Objective (1) To determine the incidence of near-miss, maternal death and mortality index; (2) to compare nearmiss cases as per WHO criteria with that of maternal mortality; and (3) to study the causes of near-miss and maternal deaths. (2002) 123Methodology A cohort of emergency obstetric admission in the study setting during the study period was followed till 42 days after delivery, and cases fulfilled WHO set of severity markers for near-miss cases for severe acute maternal morbidity (SAMM) and mortality. All maternal deaths during the same period were analysed and compared with near-miss ones. Results During the study period, there were 29,754 emergency obstetric admissions, 21,992 (73.91 %) total deliveries with 18,630 (84.71 %) vaginal deliveries and 3360 (15.28 %) caesarean deliveries. There were 161 nearmiss cases and 66 maternal deaths occurred. The maternal near-miss incidence ratio was 7.56/1000 live births, while maternal mortality ratio was 2.99/1000 live births. Mortality index was 29.07, lower index indicative of better quality of health care. Maternal near-miss-to-mortality ratio was 3.43:1. Amongst near-miss cases, haemorrhage n = 43 (26.70 %), anaemia n = 40 (24.84 %), hepatitis n = 27 (16.77 %) and PIH n = 19 (11.80 %) were leading causes, while causes for maternal mortality were PIH n = 18 (27.27 %), haemorrhage n = 13 (19.79 %), sepsis n = 12 (18.18 %), anaemia n = 11 (16.16 %) and hepatitis n = 11 (16.66 %). Conclusion Despite improvements in health care, haemorrhage, PIH, sepsis and anaemia remain the leading obstetric causes of near-miss and maternal mortality. All of them are preventable. The identification of maternal nearmiss cases using new WHO set of severity markers of SAMM was concurrently associated with maternal death. Definite protocols and standards of management of SAMM should be established, especially in rural Indian settings.
Adolescence is a period of enormous physical and psychological change for young girls. Many adolescents with menstrual disturbances never present to their family doctor or gynecologist. Embarrassment about discussing menstruation, fear of disease, and ignorance about services available may lead to delayed presentation or consultation with doctor. Aims and Objective(1) To evaluate the different gynecological problems in adolescent girls attending outpatient department. (2) To evaluate the prevalence of severe anemia requiring indoor admission in adolescent girls with puberty menorrhagia. (3) To assess the etiologies of puberty menorrhagia.Result There were a total of 655 adolescent girls attending the gynecology OPD during the study period. Menstrual complaints (84.88 %) were the commonest indication for OPD consultation among adolescent girls. 17 girls required hospitalization; all of them needed blood transfusion due to significant severe anemia resulting from puberty menorrhagia. 14 (82.35 %) had anovulatory DUB, (2002) from the Government Medical College, Nagpur. She presented a poster at AMOGS 2012 at Nanded, which was selected among the best six posters of the conference, and also a poster at the World Congress of Dilemma in Pregnancy at Nagpur in 2013. She had presented a paper on ''Analysis of near-miss cases and maternal mortality'' at SVN GMC, Yavatmal at the AICOG 2015 in Chennai and chaired a session at the AICOG 2015. She has to her credit three papers published in national and international journals, and several articles are under review. She is a MUHS-recognized teacher and MMC-accredited speaker. She is interested in studying health problems of women and girls in rural and tribal districts of Yavatmal. Her other areas of interest are high-risk pregnancy and adolescent health.The Journal of Obstetrics and Gynecology of India (September-October 2016) 66(S1):S400-S406 DOI 10.1007/s13224-015-0770-1 123 while 2 (11.76 %) had coagulation disorders, and one (5.88 %) had hypothyroidism. Conclusion Adolescent girls with menorrhagia need to be evaluated thoroughly earlier rather than later so that effective management can be started and severe anemia with its consequences can be avoided. Adolescent health education and group discussion is needed to create awareness regarding adolscent gynecological problems; it should be conducted regularly in schools and colleges.
This review article explores the potential of ChatGPT as a substitute for diabetes educators. Diabetes is a prevalent chronic disease that requires ongoing education and support for patients to effectively manage their condition. However, there is a shortage of diabetes educators, and traditional education methods have limitations in addressing patients' individual needs. ChatGPT is an artificial intelligence technology that offers a personalized and interactive approach to education and support. In this review, we provide an overview of ChatGPT technology, discuss the challenges facing diabetes educators, review evidence supporting the use of ChatGPT in diabetes education, and examine ethical considerations related to its use. We also provide recommendations for further research and development of ChatGPT in diabetes education and integration into clinical practice. ChatGPT has the potential to improve access to education and support for patients with diabetes, but further research is needed to better understand its effectiveness and limitations. It is important to ensure that ChatGPT is developed and integrated in an ethical and equitable manner to maximize its potential benefits and minimize potential risks.
