Objective : To assess the prevalence & incidence of biliary sludge and stones during pregnancy and to measure the changes in gallbladder volume.
Method and Material : The study was on 276 healthy pregnant females. Questionnaires were obtained at entry & gallbladder ultrasounds were done in each trimester & 2-4 weeks postpartum. Gallbladder volume was measured at each ultrasound.
Results : The incidence of biliary sludge and gallbladder stones during pregnancy was found to be 14.4% and 6.67% respectively. The prevalence of gallstone disease increased with advancing gestational age and the increase in gallbladder volume was also statistically significant (p<<0.001). At 2-4 weeks postpartum gallstones have disappeared in 15% while sludge disappeared in 38.7%. Amongst antenatal women with gallstone disease most were asymptomatic while itching was the commonest presenting symptom. A statistically significant correlation was found between gallstone disease and advanced age, high parity, prolonged breast feeding & raised BMI.
Conclusion : Biliary sludge and stones develop frequently during pregnancy and are
usually asymptomatic.
OBJECTIVE(S): To find which of the two risk factors - age and parity, play dominant role in cervical carcinogenesis.
METHOD(S): Detailed information regarding age and parity has been available in 12,456 women registered for cervical cytology between January 1992 and May 2005 at our gynecological out patient department. Critical analysis was carried out in these women categorizing them into two groups viz., women of different age groups with varying parity and women of different parity groups with varying age.
RESULTS: The incidence of squamous intraepithelial lesion (SIL) in the present series was 10.5% (1314 /12456) while squamous cell carcinoma was 0.8% (109 /12456). The incidence of SIL and carcinoma cervix showed progressive rise with increasing age and parity. The detailed analysis of the two groups defined above revealed SIL incidence rising with increasing parity in nearly all age groups and with increasing age in nearly all parity groups but the corresponding figures were much higher in women of high age and high parity. The SIL rate was found to be maximum in women of high age with high parity. Similar trend was also seen in case of carcinoma cervix.
CONCLUSION(S): Women of high age with high parity are at very high risk of developing carcinoma cervix and this may be due to cumulative effect of both these risk factors. Hence women of this category need special attention for mandatory cytological screening.
OBJECTIVE(S): To explore the effect of extracellular products of cervical isolates from the cases of unexplained infertility on spermatozoa.
METHODS(S): Thirty endocervical isolates obtained from 11 cases of unexplained primary infertility were studied for the effect of culture supernatants on motility and decapitation of human spermatozoa. Effect on rat, cow bull and buffalo bull spermatozoa was similarly studied.
RESULTS: Sixteen isolates showed significant decrease in motility of spermatozoa. Out of 16 isolates, 5 isolates not only showed a decreased the motility of spermatozoa but also decapitated a few spermatozoa. This effect was more pronounced on rat spermatozoa where 100% decapitation could be observed whereas in humans only 14-17% spermatozoa were decapitated. There was no prominent effect on cow bull and buffalo bull spermatozoa.
CONCLUSION(S): Decapitation of spermatozoa occurred with supernatants of Bacillus sp. and Pseudomonas sp.
OBJECTIVE(S) : To determine the risk fators of induced abortion in relation to contraceptive behaviour
METHOD(S) : A matched case control study was undertaken to investigate the possible association of induced abortion (MTP) and contraceptive behavior. Data were collected from 80 married abortion seekers attending family welfare clinic attached to Medical College, 80 pregnant controls who wanted to continue pregnancy, and 80 nonpregnant controls receiving service at the study hospital. Conditional logistic regression analysis was done for predicting risk factors.
RESULTS : Bivariate analysis showed a strong association between induced abortion and contraceptive use. Using only natural methods of contraception is found to be a significant predictor for induced abortion (OR 5.2; P = 0.0002). Mean frequency of intercourse per month was higher in subjects than in pregnant controls (3.7 vs 2.8; P = 0.018) and in nonpregnant controls (3.7 vs 2.2, P = 0.005). Women who communicate rarely with their partners about contraception have a high risk of induced abortion (OR; 2.57, P = 0.028). Attitude towards induced abortion was also found to be significant (OR 30; P <0.001) for pregnant controls and (OR 10.33; P < 0.001) for nonpregnant controls. Multivariate analysis showed three statistically significant variables (P < 0.05) using only natural methods of contraception, rare discussion about contraception with partners, and frequent intercourse.
