrual disorders 156 (52%), followed by vaginal discharge i.e. 35(11.6%), 24(8.0%) gave history of sexual assault, 24 (8%) had excessive weight gain and 20(6.6%) reported urinary tract infection. The most common type of menstrual disorder was that of oligomenorrhea 86 (55.2%). Out of 38 PCOS cases, 31(81.6%) cases presented with oligomenorrhea. Out of 300 cases, 200(66.7%) cases were aware of physical signs of puberty, 245(81.7%) cases were aware of STD, HIV and its mode of transmission, 200(66.7%) cases were aware about contraceptive methods, 150(50.0%) cases were aware about physiology of menstruation and 198(66.0%) cases were aware of menstrual hygiene. Out of 19 teenage pregnancies, in 8(42.1%) cases LSCS was done, 4(21.3%) cases had vaginal delivery and 4(21.0%) cases had MTP. Conclusions: Menstrual abnormalities are the most common gynaecological problems of adolescents. Adolescents should be addressed with dignity. It is need of the time to set up specialized adolescent gynaecological clinics.
Surgery is like hunting, If you are going for a rabbit, Be prepared to face a tiger" Placenta pre... more Surgery is like hunting, If you are going for a rabbit, Be prepared to face a tiger" Placenta previa accreta, is a rare occurrence which occurs in 3 % of women diagnosed with placenta previa with massive blood loss in almost every case resulting in cesarean hysterectomy. We report the case of central placenta previa with accreta in a case with no cause known to precipitate it. With aggressive radical surgery, massive transfusion protocol, well prepared to face it unexpectedly and vigilant postoperative management, such cases can be managed successfully.
Journal of emerging technologies and innovative research, Apr 1, 2021
Unsafe abortion with its associated complications remains a public health challenge in spite of l... more Unsafe abortion with its associated complications remains a public health challenge in spite of legalisation of induced abortion through MTP Act, 1971. Comprehensive abortion care (CAC) is an integral component of maternal health interventions as part of the National Health Mission. Present study was aimed to evaluate role of manual vacuum aspiration for induced/spontaneous abortions with uterine size less than 12 weeks at a tertiary teaching hospital & to assess safety of MVA. Present study was a prospective, observational study conducted in pregnant women underwent manual vacuum aspiration, for induced/spontaneous/incomplete abortions with < 12 weeks gestation. During study period 866 patients underwent manual vacuum aspiration procedure for first trimester MTP/missed/incomplete abortions. In present study most common age group was 26-30 years (39 %), most patients were gravida 2 (29 %). Most patients underwent MVA at 8-10 weeks gestation (38 %) & most common indication for MVA was medical termination of pregnancy (54 %) compared to incomplete abortion (46 %). In present study most common complications were blood transfusion (4.73 %), Hemorrhage (3.93%) & Incomplete abortion after MVA (2.42 %). MVA is a safe, simple, inexpensive method for first trimester induced/spontaneous/incomplete abortions. MVA is a promising method which can be practiced widely in rural areas where access to medical facilities are limited.
INTRODUCTION: Tracheostomy is one of the oldest surgical procedures one in order to treat acute u... more INTRODUCTION: Tracheostomy is one of the oldest surgical procedures one in order to treat acute upper airway obstruction, acute / Chronic respiratory failure or require continuous and intermittent respiratory support. It involves opening front wall of trachea to establish breathing and save endangered life. There have been very few cases with Tracheostomy done in hypertensive mothers. CASE: A 27 year old female Pregnant woman, 4th gravida came to our department with 3 episodes of Convulsions, in drowsy state. Patient was induced with catheter cerviprime gel induction in view of antepartum eclampsia. Patient was later shifted for Emergency LSCS in view of Antepartum Eclampsia with DIC. She delivered a male child , 2.4 kg, with normal APGAR scores at first and fifth minute. Post-operatively during monitoring patient went into Post partum haemorrhage , patient was taken for Emergency Exploratory Laparotomy SOS Obstetric Hysterectomy. Post operative recovery was uneventful. CONCLUSION: Aim of this case report involves Eclamptic mother taken for Emergency LSCS, during Anaesthesia-due to difficult intubation, patient could neither be intubated nor ventilated and hence Emergency Tracheostomy was performed. Master algorithm-Obstetric General Anaesthesia and Failed Tracheal Intubation.
