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Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

• In this work, we suggested a computerized decision-making process for deciding on the best birthing style. • A deep neural network model (DNN) was developed by using train set with h2o package. The model was selected on the basis of AUC (Area Under the Curve) & KS (Kolmogorov-Smirnov) score. The AUC, KS score for train set were 0.99, 0.98 respectively. • The prediction error rates for caeseraen & vaginal classes in train data are 0.02 & 0.00 respectively. • The results support the use of these algorithms in the creation of a clinical decision system to help gynecologists choose the most appropriate delivery method. One of the factors that worry obstetricians the most is the method of delivery. In recent years, the rate of caesarean sections has steadily climbed and now exceeds the threshold advised by medical organizations. Obstetricians typically lack the tools they need to assess whether vaginal delivery or a caesarean delivery is more appropriate. In this work, we suggested a computerized decision-making process for deciding on the best birthing style. The data was collected from 101 pregnant subjects who were admitted to hospital in eastern India for delivery from January 2021 to September 2021.The data set had 101 instances & 11 variables. The response was a binary variable with "caesarean" & "vaginal" as the outputs. A deep neural network model (DNN) was developed by using train set with h2o package. The model was selected on the basis of AUC (Area under the Curve) & KS (Kolmogorov-Smirnov) score. The AUC, KS score for train set were 0.99, 0.98 respectively. The prediction error rates for caeseraen & vaginal classes in train data are 0.02 & 0.00 respectively. The results support the use of these algorithms in the creation of a clinical decision system to help gynaecologists choose the most appropriate delivery method. [ABSTRACT FROM AUTHOR]

Background: Increase in global rate of Caesarean deliveries poses significant public health concerns as it is associated with high costs and risks for maternal, new born health. In India understanding determinants of Caesarean deliveries is of paramount importance in order to prevent maternal and child health morbidity and mortality. Aims and Objective: To investigate the socio-demographic determinants of Caesarean deliveries in India using cross-sectional data from National Family Health Survey. Methodology: The present study is a cross-sectional record based study using data from National Family Health Survey conducted in India between 2019 and 2021. The primary outcome variable is Caesarean delivery, while predictors are socio-demographic and obstetric factors. Frequency analysis used for socio-demographic variables and binary logistic regression was used to determine the determinants of Caesarean deliveries among women in the reproductive age group. The analysis was done using IBM SPSS Statistics 26.0 Software. Results: The socio-demographic and obstetric factors like maternal age, residence, education, employment, BMI, Birth order, number of Antenatal visits, place of delivery, wealth index, and media exposure are associated with Caesarean delivery. Conclusions: The study provides insights into the factors influencing Caesarean deliveries rates among women in India. [ABSTRACT FROM AUTHOR]

Objective: We compared efficacy of weight‐based (0.4 IU/kg/h) versus fixed‐dose (34 IU/h) oxytocin infusion during cesarean section. Methods: The oxytocin infusion in either group (n = 32 each) was initiated upon cord clamping. Primary outcome measure was adequacy of uterine tone at 4 min after initiating oxytocin infusion. Oxytocin associated side effects were also observed. Results: Significantly less oxytocin was used with the weight‐based versus fixed‐dose regimen (16.3 [11.2–22.4] IU vs 20.4 [15.8–26.9] IU; P = 0.036). Incidence of adequate uterine tone was clinically greater but not significantly different with the weight‐based versus fixed‐dose regimen (81.3% vs 71.9%; P = 0.376). The weight‐based regimen was associated with clinically lesser, although not statistically significant need for rescue oxytocin (25% vs 46.9%; P = 0.068) and additional uterotonic (9.4% vs 15.6%; P = 0.708); as well as oxytocin associated side effects (hypotension [34.4% vs 46.9%; P = 0.309], nausea/vomiting [18.8% vs 40.6%; P = 0.055], and ST‐T changes [0% vs 3.1%; P = 1.000]). Conclusion: Weight‐based oxytocin was not significantly different from the fixed‐dose regimen in terms of uterotonic efficacy or associated side‐effects, despite significantly lower doses being used. Use of weight‐based oxytocin infusion (0.4 IU/kg/h) can be considered in clinical practice. Trial Registration: Clinical Trial Registry of India (ctri.nic.in, number. CTRI/2021/01/030642). Synopsis: Using weight‐based oxytocin infusion results in significant reduction in dose (P = 0.036), while achieving a similar incidence of adequate uterine tone during cesarean section. [ABSTRACT FROM AUTHOR]

Cesarean births are becoming more common in India, with health implications for both mothers and infants. Between 2005 and 2015, the proportion of cesarean births to total births in India roughly doubled, from 9% to 17%. We analyze Annual Health Survey data from the state of Odisha in eastern India. These population-level, longitudinal data on births between 2007 and 2011 allows us to estimate the association between cesarean birth and breastfeeding outcomes using mother fixed effects. Mother fixed effects allow comparisons of siblings born to the same mother who experienced different types of births (vaginal and cesarean). This empirical strategy controls for many potential observable and unobservable confounders in the relationship. Ordinary Least Squares linear probability models without mother fixed effects find that babies born by cesarean in Odisha are about 14 percentage points (p<0.001) more likely to experience delayed initiation of breastfeeding (that is, not being breastfed in the first 24 hours) compared with babies born vaginally. After introducing mother fixed effects, we find that babies born by cesarean are 11 percentage points more likely to (p<0.001) experience delayed initiation of breastfeeding. Because breastfeeding success is important for protecting against infectious disease in this context, future research should investigate whether cesarean birth impacts other aspects of breastfeeding as well. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of preoperative vaginal cleansing with chlorhexidine and cetrimide solution on postoperative infectious morbidity. Methods: This prospective cohort study was conducted over a period of 18 months in the Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Women undergoing cesarean section were alternately allotted to study and control groups. Women with chorioamnionitis, antepartum hemorrhage, rupture of membranes for more than 24 h, and fever in the preoperative period were excluded. The study group received preoperative vaginal cleansing with antiseptic solution (7.5% chlorhexidine w/v and 15% cetrimide w/v); the control group did not receive vaginal cleansing. Both groups were followed for the presence of any infectious morbidity until they were discharged from the hospital. Results: Age, body mass index (calculated as weight in kilograms divided by the square of height in meters), gestational age, and the parity of the women in the study and control groups were comparable (n = 760). The rate of endometritis was lower in the study group, but the difference was not statistically significant (P = 0.054). Post‐cesarean febrile morbidity and wound sepsis were significantly lower in the study group (P = 0.017 and P = 0.02, respectively). On subgroup analysis, women in the study group with rupture of the membranes before cesarean delivery had lower wound sepsis and a reduced duration of hospital stay. Women in the study group with emergency cesarean delivery showed a significant reduction in wound sepsis, febrile morbidity, and length of hospital stay. Conclusion: Preoperative vaginal cleansing with chlorhexidine and cetrimide solution before a cesarean section reduces postoperative infectious morbidity. Synopsis: A simple intervention of preoperative vaginal cleansing with chlorhexidine and cetrimide solution reduces postoperative infectious morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Intimacy with partner and communication is positively connected with contraceptive usage. Awareness regarding contraception and birth spacing helps awoman to get away with her reproductive years safely without complications. To address women's need for family planning, the provision of a wide range of safe, effective and affordable contraceptive methods is essential. A mix of methods offered must cater to women's needs and preferences. It is also important to note that every contraceptive method has advantages and disadvantages. Contraceptive use also helps individuals to fulfill their sexual desire with no fear and stress. Materials and Methods: A retrospective analytical study was conducted at Kalpana Chawla Government Medical College, Karnal, Haryana by collectingdata of patients getting discharged from postpartum wards between 1st January, 2023 to 1st January, 2024 after either getting delivered normally or via lower segment cesarean section and their contraceptive choices were noted at the time of discharge. With an average of 400 deliveries per month, around 4800 patients werestudied in around one year duration. Results: 70 percent patients opted for Male Condom (Barrier Method) as a method of contraception, 10 percent patients wanted ligation, 10 percent for PPIUCD, 3 percent for Injection Antara, 4 percent for POP, 3 percent did not wantto use any method. Conclusion: There is an unmet need for contraception in our country. Womenare aware regarding contraceptive choices but the greatest hindrance is availability of the contraceptive device and its cost effectiveness. Disbursal at the time of discharge when the patient has a calm mind and is able to properly make a feasible choice regarding the contraceptive method is a suitable measure to capture this unmet need. [ABSTRACT FROM AUTHOR]

Background: Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. Main objectives: To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. Methods: A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. Results: The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). Conclusion: The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI. [ABSTRACT FROM AUTHOR]

