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.
BACKGROUNDUse of ultrasound for brachial plexus block has improved the precision of drug deposition around the plexus and hence the quality of the block. But there has been debate whether single point technique or double point technique is superior. Our aim was to compare the two techniques for the onset, completeness and quality of the block. METHODSA prospective observational study was designed. 140 patients were equally divided into Group A and Group B containing 70 posted for elbow, forearm and wrist surgery. A drug solution of 30 ml was prepared using Ropivacaine 0.75% 15ml + Lignocaine 2% with adrenaline 10 ml + 5ml of normal saline. Group A received 30ml of drug at the lower end of brachial plexus at 7 O'clock position. Group B received 15 ml of drug at site mentioned above and 15 ml was given at the upper part of brachial plexus at 11 O'clock position. Parameters noted were time taken for giving block, onset and completeness of sensory and motor block, encircle time, total duration of block. Unpaired student t test used for comparing quantitative variables and Chi-square test for qualitative variables. p < 0.05 was considered statistically significant. RESULTSThe time required for giving the block was more in Group B (198.57 19.56 sec) compared to Group A (151.53 14.37 sec) but the encircle time in Group B (16 3.32 min) was lesser than Group A (19.01 3.6 min). The time of onset and completion of sensory and motor block for musculocutaneous, radial, ulnar and median nerve was faster in Group B compared to Group A. Duration of block in Group A was 367 50.49 minutes, whereas in group B 388 49.98 minutes. CONCLUSIONSIn ultrasound guided brachial plexus block, even though both techniques have satisfactory results, double point technique is superior to single point technique in terms of onset, completeness and duration of the block but in terms of simplicity in technicality single point technique has the upper hand.
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