RESUMEN
To overcome shortcomings of the paper partograph, enhance care during labor and delivery, improve record keeping, and help decision-making, several countries have focused on adopting low-cost digital applications. This scoping review highlights the usability and current status of the digital partogram in obstetric care. We conducted a thorough search involving the databases ScienceDirect, PubMed, and Google Scholar for relevant studies from inception till September 2023 by using the keywords "partograph", "electronic", and "obstetric" as well as the Boolean operators "AND" and "OR". Based on the selection criteria, 25 studies exploring the application of electronic partographs (e-partographs) in obstetric care were included in the review. The majority of the studies examined the efficiency and reported the effectiveness of e-partographs in comparison to paper partographs. The e-partograph has also demonstrated a clear benefit in that the healthcare providers filled out the data, and a reminder mechanism was placed, which might help determine whether the labor process was normal or needed more care. Moreover, an e-partograph was simple to adopt and use for obstetric caregivers and had the potential to save time. To sum up, digital partograph produces superior results to paper partograph. The use of an e-partograph can keep deliveries on track while lowering the need for cesarean sections and prolonged labor. The e-partograph provides essential benefits to its users and also provides a warning system with audible and visual cues that might be utilized to detect difficulties during delivery.
RESUMEN
Maternal isoimmunization occurs when a pregnant woman develops an immune reaction due to the inheritance of a red-cell antigen, which is paternally derived and can result in fetal anemia, hemolysis, fetal death, and hydrops fetalis as the antibodies might travel through the placenta and get adhered to the antigens present in the erythrocytes of the fetus. This report highlights a rare case of Rh isoimmunization leading to fetal anemia in a 26-year-old female and evaluates the impact of intrauterine transfusion (IUT) in terms of the gestational age at delivery along with the mode of delivery, procedural complications, and overall survival rate of the fetus. In conclusion, the most frequent cause of fetal anemia is Rh alloimmunization, which should be taken into consideration while making a differential diagnosis throughout the assessment. Improvements in IUT procedures and earlier detection of the MCA-PSV by Doppler ultrasonographic examination have also contributed to better results.
RESUMEN
Cardiomyopathy accounts for 11.5% cause of pregnancy-related deaths. The causes of peripartum cardiomyopathy (PPCM) are unknown, including predisposing factors such as abnormal response to the greater hemodynamic burden of pregnancy, viral myocarditis, malnutrition, inflammation, and apoptosis. Elderly women, twin gestation, preeclampsia, smoking, and anemia are potential high-risk factors for PPCM. Here, rare case of a patient is described that presented with complaints of breathlessness, cough, and symptoms of heart failure and was diagnosed early as PPCM based on 2D echocardiography and was managed with medical therapy and timely delivery of fetus. Symptomatic relief of symptoms was relieved by diuretics, inotropic drugs, and beta-blockers. The left ventricular ejection fraction increased eventually over 3 weeks and now the patient is a follow-up case since two years from the time of episode. In conclusion, PPCM is rare, which requires prompt management and heightened mindfulness; therefore, early detection and timely treatment can reduce maternal mortality.
RESUMEN
Background Intrauterine growth restriction (IUGR) is a disorder in which the fetus fails to reach its genetic development potential and is considered to be present when the weight at birth is less than the 10th percentile; as a result, it is at risk of increased postnatal morbidity and mortality. Every year, approximately 24% of newborns worldwide are determined to have IUGR. The objective of the present study was to identify various sociodemographic, medical, and obstetric risk factors associated with IUGR. Methodology A case-control study was conducted from January 2020 to December 2022. Fifty-four cases and 54 controls were included in the study. Postnatal women with neonates having birth weight below the 10th percentile for gestational age (GA) were recruited as cases in the study. Control cases were postnatal women with neonatal birth weight appropriate for (GA). Detailed history with respect to socio-demographic, medical, and obstetric parameters was noted and compared. Results Among the sociodemographic factors, only socioeconomic status showed significant statistical differences with the age group of 21 to 25 years showing maximum (51.9%) IUGR cases. Among the maternal risk factors, anemia (29.6%) and hypertensive disorders of pregnancy (22.2%) were marked as significant risk factors for IUGR. There was no significant difference in the distribution of past medical and obstetric histories between the two research groups. Conclusion Due to the poor living conditions, low literacy rates, and general lack of knowledge, low socioeconomic level increases the risk of IUGR. This leads to nutritional deficiencies and insufficient growth environment which results in anemia and hypertensive disorders of pregnancy which are potent risk factors for IUGR. IUGR may be caused by maternal risk factors as well as past medical and obstetric conditions. However, for the risk factor of IUGR, the birth weight at the time of delivery could be taken into consideration as well.