Background: Postpartum Depression (PPD) is one of the least vocalized topics surrounding pregnancy and motherhood in India. The study aimed to assess the postpartum depression in women who had cesarean and normal vaginal deliveries. Materials and Methods: In this study, we identify postpartum depression in recently postpartum women and compare it in different maternal ages, modes of delivery (cesarean and vaginal), and sexes of the babies, since very few studies have explored these as risk factors. Data were obtained over six months from 210 women via their responses to the Edinburgh Postnatal Depression Scale (EPDS). An EPDS score of =7 out of 30 was set to determine postpartum depression, which was further classified as mild, moderate, or severe. Results: Total of 210 patients analyzed in the study out of which 157 (74.7%) exhibited PPD, which was more common in mothers aged between 19 and 27 years, and those who delivered via cesarean section. Mild depression was the most frequently occurring severity overall. Conclusion: Screening of PPD and providing suitable education should be encouraged during postpartum care or child-care visits for identifying and managing PPD, which in turn improves child development. [ABSTRACT FROM AUTHOR]

Background The rising incidence of PAS, particularly associated with increased cesarean section rates, and the added complexity of placenta previa create a challenging scenario in obstetric care. The primary objective of this investigation is to assess various fetomaternal outcomes, placing a particular emphasis on maternal morbidity and mortality, neonatal complications, and the overall efficacy of different management approaches. Methodology A retrospective design was utilized in the investigation, centering on pregnant individuals who had been diagnosed with PAS and placenta previa at Regional Institute of Medical Sciences (RIMS) in Imphal, Manipur, India, in a period between January 2018-March 2020. A cohort of 24 pregnant women, meeting specific inclusion criteria, formed the basis of the investigation. The analysis involved a comprehensive review of medical records, imaging studies, and surgical outcomes. Results Examining the data from 24 pregnant women diagnosed with both PAS and placenta previa, it was discovered that a prior cesarean section stood out as the predominant risk factor for PAS, with 100% of cases attributed to it. Planned cesarean deliveries were the predominant mode of delivery (89.7%) at a mean gestational age of 37.2±1.5 weeks. Emergency cesarean sections were infrequent but associated with lower fetal Apgar scores. Uterus preservation attempts, though limited, resulted in successful full-term pregnancies with minimal blood loss. The majority underwent cesarean hysterectomy with ovarian preservation, with significant differences in blood loss observed between cases with one prior cesarean section and those with multiple cesarean sections. Complications, particularly bladder injuries, were more prevalent in cases with non-conservative management. While the conservative management group exhibited a higher frequency of short-term complications, no severe maternal outcomes were observed. Conclusion Despite acknowledging study limitations, including the retrospective design and a relatively small sample size, the research contributes valuable insights into the complexities of managing PAS associated with placenta previa. The findings underscore the critical role of risk factor identification, early diagnosis, and tailored interventions to optimize fetomaternal outcomes in high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Pilates Method as been a popular background for almost a century and is now used worldwide as a form of fitness and holistic health because it can be tailored to individual needs and fitness levels. Lucia first adevised mat exercises performed on the floor, adapting them to individual physical and temporal constraints without compromising the wider element. He later labeled a series of specialized devices, including springs and rollers, that provide resistance to develop divergent movement patterns.13 Performing exercise with medium intensity has positive effects on the maternal health.The goal of obstetric care is to provide the right conditionsfor a safe delivery and make it a pleasant experience. Labor pain is an unavoidable component of child birth whose proper management, despite the greatadvances in midwifery, is still one of the major challengesrelated to women's health. Pregnant women should also be clinically evaluated before starting exercise to ensure there is no medical reason to stop exercising. Methods: Patients were randomly divided into two groups of 15 people in each group. In the intervention group, a Pilates exercise program was developed in collaboration with a Pilates trainer. The program was tailored to the susceptibility of pregnant women and was administered twice weekly for 8 weeks. Four tools were used in this study, including a two-part checklist, the Borg Rating of Perceived Exertion (RPE), the Visual Analogue Scale (VAS), and the McKee Childbirth Satisfaction Rating Scale. A two-section checklist was used in this study to collect the required information. Conclusion: According to the results of this study, Pilates exercise during pregnancy is a safe method to reduce the length of the active phase and second stage of labor, reducelabor pain, and increase maternal satisfaction with thechildbirth process. However, Pilates exercise did not significantlyreduce the need to episiotomy and caesarean section. [ABSTRACT FROM AUTHOR]

Background and Objectives: A clean, uncontaminated wound results from a Caesarean section. Antibiotics are mostly used to lower parturition infections and associated problems. Lowering the mortality and morbidity following surgery. This study looked at the effectiveness of using a short course of antibiotics against the longer course that is typically used in a government tertiary care facility. Material and Methods: This study was conducted as a prospective interventional study. The present study involved a total of 200 individuals who were randomly assigned to two separate groups. Each group is comprised of 100 individuals. The selection of participants was conducted in accordance with predetermined inclusion and exclusion criteria. The research was carried out at Narayana Medical College, Nellore, and Andhra Pradesh, India under the department of Obstetrics and Gynaecology. The study was done from August 2022 to August 2023, spanning a duration of one year. Results: Based on the cited current research, the estimated incidence of wound infection typically ranges from 3% to 5%. The study conducted by Robinson et al. examined the association between risk factors and wound infection. The findings indicated that extremely obese individuals had a higher risk of wound infection compared to non-obese individuals. There was no significant variation in the incidence of wound infection based on the type of skin incision employed. Its primary objective was to assess infectious morbidity and the findings revealed that the collective risk of maternal infectious morbidity was 17%. Conclusion: Based on the findings of this study, it can be inferred that a shorter duration of antibiotic treatment yields comparable efficacy to a longer duration of antibiotic treatment. No statistically significant differences were observed between the two groups in relation to febrile morbidity, wound induration, serous wound discharge, purulent wound discharge, wound gaping, or atypical vaginal discharge. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in both developing and developed countries. PPH is a severe obstetric emergency that often occurs unexpectedly, leaving birth attendants unprepared to handle it on a regular basis. Aim: To evaluate the efficacy and complications of the Bilateral Uterine Artery Ligation (BUAL) technique and B-lynch sutures in Lower Segment Caesarean Section (LSCS) for primary PPH caused by uterine atony. Materials and Methods: A hospital-based prospective, interventional study was conducted at a secondary care centre in the inpatient Department of Obstetrics and Gynaecology at District Hospital, Tumkur, Karnataka, India. The duration of the study was one year from August 1, 2019, to August 1, 2020. A total of 100 patients with atonic PPH were randomly assigned to receive either BUAL (group BUAL-50 patients) or B-lynch sutures (group B-lynch-50 patients). Age, parity, gravidity, socioeconomic status, and risk factors were compared. The mean drop in Haemoglobin (Hb) percentage, the need for blood transfusion, and complications were studied and analysed. The success of the method was defined as avoiding obstetric hysterectomy and major complications. The z-test was used to calculate the difference between the means of the two groups. Results: The mean age of the patients was 25.22±4.33 years in the BUAL group and 26.02±4.32 years in the B-lynch group. During the one-year study period, the total number of deliveries in the Institution was 4,658, with 1,864 vaginal deliveries and 2,794 LSCS performed. Among the 2,794 LSCS cases, 268 women (9.58%) developed primary PPH. Out of these 268 women, 134 (50%) were managed with primary medical treatment for atonic PPH. For those who did not respond to primary medical management and met the inclusion and exclusion criteria, 50 women underwent BUAL and were assigned to the BUAL group. Another 50 cases were treated with B-lynch sutures and assigned to the B-lynch group. The patients in both groups were matched in terms of age, socio-economic status, booking status, gestational age at delivery, induction of labour, and high-risk factors for PPH. Maternal outcomes were analysed. The mean preoperative Hb level was 9.65±1.16 g/dL, which significantly decreased to 8.54±1.27 g/dL post-procedure in the BUAL group (p-value <0.001). In the B-lynch group, the mean preoperative Hb level was 9.68±0.85 g/dL, which significantly decreased to 8.52±0.95 g/dL post-procedure (p-value <0.001). The mean blood loss among patients was 1312.14±227.65 mL in the BUAL group and 1359.22±259.07 mL in the B-lynch group, but the difference was not statistically significant (p-value = 0.33). In the present study, 17 patients (34%) in the BUAL group and 21 patients (42%) in the B-lynch group did not require blood transfusion. The Intensive Care Unit (ICU) care was necessary for 6 (12%) patients in the BUAL group and 8 (16%) in the B-lynch group. Postoperative fever was a common complication in both groups. The success rate of BUAL was 94%, while the B-lynch procedure was successful in 96% of cases. Conclusion: The PPH a significant concern for obstetricians, and effective and meticulous management is crucial in reducing maternal mortality. Both BUAL and B-lynch sutures are simple, safe, and effective methods for controlling PPH during caesarean section by uterine devascularisation. [ABSTRACT FROM AUTHOR]