International journal of scientific research, 2021
Obstetric haemorrhage along with hypertension and infection continues as the most common 'infamou... more Obstetric haemorrhage along with hypertension and infection continues as the most common 'infamous triad'of maternal deaths in both developed and underdeveloped countries of the world. It is a leading cause for admission of women into ICU 's and length of stay. According to Hoyert decrease in maternal mortality rate during the 20th century has been mainly attributed to a decrease in maternal haemorrhage. POST PARTUM HAEMORRHAGE (PPH): PPH is dened as,-It is a loss of 500 ml or more blood from the rd genital tract after the completion of 3 stage of labour. In general, an estimated loss more than average or 500 ml of blood must always alert the obstetrician. Uterine atony with bleeding from placental implantation site, genital tract trauma or both is the frequent causes of post-partum haemorrhage. LATE POST PARTUM HAEMORRHAGE: Bleeding after the rst 24 hours is called late postpartum haemorrhage. Causes of postpartum haemorrhage: • Uterine atony • Uterine inversion • Injuries to the birth canal • Puerperal hematomas • Rupture of uterus.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Jun 1, 2021
Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: T... more Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: This was a tertiary care based Observational Prospective Study design conducted between October 2018 to September 2020 to nd magnitude, morbidity associated with Obstetric haemorrhage. To study various Maternal outcomes and intervention for management of maternal near miss cases. Total 350 samples were selected by using concurrent sampling method for maternal near miss cases at tertiary care centre and who met the designed set of criteria. Result: Most common cause of MNM observed was Atonic PPH 224 (64%). 242 (69.14%) cases required blood transfusion and mean and SD of blood transfused was 10.98 ± 1.04. In our study, hemodynamic compromise was common cause of Systemic dysfunction, most common system involve in MNM observed was haematological 185 (52.86%). Overall, 218 (62.28%) cases required ICU monitoring. 166 (47.42%) cases needed emergency LSCS, Obstetric hysterectomy was performed on 56 (16%) of cases whereas 47 (13.43%) cases undergone Exploratory Laparotomy. The most common problem encountered by patients prior to hospital admissions was the unavailability of treatment at lower-level health facilities, affecting 248 out of 350 of study participants. Conclusion: Concluded from this study that Post-Partum Haemorrhage were the most common cause maternal morbidity in the study group. “Near-Miss” morbidity in PPH reect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.
Journal of evolution of medical and dental sciences, Dec 4, 2015
Introflexion of Parietis Uteri or Uterine inversion is the turning inside out of the fundus into ... more Introflexion of Parietis Uteri or Uterine inversion is the turning inside out of the fundus into the uterine cavity with incidence ranging from 1:2500. [1,2] to 1:20000. [2,3] Various aetiological factors have been linked to uterine inversion, though no obvious causes are found. Mismanagement of third stage of labour has been found to be the leading cause. OBJECTIVE To study the incidence, clinical presentation, management protocols used including surgical techniques in cases of uterine inversion and its outcome. METHOD This is an observational study carried out at GMCH Aurangabad during the years 2000 to 2014. CONCLUSION Uterine inversion is a life threatening and unpredictable obstetric emergency, which if ignored can lead to severe haemorrhage and shock. When managed promptly and aggressively, uterine inversion can result in minimal maternal morbidity and mortality.