RESUMEN
Background Pre-eclampsia (PE) is a disorder characterized by hypertension that may occur in a pregnant woman who was normotensive earlier. One of the major factors responsible consists of the inflammatory system being activated with cytokines and chemokines. The normal range of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) varies from 1 to 3 and 90 to 210, respectively. Therefore, this study was conducted to compare PE patients with normotensive pregnant women in relation to their NLR as well as PLR. Methodology From January 1, 2021, to December 31, 2022, a case-control study was conducted in the department of obstetrics and gynecology at a tertiary care center. Based on the inclusion and exclusion criteria, a total of 140 antenatal women were included and divided into a case group consisting of 70 women with PE and a control group involving 70 normotensive pregnant women. A blood sample for complete blood count testing was collected to determine NLR and PLR. Results The mean NLR in the case group and control group was 3.52 ± 1.05 and 3.22 ± 0.88, respectively, with statistically significant results. Additionally, the PLR in the case group was 98.08 ± 18.27, and in the control group, it was 85.25 ± 12.36, having a significant difference between both the groups along with a significant difference in the case group among the severe and non-severe PE. Conclusion In antenatal women, NLR and PLR increase with PE along with an increase in NLR and PLR. Additionally, with the availability of a complete blood count, detecting PE ability markers such as the NLR and PLR will be a significant advantage for managing PE to prevent adverse outcomes.
RESUMEN
Background and objective Unplanned pregnancies are very common in the postpartum period, and they often lead to negative outcomes such as abortion, low-birth-weight neonates, early delivery, postpartum bleeding, and fetal mortality. In the first 12 months after delivery, closely spaced and unintentional pregnancies can be prevented with postpartum contraception. The postpartum intrauterine contraceptive device (PPIUCD) is a method of family planning that may be used during the first few weeks after giving birth, and it is highly successful, reliable, affordable, non-hormonal, immediately reversible, long-acting, and does not interfere with lactation. Urban and educated women are largely aware of IUCD and its benefits, but the proportion of these women who use them is still small. In light of this, this study aimed to assess if providing focused antenatal counseling led to a greater postpartum IUCD acceptance rate when compared to routine counseling. Method We conducted a randomized controlled trial in the Department of Obstetrics and Gynaecology of a tertiary care center from January 2021 to December 2022. Based on the inclusion and exclusion criteria, 220 women were enrolled and were classified into two groups. Group A comprised 110 women (the focused counseling group) who received focused postpartum family planning (PPFP) counseling, and Group B consisted of the control group involving 110 women who received routine counseling. Results In both groups, the women who inserted IUCD were mostly gravida 2. Additionally, willingness to use IUCD was shown by 68% of women in the focused counseling group and 58% of women in the routine counseling group, and PPIUCD was accepted by 22% of women in the focused counseling group and 9% of women in the routine counseling group. Post-placental insertion was carried out in 18 (75%) cases in the focused counseling group and seven (70%) cases in the routine counseling group. Extended postpartum insertion (insertion within one year of delivery) was carried out in six (25%) cases in the focused counseling group and three (30%) cases in the routine counseling group. The most common reasons for the refusal were a preference for tubal ligation (TL) and a fear of side effects. When the patients were enquired about their contraceptive use over the past year on telephone conversations after one year of delivery, it was observed that 21.81% inserted PPIUCD, 30% used injectable depot-medroxyprogesterone acetate (DMPA), 13.63% had undergone TL, 11.81% used barrier contraception, while 22.72% did not use any contraception in the focussed counseling group. In the routine counseling group, 16.36% of women inserted PPIUCD, 20% used injectable DMPA, 12.72% underwent TL, 18.18% used barrier contraception, and 32.72% did not use any contraception. Conclusion Although PPIUCD is a long-acting reversible contraceptive that is safe and reliable, only a few women choose it as a method of birth control. This may be due to ignorance, misconceptions, and worries/fears about potential difficulties/adverse effects associated with IUCD insertion. The IUCD stigma mostly results from misconceptions about the fear of complications. Hence, we recommend that proper IUCD counseling be provided during antenatal care visits to dispel misunderstandings and concerns regarding potential complications associated with PPIUCD insertion.
