INTRODUCTIONThe essential components of antenatal care are screening of pregnant women for high risk factors, performing essential laboratory investigations and provision of advice regarding personal hygiene, nutrition, immunization and regular follow up visits. Literature review suggests that women with regular antenatal visits have better pregnancy outcome than their counterparts. 1The reported percentage of antenatal care coverage in India by UNICEF was 37% for four visits and 74% for at least a single visit (2014), institutional delivery rate of 47% and delivery by trained person was 52%.2 Despite ongoing efforts to improve maternal and child health in developing countries, mortality rates remain much higher than in developed countries.3 Women in developing ABSTRACTBackground: The rapid escalation of cellular network coverage and expansion of mobile phone usage has opened up a new way of deploying health services. The mobile app with message facilities help in imparting health education regarding nutrition, iron and folic acid prophylaxis, tetanus toxoid immunization, danger symptoms and signs during pregnancy etc. Present study aimed to improve maternal health and pregnancy outcome by optimum utilization of antenatal, natal and postnatal care services, with the use of mobile phone as a medium of communication between health care provider and community in rural area. Methods:The prospective randomized control study, with two hundred pregnant women each, coming for antenatal visit and having personal mobile phone facility, were randomly allocated to control and intervention group. Control group women received routine antenatal care and advice as per hospital protocol. In addition to routine care and advice, intervention group received mobile phone calls, as reminders about next visit and text messages (SMS) on important aspects of antenatal care at regular intervals. The primary outcome indicators of the study were percentage of pregnant women coming for at least four antenatal visits, percentage of institutional delivery and postnatal checkups. Results: Women in the intervention group had significantly higher number of antenatal visits, consumption of iron tablets, tetanus toxoid immunization, institutional deliveries and postnatal check-ups as compared to the control group. Conclusions: In the present study, the mobile phone intervention, significantly increased the percentage of women receiving the recommended four antenatal visits and showed a trend towards more women receiving preventive health services. Study gathered good evidence that m-Health tools present an opportunity to influence behaviour change and ensure that women access prevention services, including antenatal, natal and postnatal care. Mobile technology, specifically SMS can be successfully used to extend health information services to pregnant women.
Background-Obstetric emergencies can occur suddenly and unexpectedly. They are associated with adverse maternal and perinatal outcome. Early identification of high risk pregnancies can reduce the incidence of obstetric emergencies. Present study was carried out to find out the incidence, nature and outcome of obstetric emergencies. Material and methods-Retrospective observational study of obstetric emergencies admitted at tertiary care center over a period of two years. Results-Obstetric emergencies occurred more frequently during antenatal period (52%) than intra (32%) or postnatal period (16%). Hemorrhage and severe hypertension were the commonest emergencies during pregnancy, where as prolonged labour, obstructed labour and rupture uterus was common during intra natal period. Postpartum hemorrhage, retained placenta inversion of uterus and puerperal sepsis were common causes of emergencies during postnatal period. Maternal and perinatal mortality was significantly higher in obstetric emergency cases. Postpartum hemorrhage was the commonest direct cause and infective hepatitis was the commonest indirect cause for maternal deaths. Prematurity, low birth weight babies and birth asphyxia were responsible for 90 percent of perinatal mortality. Conclusion-Early registration, regular antenatal visits, early identification and timely referral of high risk pregnancies can reduce the incidence of obstetric emergencies. Training of nurse midwives, village health workers and doctors at primary health centers, in early identification and treatment of common emergencies can reduce the maternal and perinatal morbidity and mortality.
Background: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 wks of the gestations and before the onset of the regular painful uterine contractions .It occurs in ten percent of cases .These cases are either managed conservatively or by immediate induction of labour. Objective: To find out the efficacy and safety of induction of labour versus expectant management in women with premature rupture of membranes beyond 36 weeks gestation, in terms of induction delivery interval, operative interventions, and fetal outcome Material and Methods: A prospective, randomized controlled study was carried out for a period of two years from November 2008 to October 2010 at Rural Medical College, Loni. One hundred pregnant women with term PROM were assigned randomly, each in induction and expectant group. Results: .The mean interval from induction to delivery was significantly shorter in the induction group as compared with expectant group. Incidence of maternal morbidity was comparable in both the groups Neonatal morbidity was higher in expectant group. Incidences of hyper stimulation were more with induction group as compared to expectant group .There was no maternal or perinatal mortality in any group. Intrapartum complications and mode of delivery were similar in both groups. Conclusion: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval but increased rate of operative intervention. Maternal morbidity was comparable with induction and expectant line of management. However, neonatal morbidity was higher in expectant group.
Introduction-Caesarean section is the most commonly performed major emergency surgical procedure in Obstetrics. With the improved caesarean skill of the obstetrician and techniques of anaesthesia, the caesarean section has become a safe surgical procedure .The rate of caesarean section has shown progressive rise in last three decades in most part of the world .The immediate operative morbidity and the likelihood of complications in subsequent pregnancies, raise question marks regarding rising caesarean section rates. Material and methods-Retrospective analysis of 3980 caesarean sections performed at tertiary care teaching hospital over six years period, was undertaken to find out the rate of caesarean sections, indications and associated maternal morbidity and mortality . Results-The rate of caesarean section was in between 20 and 22 percent, during the study period .The rate has been fairly constant throughout the study period. The common indications were previous caesarean section, fetal distress, cephalopelvic disproportion, pre-eclampsia or antepartum haemorrhage. Anaemia and urinary infections resulted in postoperative febrile morbidity. Incidence of wound related complications were not significant .There were twelve maternal deaths, of which six were due to severe uncontrolled hemorrhage from placental bed during caesarean section. Conclusion-Caesarean section rate can be maintained at acceptable limits by judicious selection of cases, allowing vaginal births after caesarean sections, external cephalic versions, assisted vaginal breech deliveries in selected cases and proper interpretation of results of electronic fetal monitors. Pain relief by epidural analgesia can reduce the fear of labour and rate of elective caesarean sections.
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