The Medical Termination of Pregnancy Act, PCPNDT Act, and all ultramodern method for performing a... more The Medical Termination of Pregnancy Act, PCPNDT Act, and all ultramodern method for performing abortions have added to life-threatening complications especially due to medical abortion available over the counter. The government intended for The Medical Termination of Pregnancy Act of 1971 to reduce the incidence of illegal abortion and consequent maternal morbidity and mortality. However, 30 years after the groundbreaking legislation, the majority of women seeking abortion still turn to uncertified providers for abortion services because of the barriers to legal abortion. While some uncertified providers offer safe services, many provide unsafe abortions that result in complications or death. Women with access to fewer resources, for example, low-income rural women and adolescents, are among those most likely to turn to unsafe abortion and have complications. Levels of unsafe abortion are very high in India. In unsafe abortions mainly and in few instances after medical termination of pregnancy (MTP), life-threatening complications like uterine hemorrhage due to perforation, severe sepsis, peritonitis, visceral injuries, hemorrhagic and septic shock, renal failure, DIC, hepatic failure, and encephalopathy occur which needs early diagnosis and intervention. This chapter deals with all complications related to abortion and its management.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2015
New Indian journal of OBGYN, 2021
Objectives: To assess the strength of lower uterine segment caesarean section scar after 36 compl... more Objectives: To assess the strength of lower uterine segment caesarean section scar after 36 completed weeks up to 40 weeks with the help of transabdominal ultrasonography (USG) and correlating with maternal and early neonatal outcome in patients with previous one LSCS. Methods: This prospective study was carried out in the Department of OBGY, GMCH, Aurangabad from 1st October 2017 to 1st October 2019. All these cases underwent transabdominal USG between 36 completed weeks to 40 weeks and scar finding noted. Based on scar thickness, cases were assigned into two groups of ≤ 3 mm and > 3 mm. TOLAC (Trial of labor after caesarean) was given to cases having scar thickness > 3 mm and elective LSCS was done in scar thickness ≤ 3 mm. Correlation of maternal and fetal outcome with caesarean section scar strength parameters were done. Results: Total 211 cases were included in present study. 83 cases had scar thickness ≤ 3mm (39.3%) and 128 cases had scar thickness >3mm (63.6%). Strong association was seen between scar thickness and scar shape, border, continuity and echogenicity.105(49.76%) cases were given TOLAC with successful VBAC (Vaginal birth after caesarean), in 83(39.33%) cases had repeat elective LSCS, and 23(10.90%) cases had failed TOLAC with repeat emergency LSCS. 20 neonates needed NICU (Neonatal intensive care unit) care but causes of it were not related to scar complications. No case of obstetric hysterectomy, maternal mortality or still birth in our study. Conclusion: Successful VBAC may be advocated considering clinical factors, counseling and vigilant intrapartum management along with scar thickness of > 3mm, in tertiary care centres.
Indian journal of maternal-fetal and neonatal medicine, 2015
PARIPEX INDIAN JOURNAL OF RESEARCH, Feb 15, 2021
Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified... more Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified or untrained person. CASE: A 20 year old primigravida with 6 months ANC was referred to our hospital with the USG of uterine rupture and with a history of Dilation and curettage i/v/o anomalous baby, was in septic shock. There was also evidence of Sigmoid colon perforation. As a life saving measure Obstetric hysterectomy with colostomy done. Unsafe CONCLUSION: abortions are still in practice which has led to increased rate of mortality and morbidity. surgical intervention on a uterus of more than 20 weeks can be hazardous and should be terminated wisely.
Medpulse International Journal of Obsterics and Gyneacology, 2020
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third... more Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third stage of labour. Method: We conducted prospective observational study, in the Department of Obstetrics and Gynecology of Govt. Medical college & hospital, Aurangabad for 2 years to study physiological based cord clamping which is a method of deferred cord clamping until natural delivery of placenta. The placenta was allowed to deliver physiologically without any cord traction or cord pull, encouraging mothers own uterine contractions and taking help of gravity. Oxytocin was given intramuscularly to the mother only after complete placental delivery. Results: Out of 200 women most of them belong to age group 21-25 years (41.5%) with mean age of 24.78 ± 6.72 years. 47.5% were from upper lower class, 53.5% were G2 followed by 26.5% were primigravida's. About 72% women's GA was ranging between 37-40 weeks. In 89.5% women the time required for 3rd stage of labour ranged between 5-10 m...
New Indian journal of OBGYN, Aug 1, 2023
Objectives: To compare the effect of delayed cord clamping (DCC) versus physiological cord clampi... more Objectives: To compare the effect of delayed cord clamping (DCC) versus physiological cord clamping (PCC) on third stage of labour and fetal outcome. Methodology: This is arandomized controlled trial. Participants were randomly assigned to control group (DCC) receiving cord clamping after 1 minute of delivery of baby and the study group (PCC) receiving cord clamping after delivery of placenta. Maternal and early neonatal outcome was analyzed and compared between the two groups by appropriate statistical test. Result: Baseline maternal characteristics were comparable in both groups. The duration of third stage of labour was higher in PCC, but no significant increase in incidence of PPH, no need of additional uterotonic and no need for blood transfusion was observed. Average FHR was normal in both the groups with FHR at 1 minute higher in PCC group and FHR at 5 minutes higher in DCC group. The fetal temperature was comparable in both groups. The mean Apgar score was higher in PCC group than DCC. Fetal haemoglobin and hematocrit values were also higher in PCC group. Conclusion: PCC is safe, effective and cost-free intervention for neonatal health benefits and should be implemented in the term and pre term infants, even in resource poor settings, where it might offer a sustainable strategy to prevent transient tachypnia of new born (TTA), hypothermia and may prevent long term anemia in new born without increasing the maternal risk of third stage complication.