Introduction: Nalbuphine and magnesium sulfate are commonly used drugs for the treatment of Perioperative Shivering (POS), but there is a paucity of comparative studies on their intrathecal use in Lower Segment Caesarean Section (LSCS) patients. LSCS is the most commonly performed obstetric surgery, and Spinal Anaesthesia (SA) is advantageous in LSCS. However, shivering has been found to be the most common side-effect of SA. Aim: To compare the effect of intrathecal injection of nalbuphine and magnesium sulfate on the prevention of postspinal anaesthesia shivering during LSCS. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kathua, Jammu and Kashmir, India on 60 parturients between the ages of 20-40 years from September 2021 to January 2023. The participants had full-term gestation and an American Society of Anaesthesiologists (ASA) status of I or II, and were scheduled for LSCS under SA. The total sample was divided into two groups of 30 patients each. Group N (n=30) received 0.7 mg nalbuphine intrathecally, while Group M (n=30) received 25 mg of magnesium sulfate intrathecally, both with 0.5% bupivacaine (10 mg). Characteristics of spinal blockade, time to onset of shivering, severity of shivering, and side-effects such as nausea, vomiting, sedation, and hypotension were noted. Student’s t-test, Chi-square test, and Fisher’s exact test were used for data analysis. A p-value of <0.05 was considered statistically significant. Results: Both study groups were comparable in terms of age (p-value=0.081), height, weight (p-value=0.079), ASA grade (p-value=0.072), and duration of surgery (p-value=0.077). In group N, 5 patients (16.67%) had POS, while in Group M, 6 patients (20%) had POS, but the difference was not statistically significant. In Group N, 3 patients (10%) had a shivering score of 3 and 2 patients (6.67%) had a shivering score of 4, while in group M, 3 patients (10%) had a shivering score of 3 and 3 patients (10%) had a shivering score of 4. The difference was statistically insignificant. Perioperative complications (sedation, hypotension, nausea, and vomiting) were comparable in both groups with no statistically significant difference. Conclusion: Intrathecal injection of preservative-free 0.7 mg nalbuphine and 25 mg magnesium sulfate were both effective in reducing the incidence of postspinal shivering. Both drugs had comparable minimum perioperative complications. The intrathecal use of nalbuphine and magnesium sulfate for the prevention of postspinal shivering is encouraged, as both drugs are less expensive and readily available in the operation theaters. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, side-effects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value <0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value <0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects. [ABSTRACT FROM AUTHOR]

We developed and tested the Indian Autism Screening Questionnaire (IASQ), which was reported to be reliable and valid as compared to the Indian Scale for Assessment of Autism (ISAA) and the Childhood Autism Rating Scale -2 (CARS2). The present study describes the feasibility, acceptability, sociodemographic and developmental details of IASQ study participants in 5 settings- a psychiatry outpatients' clinic (n = 145), a specialised paediatric clinic (n = 24), a speciality disability centre (n = 174), a primary school (n = 41) and a government housing colony (n = 255). The IASQ could be easily administered and understood. Consistent with prior reports, the male-female ratio of participants with autism was 3.8:1. Developmental complications were reported more frequently in clinical settings, while delivery by Caesarean section was commoner among community-dwelling higher socioeconomic status mothers (53% of the officers' sample). Mothers of participants with autism more frequently reported Caesarean section birth for the proband (χ2 = 41.61, p <.0001) and prenatal and postnatal complications. Binary logistic regression confirmed that perinatal complications in the mother and father's (older) age at birth of the participant were associated with autism. The IASQ is a reliable, practical tool for screening for autism in clinical and non-clinical settings in India. [ABSTRACT FROM AUTHOR]

The state of pregnancy and child birth is a stretch of intense vulnerability and incurs reproductive cost, which is governed within a specific socio-ecological context. We asked in our research whether the obstetric morbidities at three stages: antepartum, intrapartum and postpartum, and their concomitants differed significantly between sedente and migrant populations. 403 Oraon indigenous women [203 sedente and 200 migrants] living in Eastern India were selected. Data on socio-demographic, reproductive, maternal health care services and obstetric morbidities were collected using semi structured schedules. We applied Categorical Principal Component Analysis (CATPCA) on the first three variables; PC1 and PC4 were loaded with "socio-demographic and maternal health care services" and PC2 and PC3 loaded with "socio-demographic and reproductive" variables. We applied Poisson regression to examine the determinants of obstetric morbidities. Bivariate analyses showed significant (p ≤ 0.05) sedente-migrant differences in variables related to socio-demographic, reproductive, maternal health care and obstetric morbidities. Poisson regression showed migrants were more likely (p ≤ 0.001) to experience ante and intrapartum morbidities than the sedentes, after controlling the confounders. PC1, PC2 and PC3 could significantly (p ≤ 0.05) predict ante and intrapartum morbidities. For postpartum morbidities, barring the variables related to availing of maternal health care services at the time of child delivery and post delivery, neither migration status nor any of the PCs was a significant predictor. For example, participants who delivered their child in health institutions and had episiotomy and/or caesarean delivery (p ≤ 0.01); and those who availed first PNC within the 24 hours of delivery, stayed under medical supervision after delivery for more than 48 hours and received higher coverage of PNCs were more and less likely respectively (p ≤ 0.05) to have experienced postpartum morbidities. We conclude that the maternal obstetric morbidities and their concomitants differed between sedente and migrant Oraon populations owing to their living in differential socio-ecological contexts. [ABSTRACT FROM AUTHOR]

Postoperative incisional pain following lower segment cesarean section (LSCS) is one of the commonly reported complaints which may affect mother-infant bonding, and restrict mobility and functional activities. To study the influence of transcutaneous electrical nerve stimulation (TENS) on pain intensity and functional activities using the Numerical Pain Rating Scale (NPRS) and the Patient Specific Functional Scale (PSFS) following LSCS from the postoperative day (POD) 1 to POD 4. This quasi-experimental study consisted of 50 postpartum women who underwent LSCS and were assigned to an intervention group (IG) that received TENS and a control group (CG) that received routine hospital care. NPRS scores between CG and IG (pre-TENS application) showed a statistically significant difference (ηp2 = 0.542, p <.001) from POD 1 to POD 4. Study participants showed an improvement in PSFS scores (ηp2 = 0.412, 0.488, 0.661, 0.304, 0.262, and 0.395, p <.001) in IG compared to CG for bed transitions, bed transfers, sitting, sit to stand, walking, and toileting activities respectively from POD 1 to POD 4 which was statistically significant. Our study results suggest that administration of TENS following LSCS shows an improvement in pain intensity and functional activities as reported on NPRS and PSFS respectively. [ABSTRACT FROM AUTHOR]

Background: UP has the 2nd highest MMR which is 197 compared with national average of 113 (RGI-SRS-2016-2018).Although institutional deliveries in India has been increased from 78.9% (NFHS-4) to 89% (NFHS-5) [ UP from 67.8% to 83.4%] but still we are far away from SDG -3 target. It reflects that there may be increase in crude coverage but not in effective coverage. Materials and Methods: It is a cross sectional study conducted in May-June 2017. Out of 8 blocks of rural Varanasi, 4 blocks were selected randomly. Best functioning facility for EmOC services in each selected block were assessed using Facility Gap Assessment Schedule of IPHS. Result: None of the facility met the recommended standard for BEmOC .Tracking of drop out of ANC and PNC services, use of Partograph, treatment of abortion-related complications, were not found at all the 4 facility. Blood grouping and RH typing was also not functional at 2 of the 4 centers. Caesarean section and availability of blood bank were also lacking in CHC (FRU). Conclusion: If condition of best functioning facility in a block is not according to the recommendation then how can we expect to provide a good maternal health service to public. [ABSTRACT FROM AUTHOR]