One of the most common psychological effects following childbirth is postpartum depression. Postpartum depression (PPD) has a significant negative impact on the child's emotional, mental as well as intellectual development if left untreated, which can later have long-term complications. Later in life, it also results in the mother developing obsessive-compulsive disorder and anxiety. Many psychological risk factors are linked with PPD. The pathophysiology of the development of PPD is explained by different models like biological, psychological, integrated, and evolutionary models, which relate the result of the condition with particular conditions and factors. This article also explains the role of methyldopa as a medication used during pregnancy and the postpartum phase with the development of PPD. There are different mechanisms by which methyldopa causes depression. The large-scale screening of the condition can be done by Edinburgh Postnatal Depression Scale (EPDS). The diagnosis can be made by clinical assessment, simple self-report instruments, and questionnaires provided to mothers. Currently, there has not been any specific treatment for PPD, but selective serotonin reuptake inhibitors (SSRIs) like sertraline are effective in acute management. Venlafaxine and desvenlafaxine are serotonin-norepinephrine reuptake inhibitors used for the relief of symptoms. The SSRI and tricyclic antidepressants (TCA) used in combination have a prophylactic role in PPD. Nowadays, women prefer psychological therapies, complementary health practices, and neuromodulatory interventions like electroconvulsive therapy more than previous pharmacological treatments of depression. Allopregnanolone drug made into sterile solution brexanolone leads to a rapid decline of PPD symptoms. PPD is a common and severe disorder that affects many mothers following childbirth but is ignored and not given much importance. Later it affects the child's psychological and intellectual abilities and mother-child bonding. We can easily prevent it by early diagnosis and timely care and management of the mother. Understanding the underlying pathophysiology would also go a long way in preventing and managing the disorder.
INTRODUCTIONHysterectomy, abdominal, vaginal or laparoscopic assisted vaginal hysterectomy is the most commonly performed elective major gynaecological surgery. 1 The current ratio of abdominal to vaginal hysterectomy is 3:1 for the treatment of benign disorders. The ratio should be reversed because fewer post-operative complications are associated with the vaginal route, which allows earlier recovery and return to work. 2Vaginal Hysterectomy is a technique that had already been introduced and performed centuries ago but with little success among gynaecologist probably because of an in experience or lack of enthusiasm among gynaecologist who performed the abdominal route believing it to be safer and easier procedure. In recent decade increased expertise has been achieved by the gynaecologist and better compliance has been reported by the patients. This has led to increased number of vaginal hysterectomies compared to abdominal hysterectomies.Vaginal surgery is least invasive and results in better quality of life. Many nulliparous women and many women who have undergone caesarian delivery do infact have sufficient vaginal capacity to allow vaginal hysterectomy. As long as surgeon can obtain adequate ABSTRACT Background: Hysterectomy is the major gynaecological surgery performed by gynaecologist all over the world. Various approaches have been tried by gynaecologist all over the world including abdominal, vaginal, laparoscopic, notes and robotic hysterectomy. Vaginal approach greatly reduces complications, decreases hospital stay, lowers hospital charges, post-operative discomfort and cosmetically better compared to abdominal and laparoscopic approaches. Vaginal hysterectomy in large sized uterus can be facilitated by bisection, myomectomy, debulking, coring and clamp less approach. The aim and objective of the study was to compare outcome of NDVH with outcome of TAH in terms of post-operative morbidity and duration of hospital stay. Methods: A total of 100 cases were selected with enlarged uterus of which 50 underwent NDVH and rest 50 underwent TAH. All patients were evaluated for operative time, intra-operative and post-operative complications and duration of hospital stay. Data were recorded and processed and standard statistical software were used. Results: Patients undergoing NDVH had an average operating time of 48.68 mins whereas for those undergoing TAH was 92.52 mins ('p'-value <0.001). Intra-operative complications were noted in 2% of patients undergoing NDVH whereas in 20% of patients undergoing TAH ('p'-value 0.016). Post-operative complications were noted in 34% of patients undergoing NDVH v/s 70% in TAH ('p'-value <0.001). Patients undergoing NDVH had a mean hospital stay of 5.96 days whereas 9.10 days in those undergoing TAH ('p'-value <0.001). Conclusions: NDVH is associated with decreased operative time, post-operative morbidity, early ambulation and early discharge from hospital compared to TAH.
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