RESUMEN
Background Placenta-mediated complications, such as preeclampsia, placental abruption, and fetal growth restriction, can indeed lead to significant maternal and perinatal morbidity and mortality. Early detection and management of these conditions are crucial to ensuring optimal outcomes for both the mother and baby. However, there have been inconsistent correlations found between maternal homocysteine levels and placenta-related problems in various studies. Therefore, prospective research based on data pointing to a role for hyperhomocysteinemia in placenta-mediated complications will open doors for early detection and management of these complications. Thus, this study aims to determine if a higher risk of placenta-mediated problems is connected with a higher maternal plasma homocysteine content between 10 and 14 weeks of gestation. Methodology An observational prospective cohort study was conducted in the Department of Obstetrics and Gynecology, consisting of all the antenatal women between 10 and 14 weeks of gestation attending outpatient departments or inpatients admitted in labor rooms or wards having singleton pregnancies. Along with socio-demographic information and detailed history, a clinical examination was performed, and blood samples were collected to determine plasma homocysteine levels. Results As per the receiver operating characteristic curve (ROC curve), the cut-off value taken was <5 for the low level of serum homocysteine, 5 to 15 micromol/L for the normal value, and >15 micromol/L for a raised serum homocysteine level. The cutoff value for our study was 45 micromol/L with a sensitivity of 78.33%, a specificity of 91.67%, a positive predictive value of 90.38%, and a negative predictive value of 80.88% with a diagnostic accuracy of 85%. This means that, for most of the women included in the present study, those who developed placenta-mediated complications had serum blood homocysteine levels of 45 micromol/L or more at 10-14 weeks of gestation. Conclusion Women with high homocysteine levels in the late first trimester had more placenta-mediated complications, such as abruption, pre-eclampsia, restricted fetal growth, and recurrent pregnancy losses, compared to women with a normal level of homocysteine in the late first trimester. Therefore, measuring blood homocysteine levels in pregnancy may be helpful as a diagnostic test for the early detection of high-risk individuals for placenta-mediated complications.
RESUMEN
Background Among the hypertensive disorders of pregnancy, certain diseases like preeclampsia (PE) and eclampsia have the maximum impact on morbidity and mortality of the mother as well as the newborn. Proteinuria determination is used to assess renal damage in PE. There are several ways to evaluate proteinuria in pregnant women, but the gold standard remains the 24-hour urine albumin (24-h UA) excretion. Spot urine albumin creatinine ratio (UACR) can be used for rapid diagnosis of PE which is fast, reliable, and easy to use. Hence, our tertiary care center conducted the current study to assess the accuracy of spot UACR with 24-h UA for detecting proteinuria in antenatal women to diagnose PE and to evaluate the obstetric outcome in antenatal women with PE. Methodology A descriptive, cross-sectional study was conducted on 98 antenatal women diagnosed with PE. Urine albumin was done by dipstick method and the presence or absence of proteinuria was noted. Both, the 24-h urine sample and a random sample for spot UACR were sent for analysis. Results Spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria. Additionally, significant proteinuria was associated with an increased rate of induced labor, a cesarean section in patients, lower mean gestational age at the time of delivery, lower birth weight, and increased rate of intrauterine fetal death. Conclusion The study concluded that spot UACR has more specificity than sensitivity along with a high negative predictive value for the detection of proteinuria and therefore, can be used for the diagnosis of proteinuria in women with PE. Hence, spot UACR is a reliable, faster, and more accurate method for the detection of proteinuria in PE and can be used for early diagnosis and timely management leading to a decrease in mortality and morbidity of the mother and the fetus.
RESUMEN
Peritoneal tuberculosis (TB) is one of the types of extrapulmonary TB that predominantly involves the omentum, liver, intestinal tract, spleen, or female genital tract. It can occasionally result in gynecological-related oncology diagnoses such as advanced ovarian cancer due to its non-specific signs and symptoms, making it very difficult to detect. This report presents a case of a 22-year-old female who presented with the chief complaints of pain and distension of the abdomen for one month with dysuria. Ultrasonography and magnetic resonance imaging was performed that reported a large uni-loculated cystic pelvic abdominal lesion likely to be of ovarian origin and suggestive of neoplastic etiology with bilateral hydroureteronephrosis. To confirm the diagnosis, an exploratory laparotomy was performed which revealed extrapulmonary abdominal TB, and was registered for Directly Observed Treatment Shortcourse (DOTS) following which anti-tubercular drugs were given. In conclusion, this case report highlighted the masquerading behavior of encysted peritoneal TB as an ovarian tumor, and the fact that it should, therefore, should be considered in the differential diagnosis in regions where TB remains endemic, such as in developing countries. Hence, an appropriate diagnosis can prevent the need for unnecessary surgical operations and adequate therapy can save the patient's life.