Introduction: Referral of patients has improved fetomaternal outcomes in developing countries like India. Identifying high-risk obstetric cases, severe maternal complications, and promptly referring them to a centre equipped with Basic Emergency Obstetric and Newborn Care (BEmONC) helps reduce morbidity and mortality. Aim: To examine the clinical profile of referred obstetric patients admitted to a tertiary care centre and analyse the characteristics of admission, referral pattern, level of delay, and their fetomaternal outcomes. Materials and Methods: A hospital-based observational crosssectional study was conducted from July 1, 2021, to June 30, 2022, at Assam Medical College and Hospital, Dibrugarh in Assam, India. The study included 700 referred obstetric patients from private and public healthcare settings. Variables such as place of referral, referrer (medical officer/self-referral/staff nurse/specialists), delay in referral, reasons for referral, pregnancy period during referral, diagnosis at admission and referral, availability of proper referral documents, and fetomaternal outcomes such as mode of delivery and gestational age at delivery were assessed. Categorical variables were summarised as proportions and percentages. Results: Out of the total 18,245 obstetric admissions during the study period, approximately 14,500 patients were referred, accounting for 80% of all admissions. Among the 700 study participants, 616 (88%) referrals were from nearby public sectors. A total of 147 (21%) experienced delay due to transportation. 644 (92%) had referral slips, but only 224 (32%) had proper documentation. A number of 322 (46%) were intrapartum referrals. A total of 350 (50%) were primigravida, while 344 (49%) were multigravida. Apart from these 694 pregnant mothers, six referrals were for babieswithout any maternal complications or high risk factors. 112 (16%) referrals were for cases of IUGR and oligohydramnios, and 98 (14%) were preterm referrals. A total number of 276 (47%) deliveries were performed via caesarean section. A total of 35 patients were discharged antepartum, and there were nine maternal deaths. Additionally, 148 neonates required ICU admissions, 225 were preterm, and 558 babies were discharged. Conclusion: Referrals were made for both maternal and foetal causes. The majority of obstetric admissions in our institution were referrals, resulting in an increased delivery rate and a higher trend of caesarean section. The presence of a well-equipped NICU also contributed to the referral pattern. [ABSTRACT FROM AUTHOR]

Introduction: Ovarian masses are not uncommon in pregnancy. The increased use of Ultrasonography (USG) in recent years has led to the detection of asymptomatic ovarian masses in pregnant women. Dermoid cysts are the most common type of ovarian germ cell tumour in pregnancy. Most of them are asymptomatic and are incidental findings. However, a few can present with complications such as torsion and rupture. The diagnosis and management of dermoid cysts in pregnancy present a clinical dilemma. Aim: To evaluate the management and outcomes of antenatal patients diagnosed with dermoid cysts. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Christian Medical College, Vellore, Tamil Nadu, India, from January 2015 to January 2022. The study included 37 patients, and data regarding the diagnosis of dermoid cysts, their radiological and clinical characteristics, management, and pregnancy outcomes were collected from the electronic database. Descriptive statistics were used for reporting demographic and clinical characteristics. Categorical variables were presented as numbers with percentages, while continuous variables were presented as mean with Standard Deviation (SD) or median with Interquartile Range (IQR). Results: The dermoid cysts ranged in size from 2.2 cm to 30 cm, with a mean size of 7.28±4.51 cm. A total of 35 (95%) of them were incidentally detected. USG was the imaging modality used for diagnosis and follow-up. Only 30% (11/37) of the patients required surgical intervention during the antenatal period. Torsion was the indication for emergency surgical intervention in 46% (5/11) of cases. Laparoscopy was the preferred approach for surgical intervention in 91% (10/11) of patients. The remaining 70% (26/37) of patients were managed conservatively with serial USG, and no adverse outcomes were reported. Among the patients who underwent caesarean section for obstetric indications, 35% (13/37) also underwent surgical intervention for the dermoid cyst (either cystectomy or oophorectomy) during the same procedure. Conclusion: Antenatal patients diagnosed with dermoid cysts during pregnancy can be managed conservatively with serial USG, with a plan for surgical intervention if needed. In cases where surgical intervention is required, it can be safely performed as a laparoscopic procedure. In case of complications such as torsion, laparoscopy can be performed during pregnancy with appropriate precautionary measures. [ABSTRACT FROM AUTHOR]

Background Mothers with cesarean section need more attention and care. Early ambulation is the essential to restore the maximum muscle function and improve the health during postoperative period. Early ambulation certainly has proven to be effective in preventing postoperative complications. Aim To evaluate the effectiveness of early ambulation on postoperative recovery among cesarean mothers. Methods Nonprobability purposive sampling technique was used to select 60 cesarean mothers, with 30 samples in each of the experimental and control group. Mothers in the intervention group received bed exercises by the investigator such as flexion and extension of the extremities, upper limb exercises, lower limb exercise, turning the patient, sitting with dangling the feet, and deep breathing exercises which was initiated at 10 hours of cesarean section followed by standing and walking at 12 hours of cesarean section for twice a day, whereas the control group received routine treatment as per the hospital protocol. Demographic proforma was used to assess the demographic characteristics, and structured postoperative recovery assessment tool was used to assess four major components such as pain, breast feeding, postnatal changes, and activity of daily living. The obtained data were analyzed using descriptive and inferential statistics. Statistical Analysis Significant difference in the postoperative recovery score was calculated by using RM-ANOVA and independent t -test and the association of postoperative recovery score with selected demographic variables done by chi-square test. Results The majority of mothers in intervention (66.7%) and control group (63.3%) were 24 to 29 years old and had secondary education (60% each). There was significant difference in breast feeding (p = 0.001), involution of uterus (p = 0.047), amount of lochia (p = 0.027), and activity of daily living in the intervention group (p < 0.05) compared with the control group. Conclusion Early ambulation improves the postoperative recovery and helps to achieve a good sense of well-being. [ABSTRACT FROM AUTHOR]

Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to document the fetomaternal outcome in HIV‑infected pregnant women delivering at a tertiary health‑care center of South Gujarat. Subjects and Methods: This study was a secondary data analysis of pregnant HIV‑infected women delivering between May 2017 and April 2021 in the Department of Obstetrics and Gynecology, a tertiary health‑care center of South Gujarat. Statistical Analysis: Secondary data analysis was performed using IBM SPSS ver. 20.0 (IBM SPSS Corp., Armonk, NY, USA). Results: A total of 145 HIV‑infected pregnant women were delivered at our institute during the study period. Thirteen (8.97%) participants had preterm delivery. Eighty‑eight (60.68%) of the 145 participants had vaginal delivery and 57 (39.32%) underwent cesarean section. One hundred and forty‑three (98.62%) of our 145 participants had live births, whereas 2 (1.38%) had stillbirths. Most of the newborns, i.e., 96 (64.43%) had a birth weight of between 2 and 3 kg, and 25 (16.77%) had a birth weight of <2 kg. Out of 147 live‑born babies, 36 (24.48%) babies were admitted to the neonatal intensive care unit NICU. Conclusion: Although the HIV positivity in our general population is <1%, it entails a slightly higher risk of preterm birth and stillbirth for the HIV‑positive pregnant women. Early registration and appropriate antenatal care are necessary for optimizing the fetomaternal outcome. [ABSTRACT FROM AUTHOR]

Background: Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. Methods: We used data from the latest round of the National Family Health Survey conducted during 2019–21. The survey covered 636,699 households, and 724,115 women in the age group 15–49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. Result: Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96% in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35–10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. Conclusion: High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India. [ABSTRACT FROM AUTHOR]

Background: It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. Material and Methods: In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Results: Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002]. Conclusion: Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage with an atonic uterus is one of the leading causes of maternal mortality during Lower Segment Caesarean Section (LSCS) in nearly 50% of cases. Oxytocin is the most commonly administered drug for achieving post-delivery adequate uterine contractions and placenta expulsion, thereby preventing postpartum haemorrhage. Co-administration of phenylephrine during LSCS under spinal anaesthesia inhibits Oxytocin-induced hypotension. Aim: To compare the effectiveness of co-administration of two different doses of phenylephrine with oxytocin in preventing the incidence of Oxytocin-induced hypotension. Materials and Methods: A randomised, double-blinded controlled trial was in the Department of Anaesthesiology, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India from August 2021 to July 2022, involving 120 parturients with American Society of Anaesthelsiologists (ASA) grade second undergoing LSCS under subarachnoid block. They were randomised into three groups: Group A received oxytocin 3U with normal saline, Group B received Oxytocin 3U with Phenylephrine 50 mcg, and Group C received Oxytocin 3U with Phenylephrine 75 mcg administered intravenously over five minutes after the baby's extraction. The incidence of hypotension, requirement for the total rescue dose of Phenylephrine, and side effects were recorded. Statistical analysis was performed using Analysis of Variance (ANOVA) and Chi-square test. Results: Demographic parameters such as age, height, weight, gestational age, and duration of surgery were comparable in all groups. The incidence of hypotension (Group A (Control): 77.5%, Group B (PE50): 47.5%, Group C (PE75): 22.5%, p<0.001), lowest Mean Arterial Pressure (MAP) after Oxytocin infusion (Group A: 67.80±6.16 mmHg, Group B: 68.23±3.96 mmHg, Group C: 72.50±5.87 mmHg, p<0.001), dose of rescue vasopressor requirements (Group A: 75.5±56.61, Group B: 40±50.89, Group C: 17.50±34.99, p<0.001), and incidence of side effects were significantly lower in Group C compared to Group B and Group A. Conclusion: Compared to Phenylephrine 50 mcg, the co-administration of Phenylephrine 75 mcg with Oxytocin 3U reduces the incidence of Oxytocin-induced hypotension and the need for rescue vasopressors during LSCS under subarachnoid block. [ABSTRACT FROM AUTHOR]

