Failure to acknowledge the impact of sex and gender differences affects the quality of health care provision, and is an impediment to reducing health inequities. Systematic efforts were initiated in Maharashtra, India for reducing these disparities by developing gender‐integrated curricula in undergraduate (UG) medical education between 2015 and 2018. A review of UG obstetrics and gynecology curricula indicated a lack of gender lens and focus on the reproductive rights of women. Based on these gaps, a gender‐integrated curriculum was developed, implemented, and tested with medical students. Significant positive attitudes were seen among male and female students for themes such as access to safe abortion; understanding reproductive health concerns and their complex relationship with gender roles; violence against women as a health issue; and sexuality and health. These results strengthened the resolve to advocate for such a curriculum to be integrated across all medical colleges in the state.
Background Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth – the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India. Methods We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs’ motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs’ perspectives on content and delivery of training and service delivery. Results The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services. Conclusions In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts. Plain language summary Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence against women in low and middle-income countries focuses on the impact of these interventions. This practical implementation report focuses on the interventions themselves, describes the processes of developing and adapting the intervention, and thus provides important insights for donors, policy-makers and researchers.
Background:The study of intraoperative difculties in extraction of baby in previous cesarean section Method:This is a tertiary centre based prospective observational study conducted in the department of Obstetrics and Gynaecology, at our tertiary health Care hospital between the study period October 2018-september 2020.A total 1200 cases of patients with previous cesarean section were studied . They are divided into number of previous scar and the intraoperative surgical difculty encountered by the surgeon in delivering the baby based on the consequences of scar from previous cesarean section. Results: The incidence of repeat cesarean section being 9.4%, among which only of 38% cases were encountered with difculties in cesarean section by the surgeons in the institute. Among which 26.3% cases were encountered with Adhesions,4.2% with difculty in delivery of baby, 1.5% cases needed assistance by senior surgeon in delivering baby and 6% among that had poor perinatal outcome. Conclusions: The common clinical entity of “previous cesarean section” in subsequent pregnancies, giving a high risk pregnancy status to the reference pregnancy. The risks associated with repeat cesarean section can be reduced by many measures including-vigorous ANC surveillance to reduce the risk of primary CS, intervention by operative vaginal delivery whenever needed, giving trial of labor in cesarean section(TOLAC) with skilled monitoring, counselling of patients regarding perineal exercises in pregnancy. Most complications will be recognized at the time of operation and easily corrected either by the operating surgeon or by seeking assistance from other specialties
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Background: Hypertensive disorders of pregnancy have a clinical spectrum ranging from non-severe to severe preeclampsia and then potentially to eclampsia. Magnesium sulfate is drug of choice for women with eclampsia and now adapted for prophylaxis of seizures in women with preeclampsia. Methods: It is randomized clinical trial, including 876 patients with preeclampsia fulfilling inclusion criteria. Patients with severe preeclampsia received anticonvulsant prophylaxis with magnesium sulfate. Patients with non-severe preeclampsia were randomized in two groups study group and control group. Patients in study group had received anticonvulsant prophylaxis with magnesium sulfate. The data obtained was analyzed with respect to maternal and perinatal outcome, severity of disease progression and adverse reactions of magnesium sulphate in each group. Results: In this study statistically, significant difference was seen with respect to severity of disease progression and incidence of eclampsia among study and control group. Conclusions: Administration of Magnesium sulfate in patients with non-severe preeclampsia does not affect the progress of labour or perinatal outcome, on contrary it improves maternal outcome by reducing incidence of eclampsia and progression of disease, without significant side effect of drug.
Background: Eclampsia is an obstetric enigma. Eclampsia as a clinical entity has been known from times immemorial. Even today it is one of the dreaded complications. Today also eclampsia is a life-threatening emergency that continues to be a major cause of serious maternal and perinatal morbidity and it’s still the leading cause of maternal mortality in our country.Methods: Method analysis of case records of all eclampsia cases from study period of October 2013 to September 2015, a observational study.Results: The incidence of eclampsia was found to be 1.06% in GMC, Aurangabad. The number of maternal deaths of eclampsia patients was 7 out of 335 eclampsia cases. Maternal mortality in eclampsia patients was 2.08% in 2-year study, however maternal mortality in hospital was 0.23% in 2 years study and the perinatal mortality rate in eclampsia was 361 per 1000 total births. while it is 84 per 1000 total birth for total deliveries in GMC Aurangabad during study. Majority of patients i.e. 87.75% were in the age group of 16-25 years, 55.82% of total eclampsia were primigravida 57% eclampsia cases were referred from government or private hospitals, 11% booked in GMC and 32% patients were self. Antepartum eclampsia was the commonest type 82.11%. 80% patients of eclampsia were delivered vaginally and 18% underwent caesarean section ,2% instrumental deliveries. 12% of babies had birth weight 1000gm. 41% babies delivered with weight 2001 gm. Out of 264 live births 92 babies required NICU admission and 45 babies died in early neonatal period.Conclusions: With good antenatal, intranatal and postnatal care with judicious use of anti-hypertensive, anti-convulsant and battery of investigations and judicious obstetric intervention, maternal and perinatal mortality can be reduced.
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