Background: Hypertensive disorders are the most common medical disorders in pregnancy contributing significantly to maternal and perinatal mortality and morbidity worldwide. The incidence is around 3-10% of all pregnancies. The aim of antihypertensives is to reduce, stabilize the blood pressure and thus minimize the risks such as placental abruption, maternal cardiac failure, cerebral hemorrhage; but they should not have any adverse effects on the uteroplacental circulation and the fetus. Antihypertensive drugs are often used to lower blood pressure to prevent this progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. The aim and objectives of the study was a comparative study of the efficacy of methyldopa, nifedipine versus labetalol and the feto-maternal outcome in gestational hypertension in a tertiary care referral centre. Methods: A prospective study on 240 outpatients as well as inpatients of the antenatal ward of Obstetrics and Gynaecology department of Chhattisgarh Institute of Medical Sciences, Bilaspur which is a tertiary care referral hospital. The patients randomly divided in three groups. The first group received alpha-methyl dopa 250mg tds, second 20 mg bd nifedipine and the third one labetalol 100mg bd. Mean arterial pressure calculated by systolic BP +2 DBP/3.The fall in BP calculated along with time required, dose of drug required, spontaneous/ induced labour or caesarean section, adverse maternal and the fetal outcome was observed. Results: Maximum number of patients that is 145(60.42%) patients belonged to the age group of 19 to 24 years and were primigravida (70.42%) presenting at 33-37 weeks of gestation. Significant fall in MAP was seen in patients receiving nifedipine and labetalol. Mean time to control blood pressure is 46.32 hrs in methyldopa group, 30.44hrs in nifedipine group and 37.24 hrs in labetalol group. 103 (42.9%) patients had normal delivery whereas 137 (57.1%) required a caesarian section, higher rate of spontaneous labour in nifedipine and labetalol group. Most common sideeffect observed was headache; the other side effects included drowsiness, more in patients treated with methyldopa, weakness, more in patients treated with labetalol. The fetal outcome was better with labetalol and nifedipine than methyl-dopa group. Conclusions: The decreased association from maternal and fetal side-effects, the comparatively better hypotensive action indicates that labetalol and nifedipine is suitable for use during pregnancy. Labetalol is safer, quicker in achieving adequate control of blood pressure with considerable prolongation of the duration of pregnancy with fewer side effects on the mother as well as the neonate when used in the management hypertensive disorders of pregnancy.
Background: Hypertensive disorders of pregnancy constitute one of the major threats to maternal health. Eclampsia is still a leading cause of maternal morbidity and mortality in developing countries. This study was carried out to determine the incidence of eclampsia, demographic profile of patients, obstetric outcome, fetal outcome, maternal morbidity and mortality. Methods: A 5 year retrospective observational study included 521 patients who presented in emergency with eclampsia and admitted between April 2010 and March 2015, in the department of Obstetrics and gynecology, government medical college (Chhattisgarh institute of medical sciences) and tertiary care hospital Bilaspur, Chhattisgarh. Results: Based on 14,876 pregnancies in the 5 year period in our referral hospital, we estimated an incidence of 3.5%.70.8% were primigravida and 86.4% of patients had no regular antenatal care. Majority of the cases (82.1%) presented as antepartum/intrapartum eclampsia in the age group 20-24 years (65.4%).The patients usually presented at term(62.4%) with 69.7% having vaginal delivery as compared to 30.3% undergoing LSCS. The fetal outcome showed 56.2% live-births, 25.5% had early neonatal death and 13.3% stillborn. The complications most commonly observed were puerperal sepsis (11 %),oliguria(8.1%), pulmonary edema(5.9%) and maternal mortality as 8.4 %. Conclusions: Most of the life-threatening eclampsia cases can be prevented by simple awareness and motivation towards antenatal care. In Chhattisgarh state where majority of rural population are tribal, illiterate, living in difficult to reach areas, delay in referral, due to unavailability of clinicians or medical officers in peripheral areas for antenatal examination.The best way to reduce the burden is by creating an awareness, proper antenatal care, timely referral and thus prevent the occurrence of eclampsia.