Objective: To assess clinical characteristics and outcomes of women who underwent concurrent valve replacement with caesarean section for severe rheumatic mitral valve disease with refractory heart failure. Methods: All women admitted to a single centre from 2011 to 2020 with severe rheumatic mitral valve disease, having recurrent episodes of pulmonary edema on optimal medical therapy and contraindication to percutaneous balloon mitral valvotomy, who underwent concurrent valve replacement (for native valve disease) along with caesarean section, were included. Results: Among 1300 pregnancies with rheumatic heart disease, six underwent the concurrent procedure. All had replacement of mitral valve except one who had both aortic and mitral valve replacements, between 33 and 39 weeks of gestation. There were no maternal deaths, and there was one neonatal loss from late-onset sepsis. Conclusion: Pregnant women with severe rheumatic mitral valve disease with refractory heart failure, unsuitable for minimal access interventions, can be considered for a concurrent valve replacement with caesarean section. [ABSTRACT FROM AUTHOR]

Background & Objective: Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway obstruction resulting in hypoxemia, hypercapnia and sleep fragmentation. It is intriguing to consider the consequences of these events on pregnancy outcomes. This study was conducted to determine the prevalence of obstructive sleep apnoea among pregnant women and its association with pregnancy outcomes. Materials & Methods: It has been found that subjects belonging to the age group 21- 25 years had increased sleep disturbances and reduced quality of sleep. Also, pregnant women in the first trimester were found to have poor quality sleep. Results: Pregnancy outcomes associated with OSA were found as high chance of caesarean section, gestational diabetes mellitus, Gestational hypertension, low birth weight and APGAR<7. Conclusion: Hence, early detection and its prevention can improve the pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility. Methods: This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed. Results: All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period. Conclusion: Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG). Methods: Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions. Results: The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95–2.29; NFHS-5) those for underweight women. Women aged 35–49 were also twice (OR = 2.10; 95% CI 1.92–2.29; NFHS-5) as likely as those aged 15–24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74–4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor. Conclusion: The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges. [ABSTRACT FROM AUTHOR]

Background. The optimum time of labour induction among women with a previous caesarean without any pregnancy complication and eligible and willing for vaginal delivery is not specified. This study compares the vaginal birth rates between induction at 40 weeks and expectant management till 41 weeks. Method. We conducted this parallel design nonblinded, randomized controlled trial in a tertiary care teaching institution in South India on women with a previous lower segment caesarean section eligible for a trial of labour with singleton foetus without any pregnancy complication at recruitment. We screened 1886 women. Sixty women underwent block (of 6 each) randomization into two groups of thirty each at 40 weeks. We induced the women in the intervention group at 40 weeks with oxytocin or a single 24-hour application of a Foley catheter followed by oxytocin infusion and amniotomy. The expectant group underwent maternal and foetal surveillance and induction at 41 weeks with the same protocol if not delivered by then. We compared the primary outcome of the proportion of vaginal birth rate with a chi-square test. Result. Data from all sixty women were analyzed. Twenty (66.67%) in the induction compared to ten (33.33%) in the expectant group delivered vaginally. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P = 0.016). One woman in the expectant group had scar dehiscence. Conclusion. Among women with a previous caesarean scar, labour induction at 40 weeks has a significantly higher vaginal birth rate than those managed expectantly till 41 weeks. More extensive trials are feasible and recommended. Trial Registry. The trial was prospectively registered with the clinical trial registry of India. This trial is registered with CTRI/2018/09/015719 (date of registration 14th September 2018). [ABSTRACT FROM AUTHOR]

Background: In the 21st century, India is still struggling to reduce the burden of malnutrition and child mortality, which is much higher than the neighbouring countries such as Nepal and Shri Lanka. Preterm birth (PTB) and low birth weight (LBW) predispose early-age growth faltering and premature mortality among children below the age of five. Thus, highlighting the determinants of LBW and PTB is necessary to achieve sustainable development goals. Objective: The present study provides macro-level estimates of PTB and LBW and aims to highlight the nature of the association between various demographic, socioeconomic, and maternal obstetric variables with these outcomes using a nationally representative dataset. Methods: Data on 170,253 most recent births from the National Family health survey (NFHS-5) 2019–21 was used for the analysis. The estimates of PTB and LBW are measured by applying sample weights. The correlates of LBW and PTB were analyzed using logistic models. Results: There were cross-state disparities in the prevalence of PTB and LBW. In India, an estimated 12% and 18% of children were LBW and PTB, respectively, in 2019–21. Maternal obstetric and anthropometric factors such as lack of antenatal care, previous caesarean delivery, and short-stature mothers were associated positively with adverse birth outcomes such as LBW and PTB. However, a few correlates were found to be differently associated with PTB and LBW. Mothers belonging to richer wealth status had higher chances of having a preterm birth (OR = 1.16, 95% CI: 1.11–1.20) in comparison to poor mothers. In contrast, the odds of having LBW infants were found to be increased with the decreasing level of the mother's education and wealth quintile. Conclusions: In India, PTB and LBW can be improved by strengthening existing ante-natal care services and evaluating the effects of the history of caesarean births on future pregnancies. [ABSTRACT FROM AUTHOR]

Background and objectives: An investigational short course of antibiotics (two doses of Inj. Cefotaxime 1g IV) was compared to the conventional long course antibiotic for the prevention of postoperative infectious complications in patients undergoing elective caesarean sections at a government tertiary care hospital. To Determine which treatment most successfully stops infectious morbidity, like high body temperature, abnormal vaginal discharge, wound induration, wound discharge, and wound gaping. Methods: A prospective interventional study was undertaken by the Obstetrics and Gynaecology Department at Guntur Medical College in Guntur, Andhra Pradesh, India, from February 2022 to January 2023. For this study, 400 participants were randomly assigned to one of two groups. Two hundred individuals make up each group. Participants were chosen based on whether or not they met the inclusion/exclusion criteria. Result: Two groups of 200 patients each participated in the trial. 162 (81%) of the 200 participants were multi-para, while 38 (19%) were primi-para. 30 (15%) of the first group's 200 patients were primi, 9 (4.5%) were multi gravida, and 161 (80.5%) were multiparas who had previously had LSCS but chose to have another one. Its P value is 0.6. Thirty-six women experienced wound induration, 15 (7.4%) in Group 1 and 21 (10.6%) in Group 2. p=0.09 indicated no statistical significance. Serous wound leakage occurred in 12 (6%) group 1 patients and 15 (7.5%) group 2 patients. 41 (10.25%) of 400 patients had pus discharge, 22 (11%) from Group 1 and 19 (9.5%) from Group 2. Both groups' p values are insignificant. Conclusion: This study found that short-term antibiotics are as effective as long-term ones. Both groups had similar febrile morbidity, wound induration, serous and purulent wound discharge, wound gaping, and abnormal vaginal discharge. Lower-strength antibiotics are increasingly relevant due to antibiotic resistance. The short regimen is cheaper than the extended one since it uses less antibiotics. The short-course antibiotic is safe, effective, convenient, and manpower-saving. Thus, preventing irregular drug administration and replacing the three days of intravenous antibiotics followed by oral antibiotics used in tertiary government centres. [ABSTRACT FROM AUTHOR]

Introduction: The birth of a baby through the vaginal route is a traditional way of delivery. But, at times normal vaginal delivery is not desirable due to various reasons. Under such circumstances, Lower section caesarean section (LSCS) is carried out to deliver the baby safely. There are rising concerns about the increasing rate of caesarean sections with wide variations in rates across the globe. Factors that influence the decision to perform a LSCS are often complex and multifactorial. Understanding these complexities is one of many steps to help stop the rise of any unnecessary LSCSs or prevent their overuse. Aim: To find out factors influencing the choice of caesarean delivery among recently delivered mothers through caesarean section and within puerperium. Method: A cross-sectional survey using pretested, self-administered, semistructured questionnaire was done between December 2022 to February 2023 among patients recently delivered through caesarean section and within puerperium. Result: A total of 250 participants were approached over a three-month period. Among them, 211 completed the survey. The majority of participants were in the age group 25 to 30 years, Hindu by religion, and residents of rural areas. Sixty-four participants perceived that LSCS was done for the safety of the baby. Educational status (p<0.001), place of previous delivery (p<0.001), and count of current LSCS (p=0.016) were the factors associated with caesarean delivery satisfaction and it was found to be statistically significant. Conclusion: About one-third of the participants perceived that LSCS was done for the safety of the baby. The majority of participants were satisfied with the decision of LSCS. [ABSTRACT FROM AUTHOR]