CONCLUSION(S) : Natural methods of contraception, increased frequency of sexual intercourse, and rare communication with partners about contraception were found to be significant predictors for seeking abortion.
OBJECTIVE(S) : To find out the efficacy and safety of intravaginal misoprostol insertion for second trimester termination of pregnancy.
METHOD(S) : One hundred and forty cases of second trimester termination of pregnancy done from September 2001 to August 2004 using intravaginal misoprostol 600 mg followed by 400 mg every 4 hourly till abortion or a maximum of 2600 mg over 24 hours were analyzed.
RESULTS : A majority of the women was married, the mean gestational age was 26.42 years, and the mean gravidity 2.96 ± 1.56. The success rate was 99.26%. The mean induction abortion interval was 12.27± 5.71 hours. However, it was more in primigravidas as compared to that in multigravidas. The mean dose of misoprostol required was 1638.57 ± 322.67 mg. The side effects observed were nausea, vomiting, diarrhea and fever.
CONCLUSION(S) : Intravaginal misoprostol is a safe, effective, cheap and acceptable method for second trimester termination of pregnancy.
Objective : To determine whether other androgens [androstenedione (A4), 17-hydroxy progesterone (17OHP) and dehydroepiandrosterone (DHEA)] were elevated in women with classically defined idiopathic hirsutism (IH)/patient-important hirsutism (PIH).
Study Design : Retrospective analysis.
Setting : Outpatient endocrine department of a tertiary care hospital.
Patients : In total, 30 consecutive women with IH/PIH were included. IH/PIH was defined as presentation with hirsutism with normal menstrual cycles (25–35 days), normal total (<45 ng/dL) and free T (fT) (<0.6 ng/dL) and normal ovaries sonologically (transabdominal ultrasonogram ovarian volume<10 cm3 ) without any other signs of virilization. Clinical and biochemical details were collected and analyzed. Androgens were measured by LC–MS/MS. A4≥2.5 ng/mL, DHEA≥15 (age<18) or≥11.8 (age≥18) ng/mL, DHEAS≥2847 ng/mL or 17OHP≥2 ng/mL were considered high.
Results : With the mean age of 22 years and mean BMI of 25 kg/m2 , 12/30 (40%) had IH and remaining PIH. DHEA alone was elevated in 60% and A4 alone in 33%. Overall, 23/30 (73%) had any one elevated androgen with normal total and free testosterone. There was no correlation with modified Ferriman–Gallwey score, and there was no significant difference in androgens between IH and PIH.
Conclusion : A high proportion of women with classically defined IH/PIH have elevated DHEA and/or A4. Though on pharmacotherapy basis, there would be no change in management, the role of hyperandrogenemia detected by sensitive assays
on metabolic functions and cardiovascular risk has to be studied.
Background : Breast cancer is the most common malignancy in Indian women. There is scant data from Indian hospital based populations on the prevalence of risk factors of this disease. We performed this study to quantify and analyze various epidemiological risk factors in Indian breast cancer patients.
Methods : This was a multicenter collaborative study wherein breast cancer patients older than 18 years were served a structured questionnaire after informed consent. Patients or their relatives were required to fill out the questionnaire and those who were unable to read and write were excluded. Data were abstracted from case record forms and variables were descriptively analyzed.
Results : Between January 2015 and February 2016, 800 patients were screened, of whom 736 patients with a mean age of 50.13 years were enrolled in the study. The mean number of pregnancies was 2.75 (0–11), the number (percentage) of women who had breastfed for more than 6 months was 628 (85.3) and 406 (55.1%) patients were post-menopausal at the time of breast cancer diagnosis. Of the enrolled patients, 91 (12.8%) had history of exposure to passive smoke, 13 (1.8%) had partners who were heavy smokers, 27 (3.7%) had history of oral contraceptive use, 4 (0.5%) had history of hormone replacement therapy, and 103 (14%) had undergone hysterectomy with oophorectomy.
Conclusion : Our study contributes to the descriptive prevalence of some known risk factors in Indian breast cancer patients.
Study Objective : Assessment of safety and feasibility of total laparoscopic hysterectomy in a high-volume tertiary care centre.
Design : Retrospective study design. Setting Tertiary care centre: Galaxy care Hospital, Pune, India.
Materials and Methods : This is a retrospective observational study conducted in a tertiary care resident training hospital in Pune which is a high-volume teaching hospital. 1200 total laparoscopic hysterectomy patients between July 2013 and June 2019 operated by a group of trained surgeons were analysed, and parameters, namely demography, indication of surgery, surgical time, intra-operative blood loss, post-operative complications, duration of hospital stay, discharge and follow-up, were studied.
