The study has highlighted that yoga is a noninvasive, easy to learn mind-body medicine and complementary health practice, effective in alleviation of labor pain and possibly improving birth outcome.
Introduction: In India's immense population, the maternal mortality ratio in 2016-2018 was 113. We are still away from the sustainable development goals (SDGs) of MMR less than 70 per 100,000 live births set by the United Nations. 1 In obstetric patients, due to the occasional occurrence of critical conditions, it is hard to identify the initial signs of grievous illness. Focusing on mothers whose comorbidities place them at risk of severe maternal morbidity is a strategy for risk reduction. The obstetric comorbidity index (OB-CMI) is one such tool that summarizes the burden of maternal comorbidities with a quantified approach. Aim: To evaluate the performance of OB-CMI in identifying women at risk of severe maternal morbidity (SMM) during labor. Material and methods: We did a retrospective analysis of hospital records of pregnant women >28 weeks gestation admitted to the labor room, in labor, or planned for delivery (January-June 2019). On admission, the OB-CMI was calculated for each patient based on history, examination, and investigations. Any SMM (ACOG and Society for Maternal-Fetal Medicine consensus definition) experienced before discharge was recorded. Association between OB-CMI and SMM was analyzed. Results: Out of the 1678 women included in the study, 36 women experienced SMM (2.1%). The OB-CMI ranged from 0 to 10, with a median of 0. The median of patients experiencing SMM was 5 as compared to 0 in those who did not (p <0.000). For every 1-point increase in the score, patients experienced a 2.02 increase in odds of severe maternal morbidity (95% confidence interval, 1.75-2.34). The ROC analysis revealed good discrimination between OB-CMI and SMM (0.841, 95% confidence interval 0.752-0.930). Conclusion:The prevention of SMM is a priority and OB-CMI is a clinically valid tool to identify women at risk during delivery. It is useful as a screening tool, for triaging high-risk patients in specialized institutions that are well equipped. It could also complement physiologic-based screening tools and help in early intervention.
Introduction: Hysterectomy is a common gynecological procedure performed worldwide. Most of the international guidelines state that whenever feasible, they have to be performed vaginally or laparoscopically or with laparoscopic assistance as it is beneficial to patients. But majority are still being done by laparotomy. Minimally invasive surgery (MIS) is being widely adopted nowadays, and we need quality and performance indicators to analyze their benefits. One such indicator is technicity index (TI). Technicity is defined as the number of hysterectomies performed vaginally [non-descent vaginal hysterectomy (NDVH)] and laparoscopically [laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH)] over the total number of hysterectomies performed in a particular health facility, in a year. Objective: To determine the TI from January 2014 to December 2018. Materials and methods: This was a retrospective, observational study in which the approach to all hysterectomies performed during January 2014 to December 2018 was recorded at Father Muller Medical College, Mangaluru. Hysterectomies done for obstetric indications and malignancies were excluded. The routes adopted for all types of hysterectomies were calculated, and the TI was calculated for every year. Results: In total, 2,268 hysterectomies were performed in 5 years, of which 222 (9.7%) were laparoscopic, 301 (13.27%) vaginal, and 1,745 (76.94%) total abdominal hysterectomies. The TI ranged from 17.21% to 29.11%. The average index for 5 years was 23.05%. Conclusion:Technicity index can be used to monitor shift toward minimally invasive procedures in our department. Assessing our level of care is necessary to effectively modify patient care. We can approach a higher TI by allocating resources to teach and provide MIS.
Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast® and Vicryl Rapide® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast® (n=47) or Vicryl Rapide® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p<0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 versus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast® and Vicryl Rapide® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast® suture is clinically equivalent to Vicryl Rapide® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020
Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast® and Vicryl Rapide® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18—40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast® (n=47) or Vicryl Rapide® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p<0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 versus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast® and Vicryl Rapide® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast® suture is clinically equivalent to Vicryl Rapide® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020
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