Zenodo (CERN European Organization for Nuclear Research), May 9, 2023
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, May 1, 2023
Objectives: To understand the phenomenon of labour room violence against women and HCP's perc... more Objectives: To understand the phenomenon of labour room violence against women and HCP's perceptions of behaviours constituting mistreatment in labour room, to study the factors responsible for mistreatment in labour rooms and to study the changes after training of RMC practices. Methods: This study analyses mixed-methods data obtained through systematic clinical observations and open-ended comments recorded by the observers to describe care and in -depth interview to capture HCPs perception of labour room violence. Findings: There are 7 major categories of disrespect and abuse that women encountered during childbirth in health facilities which are verbal abuse, non-consented clinical care, non-condential care (including denial of privacy), non-dignied care, discrimination based on specic patient attributes, abandonment or denial of care and detention in facilities.(1) According to the present study, these forms of mistreatment has been drastically reduced in our institute in addition to which good RMC practices are adopted, so that a woman can experience decent & ethical but an honourable start towards her motherhood. Conclusions: Training of HCPs to understand the concept of respectful maternity care, development of a handbook with standard operating protocols(14) for women in labour, introduction of different birthing positions as well as birth companions were described as key components to inculcating respectful maternity care. The programme was on going one, with respectful maternity care practices being passed on from older to newer staff through a system of continuous teaching and guidance on the job, hence institutionalising these new practices through constant engagement, supervision and incremental.
International journal of clinical obstetrics and gynaecology, Nov 1, 2017
The study was carried out to find out prevalence of abnormal glucose challenge test (GCT), using ... more The study was carried out to find out prevalence of abnormal glucose challenge test (GCT), using DIPSI guidelines by using venous as well as capillary glucometer test in pregnant women and also to study the risk factors along with feto-maternal outcome in diagnosed cases of abnormal GCT. Material & Methods: The present longitudinal study was conducted between June 2015 to May 2017 in GMCH, Aurangabad. A total of 700 pregnant women seeking antenatal care between 16-32 weeks gestation were enrolled for study. Selected women were subjected for 75gm oral glucose challenge test. Venous plasma glucose as well as capillary blood glucose values were estimated and compared. Abnormal glucose tolerance was diagnosed on the basis of 2 hour plasma glucose values more than 120 mg/dl. Prevalence of abnormal GCT & risk factors were studied. Women diagnosed and treated as per DIPSI guidelines and followed up for maternal and fetal outcome. Data collected was entered in Microsoft excel and analysed further using SPSS Software version 23 package. Results: Out of 700 antenatal women, 70 women were diagnosed as having abnormal GCT by venous plasma glucose. method. Abnormal GCT was seen in 10% of the screened participants. Statistically Significant association was found between abnormal GCT and age, BMI, gravidity, positive family history, history of previous fetal or early neonatal deaths. Sensitivity of capillary glucometer method was 100% and specificity was 99.68% when compared to venous laboratory method. Out of 70 cases diagnosed as abnormal GCT, 6 lost to follow up. In follow up of 64 women with abnormal GCT, 50 women were treated with medical nutritional therapy and 20 required MNT & insulin. 56 women delivered at term & 8 women had preterm delivery. Conclusion: In low resource settings where Venous plasma glucose is impossible, universal and timely screening of all pregnant women with 75 gm GCT with glucometer should be done to reduce adverse pregnancy outcome and for preventing type 2 DM. Creating awareness regarding risk factors and targeting this population for lifestyle modification is very essential in order to prevent fetal origin of adult onset diseases.