RESUMEN
The prevalence of caesarean section (CS) is rising rapidly. However, it should be carried out only under valid obstetric indications due to the various complications associated with it. Therefore, to record CS incidences, Robson's Ten Group Classification System (TGCS) was implemented. This review focuses on the prevalence of CS rates found in various studies and identifies the clinically important groups that were most involved in CS deliveries. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines were followed in this review. "Caesarean delivery" OR "Robson's Ten Group" OR "Classification System" were keywords used to search literature. Twenty-one studies were included in this review based on eligibility criteria. We concluded that group 5 was the major contributing factor for the increase in CS rates followed by group 10, group 4, group 2, and group 1. Previous CS was the most common factor responsible for increasing CS rates. We emphasize that Robson's TGCS is an essential parameter for recording CS rates and is simple to use for CS rate comparison.
RESUMEN
Background Thyroid hormone has a significant effect on women's life. Its dysfunction is widespread, particularly among women over 50. Understanding how thyroid disease's clinical symptoms change with aging is crucial when treating peri-and postmenopausal women. Considering that 30% of India's population is female, the thyroid disease epidemic appears to affect Indian women more than any other ailment. Therefore, the main aim of the study was the detection of the frequency of thyroid disorder in pre and postmenopausal women and its association with menopausal symptoms. Methodology An analytical cross-sectional study was conducted at a tertiary care centre. All premenopausal and postmenopausal women attending the obstetrics and gynaecology department above 40 years of age, achieving natural menopause, and willing to participate were included in the study. Results A total of 150 women above 40 years of age were included in the study out of which 61 females were premenopausal age and 89 females were postmenopausal age. It was found that 53.3% were euthyroid, 13.3% had hypothyroidism, 3.4% had hyperthyroid, 23.3% had subclinical hypothyroidism, and 6.7% had subclinical hyperthyroidism. Menopausal symptoms when compared to thyroid disorder demonstrated that somatic symptoms did not differ significantly across different thyroid disorder, psychological symptoms consisting of depressive mood was more prevalent among hypothyroid and hyperthyroid female (P<0.05), and urogenital symptoms consisting of sexual problems and bladder dysfunction did not differ significantly (P>0.05) in different thyroid disorder. Conclusion The present study concludes that thyroid disorder is common among pre- and postmenopausal age group women. Therefore, timely detection and intervention should be taken into consideration, and even if the thyroid level is found to be normal still lifestyle modification and counselling can help in improving the quality of life.
RESUMEN
Background Cesarean section (CS) involves the delivery of the fetus through incisions in the abdomen or uterine walls which is an alternative to vaginal delivery. In the majority of women, second-stage CS is performed without even attempting assisted vaginal delivery. This leads to difficulty for obstetricians for whether to perform an immediate CS or attempt a difficult vaginal birth as the effective method of delivery as CS are linked with higher morbidities which further increase when a CS is performed in the second stage. Hence, the present study was performed to find out obstetrics results in women undergoing second-stage CS. Method A cross-sectional study was conducted in the Department of Obstetrics and Gynecology of a tertiary care center attached to a medical college to study obstetric outcomes in women undergoing second-stage CS from January 2021 to December 2022 on 54 postnatal women who underwent second-stage CS. Results The mean age was 26.7 ± 3.9 years ranging between 19 and 35 years involving a majority of primiparity women. Maximum patients were having gestational age between 39 and 40 weeks and had spontaneous labor. The main indication of second-stage CS was non-reassuring fetal status and the method of delivery mainly involved for the deeply impacted head was the modified patwardhan technique in which if the head is embedded deeply in the pelvis in the OP position the anterior shoulder is delivered first followed by the same side leg then opposite side leg followed by the arm is gently delivered. Baby's trunk, legs, and buttocks are moved out by pulling them carefully and gently. And lastly, the head of the infant is finally moved out. The intra-operative complications mainly found were an extension of uterine angle and the post-operative complication was post-partum hemorrhage (PPH). The most common neonatal complication was the requirement for neonatal intensive care unit (NICU) admission. In conclusion, the present study reported a hospital range between seven and 14 days in comparison to other studies that reported hospital stays between three and 15 days. Conclusion In conclusion, higher maternal and fetal morbidities were associated with CS performed at full dilation of the cervix. The most common maternal complication seen was an injury to uterine vessels along with PPH however neonatal complications included the requirement of NICU monitoring. As there are no appropriate guidelines for the same, formulation of guidelines for performing CS at full dilation is required.
