Background:The indications for cesarean sections have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economic and medico legal factors play a role in this rising trend of cesarean section. Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a cesarean birth. This study was conducted to determine the rate, indications and complications of primary cesarean section in primi and multiparae. Methods: This was a cross sectional study carried out on primary cesarean section in the Department of Obstetrics and Gynecology, P.D.U. Medical College and Hospital, Rajkot during one year period from April 1, 2014 to March 31, 2015. During this study, patients (booked or unbooked) attending the labour room, undergoing primary cesarean section in the department will be selected according to the inclusion criteria. Their intraoperative and postoperative complications would be noted and also maternal and fetal morbidities and complications if any. The study does not include women who had Gestational age of less than 28 weeks, who underwent cesarean section in previous pregnancy, previous uterine surgery or hysterotomy and who had multiple gestations. Results: Out of 7295 deliveries performed during one year period, overall 1349 CS were performed with an incidence of 18.5%. The frequency of primary cesarean section was higher in primipara (72.4%) than multipara (27.6%) women. Emergency cesarean section (79.3%) was performed more than elective cesarean section (20.7%) in both the study group and most of them, did not taken ANC. 28.5% of the patients were unbooked and 46.6% of the patients were referred. Illiteracy was present in 31.7% cases and 62.6% cases belonged to rural areas. Anemia, malpresentations, oligohydramnios, eclampsia and preeclampsia were more common antenatal complications in primipara patients than multipara patients, while APH was more common complication in multiparity. In unbooked patients, anemia was found more commonly. Malpresentation (34.3%) was the commonest indication for cesarean sections in both the study groups. Intraoperative complications like extension of uterine incision, placenta praevia, PPH were found more in caesarean section done in emergency than electively and more in multipara patients. Maternal morbidity was seen in 18.5% of cases and more in multipara (25.4%) than primipara (15.9%). Abdominal distension, wound gap and fever were the common morbidities while no maternal mortality in the present study. 330 out of 685 babies were admitted in NICU and majority of them were for jaundice, preterm care and birth asphyxia. Perinatal mortality in the study was 6.6% and among them antepartum hemorrhage has the highest perinatal mortality rate. Prematurity was the most common cause of neonatal deaths. Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of t...
The objective of the current study was to develop a specific, precise, accurate and robust gradient stability indicating reversed-phase ultra performance liquid chromatography (RP-UPLC-PDA) assay method and validated for determination of edoxaban tosylate in API. Gradient separation was achieved on an acquity UPLC BEH C18 column (50 mm, 2.1 mm and 1.7 μm) column using mobile phase of acetoitrile:20 mM potassium dihydrogen phosphate, pH 3.0 ± 0.05 adjust with OPA at flow rate of 0.6 mL/min, the injection volume was 1 μL and the detection was carried out of 289 nm by using photodiode array detector. The drug was subjected to oxidation, hydrolysis, photolysis, and heat to apply stress condition. The method was linear in the drug concentration range of 100-300 μg/mL with correlation coefficient of 0.999. Degradation products produced as a result of stress studies did not interfere with detection of edoxaban tosylate and the assay, thus developed stability indicating method can be used for routine analysis in pharmaceutical industry.
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