New Indian journal of OBGYN, Aug 1, 2023
Background: Adolescent is age between 11-19 years, where there are enormous physical, psychologic... more Background: Adolescent is age between 11-19 years, where there are enormous physical, psychological, sexual, emotional and behavioural changes. They constitute 22 % of population in India. Hence, their unique problems need to be addressed. Objectives: 1) To study gynaecological problems and their clinical profile in adolescent girls. 2) To evaluate treatment modalities of gynaecological problems in adolescent girls. 3) To evaluate reproductive health awareness among adolescent girls. Methods: Girls in the age group of 11 to 19 years attending gynaecology OPD or emergency were included in the study. First, the girl was interviewed keeping her privacy and dignity. A detailed history and examination were done emphasizing on pubertal events such as thelarche, pubarche, pregnancy and menarche. Investigations like hemogram, coagulograms, hormonal assays, and sonography were done wherever applicable. Results: 71.67% achieved menarche at 14-16 years of age. Most common gynaecological problems among the adolescent girls were menstrual disorders 156 (52%), followed by vaginal discharge i.e. 35(11.6%), 24(8.0%) gave history of sexual assault, 24 (8%) had excessive weight gain and 20(6.6%) reported urinary tract infection. The most common type of menstrual disorder was that of oligomenorrhea 86 (55.2%). Out of 38 PCOS cases, 31(81.6%) cases presented with oligomenorrhea. Out of 300 cases, 200(66.7%) cases were aware of physical signs of puberty, 245(81.7%) cases were aware of STD, HIV and its mode of transmission, 200(66.7%) cases were aware about contraceptive methods, 150(50.0%) cases were aware about physiology of menstruation and 198(66.0%) cases were aware of menstrual hygiene. Out of 19 teenage pregnancies, in 8(42.1%) cases LSCS was done, 4(21.3%) cases had vaginal delivery and 4(21.0%) cases had MTP. Conclusions: Menstrual abnormalities are the most common gynaecological problems of adolescents. Adolescents should be addressed with dignity. It is need of the time to set up specialized adolescent gynaecological clinics.
Surgery is like hunting, If you are going for a rabbit, Be prepared to face a tiger" Placenta pre... more Surgery is like hunting, If you are going for a rabbit, Be prepared to face a tiger" Placenta previa accreta, is a rare occurrence which occurs in 3 % of women diagnosed with placenta previa with massive blood loss in almost every case resulting in cesarean hysterectomy. We report the case of central placenta previa with accreta in a case with no cause known to precipitate it. With aggressive radical surgery, massive transfusion protocol, well prepared to face it unexpectedly and vigilant postoperative management, such cases can be managed successfully.
Journal of emerging technologies and innovative research, Apr 1, 2021
Unsafe abortion with its associated complications remains a public health challenge in spite of l... more Unsafe abortion with its associated complications remains a public health challenge in spite of legalisation of induced abortion through MTP Act, 1971. Comprehensive abortion care (CAC) is an integral component of maternal health interventions as part of the National Health Mission. Present study was aimed to evaluate role of manual vacuum aspiration for induced/spontaneous abortions with uterine size less than 12 weeks at a tertiary teaching hospital & to assess safety of MVA. Present study was a prospective, observational study conducted in pregnant women underwent manual vacuum aspiration, for induced/spontaneous/incomplete abortions with < 12 weeks gestation. During study period 866 patients underwent manual vacuum aspiration procedure for first trimester MTP/missed/incomplete abortions. In present study most common age group was 26-30 years (39 %), most patients were gravida 2 (29 %). Most patients underwent MVA at 8-10 weeks gestation (38 %) & most common indication for MVA was medical termination of pregnancy (54 %) compared to incomplete abortion (46 %). In present study most common complications were blood transfusion (4.73 %), Hemorrhage (3.93%) & Incomplete abortion after MVA (2.42 %). MVA is a safe, simple, inexpensive method for first trimester induced/spontaneous/incomplete abortions. MVA is a promising method which can be practiced widely in rural areas where access to medical facilities are limited.