RESUMEN
Background Iron requirements rise dramatically throughout the second and third trimesters of pregnancy. Pregnant women are more susceptible to anemia because their need for iron increases during pregnancy, which is difficult to achieve through diet alone. Methodology A randomized controlled trial (non-blinded and parallel group) was undertaken with the recruitment of 174 women. However, 35 women were lost to follow-up, and the study was ultimately completed with 139 participants distributing 68 women in Group A (intervention group) and 71 women in Group B (non-interventional group). Educational handouts were explained to the participants with iron supplements in Group A and only supplements were given to Group B, and the participants were followed up till three months before the recruitment period. Compliance with iron supplementation and a rise in hemoglobin were noted. Results In this study, maximum women were in the 22-30 years age group and were almost evenly distributed with respect to parity with no statistically significant difference in the groups. All the participants were started with oral iron therapy. No additional parenteral iron therapy was given. Women in Group A showed good compliance for iron supplementation than those in Group B. It was determined that this difference was statistically insignificant (>0.05). In the majority of women, the reason for poor compliance was frustration to follow oral iron therapy daily (52.3% in Group A and 21.7% in Group B). There were other reasons like forgetfulness, heartburn, vomiting, constipation, and nausea as the reason for poor compliance. The hemoglobin levels were compared at the recruitment and a mean rise in hemoglobin levels was noted in groups A and B at the follow-up period after three months. There was a greater mean rise in hemoglobin concentration in Group A (1.28) than in Group B (0.63), which was statistically insignificant (>0.05). Conclusion The current study found that among pregnant women with iron-deficient anemia, instructional handouts did not promote compliance with oral iron treatment. The main reasons for low compliance were frustration with taking the oral drug, followed by forgetfulness, heartburn, vomiting, constipation, and nausea. In pregnant females with anemia brought on by iron deficiency, educational handouts did not enhance hemoglobin status.
RESUMEN
Maternal mortality is a major public health issue globally. The exact incidence of maternal cardiac arrest (CA) is uncertain in developing countries like India as there is a paucity of reliable maternal registries. CA in pregnancy is rare and requires a multidisciplinary team well versed in the cascade of steps during cardiopulmonary resuscitation (CPR) in managing such patients. Here we report a case of a 29-year-old primigravida at 29 weeks antenatal woman in cardiac arrest in which CPR with advanced care life support was initiated and resuscitative hysterotomy was performed within 4 minutes of no return of spontaneous circulation, which helped in the revival of the patient. It serves as an important basis for maternal health and the delivery of healthy neonates, as seen in our case. Because of this, it is crucial to have a comprehensive understanding of pregnancy physiology as well as basic and advanced cardiac life support techniques with a focus on CA in pregnancy. Frequent simulation learning and training on the treatment of CA in pregnancy should therefore be encouraged.
RESUMEN
Acute fatty liver of pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or the postpartum period. We report a case of 24-year-old G2A1 with GA of 35 weeks who presented with amenorrhea, nausea, fever, vomiting, headache and yellowness of eyes. The patient was diagnosed with severe preeclampsia with Intrauterine death (IUD) with hemolysis elevated liver enzymes low platelets (HELLP). Investigations showed hypoglycemia, low platelet count, and raised liver enzymes with an altered coagulation profile. The patient was kept in the Medicine Intensive care unit, induction was done with misoprostol, and she delivered an IUD baby. The condition of the patient deteriorated, and she developed pulmonary edema. Thus, she was intubated. Ultrasonography (USG) of the liver showed altered echotexture. The condition of the patient was then improved. AFLP requires a high index of suspicion for early diagnosis. Hypoglycemia in a pregnant woman without overt /gestational diabetes mellitus along with deranged liver panels and thrombocytopenia gives a clue in diagnosing AFLP. Timely diagnosis and intervention can reduce both maternal and fetal morbidity and mortality.
