Background: Non-pneumatic anti-shock garment (NASG) is a first-aid device that reverses hypovolemic shock and decreases obstetric haemorrhage. It consists of articulated neoprene segments that close tightly with Velcro, shunting blood from the lower body to the core organs, elevating blood pressure and increasing preload and cardiac output. The use of an NASG can stabilize a patient while awaiting transport, during transport, or during delays in receiving care at referral facilities.Methods: A prospective observational study of use of non-pneumatic anti shock garment (NASG) in cases with obstetric hemorrhagic shock was carried out at a tertiary referral center. As soon as severe shock was recognized in the hospital, the anti-shock garment was placed. Data on various parameters related to use of NASG was collected and interpreted to draw conclusions.Results: NASG was used in 25 cases of hemorrhagic shock during one-year period. Post-partum hemorrhage (36%) was the commonest indication for NASG use, followed by ruptured tubal ectopic pregnancy (28%). It was observed that 68% and 32 % of women had shock index of 1-1.5 and above 1.5 respectively at the time of application of NASG. The shock index rapidly improved to 0.5-0.9 in 92% and 1-1.5 in 8 percent of cases respectively after the application of NASG. The NASG was mainly used in labour room (40%) and emergency department (36%).  NASG was applied by nurses and doctors together in 64% of cases. NASG was kept for a period 24 hours in 92% cases. The survival rate was 96% following use of NASG.Conclusions: NASG is a temporizing alternative measure in hemorrhagic shock management that shows a trend to reduce hemorrhage related deaths and severe morbidities. NASG should be made available at all health facilities that deal with high risk pregnancies and deliveries.

Background: Severe deficiency of vitamin D3 leads to increased risk of pre-eclampsia, gestational diabetes, preterm labour, and reduced bone mineral density in mother as well as child. Objectives were to know prevalence of vitamin D3 deficiency and insufficiency in pregnant mothers and to understand rural urban difference in vitamin D3 levels.Methods: An observational cross-sectional study was done on data of 1100 pregnant mothers coming to ANC clinics at Rural and urban health centres, of Panvel block, Maharashtra, for Serum 25-hydroxyvitamin D using venous blood samples. The duration of study was from June 2019 to December 2021.Two study groups were made rural and urban. Statistical software’s like Excel, SPSS were used.Results: Fifty five per cent pregnant mothers were from rural and 45% from urban settings. Study revealed that in rural study group 16% were grossly deficient, and 69% had insufficient levels. In urban group15% had deficient and 70% had insufficient levels of Vitamin D3. An overall inadequacy of 85% was found at the end of study. Out of the total study population 26% of pregnant mothers were in first and third trimester and 48%in second trimester. No relationship was established in vitamin D3 levels and demographic settings or gestational age.Conclusions: In India vitamin D3 supplementation is not part of antenatal care, but seeing the high prevalence of deficiency and insufficiency, which indicate an on-going hidden epidemic, prophylactic vitamin D3 supplementation can be thought of in national health programs like RMNCH+A.

Background: Postpartum haemorrhage (PPH) is a life-threatening complication, that occurs suddenly and unexpectedly. Institutional delivery by skilled birth attendant who are trained in active management of third stage of labour and those who can use of Uterine Balloon Tamponade and Non-pneumatic anti shock garment can reduce incidence and morbidity related to PPH. The objective of the paper was to share the experiences of the training programmes held for maternal health care workers in the newer modalities of PPH management.Methods: During one and a half year period, 32 Continuation of Medical Education (CME) programmes, with the theme of “Managing Obstetric Emergencies and Obstetric Trauma”, covering important topics related to high risk pregnancies like Hypertension, Eclampsia ,Anaemia and Haemorrhage at 32 health institutions, spread over 11 states and 2 union territories in India, were conducted .In addition,42 hands on workshops  at various health facilities were conducted with training of more than 2575 maternal health care providers.Results: The pre and post test scores revealed that 95 percent of the maternal health care providers were unaware about the use of Uterine Balloon Tamponade (Bakri balloon) in PPH and Non-pneumatic anti shock garment (NASG). Seventy percent were unaware about the proper sequence of steps of active management of third stage of labour. Training programmes helped to improve the knowledge, whereas hands on workshop, helped in skill development of the health care providers. The participants expressed great satisfaction regarding the knowledge and skills they acquired through training programme on management of post-partum haemorrhage. They gave positive feedback about the quality, contents and conduct of training programme.Conclusions: There is need for refresher training of maternal health care providers in newer modalities like AMTSL, NASG and Bakri balloon, which have potential to save lives.

Background: Acute inversion of uterus also called as puerperal inversion of uterus is a rare, but life-threatening complication of third stage of labour. Severe uterine atony, mismanagement of third stage of labour, adherent placenta are some of the common factors associated with the occurrence of acute inversion of uterus. Early recognition and prompt treatment are important to save life of the woman.Methods: A retrospective cross-sectional record-based study was carried out to find out the incidence, presentation and outcome of cases of acute inversion of uterus admitted to Pravara Rural Hospital Loni for a period of three years (October 2015 to September 2018).Results: During the study period, there were 27,134 deliveries including 8,834 caesarean sections. There were six cases of acute inversion of uterus in the hospital during study period. The incidence of acute inversion of uterus was 0.22 per one thousand deliveries (0.27 per thousand vaginal deliveries and 0.11per one thousand caesarean sections). Three cases were referred from outside hospital and three cases had delivered at Pravara Rural Hospital. Five cases had delivered vaginally, where as one case had undergone caesarean section. There were two maternal deaths and four survivals among six cases of inversion of uterus. Severe anaemia, irreversible hypovolemic shock and multi-organ failure were causes of maternal deaths.Conclusions: Prompt recognition of uterine inversion and its immediate reposition under anaesthesia was a key for successful management. Delay in recognition and transfer of cases resulted in haemorrhagic and neurogenic shock, leading to death of a women. Institutional deliveries with practice of principles of active management of third stage of labour (AMTSL) and improvement in emergency obstetric care services at peripheral hospitals, avoiding delays at all levels will help to reduce the incidence, morbidity and mortality associated with acute inversion of uterus.