INTRODUCTION: Tracheostomy is one of the oldest surgical procedures one in order to treat acute u... more INTRODUCTION: Tracheostomy is one of the oldest surgical procedures one in order to treat acute upper airway obstruction, acute / Chronic respiratory failure or require continuous and intermittent respiratory support. It involves opening front wall of trachea to establish breathing and save endangered life. There have been very few cases with Tracheostomy done in hypertensive mothers. CASE: A 27 year old female Pregnant woman, 4th gravida came to our department with 3 episodes of Convulsions, in drowsy state. Patient was induced with catheter cerviprime gel induction in view of antepartum eclampsia. Patient was later shifted for Emergency LSCS in view of Antepartum Eclampsia with DIC. She delivered a male child , 2.4 kg, with normal APGAR scores at first and fifth minute. Post-operatively during monitoring patient went into Post partum haemorrhage , patient was taken for Emergency Exploratory Laparotomy SOS Obstetric Hysterectomy. Post operative recovery was uneventful. CONCLUSION: Aim of this case report involves Eclamptic mother taken for Emergency LSCS, during Anaesthesia-due to difficult intubation, patient could neither be intubated nor ventilated and hence Emergency Tracheostomy was performed. Master algorithm-Obstetric General Anaesthesia and Failed Tracheal Intubation.
International journal of scientific research, 2021
Obstetric haemorrhage along with hypertension and infection continues as the most common 'infamou... more Obstetric haemorrhage along with hypertension and infection continues as the most common 'infamous triad'of maternal deaths in both developed and underdeveloped countries of the world. It is a leading cause for admission of women into ICU 's and length of stay. According to Hoyert decrease in maternal mortality rate during the 20th century has been mainly attributed to a decrease in maternal haemorrhage. POST PARTUM HAEMORRHAGE (PPH): PPH is dened as,-It is a loss of 500 ml or more blood from the rd genital tract after the completion of 3 stage of labour. In general, an estimated loss more than average or 500 ml of blood must always alert the obstetrician. Uterine atony with bleeding from placental implantation site, genital tract trauma or both is the frequent causes of post-partum haemorrhage. LATE POST PARTUM HAEMORRHAGE: Bleeding after the rst 24 hours is called late postpartum haemorrhage. Causes of postpartum haemorrhage: • Uterine atony • Uterine inversion • Injuries to the birth canal • Puerperal hematomas • Rupture of uterus.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Jun 1, 2021
Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: T... more Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: This was a tertiary care based Observational Prospective Study design conducted between October 2018 to September 2020 to nd magnitude, morbidity associated with Obstetric haemorrhage. To study various Maternal outcomes and intervention for management of maternal near miss cases. Total 350 samples were selected by using concurrent sampling method for maternal near miss cases at tertiary care centre and who met the designed set of criteria. Result: Most common cause of MNM observed was Atonic PPH 224 (64%). 242 (69.14%) cases required blood transfusion and mean and SD of blood transfused was 10.98 ± 1.04. In our study, hemodynamic compromise was common cause of Systemic dysfunction, most common system involve in MNM observed was haematological 185 (52.86%). Overall, 218 (62.28%) cases required ICU monitoring. 166 (47.42%) cases needed emergency LSCS, Obstetric hysterectomy was performed on 56 (16%) of cases whereas 47 (13.43%) cases undergone Exploratory Laparotomy. The most common problem encountered by patients prior to hospital admissions was the unavailability of treatment at lower-level health facilities, affecting 248 out of 350 of study participants. Conclusion: Concluded from this study that Post-Partum Haemorrhage were the most common cause maternal morbidity in the study group. “Near-Miss” morbidity in PPH reect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.
Journal of evolution of medical and dental sciences, Dec 4, 2015
Introflexion of Parietis Uteri or Uterine inversion is the turning inside out of the fundus into ... more Introflexion of Parietis Uteri or Uterine inversion is the turning inside out of the fundus into the uterine cavity with incidence ranging from 1:2500. [1,2] to 1:20000. [2,3] Various aetiological factors have been linked to uterine inversion, though no obvious causes are found. Mismanagement of third stage of labour has been found to be the leading cause. OBJECTIVE To study the incidence, clinical presentation, management protocols used including surgical techniques in cases of uterine inversion and its outcome. METHOD This is an observational study carried out at GMCH Aurangabad during the years 2000 to 2014. CONCLUSION Uterine inversion is a life threatening and unpredictable obstetric emergency, which if ignored can lead to severe haemorrhage and shock. When managed promptly and aggressively, uterine inversion can result in minimal maternal morbidity and mortality.