Rising in the rates of C-section deliveries worldwide is a major public health concern. According to WHO, C-section rate continues to rise globally, accounting for more than 1 in 5(21%) childbirths. There is lack of evidence supporting the maternal and neonatal benefits with the increasing C-section rates. Robson's Ten Group Classification system (RTGCS) serves as an initial structure with which caesarean section rates can be analyzed and allow us to bring changes in clinical practice. The objective of the current study was to audit C-section rate using Robson's Ten Group Classification System in our tertiary care hospital, and to identify the main contributors of each subgroup to overall Csection rate. This was a cross-sectional study conducted at out tertiary care center, Karpaga Vinayaga Institute of Medical Sciences and Research Centre (KIMS&RC), Madhuranthagam, Tamil Nadu, India during the period of January 2019 to December 2021. The study was conducted by reviewing the hospital record for analyzing the C-sections performed during the above-mentioned period. The study population include the pregnant women who underwent Csections in our hospital during the specified period. The 401 women who underwent C-section were classified in Robson's Ten group classification system, 45% women in Group 5 and it contributed to the maximum number of the total C-section rates. The second highest contributor was Group 1 and Group 2 contributing to 41% of the overall C-section rates. The Robson's Ten group classification system provides a useful framework for auditing C-section rates. Regular audits and standardization of indication of C-section will help in reducing the C-section rate in future. [ABSTRACT FROM AUTHOR]

Introduction: Cervical assessment has moved from digital examination to sonographic evaluation in recent years. Predicting the time of onset of labour and mode of delivery at term is a great concern for both the pregnant woman and her relatives. Aim: To predict the time of onset of labour and mode of delivery by Transvaginal sonographic measurement of cervical length at term. Materials and Methods: This longitudinal study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, Kattankalathur, Tamil Nadu, India, from March 2021 to August 2021. All low-risk singleton pregnancies between 38-40 weeks of gestation were included. Cervical length (in mm) was measured transvaginally by the principal investigator between 38 and 40 weeks. When the labour sets in the duration between cervical length measurement and the onset of labour, duration of labour and mode of delivery were noted. Pearson correlation coefficient was used to quantify the association between cervical length and time of onset of labour and duration of labour. Results: In the study, 164 low-risk patients (143 Primigravida patients+21 Multigravida patients) between 38-40 weeks were included. In patients with spontaneous onset of labour, 45 (70.3%) had labour onset within 120 hours (5 days) when cervical length was ≤30 mm, when compared with 7 (22.58%) when cervical length was >30 mm (p=0.001). In patients with cervical length ≤30 mm, vaginal delivery occurred in 47 (73.43%) (p=0.019). In women with induced labour with cervical length =30 mm, 13 (61.9%) had labour onset within 120 hours when compared to 15 (30.6%) in women with cervical length >30 mm (p=0.02). Vaginal delivery occurred in 5 (29.41%) of women when cervical length was =30 mm compared to 32 (65.30) in women when cervical length >30 mm which may be attributed to other causes. There was a significant positive correlation between cervical length and time of onset of labour (Correlation coefficient=0.221, p-value=0.004). There was a negative correlation between cervical length and duration of labour which was not statistically significant (Correlation coefficient=-0.108, p=0.25). There was no significant difference in mean cervical length measurement between vaginal delivery and caesarean section. Conclusion: Transvaginal cervical length measurement at term positively correlates with time of onset of labour but not with duration of labour and mode of delivery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effect of COVID-19 infection on the rate and indications for cesarean section (CS) according to Robson's Ten-Group Classification system. Methodology: Our study was a 6-month retrospective observational study at the Maternal and Child Health Wing where every antenatal woman who was admitted irrespective of gestational age and whether in labor or not was customarily screened for COVID-19 infection. Based on the mode of delivery, all delivered women were classified into two groups: vaginal or cesarean, and the information was then further classified according to Robson's classification. Data collected were analyzed using Excel sheets, and Chi-square test was applied to evaluate if the difference in CS rates was statistically significant. Results: During COVID months, a total number of confinements were 877, among which the cesarean section were 381, contributing to a rate of 43.4%. The total COVID-19-positive confinements during the same period were 68. Group 2 formed the vast majority of CSs, followed by Group 1 and 5. During the post-COVID months, summation of confinements was 1443, among which the CS were 580, thereby contributing to a rate of 40.1%. In contrast to COVID time, Group 5 formed the greatest chunk contributing to CS rate, followed by Group 2 and 1. There was a statistically significant difference among confinements during COVID and post-COVID period and between CS rates among COVID-19 positive and negative women. Conclusion: During the COVID pandemic, there was a decrease in the number of confinement in our hospital. However, the CS rate increased and according to Robson's classification Group 1 and 2 made greatest contribution to CSs due to changed dynamics. [ABSTRACT FROM AUTHOR]

Early initiation of breastfeeding (EIBF) within 1 h of birth is crucial in preventing newborn deaths and plays a vital role in early infant nutrition. Promoting and supporting breastfeeding is an integral part of midwifery. The objective of the study was to improve the EIBF rate in neonates born through a Cesarean Section (CS) from 0% to 50% within six months through a quality improvement (QI) process and to assess the maternal experience of EIBF in operation theatre (OT). Six Plan-Do-Study-Act (PDSA) cycles were conducted to test the change ideas proposed by the team members for a month to improve EIBF. Participants of the study were the stable term newborns delivered by CS under spinal anesthesia. The EIBF rate improved from 0% to 88% after the sixth PDSA cycle. The effect was sustained for six months. Mothers of 51 neonates (98%) who received EIBF reported that their newborns were breastfed successfully, and it was not physically tiring to feed immediately in the OT. A quality improvement (QI) initiative was able to improve and sustain the improved EIBF rate after CS. Early skin-to-skin contact to be initiated with EIBF for better neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: In obstetrics, aftercoming head of breech poses a great challenge, and its entrapment is often an obstetrician's nightmare. In an attempt to avoid this unpleasant situation, many manoeuvres have come up namely Burns-Marshall, Mauriceau-Smellie-Veit (MSV) & its modification, Piper's forceps & the like. The aim of this study is to compare modified MSV technique with Shiralee's remodification of the same, in terms of efficacy, effectiveness, perinatal morbidity, and mortality. Materials and methods: A prospective comparative study was carried out over a period of two years in women who had singleton term breech vaginal delivery at Kamla Raja Maternity Wing, JA Group of Hospitals, Gwalior (M.P.), India. Available demographic variables, obstetric characteristics and perinatal outcomes were analyzed. Results: Out of 10,276 cases of deliveries during the study period, the incidence of term breech deliveries was 298 (2.9%) among which the mode of only 52 (17.5%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency caesarean section could not be performed. One parturient in the modified MSV group faced entrapment of aftercoming head, requiring Dührssen's incision. Adverse perinatal outcomes were seen in 26% of deliveries in Group 1 (modified MSV), whereas in only 14% of cases in Group 2 (SRMMSV). Thirty two percent of neonates had an APGAR score <7 at 5 minutes in Group 1, as compared to 20% newborns in Group 2. NICU admissions were 48% in the former and 28% in the latter. The incidence of birth injuries in the two groups was 16% & 8% respectively. There was one perinatal mortality in the modified MSV group & none in the SRMMSV group. Conclusion: The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities and contemporary practices, especially when the deliveries are not well planned. Shiralee's remodification of the modified MSV manoeuvre was found to be more efficacious with lesser perinatal morbidity, in comparison to the already existing MSV method. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean delivery is defined as the birth of a fetus through an incision on the abdomen and uterus. Uterine dehiscence generally refers to an incomplete, and frequently a clinically occult, uterine scar separation where the serosa remains intact. This study estimates the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Aim: To estimate the incidence of intraoperative finding of scar dehiscence in anemic women undergoing repeat cesarean delivery. Materials and Methods: Data taken from the records for the past 5 years in the parturition register maintained in the labor room of our institution. Study design: Retrospective study. Sample size: All women who underwent repeat cesarean delivery in the past 5 years. Results: In the study 81.5% had 1 previous LSCS, 18.1% had 2 previous LSCS and 0.4% had 3 previous LSCS. 72.2% had no anemia. 12.3% had mild, 13.7% had moderate and 1.8% had severe anemia. Among subjects without anemia, 33.2% had scar dehiscence, among subjects with mild anemia 46.4% had scar dehiscence, among subjects with moderate anemia 72.6% had scar dehiscence and among subjects with severe anemia 87.5% had scar dehiscence. Anemic subjects had 3.26 times higher incidence for scar dehiscence compared to non-anaemic subjects intraoperatively. With increase in severity of anemia there was an increase in incidence of scar dehiscence. Discussion: The rate of Cesarean delivery has considerably increased during the past few decades. Cesarean delivery can lead to many acute and chronic complications and one of them is scar dehiscence. Anemia in pregnancy is a common condition found in the practice of obstetrics. India contributes to about 80% of maternal deaths due to anemia in South Asia. Iron deficiency anemia is the most common form of anemia seen and iron deficiency has been shown to result in impaired collagen synthesis. The impaired collagen synthesis can impair the healing of the uterine scan and lead to complications such as scar dehiscence in subsequent pregnancies. Conclusion: Reduced integrity of the uterine scar may be a consequence of an iron deficient state and timely identification and treatment of anemia in an ongoing pregnancy may be important to improve the integrity of the cesarean scar and in turn reduce the rate of cesarean scar dehiscence. [ABSTRACT FROM AUTHOR]

