BACKGROUND: Eclampsia is a very serious complication of pregnancy which is responsible for high maternal and perinatal mortality. Worldwide, it accounts for 50,000 maternal deaths annually. In spite of several global and regional interventions and initiatives from governments and other concerned agencies, maternal mortality is still very high in India, with eclampsia as a major cause. This study was conducted to determine the mode of deaths and incidence of maternal mortality associated with eclampsia and to assess how socio-demographic and clinical characteristics of the women influence the deaths. MATERIALS AND METHODS: This is a retrospective study of 111 eclampsia related maternal deaths over a period of 5 years from January 2008 to December 2012. Data pertaining to their age, parity, booking status, gestational age at delivery, and time interval from admission to death were also obtained from the records for analysis. RESULTS: Eclampsia accounted for 43.35% of total maternal deaths, with case fatality of 4.960%. The commonest mode of death in eclampsia is pulmonary oedema. Death due to eclampsia commonly occurs in younger age group of 19-24 years and in primi gravid. Eclampsia related deaths were mostly seen in illiterate and unbooked cases. Maternal deaths were also very common in lower socio economic status. CONCLUSION: Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is a need to educate and encourage the general public for antenatal care and hospital delivery by which we can defeat this powerful enemy.

BACKGROUND: Apha-2 agonists are combined with local anesthetics to extend the duration of regional anesthesia. We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia. METHODS: Sixty patients scheduled for elective forearm and hand surgery were divided into two equal groups in a randomized double blind fashion. The patients received brachial plexus block via supraclavicular route with the help of nerve stimulator. In group L (n=30) 35cc of levobupivacaine with 1ml of isotonic saline and in group LD (n=30) 35cc of levobupivacine with 1 ml of (100 microgram) of dexmedetomidine was given. Duration of motor and sensory block and time to first rescue analgesia were recorded. Data analysis was done by SPSS version 16.0 [SPSS Inc ILLINOIS, USA, 2008]. Categorical variables were analyzed using Pearson"s Chi-square test. Normally distributed numerical variables were analyzed using unpaired "t" test. Skewed numerical variables within the group were analyzed using Man-Whitney "U" test. All tests were two tailed. Statistical significance was defined as P<0.05. RESULTS: Sensory and motor block durations were longer in group LD as compared to L (P<0.01). Duration of analgesia was significantly longer in group LD as compared to group L (p<0.05). CONCLUSION: Dexmedetomidine added to levobupivacaine in supraclavicular brachial plexus block prolongs the duration of block and the duration of postoperative analgesia.

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Background Limited evidence exists on perinatal transmission and outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates. Objective To describe clinical outcomes and risk factors for transmission in neonates born to mothers with perinatal SARS-CoV-2 infection. Design Prospective cohort of suspected and confirmed SARS-CoV-2 infected neonates entered in National Neonatology Forum (NNF) of India registry. Subjects Neonates born to women with SARS-CoV-2 infection within two weeks before or two days after birth and neonates with SARS-CoV-2 infection. Outcomes Incidence and risk factors of perinatal transmission. Results Among 1713 neonates, SARS-CoV-2 infection status was available for 1330 intramural and 104 extramural neonates. SARS-CoV-2 positivity was reported in 144 intramural and 39 extramural neonates. Perinatal transmission occurred in 106 (8%) and horizontal transmission in 21 (1.5%) intramural neonates. Neonates roomed-in with mother had higher transmission risk (RR1.16, 95% CI 1.1 to 2.4; P =0.01). No association was noted with the mode of delivery or type of feeding. The majority of neonates positive for SARS-CoV2 were asymptomatic. Intramural SARS-CoV-2 positive neonates were more likely to be symptomatic (RR 5, 95%CI 3.3 to 7.7; P <0.0001) and need resuscitation (RR 2, 95%CI 1.0 to 3.9; P =0.05) compared to SARS-CoV-2 negative neonates. Amongst symptomatic neonates, most morbidities were related to prematurity and perinatal events. Conclusion Data from a large cohort suggests perinatal transmission of SARS-CoV-2 infection and increased morbidity in infected infants.

Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. To analyze the rate and indications for C-Section and associated maternal morbidity and mortality were the main objectives of present study.Methods: This retrospective study was conducted over a period of one year from 1st May 2017 to 30th April 2018 at the Department of Pediatrics and OBG, IMS & SUM Medical college and Hospital, Bhubaneswar (Odisha), eastern India. Data of Patients who delivered by C-Section in our hospital during the defined study period was recorded and a statistical analysis of various parameters namely, the caesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 1619, out of which C-Sections were 574.The overall CS rate was 35.45%. Previous LSCS was the leading indication to the CS rate (29.96%) followed by arrest of labour (13.94%), CPD (11.84%), foetal distress (10.97%), breech presentation (5.74%), oligohydroaminous/IUGR (5.21%), failed induction of labour (5.21%), pregnancy induced hypertension(PIH) (4.87%) and multifetal gestation (3.84%), prematurity (3.31%). 12.01% patients had various complications mainly infection (6.27%) and hemorrhage (3.48%). There was no mortality during this period.Conclusions: Being a tertiary care hospital, a high rate of Caesarean deliveries was observed, Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit CSR.

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Monitoring the renal arterial Doppler flow velocity indices, the resistive index and pulsatility index, with ultrasound may help predict renal dysfunction. However, such monitoring has been done intermittently by transcutaneous ultrasound in the postoperative intensive care setting. In the operating room, transesophageal echocardiography (TEE) is an alternative to transcutaneous ultrasound for obtaining indices of renal perfusion. However, it is difficult to locate the right kidney using TEE. We propose a new technique to locate the left kidney that, in our experience, is simple and easy to perform. We believe, starting from a transgastric left ventricular short-axis view, turning left to locate the abdominal aorta, and following it to the origin of the left renal artery may help locate the left kidney faster than previously described techniques. We also propose a new technique to monitor these Doppler indices using TEE during the intraoperative period.