Result(s) : A total of 1200 women who underwent total laparoscopic hysterectomy for various indications were included in the study. TLH was successfully performed in all women. Mean age of women was 45 years. 72.00% had a BMI between 18.5 and 24.9, 16.08% had a BMI between 25 and 29.9, 3.92% had a BMI of>29.9 while 8% had a BMI<18.5. Indications for surgery included uterine fibroid (33.08%), adenomyosis (22.25%), endometrial hyperplasia (14.33%), endometrial polyp (7%), endometriosis (3.33%), postmenopausal bleeding (9.25%), chronic PID (5.25%), prolapse (4.25%) and risk reduction surgery in 1.25%. 2.00% had intra-operative complications while 7.58% had post-operative complications which were identified and managed successfully.
Conclusion(s) : Advances and innovation in equipment, energy sources and surgical training have made TLH a well-tolerated
and efficient surgery. Irrespective of the previous morbidity, pathology and uterine size, TLH is a duplicable and safe in a
well-trained high-volume centre.
Objectives : To assess the maternal morbidity during pregnancy, delivery and postpartum period, needing hospitalization and admissions in intensive care unit (ICU), interventions required, and their outcome.
Methods : During the three year period, from 1st July 2002 to 30th June 2005, 55 obstetric patients were admitted to the ICU. Cases were reviewed in detail including age, parity, reason for ICU admission, clinical features, response to interventions and maternal outcome.
Results : Twenty-five antepartum, 27 postpartum, and three postabortal cases made up the total of 55 cases. Mean maternal age was 26.89±8 years, 29% were primigravidas and 71% multigravidas. The length of stay in the hospital ranged from 1 to 15 days. Severe anemia, postcesarean problems, puerperal sepsis, pregnancy induced hypertension, eclampsia, and cortical vein thrombosis were the main reasons for ICU admissions Renal failure, coagulopathy, and respiratory dysfunction were the main organ failures. All women required ventilatory support. Specialized interventions like dialysis, multiple transfusions of blood and blood products, and surgical interventions were also required. 43.63% (24/55) women died, most of them due to multi-organ dysfunction.
Conclusions : Invasive hemodynamic monitoring and ventilatory support were the two main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity.
Study Objective : Assessment of feasibility of office hysteroscopy in Indian setting.
Design : Retrospective study design.
Setting : Tertiary care centre: Galaxy care Hospital, Pune, India.
Patients : Three thousand consecutive women undergoing office hysteroscopy between 2012 and May 2018.
Interventions : Office hysteroscopy 2200 cases (2012–2017) with Bettocchi 2.9 scope and Hamou endomat. Eight hundred cases (2017–2018) with Bettocchi 1.9 scope and EASI. Normal saline was used as distension medium. With Hamou endomat, settings have drip rate of 200 ml/min with irrigation pressure of 75 mmHg and suction bar 0.15. With EASI, settings were for Bettocchi 4 (1.9 mm) and Bettocchi 5 (2.9 mm) scope with 45 mmHg. Hysteroscopies were carried out by an experienced operator trained in office hysteroscopy. All hysteroscopies were done in early proliferative phase (4th–11th day).
Main Outcome : Measures Success, failure and complication rates.
Results : Hysteroscopies were successfully performed in nearly 98.66% of cases with 4 patients requiring a two-step procedure due to>3 cm pathology. One thousand eight hundred eight (62.2%) were diagnostic hysteroscopies, while operative hysteroscopies were performed in one thousand one hundred twenty (37.8%). One patient (1/3000) had a vasovagal attack.
Conclusions : In outpatient setting, counselling the patient for office hysteroscopy played an important role to overcome pain
and anxiety, in addition to low pressure, continuous fow irrigation and vaginoscopic approach. Traditional resectoscopic
surgeries should be reserved for challenging cases (i.e. endometrial ablation) or for certain pathologies (myomas>2.0 cm,
broad-base, large-size polyps). Recent advances in technique and instrumentation facilitate this approach and might encourage greater adoption by the gynaecology community. With the right approach, technique and setup, ofce hysteroscopy is feasible
with favourable outcomes.
Objective : To correlate serial monitoring of lactic acid in pregnancy-associated sepsis (PAS) subjects with maternal prognosis.