Introduction: Caesarean techniques have evolved over time to increase their safety. Intra-abdominal closure of uterine incision seems more physiological. Exteriorisation makes repair easier with a better exposure. But this causes tension to the supporting structures attached to uterus and stretching of vasculature with the risk of intraoperative haematoma or aneurysm later on. Aim: To compare the in-situ repair Group and exteriorised repair group caesarean delivery under spinal anaesthesia regarding occurrence of intraoperative and postoperative complications of interest. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at College of Medicine and Jawaharlal Nehru Memorial Hospital, West Bengal, India, over a period of two years from April 2014 to March 2016. Four hundred women undergoing caesarean section who fulfilled the inclusion and exclusion criteria were recruited in the study. They were randomly allocated into two study groups as per a computer generated random allocation table. In Group A (n=200) uterine incision was closed after uterus was exteriorised and in Group B (n=200) uterine incision was closed keeping it inside the abdomen. Intraoperative and postoperative parameters of interest such as nausea-vomiting, drop in pulse rate, incision closure time, drop in haemoglobin, blood transfusion rate, return of bowel sounds, febrile morbidity, surgical site infection, hospital stay etc., were noted and compared between the two groups. Numerical variables were expressed as mean and standard deviation and analysed using independent sample t-test. For qualitative variables frequency and percentage were calculated and analysed using Chi-square. Collected data was transferred and analysed using Statistical Package for Social Sciences (SPSS) version25. The p-value ≤0.05 was considered significant. Results: The demographic profiles like age, parity, gestational age etc. of both the groups were similar. There was a significant difference in uterine closure time (9±2.5 minutes in in-situ repair group vs. 10±2 minutes in exteriorisation and repair groups, respectively (p<0.001**). Mean drop in pulse rate, incidence of nausea, vomiting were similar in both the groups (p>0.05). Mean drop of haemoglobin was more in the intraabdominal closure group (1.5±1.3 gm/dL) as compared to the group of closure after exteriorisation (1.4±1.3 gm/dL) though the difference was not significant statistically (p=0.44). Postpartum blood transfusion rate was 6.5% in exteriorised repair group and 9% in in-situ repair group (p=0.35). Postoperative morbidity like fever, surgical site infection, length of hospital stay was similar in both the groups. Conclusion: Choice of uterine closure method is operator dependent and either method of uterine closure is acceptable when practiced and skill is gained. Exteriorisation is advantageous when excessive bleeding is encountered. Though time taken for closure in in-situ group is statistically more it is similar practically. Bowel sounds returned earlier postoperatively in in-situ group. [ABSTRACT FROM AUTHOR]

Introduction: Comforting manoeuvres like hand holding and calming conversation with the parturients may decrease anxiety among them by establishing a rapport and building confidence and trust to alleviate fear. Aim: Evaluation of role and effectiveness of comforting manoeuvres (hand holding and calming conversation) in relieving patient's anxiety and subjective satisfaction undergoing caesarean section in regional anaesthesia. Materials and Methods: This was a single centre randomised control trial conducted in the Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from February 2022 to June 2022. There were 144 parturients, in the age group 18-40 years, American Society of Anaesthesiology (ASA) II, and admitted for Caesarean section under regional anaesthesia. Patients were randomised into four groups-control group (C)- group 1, only calming conversation (CC)- group 2, only Hand Holding (HH)- group 3 and Hand Holding and Calming Conversation (CH)- group 4. Demographic details of the patient, Visual Analogue Scale (VAS) for anxiety, Blood Pressure (BP), Heart Rate (HR), Respiratory Rate (RR) and patient satisfaction score on a 1-5 Likert scale were noted preoperatively. VAS was noted preoperatively and postoperatively for all groups. Patient Satisfication Score (PSS) was noted postoperatively. The HR, Mean Arterial Pressure (MAP), and RR were noted every 5 minutes for 20 minutes, then every 10 minutes till the end of the surgery, and 30 minutes after surgery. Any anxiolytic medication used intraoperatively was documented for all groups. Results: Total of 144 participants were analysed with 36 patients in each of four groups. Mean age (years) for group 1 was 23.36, group 2 was 23.25, group 3 was 23.17, and group 4 was 23.22. Baseline VAS was similar in all the groups. Postoperative VAS differed significantly - group 1 was 3.33±0.926, group 2 was 1.53±0.845, group 3 was1.47±0.845 and group 4 was 1.11±0.708. PSS also differed significantly - for group 1 was 2.42±0.732, group 2 was 3.50±0.697, group 3 was 3.67±0.717 and group 4 was 3.92±0.692. Stabilisation of hemodynamics in terms of BP, HR and RR was significantly better in all three interventional groups as compared to the control group. Conclusion: All three manoeuvres (hand holding, calming conversation alone and in combination) were equally effective in reducing perioperative anxiety, stabilising the hemodynamics and improving patient satisfaction in parturients undergoing caesarean section under regional anaesthesia. Comforting manoeuvres are simple, easy to practice and without any financial implication. [ABSTRACT FROM AUTHOR]

Against the backdrop of the alarming rise in Caesarean section (C-section) births in India, this study aimed to examine the association between C-section births, fertility decline and female sterilization in the country. A cross-sectional design was used to investigate the association between C-section delivery and subsequent reproductive behaviour in women in India. Data were from the National Family Health Survey (NFHS-4). The study sample comprised 255,726 currently married women in the age group of 15–49 years. The results showed a strong positive relationship between C-section births and female sterilization. The predicted probabilities (PP) from the multivariate regression model indicated a higher chance of female sterilization in women with C-section births (PP = 0.39, p <0.01) compared with those with non-C-section births (PP = 0.20, p <0.01). Both state-level correlation plots and Poisson regression estimates showed a strong negative relationship between C-section births and mean children ever born (CEB). Based on the results, it may be concluded that the use of C-sections and sterilization were strongly correlated in India at the time of the NFHS-4, thus together contributing to fertility decline. A strong negative association was found between the occurrence of C-sections and CEB. The increased and undesired use of C-section births and consequent female sterilization is a regressive socio-demographic process that often violates women's rights. Fertility decline should happen through informed choice of family planning and must protect the reproductive rights of women. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO's latest guidelines for effective, respectful care during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women's experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase); and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase). Methods: In the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women's experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness. Discussion: Findings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally. Trial registration: CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022). Plain language summary: The new WHO Labour Care Guide (LCG) is an innovative partograph that emphasises women-centred, evidence-based care during labour and childbirth. Together with clinicians working at four hospitals in India, we will develop and test a strategy to implement the LCG into routine care in labour wards of these hospitals. We will use a randomised trial design where this LCG strategy is introduced sequentially in each of the four hospitals, in a random order. We will collect data on all women giving birth and their newborns during this period and analyse whether the LCG strategy has any effects on the use of Caesarean section, women's and newborn's health outcomes, and women's experiences during labour and childbirth. While the trial is being conducted, we will also collect qualitative and quantitative data from doctors, nurses and midwives working in these hospitals, to understand their perspectives and experiences of using the LCG in their day-to-day work. In addition, we will collect economic data to understand how much the LCG strategy costs, and how much money it might save if it is effective. Through this study, our international collaboration will generate critical evidence and innovative tools to support implementation of the LCG in other countries. [ABSTRACT FROM AUTHOR]

