Background: The aim of the study is to compare and evaluate between unengaged (UE) and engaged (E) groups at term or in labour, incidence of unengaged and engaged heads, need for medical or surgical intervention, progress of labour and feto-maternal outcome.Methods: It is a prospective comparative study carried at tertiary care hospital for a period of 18mths from May16-November17. Out of 377 patients, 100 patients were selected in each group with unengaged (group A) and engaged (group B) heads. Patients consent, and ethical approval was taken. History, examination and investigation was done at each visit. Incidence of unengaged heads at term or in labour, duration of each phase of labour and its partographic analysis, need for medical or surgical intervention, mode of delivery and fetomaternal outcome was calculated.Results: Incidence of unengaged heads at term is 61%. 17% patients in unengaged group as compared to 10% required induction of labour while 73(73%) patients in unengaged group required augmentation with oxytocin as compared to 36(36%) patients in engaged group. Duration of labour in each phase was more in unengaged group. Incidence of lower segment caesarean section (LSCS) was 37% in unengaged group as compared to 23% in engaged group. Fetomaternal morbidity which was higher in unengaged was documented.Conclusions: Although with unengaged head being a significant risk factor for LSCS, with watchful expectancy and careful intervention, most patients will deliver vaginally with minimal fetomaternal morbidity.
Background: Umbilical cord around neck of the foetus is called the nuchal cord. The aims and objectives are to find out the incidence of nuchal cord around foetal neck at delivery, and to compare and evaluate intrapartum and postpartum maternal and foetal outcome in those with or without nuchal cord at delivery. Methods: It is a prospective cross-sectional study conducted at tertiary care hospital for period of 12 months. Of 1380 patients, 934 patients were enrolled in present study after meeting the inclusion and exclusion criteria of which 150 patients were included in study group who delivered with nuchal cord and 784 patients in control group who delivered without nuchal cord. Results: Present study showed 18.84% incidence of nuchal cord at delivery. Duration of labour was 6.51hrs in study group and 6.15hrs in control group and the difference was statistically significant. Rest of the intrapartum and postpartum events were statistically not significant. Mean length of cord was more in patients delivered with loop of cord around foetal neck as compared to another group and it is statistically significant. Conclusions: Nuchal cord is a common finding at the time of delivery. However, it is per-se not an indication of LSCS and it only increases the operative morbidity.
Background: Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance with recognition or onset during pregnancy is associated with a higher rate of maternal and fetal compromise. OGTT is the current gold standard for screening for GDM. It is a two-step test which requires the pregnant woman to be in a fasting state for a long duration. DIPSI is a one-step procedure for diagnosing GDM does not require patients in a fasting state and is a simple, economical and feasible alternate in Indian scenario. The aim of this study is to compare DIPSI criteria-based test with conventional OGTT for diagnosis of GDM.Methods: A hospital-based screening study was conducted at Department of Obstetrics and Gynecology, K J Somaiya Medical College and hospital, Mumbai for duration of May 2015 to June 2016. A total of 200 consecutive pregnant women in the second and third trimester of pregnancy registered at our antenatal clinic and satisfying the eligibility criteria were taken in the study after informed consent. Pregnant women with 2-h PG ≥ 7.8 mmol/L (DIPSI criterion) were diagnosed as GDM and rest were classified as normal glucose tolerant (NGT) women. One week later all of them were made to undergo the conventional 75 gm OGTT. Data was analyzed using statistical software SPSS ver. 21.Results: The sensitivity and specificity of DIPSI was 86.8% and 98.8% with PPV and NPV of 94.3% and 97.0% and overall diagnostic accuracy was 96.5%.Conclusions: The results of present study show that DIPSI is a simple, single, convenient, economical screening test for GDM and can be used as both diagnostic as well as screening test with good diagnostic efficacy.
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