Methods : All pregnant, post-abortal (2 weeks) and postpartum women with suspected sepsis fulfilling any 2 of the Quick Sequential Organ Failure Assessment criteria were considered as cases. Lactic acid was measured at 0, 24 and 48 h of admission, and lactate clearance was calculated.
Results : The mean value of lactic acid was significantly higher in the Intensive Care Unit (ICU) group than the Non-ICU group at 0, 24, and 48 h with values being (6.00±2.46 mmol/l vs 3.25±1.92 mmol/l), (4.44±2.24 mmol/l vs 2.91±1.77 mmol/l) and (5.65±2.91 mmol/l vs 2.99±1.93 mmol/l), respectively. Lactic acid in the survivor group was signifcantly lower as compared to the mortality group (3.79±0.32 mmol/l vs 7.3±0.56 mmol/l). A cut-of of 3.8 mmol/l with area under the curve of 0.814 has a sensitivity of 84% and specifcity of 68% for predicting ICU admission. The mean lactate clearance was 46% in cases who survived and 22.5% in cases who had mortality. When lactate clearance was 60%, no mortality was seen, whereas when there was 100% rise in lactic acid, they all had mortality.
Conclusion : The mean lactic acid at 0, 24 and 48 hours was signifcantly higher in the ICU group as compared to the NonICU group. Serum lactic acid at zero hours of the presentation was signifcantly higher in ICU cases. Lactate clearance (fall)
helps to prognosticate as fall of ≥60% lactic acid level is associated with 100% survival, whereas a rise of 100% in serum
lactic acid is associated with 100% mortality
Background : This study aimed to evaluate the usefulness of the first-trimester crown-rump length (CRL) and nuchal translucency (NT) discordance in monochorionic diamniotic twins (MCDA) for the prediction of complications—twin–twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR) or intrauterine fetal demise (IUFD).
Methods : Intertwin discordance in the CRL and NT was calculated as a percentage of the larger CRL and NT, respectively. The performance of inter twin discordance (CRL≥10% and NT≥20%) for predicting complications was analysed using standard statistical screening test methods.
Results : Fifty-eight MCDA twin pregnancies were studied. Out of them, 19 (32%) pregnancies resulted in one of the complications studied (4 TTTS, 10 sFGR, 5 IUFD). CRL and NT discordance showed an increased probability of developing complications positive likelihood ratio (LR+) {95% confidence interval}: 2.05 {0.46–9.23} and 1.88 {1.03–3.45}, respectively. NT discordance showed a sensitivity of 57%.
Conclusions : Although discordant first-trimester CRL and NT in monochorionic twins are poor screening tools for early
prediction, if positive, they increase the risk of developing complications
Introduction : WHO states that obstetric hemorrhage, hypertensive disorders of pregnancy and sepsis account for approximately 50% of maternal deaths worldwide. All these conditions are associated with changes in vital signs including blood pressure (BP) and heart rate (HR). Shock index (SI) is the ratio of HR to systolic BP.
Aims and Objectives : To evaluate role of shock index as an early indicator of adverse maternal outcomes and to determine the threshold points of SI for five adverse maternal outcomes.
Methodology : This was a prospective observational study on 1004 consecutively enrolled subjects presenting in labor. Vital signs and Shock Index were recorded. SI thresholds were analyzed with respect to obstetric complications and adverse outcomes. Parametric tests such as Chi-square, comparison of proportions, comparison of mean and ROC curve analysis were applied on the data.
Results : The mean SI value in the vaginal delivery group was 1.02 ± 0.26 and it was 0.95 ± 0.033 in the caesarean delivery group. The values of SI ((Mean and SD) for ICU admission were (1.23 (±0.35)), for (MODS) it was (1.47 (±0.84)), for blood transfusion>4 units it was (1.15 (±0.41)), for surgical intervention it was (1.58 (±0.51)) and for maternal death (1.39 (±0.85)). SI≥1.4, had sensitivity 26.82% (21.09–33.19); specificity 100%(99.53–100), PPV was 100% and NPV was 82.96%(81.8–84.06)with an AUC of 0.8 (0.78–0.83) on ROC analysis. In subjects with PIH/eclampsia, SI was lower and in patients with severe anemia, SI was higher
Conclusion : SI performed well as a screening tool in the prediction of adverse maternal outcomes. SI≥0.9 was significantly
associated with maternal adverse outcomes: ICU admission, MODS, surgical intervention, blood transfusion and death. The
study proposes an SI cut-of of 0.9 for referral and a cut-of of 1.1 for intervention in a tertiary care hospital. Patients with
PIH/eclampsia tend to have lower mean SI values as compared to the rest of the study population, suggesting that SI may
not be a reliable indicator in patients with PIH/eclampsia
Background/Purpose : Pregnant women with polycystic ovary syndrome seem to be prone for adverse maternal and perinatal outcomes, but there is no conclusive evidence. Indian data evaluating the pregnancy outcome in women with polycystic ovary syndrome are sparse. This study was proposed to evaluate the pregnancy outcome in women with polycystic ovary syndrome.
