Immediate skin-to-skin contact versus care under radiant warmer at birth in moderate to late preterm neonates - A randomized controlled trial

OBJECTIVE

To compare the effect of immediate care at birth in skin-to-skin contact (SSC) or under a radiant warmer on cardiorespiratory stability at 60 minutes of age in moderate-to-late preterm neonates.

METHODS

In this open-label, parallel-group, randomized controlled trial, neonates born at 330/7 to 366/7 weeks of gestation by vaginal delivery and breathing or crying were randomized to receive care at birth in SSC (n = 50) or under a radiant warmer (n = 50). In the SSC group, immediate care at birth including drying and clearing of the airway was provided in SSC over the mother's abdomen. SSC was maintained for an observational period of 60 minutes after birth. In the radiant warmer group, care at birth and post-birth observation was performed under an overhead radiant warmer. The primary outcome of the study was the stability of the cardio-respiratory system in late preterm infants (SCRIP) score at 60 minutes of age.

RESULTS

Baseline variables were similar in the two study groups. The SCRIP score at 60 minutes of age was similar in the two study groups (median: 5.0, IQR: 5-6 vs. 5.0, 5-6). The mean axillary temperature at 60 minutes of age was significantly lower in the SSC group (°C; 36.4 ± 0.4 vs. 36.6 ± 0.4, P = 0.004).

CONCLUSION

It was feasible to provide immediate care at birth in moderate and late preterm neonates while being positioned in SSC with the mother. However, in comparison to care under a radiant warmer, this did not lead to better cardiorespiratory stability at 60 minutes of age.

TRIAL REGISTRATION

Clinical Trial Registry of India (CTRI/2021/09/036730).

Maternal and Neonatal Outcomes in Patients of Gestational Diabetes Mellitus on Metformin Therapy

Background

Present study carried out in a tertiary referral hospital in North India attempts to determine the maternal and neonatal outcomes of metformin therapy in patients of gestational diabetes mellitus.

Objectives

To evaluate maternal and neonatal outcomes in patients of GDM on metformin therapy and to study its adverse effects.

Method

In this prospective observational study, all women diagnosed with GDM not controlled by medical nutrition therapy were started on metformin therapy and the maternal and neonatal outcomes were studied.

Results

A total of 104 patients of GDM, not controlled on MNT and requiring pharmacotherapy, were enrolled for the study. An important clinical data from the study were that in 63.5% of patients there was no family history of diabetes mellitus. Average weight gain during pregnancy ranged from 6 to 10 kg. Glycemic control was achieved in 96.2% of patients with varying doses of metformin therapy, and it reached statistical significance. Duration of metformin therapy ranged from a minimum of 2 months to a maximum of 6 months. No serious side effects were noted except for hypoglycemia in one patient. Patient acceptability toward metformin intake was good. Mean birth weight of newborns was 2972 ± 280 g, and no case of fetal macrosomia was seen. Neonatal hypoglycemia was seen in 3.8% of the babies and 6.7% required NICU admission. No case of congenital malformation was reported.

Conclusions

Metformin is a clinically effective, inexpensive and safe drug for treating gestational diabetes mellitus.

Xanthogranulomatous Endometritis: A Benign Uncommon Masquerader of Malignancy

Xanthogranulomatous endometritis is an uncommon benign lesion characterized by the destruction of endometrium and replacement by the sheets of foamy histiocytes, lymphocytes, plasma cells, multinucleated giant cells, fibrosis, calcification, and accompanying polymorphonuclear leukocytes. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. We report the case of a 61-year-old postmenopausal female who presented with pyometra, bulky uterus, and cervical stenosis, and histopathology revealed XGE.

Risk Factors and Incidence of Puerperal Genital Haematomas

INTRODUCTION

Puerperal genital haematomas although an uncommon entity but is elusive. This painful condition is not only distressing and dangerous to patient but is embarrassing to the obstetrician who has conducted the delivery.

AIM

This study has been planned to evaluate the incidence and risk factors for puerperal genital haematomas.

MATERIALS AND METHODS

A case control study was done from August 2005 to August 2015, of all puerperal genital haematomas. All patients, who had undergone drainage for the puerperal genital haematoma, were enrolled as cases. Two controls were chosen for each case, who had delivered immediately after the case. All the patients were evaluated for the characteristics of haematoma and the management of the same. Cases and controls were compared for the evaluation of risk factors for puerperal genital haematoma.

RESULTS

During the study period 27,826 vaginal deliveries were performed in our institute. Thirty nine haematomas were drained during this period. Incidence of haematomas was one in 1,113 deliveries, in our institute. Among the puerperal haematomas, vulvovaginal was the most common type. Perineal pain was the most common complaint. To evaluate the risk factors, 77 controls were enrolled. Primigravida, hypertensive disease of pregnancy and coagulopathy were the significant risk factors with p-value of <0.01, 0.01 and 0.03 respectively. Episiotomy too was a risk factor with a p-value of 0.002.

CONCLUSION

Primigravida, hypertensive disease of pregnancy, coagulopathy and episiotomy are still the most common risk factors.