Introduction: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital. Caesarean section is a live saving procedure but when performed without appropriate indications can add risk to both mother and baby. As per WHO report, at population level, Caesarean section rates higher than 10% are not associated with reductions in maternal and new-born mortality rates. In India as per District level household survey 3 (DLHS) Caesarean section rate is 28.1% in private sector and 12% in public sector health care facilities. The close embryonic development and anatomical proximity of the urinary bladder and genital organs, are responsible for the urinary tract to injury during surgical procedures in the female pelvis. During LSCS bladder injury is demonstrated by the presence of gas filling up the Foley bag or visibly bloody urine in the Foley bag. Veress needle injuries and other small injuries to the bladder can be successfully managed conservatively by catheter drainage for seven to 14 days followed by cystography while large bladder injuries, such as from 5- or 10-mm trocar or surgical dissection usually require suturing the injuries closed. Risk factors for bladder injury during LSCS include previous operations, exposure to radiation, malignancy, chronic infection, and inflammation. Aims and objectives- The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022. Cases with the documented urological injuries during these procedures were analysed further Material And Methods: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2021 to December 2022, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period. In suspected cases of bladder injuries cystogram X-ray of the bladder after injection of contrast medium is performed. For extraperitoneal injuries (grade 2) without complicating factors, treatment is a insertion of Foley catheter for 7 - 14 days. grade 3 to grade 5 injuries generally require operative repair. Closed suction drains should be left in place after repairs. Suprapubic tube placement is not necessary in most cases. For injuries to the ventral bladder, dome, or posterior bladder, the mucosa is closed in a running fashion using 3-0 vicryl followed by a seromuscular running suture of 2-0 vicryl. The bladder is irrigated to ensure a watertight closure. A third layer in a Lembert fashion can be used in cases at high risk for fistula formation or when a leak is identified. In the laparoscopic setting, a one-layer closure is performed using 2-0 vicryl to close all layers of the bladder. An additional layer can then be added using a 2- 0 vicryl in a Lembert fashion for more extensive injuries. Results: The study was a retrospective analysis of all obstetric and gynaecological surgeries over a period of one years from December 2018 to December 2019, there were 3000 LSCS done in the department of Obstetrics and gynaecology, GMC Shahdol in the given study period. In this study mean age of bladder injury is 34.8 years and for ureteric injury 35 years. Parity for bladder injury 2.4 and for ureteric injury 3. Gestational age is similar for both is 37 weeks. In this study there are 2990 LSCS done and 10 peripartum hysterectomy done. Among all patients who underwent cesarean section 1.5% suffered from bladder injury, 0.01% ureteric injury and 0.01% for ureteric and bladder injury. Similarly, in peripartum hysterectomy, 40% suffered from bladder injury and no one have ureteric injury. Total 52 [1.5%] cases have injury. Among all patients who suffered from bladder injury, mostly cases are primigravida cases, which are 57% cases. 13% cases are more than two section patients. Others are previous two section 9%, Placenta previa and placenta accreta 7.6%, Previous history of myomectomy and hysterotomy 3.8% and 1.9% cases from 2nd stage labour and CPD patients. In bladder injury, most of the cases are bladder dome [81.5%], posterior wall [14%], lateral wall [4%] cases and none cases in bladder neck injury. Most bladder injury repaired by triple layers vicryl with SPC insertion [44%], without SPC [38%] and only catheterization only 11% cases. All ureteric injury repaired by DJ stent insertion with repair. SPC removed after 14 days. Conclusion: 1.5% of the bladder injuries were observed. Early detection and prompt management of bladder injury can decrease the morbidity and mortality in LSCS cases. The incidence urological injuries during obstetrics and gynaecological procedures are rare but the morbidity associated these are significant. There for surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel. [ABSTRACT FROM AUTHOR]

Background-The most commonly executed significant surgical procedure among females is the caesarean section. The objective of this investigation was to ascertain the frequency of initial Caesarean deliveries among women who have previously given birth, the reasons for such procedures, and the resulting consequences for maternal health. Methods: A cross-sectional study was conducted to examine primary caesarean section in multigravida who was admitted to the Tertiary Care central India. The present investigation comprised a sample of 83 participants. The process of obtaining written informed consent was carried out. Results-Advanced maternal age, higher pre-pregnancy body mass index, greater gestational weight gain, elevated infant birth weight, as well as primiparous status and urban residency, have been identified as factors associated with an increased likelihood of caesarean section delivery. Conclusions:Complications are frequently associated with vaginal deliveries. Regular care is necessary for all patients during the antenatal period. Institutionalizing multigravida deliveries may serve as a viable strategy for mitigating maternal and perinatal mortality rates. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) is the most common complication following childbirth. Postpartum haemorrhage remains a significant contributor to maternal mortality and morbidity throughout the world. PPH is often classified as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, occurring from more than 24 hours post birth to up to 12 weeks postpartum. Aims: The aim of this study was to determine the percentage of patients requiring medical therapy for PPH management and to determine the percentage of patient requiring surgical therapy for PPH management. Methods: The present study was a population and hospital based observational study conducted in the Dept of Gynae and Obstetrics, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. All the patients presenting with postpartum haemorrhage following delivery during my study period and meeting my inclusion criteria which is 304. Template was generated and analysis was done on STATA11 software. Results: In the present study the overall incidence of PPH is 1.4%(304 out of 22,182 deliveries). higher prevalence is seen between 24-27yrs and >=27yrs. Prevalence of PPH is more in women with no schooling (31.9%) The PPH occurred mostly at the gestational age 37- 40wks (60%). Atonic PPH has higher prevalence (50.6%) than other types of PPH. In instrumental delivery traumatic PPH has higher prevalence (50%). In caesarean section Atonic PPH (80.64%) had higher prevalence than any other types. Atonic type of PPH is responsible for most maternal death (75%). Uterine tamponade was mostly done and successful in PPH following vaginal delivery (86.66%). Conclusions: To conclude, majority of deaths following PPH is preventable if timely and prompt intervention is made. Antenatal anaemic status contributed a significant role in PPH occurrence which should be corrected to decrease the prevalence of PPH. [ABSTRACT FROM AUTHOR]

Background: Intrapartum care is of paramount importance in overall respectful maternity care (RMC). Uterine fundal pressure maneuver (UFPM) is the most controversial obstetric maneuver considered obsolete in many countries. UFPM is associated with adverse life threatening maternal and fetal effects. The baseline prevalence of UFPM in our tertiary care teaching hospital with a heavy patient load was 78.4% which was quite high. Our aim was to reduce the prevalence of UFPM by 75% from baseline over a period of 10 months. Methods: After root cause analysis, we formulated the departmental Standard Operating Procedures on safe vaginal delivery and birth practices and initiated the Labour Room Quality Improvement Initiative. We sensitized and created awareness among the resident doctors and nursing staff regarding the high prevalence of UFPM through dedicated lectures, intercommunication via WhatsApp groups and strict vigilance in the labor wards. The point of care quality improvement (QI) methodology was used. The primary outcome was decrease in the prevalence of UFPM. Results: The prevalence of UFPM reduced from the baseline value of 78.4%–4% over the period of 7 months. Post intervention it gradually increased and sustained at 21.2% over a follow‐up period of 3 months. Conclusion: QI methods can effectively and rapidly improve the acceptance and adherence to newer initiatives in a busy tertiary care health facility to reduce the prevalence of UFPM and eventually improve the overall RMC. [ABSTRACT FROM AUTHOR]

In India, caesarean delivery (CD) accounts for 17% of the births, of which 41% occur in private facilities. However, areas to CD in rural areas are limited, particularly for the poor populations. Little information is available on state-wise district-level CD rates by geography and the population wealth quintiles, especially in Madhya Pradesh (MP), the fifth most populous and third poorest state. Investigate geographic and socioeconomic inequities of CD across the 51 districts in MP and compare the contribution of public and private healthcare facilities to the overall state CD rate. This cross-sectional study utilised the summary fact sheets of the National Family Health Survey (NFHS)-5 performed from January 2019 to April 2021. Women aged 15 to 49 years, with live births two years preceding the survey were included. District-level CD rates in MP were used to determine the inequalities in accessing CD in the poorer and poorest wealth quintiles. CD rates were stratified as <10%, 10–20% and >20% to measure equity of access. A linear regression model was used to examine the correlation between the fractions of the population in the two bottom wealth quintiles and CD rates. Eighteen districts had a CD rate below 10%, 32 districts were within the 10%–20% threshold and four had a rate of 20% or higher. Districts with a higher proportion of poorer population and were at a distance from the capital city Bhopal were associated with lower CD rates. However, this decline was steeper for private healthcare facilities (R2 = 0.382) revealing a possible dependency of the poor populations on public healthcare facilities (R2 = 0.009) for accessing CD. Although CD rates have increased across MP, inequities within districts and wealth quintiles exist, warranting closer attention to the outreach of government policies and the need to incentivise CDs where underuse is significant. [ABSTRACT FROM AUTHOR]