Methods : This descriptive study on 135 pregnant women with polycystic ovary syndrome was carried out in a tertiary care hospital in South India from January 2016 to October 2017. Data regarding present pregnancy, polycystic ovary syndrome and maternal/ perinatal outcomes were analysed using SPSS version 20. Categorical variables studied were parity, various maternal and perinatal outcomes.
Results : The mean age was 26.8 years, 77% had high BMI, and 88% had history of primary infertility. The mean age was 26.8 years, 77% had high BMI, and 88% had history of primary infertility. The proportion of hypertensive disorders of pregnancy was (17.8%), PROM (18.5%), low APGAR score at 5 min (13%), gestational diabetes (13%), miscarriage (2.2%), preterm delivery (10.4%), caesarean delivery (30.4%), low birth weight babies (2%), macrosomia (0.7%), PPROM (8%), perinatal mortality (2%) and NICU admission (20%).
Conclusion : The proportion of hypertensive disorders of pregnancy, PROM, low birth weight babies, low APGAR score at
5 min was found to be higher, but the proportion of GDM, miscarriage, preterm delivery, meconium stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission and congenital
anomalies was found to be either similar or lower in pregnant women with PCOS in our study to those described in the
general pregnant population.
Background and Aim We aimed to compare the levels of clinical, biochemical, hormonal, and metabolic parameters as well as serum CRP, fibrinogen, leptin, and adiponectin in cases with PCOS and control group to investigate whether they play a role in the etiology of the syndrome.
Materials and Methods The present study included a total of 90 subjects, 45 subjects were diagnosed with PCOS (n = 45) and 45 subjects served as control group (n = 45). Serum CRP, fibrinogen, leptin, and adiponectin levels were analyzed for each subject.
Results Serum CRP, fibrinogen, and leptin were found to be higher (statistically significant) in the group with PCOS as compared to the control group (p < 0.05). Serum Adiponectin was higher in the control group (statistically significantly) as compared with the patients in the PCOS group (p < 0.05).
Conclusion CRP and fibrinogen (cardiac risk factor markers) increase in women with PCOS. The levels of leptin which affects metabolism increase, whereas the levels of adiponectin decrease.
PCOS , CRP , Leptin , Adiponectin , FibrinogenBackground/Purpose Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH.
Methods In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24 h postpartum. Primary outcomes were blood loss of 500 ml or greater and at least 10% change in peripartum haematocrit levels.
Results Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route.
Conclusion At the recommended dose, sublingually administered misoprostol (‘the sweet of life’) is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol. ClinicalTrials.gov identifier PACTR201911500348367.
Postpartum haemorrhage , Misoprostol · Rectal , Sublingual , Adverse effectsAim of the Study Studies have shown that gestational diabetes mellitus (GDM) causes disproportionate growth and increased adiposity in their newborns; however, the effect of gestational glucose intolerance (GGI), i.e., 2 h plasma glucose (PG) between 120 and 139 mg/dl in pregnancy on their newborns growth and adiposity is not well established. The objective of the present study is to evaluate the effect of GGI in pregnancy on anthropometry and adiposity of their newborns at birth in urban South Indian population.
Materials and Methods An observational study was conducted on 119 urban South Indian pregnant women and their newborns. PG levels 2 h after ingestion of 75 g glucose load were determined between 24 and 28 weeks of gestation, and depending on their PG levels, these women were categorized into three different groups, (a) normal glucose tolerance
Gestational diabetes mellitus (GDM) , Gestational glucose intolerance (GGI) , Skin fold thickness (SFT) ,Fasting plasma glucose (FPG) , Postprandial plasma glucose (PPPG) , Newborn anthropometric measurements Disproportionate growth · Adiposity · Plasma glucose (PG)Context The accuracy of colposcopy has recently been called into question particularly with regard to determining the site requiring biopsy. The technique of colposcopy is largely operator dependent, and the agreement between colposcopists is less reliable than once presumed. In an attempt to standardize colposcopy a new scoring system, the Swede score has been devised, which includes lesion size as a variable to be scored in addition to the 4 variables found in the modified Reids Colposcopic Index (RCI).
