Preterm birth remains a major clinical problem. Prematurity is not only a major cause of perinatal mortality but also leads to greater risk for short and long term complications including disability and impediments in growth and mental development. To compare vaginal with intramuscular progesterone administration to prevent preterm labor and to detect the effect of both on the uterine and foetal circulations. STUDY DESIGN: comparative interventional study. POPULATION: 100 pregnant women attending NRSMCH Kolkata, Obstetrics emergency with threatened preterm labour before 34 weeks of gestation. STUDY PERIOD: one year. METHODS: Gestational age was confirmed clinically and by USG of early weeks of gestation. Efficacy and tolerability of progesterone in two routes i.e., intramuscular and vaginal for prevention of threatened preterm labour were compared. OUTCOME: Ante partum, intrapartum and perinatal outcomes were compared between two groups by statistical analysis of data's using chi-square test and student-t test. CONCLUSION: Vaginal progesterone was as effective as intramuscular progesterone in reducing preterm birth with fewer side effects in favor of vaginal route.
Low birth weight (LBW) affects newborns’ survival and is a global concern especially for developing countries. It is the most common health indicator for assessing neonates’ health conditions. The present study was conducted to determine the prevalence of LBW in India in background of global perspective. A systemic review of the literatures was done, available in the principle medical databases including PubMed (including Medline), Google scholar, Web of science and Scopus from 2000 to 2021. A total of 65 articles were identified in the described database. Altogether 24 articles met the inclusion criteria and were eligible for data analysis. According to the all four national family health survey (NFHS) a decreasing trend is observed in the prevalence of LBW. The prevalence of LBW in India is 16.4 % in NFHS-4, 20.9% in NHFS-3, 22.9% in NFHS-2 and 25.2% in NHFS-4 respectively. A number of socio-demographic and maternal factors are responsible for LBW babies in India. LBW babies are global public health concern. Special emphasis should be given to the underlying factors responsible for LBW babies in India.
INTRODUCTION:APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Progesterone is essential in maintenance of pregnancy and helps in prolongation of pregnancy. Different trials have been done to show the efficacy and safety of progesterone in prevention of preterm birth but study related to use in expectant management of symptomatic placenta previa is very limited. AIMS AND OBJECTIVE: The objective of our study is to determine the effectiveness of intramascular 17 alpha hydroxy progesterone Caproate therapies vs. placebo in conservative management of patient with symptomatic placenta previa before 34 weeks of gestation. MATERIALS AND METHODS: It is a randomized control study with 100 pregnant women attending Obstetric deptt. at Nilratan Sircar Medical College and Hospital, Kolkata with symptomatic placenta previa having episode of warning haemorrhage before 34 weeks of gestation and fulfilling inclusion criteria were enrolled for the study in a two year period from January 2013 to December 2014. Statistical analysis was performed using student t-test and chaisquare test where appropriate. RESULTS AND ANALYSIS: In our study prolongation of pregnancy in progesterone receiving group is statistically significant (p-value<0.001), significant difference were also found in gestational age at delivery (p value of 0.0288), birth-weight (p-value of 0.0470). CONCLUSION: In this study use of 17 alpha hydroxy progesterone in expectant management of symptomatic placenta previa tends to be beneficial than placebo.
BACKGROUND Prematurity is a major cause of perinatal mortality and short-and long-term morbidity. Preterm birth before 34 weeks constitutes 40% of total and contributes to majority of mortality and morbidity. Threatened preterm labour (PTL) is diagnosed by painful palpable uterine contraction at least once per 10 minutes and may or may not be associated with cervical changes. Calcium-channel blocker and oxytocin antagonist were shown to delay delivery by 7 days, β2-agonist drugs delay by 48 hrs., respectively, but they carry more side effects. Magnesium sulfate has not been proved to have effective tocolytic action. There is insufficient data about the effects on the baby of these tocolytic drugs. Progesterone is essential for the maintenance of pregnancy and acts by establishing uterine quiescence and maintaining cervical length by different mechanisms. Progesterone has been administered as oral capsule, vaginal gel or suppository, or intramuscularly in different trials to show the efficacy and safety of progesterone in prevention of recurrent preterm delivery. Different routes have variable efficacy and different side effect profiles when used in preterm labour. The aim of this study is to assess the efficacy and tolerability of vaginal micronized progesterone compared to intramuscular 17 α OH progesterone caproate in management of threatened preterm labour before 34 weeks of gestation. METHODS 100 pregnant women with threatened preterm labour before 34 weeks of gestation and fulfilling inclusion and exclusion criteria were randomized into two groups. One group received vaginal micronized progesterone 200 mg twice daily and other group received I/M 17 α OH progesterone caproate 250 mg twice in a week. Cases were followed up till 6 weeks postpartum. RESULTS Efficacy and tolerability of progesterone in two different routes for prevention of PTL were compared by statistical analysis of data using chi-square test and student-t test. Efficacy of both routes is similar as determined by primary outcome like gestational age at delivery admission, delivery interval, and birth weight. Vaginal group has significantly lesser side effects in comparison to IM group. CONCLUSIONS Vaginal progesterone was as effective as intramuscular progesterone in reducing preterm birth in threatened preterm birth with fewer side effects in vaginal route. Larger studies are required to confirm the findings.
Since the end of December 2019, corona virus disease (COVID-19) has spread globally. Though the majority of COVID-19 cases in pediatric age group have not been critical, a novel disease named as multisystem inflammatory syndrome in children (MIS-C) have been emerging as the pandemic progresses. A systemic review of the literature was performed in the principle medical databases including Pubmed, Embase and Google Scholar between December 2019 and March 2021. A total of 40 articles were identified in the described database. Altogether 12 articles met the inclusion criteria and were eligible. The critical and severe case were more in infant age group, also the number of hospitalization was more in infant age group than other pediatric age groups. A number of case reports reflected that infants with COVID-19 positive may present with shock and sepsis. The mean age of MIS-C COVID-19 positive children was 1.1 year emphasizing the vulnerability of infant age group to this novel disease MIS-C. MIS-C is a new type of presentation of COVID-19 infection. Special emphasis should be given in infant age group with COVID-19 who are vulnerable to develop MIS-C.
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