The Medical Termination of Pregnancy Act, PCPNDT Act, and all ultramodern method for performing a... more The Medical Termination of Pregnancy Act, PCPNDT Act, and all ultramodern method for performing abortions have added to life-threatening complications especially due to medical abortion available over the counter. The government intended for The Medical Termination of Pregnancy Act of 1971 to reduce the incidence of illegal abortion and consequent maternal morbidity and mortality. However, 30 years after the groundbreaking legislation, the majority of women seeking abortion still turn to uncertified providers for abortion services because of the barriers to legal abortion. While some uncertified providers offer safe services, many provide unsafe abortions that result in complications or death. Women with access to fewer resources, for example, low-income rural women and adolescents, are among those most likely to turn to unsafe abortion and have complications. Levels of unsafe abortion are very high in India. In unsafe abortions mainly and in few instances after medical termination of pregnancy (MTP), life-threatening complications like uterine hemorrhage due to perforation, severe sepsis, peritonitis, visceral injuries, hemorrhagic and septic shock, renal failure, DIC, hepatic failure, and encephalopathy occur which needs early diagnosis and intervention. This chapter deals with all complications related to abortion and its management.
Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2015
New Indian journal of OBGYN, 2021
Objectives: To assess the strength of lower uterine segment caesarean section scar after 36 compl... more Objectives: To assess the strength of lower uterine segment caesarean section scar after 36 completed weeks up to 40 weeks with the help of transabdominal ultrasonography (USG) and correlating with maternal and early neonatal outcome in patients with previous one LSCS. Methods: This prospective study was carried out in the Department of OBGY, GMCH, Aurangabad from 1st October 2017 to 1st October 2019. All these cases underwent transabdominal USG between 36 completed weeks to 40 weeks and scar finding noted. Based on scar thickness, cases were assigned into two groups of ≤ 3 mm and > 3 mm. TOLAC (Trial of labor after caesarean) was given to cases having scar thickness > 3 mm and elective LSCS was done in scar thickness ≤ 3 mm. Correlation of maternal and fetal outcome with caesarean section scar strength parameters were done. Results: Total 211 cases were included in present study. 83 cases had scar thickness ≤ 3mm (39.3%) and 128 cases had scar thickness >3mm (63.6%). Strong association was seen between scar thickness and scar shape, border, continuity and echogenicity.105(49.76%) cases were given TOLAC with successful VBAC (Vaginal birth after caesarean), in 83(39.33%) cases had repeat elective LSCS, and 23(10.90%) cases had failed TOLAC with repeat emergency LSCS. 20 neonates needed NICU (Neonatal intensive care unit) care but causes of it were not related to scar complications. No case of obstetric hysterectomy, maternal mortality or still birth in our study. Conclusion: Successful VBAC may be advocated considering clinical factors, counseling and vigilant intrapartum management along with scar thickness of > 3mm, in tertiary care centres.
Indian journal of maternal-fetal and neonatal medicine, 2015
PARIPEX INDIAN JOURNAL OF RESEARCH, Feb 15, 2021
Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified... more Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified or untrained person. CASE: A 20 year old primigravida with 6 months ANC was referred to our hospital with the USG of uterine rupture and with a history of Dilation and curettage i/v/o anomalous baby, was in septic shock. There was also evidence of Sigmoid colon perforation. As a life saving measure Obstetric hysterectomy with colostomy done. Unsafe CONCLUSION: abortions are still in practice which has led to increased rate of mortality and morbidity. surgical intervention on a uterus of more than 20 weeks can be hazardous and should be terminated wisely.
Medpulse International Journal of Obsterics and Gyneacology, 2020
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third... more Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third stage of labour. Method: We conducted prospective observational study, in the Department of Obstetrics and Gynecology of Govt. Medical college & hospital, Aurangabad for 2 years to study physiological based cord clamping which is a method of deferred cord clamping until natural delivery of placenta. The placenta was allowed to deliver physiologically without any cord traction or cord pull, encouraging mothers own uterine contractions and taking help of gravity. Oxytocin was given intramuscularly to the mother only after complete placental delivery. Results: Out of 200 women most of them belong to age group 21-25 years (41.5%) with mean age of 24.78 ± 6.72 years. 47.5% were from upper lower class, 53.5% were G2 followed by 26.5% were primigravida's. About 72% women's GA was ranging between 37-40 weeks. In 89.5% women the time required for 3rd stage of labour ranged between 5-10 m...