Aim To assess the diagnostic accuracy of Swede score for pre-invasive cervical lesion.
Setting and Design A cross-sectional study in a tertiary care centre.
Method Swede score was calculated for assessment of pre-invasive cervical lesions on patients undergoing colposcopy who were suspected with pre-invasive cervical lesion. Cervical biopsy was taken if modified RCI ≥ 3 or Swede score ≥ 5. Histopathology report of the cervical biopsy was taken as gold standard.
Results Swede scores of 5 or more had sensitivity, specificity, positive and negative predictive values of 94.9%, 88.4%, 75.5% and 92.9% respectively.
Conclusion The Swede score by just incorporating one additional variable that is size of the lesion, showed better correlation with histopathology.
Swede score , Colposcopy , Pre-invasive , Cervical lesion , EfficacyObjectives To determine the efficacy of tranexamic acid in decreasing blood loss in elective/emergency LSCS.
Materials and Methods A prospective randomised case control study was done in 200 pregnant women undergoing elective/ emergency LSCS in the Department of Obstetrics and Gynaecology, at a tertiary care teaching hospital in Mysuru, from December 2018 to September 2019. Women in the age group of 18–35 years were included in the study. Those with anaemia (Hb < 10 gm%), hypertension in pregnancy, bleeding diathesis, GDM on insulin, polyhydramnios, oligohydramnios, cardiac and chronic liver disorders were excluded from the study. Two hundred women undergoing emergency/elective LSCS were divided into case (group 1) or control (group 2) groups using a computer-generated random number table. Tranexamic acid (10 mg/Kg) was given in 100 ml Normal Saline 10 mins prior to skin incision to women in the first group, along with routine care (10 Units of Oxytocin IM soon after extraction of the baby). Routine care, as per institutional protocol, was followed in the second group. The primary outcome was to estimate the intraoperative blood loss. Blood loss was measured by weighing pads, mops, drapes before and after surgery and blood in the suction container after surgery. Two separate suction catheters and containers were used, in order to minimise mixing of blood and amniotic fluid. Total blood loss was calculated as the difference in the weight of the pads, mops and drapes before and after surgery and the sum of the amount of blood in suction container. The difference between the pre-operative and post-operative haemoglobin and haematocrit was compared. The pre-operative, intra-operative and post-operative hemodynamics were also compared.
Results Statistical analysis was done using MS Excel and R-3.5.1 software. Unpaired and paired t test were used. In our study, there was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative hemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery.
Conclusion Tranexamic acid can be safely used as a prophylactic agent to reduce bleeding during elective and emergency LSCS.
Tranexamic acid , Elective/emergency LSCS , Blood loss , HaemoglobinBackground The cerebroplacental ratio (CPR) is emerging as a predictor for adverse perinatal outcome in term pregnancies. Earlier, it has shown a role in small for gestational age (SGA) pregnancies, but a proportion of appropriate for gestational age foetuses (AGA) despite of good size have impaired growth velocity and are thereby at risk of adverse outcome. CPR has implication for assessment of well being of SGA and AGA foetuses close to term.
Objective To investigate the association between foetal CPR and adverse perinatal outcome in uncomplicated term AGA pregnancies.
Methods This was a prospective observational study done in Department of Obstetric and Gynaecology, King George Medical University, Lucknow, over a period of one year. Women > 37 week singleton pregnancy with no known risk factor who had Doppler USG done within a week of delivery were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. These patients were followed up till delivery to look for various perinatal outcomes. Results Out of 127 low-risk AGA pregnancies who went for USG colour Doppler scan, 117 patients who met our inclusion criteria were analysed; out of 117 patients 23(i.e. 19.65 %) were having CPR < 1 and 94 patients (i.e. 80.34%) were having CPR>1. Among 23 patients with CPR < 1, 22 (91.30%) had adverse outcome as compared to only 20.21% patients with CPR > 1, and this is found to be statistically significant (p < 0.001).
Conclusion Our study found CPR measure to be a very promising tool for optimising the identification of at risk foetus in low-risk AGA pregnancies.
Cerebroplacental ratio , Appropriate for gestational age , Small for gestational