Background: Hysterectomy has always been a subject of controversy in India and increasing rate of unnecessary hysterectomies in young, premenopausal women is cause for concern regarding women’s health and rights. The aim of this study is to review and analyse cases of hysterectomy in a rural population and to correlate with underlying factors behind seeking hysterectomy as a treatment of choice for pelvic pathologies.Methods: This was an ambidirectional observational descriptive study in which 352 women were included who underwent hysterectomy between January 2016 to July 2017 in the Department of Obstetrics and Gynecology, Government Medical College Rajnandgaon and a tertiary care referral hospital of central Chhattisgarh, India.Results: Majority were between 31-50 years of age group, grandmultipara, uneducated, insured by National health insurance scheme.76.1% patients had attended medical college hospital to avail free services. 60.5% took prior treatment from unqualified/ unregistered/registered general practitioners. Erratic use /use of suboptimal dosage of hormones to stop abnormal uterine bleeding, nonspecific antibiotics to treat infection, incomplete treatment and poor compliance were possible reasons behind failure of previous treatments. Abnormal menstruation was the commonest presenting complaint observed in 75.2%. 72.4% patients refused to come for follow up and reasons were unavailability of transport facility, fear of losing job, loss of daily wages and financial constraints. Commonest indication for hysterectomy was symptomatic fibroid in 32.0%. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the most common procedure done in 59.0%. The rate of hysterectomy came out to be 57.6% which is quite higher than that reported in other studies. Fever was the most common complication encountered in 0.80%.Conclusions: Despite the remarkable improvement in conservative management and media coverage, hysterectomy still remains the most preferred modality of treatment with excellent satisfaction for pelvic pathologies in rural India.
Background: Menopause is a natural process that results in atresia of almost all oocytes in ovaries, causing an increase in follicle-stimulating hormone and luteinizing hormone levels and a decrease in estrogen levels. Menopausal symptoms impact physical, psychological, vasomotor, and sexual health-related quality of life among women. Aim and objective: The study was planned with the aim to assess the commonly reported menopausal symptoms among rural women of Central India, Rajnandgaon, Chhattisgarh, using the menopause rating scale (MRS). Materials and methods: An observational cross-sectional study was carried out in the Department of Obstetrics and Gynecology, Atal Bihari Vajpayee Memorial Medical College Rajnandgaon, Chhattisgarh, for a period of 6 months. In all, 199 patients who had attained menopause were analyzed. Menopausal symptoms were assessed using modified MRS). Quantitative data were presented as frequencies and percentages by using SPSS version 21. Results: Two hundred Questionnaires were distributed among the females who attended gynecology OPD and IPD and 199 gave consent to participate in the study; the response rate was 99.5%. The mean age at menopause was 45.35 ± 4.42 years. In all, 100% of women reported having experience of more than five menopausal symptoms. The prevalence of symptoms in urogenital-sexual was 76.88%, somatic 75.62%, and psychological 73.33%. Conclusion: Menopause-related symptoms are highly prevalent among middle-aged women in rural areas of Rajnandgaon, Chhattisgarh; this signifies the urgent need for community-based screening for such condition. Physical symptoms (joint and muscle problems) are the most commonly reported one. Healthcare providers have to be sensitized to special health needs of these rural middle-aged menopausal women.
A fibroepithelial polyp (FEP) is a relatively uncommon benign condition of vulva, mainly of reactive origin, occurs in women of reproductive age, mostly during pregnancy. Here is a case which presented with bilateral vulval mass, for that she underwent surgical excision. Histopathological examination revealed bilateral fibroepithelial vulval polyp. After 4 years of uneventful interval same female came with term pregnancy with a huge vulval mass on left side, having similar characteristic features as previous one. Emergency cesarean section followed by excision of polyp in the same sitting done. Histopathological report confirmed the finding of fibroepithelial polyp this time also. Only few cases of recurrent fibroepithelial polyp of vulva associated with pregnancy have been reported till date. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 245-247
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