Screening methods (clinical breast examination and mammography) to detect breast cancer in women aged 40-49 years

Objective:

The aim of this study is to detect breast cancer rate, nodal status, tumor size, and associated risk factors using clinical breast examination (CBE) and mammography as screening tools in women aged 40–49 years.

Materials and Methods:

A total of 500 women were screened in a time period of 2 years, between the ages of 40–49 years for breast cancer. Screening tools used were CBE and mammography. Clinical history and risk factors related to breast cancer were recorded. CBE was performed to detect any breast pathology followed by mammographic screening. Breast Imaging Reporting and Data System (BI-RADS) mammographic density categories were used for reporting breast imaging on mammography. For women with dense breasts or an inconclusive mammography report, ultrasonography was performed to assess the lesion/s. Suspicious lesion was subjected to fine-needle aspiration cytology or an open surgical biopsy for a confirmatory diagnosis. Women with history of breast cancer were excluded from the study.

Results:

CBE was normal in almost 90% of the women. Screening mammography revealed Breast Imaging Reporting and Data System (BI-RADS) I and BI-RADS II in 58.4% and 34.6% of women, respectively. Only 7% of women belonged to BI-RADS III and none in BI-RADS IV category.

Conclusion:

The study findings are in agreement with the recommendations of the World Health Organization, US preventive task force and UK guidelines that recommend screening mammography in women starting at 50 years.

Comparison of One-Step Versus Two-Step Screening for Diagnosis of GDM in Indian Population: A Randomized Controlled Trial

OBJECTIVE

To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step versus two steps as a screening procedure.

METHODOLOGY

A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two-step approach (ACOG recommendation), and group B comprised of women screened by one-step method (IADPSG criteria). Women diagnosed with 'gestational diabetes' were followed in an antenatal clinic, and incidence of GDM and maternal and fetal outcome between two groups were analyzed using SPSS.

RESULTS

The incidence of GDM was almost double using one-step versus two-step approach which was 19.2 and 11.8%, respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI 1.01-5.79). Further, fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A versus 7.4% in group B. In the group B, 15 patients (15.8%) with GDM (based on FBS ≥ 92 mg/dl at first ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.

CONCLUSION

The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥ 92 mg/dl at first ANC visit as per IADPSG) and suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.

Combined spinal-epidural for labor analgesia with low-dose bupi- vacaine but without any opioid in the spinal component: can we improve upon the traditional?

AIM

To compare the efficacy and safety of combined spinal-epidural (CSE, with the spinal component using low-dose heavy bupivacaine without opioid) with low-dose epidural analgesia in labor.

METHODS

Sixty consenting adult parturients requesting epidural were randomly allocated to two equal groups to receive either low-dose epidural or CSE analgesia. The Epidural Group received 10ml of a mixture of 0.1% bupivacaine and 2 µg/ml fentanyl, followed by a 6 ml first bolus after 10 min if needed (not considered as a top-up). All patients received 8 ml/h continuous background infusion, with patient-controlled top-up bolus of 6 ml with a lock-out interval of 12 min. In the CSE Group, 0.5% (heavy) bupivacaine 2.5 mg was used to produce spinal block (without concomitant use of any opioid), followed by epidural continuous background infusion of 8 ml of 0.1% of bupivacaine and 2 µg/ml of fentanyl, with a similar top-up provision as in the Epidural Group. Primary outcome was total drug consumption during labor, corrected by the duration of labor (ml/h).

RESULTS

Mean total drug consumption during labor was significantly less in the CSE group (9.69 ml/h) than in Epidural group (13.52 ml/h ; P < 0.00 1). CSE also led to significantly faster onset of analgesia and sensory block. There was no significant difference between the two groups with regard to all other variables. Maternal satisfaction was rated as 'excellent' by all subjects.

CONCLUSIONS

CSE using low-dose heavy bupivacaine without opioid required less drug consumption produced faster onset of pain control and sensory block than low-dose epidural analgesia. There were no other significant inter-group differences.

Uterine granuloma involving the myometrium: Two case reports

Uterine granulomas confined to the myometrium are uncommon. Granulomas maybe infectious, non-infectious or idiopathic in origin. They may be diffuse or focal in nature. In this report, we describe two cases of granulomas of diffuse variety involving the myometrium. The first case shows non-necrotizing granuloma probably related to previous instrumentation. The second case depicts caseating granulomas along with Leiomyoma of uterus.

Contraceptive practices and awareness of emergency contraception in educated working women

BACKGROUND

Regular contraceptive use and emergency contraception are tools to prevent pregnancies.

AIMS

This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital.

SETTINGS

Educated workingwomen in a medical college hospital.

DESIGN

Cross-sectional study.

MATERIALS AND METHODS

The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception.

RESULTS

Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception.

CONCLUSIONS

A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.

Contraceptive practices and awareness of emergency contraception in educated working women

BACKGROUND

Regular contraceptive use and emergency contraception are tools to prevent pregnancies.

AIMS

This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital.

SETTINGS

Educated workingwomen in a medical college hospital.

DESIGN

Cross-sectional study.

MATERIALS AND METHODS

The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception.

RESULTS

Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception.

CONCLUSIONS

A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.