RESUMEN
Vaginal vault prolapse is a painful condition in which the vaginal cuff descends. This report presents a case of a 65-year-old obese and diabetic female who was suffering from a third-degree vault prolapse. Conventionally used non-surgical treatments, such as exercises for the pelvic floor, are not as effective as surgical approaches for the treatment of third-degree vault prolapse. Post-hysterectomy vaginal vault prolapse can be treated safely and effectively with abdominal sacral colpopexy using a permanent mesh. Due to several risk factors, such as grand parity, advancing age, and poor lifestyle mainly involving exercise to strengthen pelvic floor musculature, the vaginal route of surgery was employed, which was found to be effective, and thus the treatment was successful. In conclusion, such individualized as well as unique approaches to such rare cases can produce efficacious results.
RESUMEN
There is already abundant corroboration indicating that elevated serum homocysteine levels may be related to the risk of coronary, cerebral, and peripheral arterial diseases. High homocysteine levels have often been associated with placental vasculopathies and complications related to the placenta, such as fetal growth restriction, Abruption, hypertensive disorders of pregnancy, and recurrent abortions. This scoping review aims to integrate the currently available scientific literature and fill the gaps in our understanding of homocysteine metabolism during pregnancy and its relationship to placenta-mediated complications. Moreover, to summarize the existing literature on the correlation between raised maternal homocysteine levels in early gestation and its association with placenta-mediated complications. We developed this scoping review article by performing a literature review as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the search was conducted using PRISMA-S (an extension to PRISMA focusing on reporting the search components of systematic reviews) guidelines. The research question was clarified and modified using keywords with important literature published online between 2010 and 2022, which were included from PubMed, and Google Scholar databases with recognized titles and abstracts were examined and cross-checked for case overlap to choose the original reports. A summary of the descriptive data was organized according to the clinical manifestations (symptoms, imaging, and laboratory results) and outcomes (maternal and perinatal). In conclusion, a review of research papers from 2010 to 2022 showed that homocysteine levels during pregnancy fluctuate and are probably influenced by a population's regional, cultural, and socioeconomic status. According to the data, there is an association between elevated homocysteine levels and complications of pregnancies, such as early spontaneous abortions, pre-eclampsia, fetal development restriction, and abruption, as well as in certain cases of maternal and fetal mortality.
RESUMEN
Introduction In spite of the implementation of the National nutritional anemia prophylaxis program in India, the prevalence of anemia during pregnancy is 50 in 100 women. One main cause for the high frequency of anemia among antenatal women in India is a lack of iron consumption. Few studies are available in the literature where efforts have been made to improve compliance with iron therapy. In the same line of thinking, it was decided in the present study to use mobile phone calls as a reminder for iron tablets. Method The present study is a randomized controlled open-label trial. Antenatal women with gestational age between 13-28 weeks of pregnancy diagnosed with iron deficiency anemia (Hb - 8 to 11 gm/dl) having mobile phones were included in the study. Recruited women were randomized into two groups of study groups receiving standard therapy with the addition of fortnightly mobile phone call reminders and a control group receiving standard therapy alone. Results Compliance with iron supplementation was observed higher in the study group as compared to the control group (range of 48% to 93%). There was a mean hemoglobin rise in both the groups at the time of delivery compared with the hemoglobin at the time of recruitment (Study group- 9.74 to 10.69, Control group- 9.48 to 10.06). There was a statistically higher (0.00001) increase in the mean hemoglobin concentration in the study group (0.96 gm/dl) as compared to the control group (0.59 gm/dl). The reasons for poor compliance were boredom with taking daily oral iron therapy (66.66%), constipation (3.7%), forgetfulness (14.81%), and heartburn (14.81%). There was no statistical difference in the reason for poor compliance with iron supplementation in both groups. Conclusion The present study concludes that mobile phone call reminders along with standard therapy with iron supplementation improve compliance with iron supplementation and lead to a greater rise in hemoglobin in antenatal women with iron deficiency anemia.
RESUMEN
OBJECTIVE: GridlockED gameplay workshops were delivered in Canada. This project investigated workshop attendees' experiences, seeking to identify learning points to inform improvement of the workshop. METHODS: GridlockED sessions were held through 2018 and 2019. Workshops targeted medical trainees. After a standardized video, learners played for approximately 90 minutes. Learners completed a postgameplay survey with 7-point Likert scale questions about their experience. RESULTS: Seventy-two participants responded to our survey (41 medical students, 13 physician assistant students, 12 emergency medicine residents, and six faculty members). Trainees rated GridlockED as both enjoyable and a meaningful educational experience, with a mean (±SD) rating of 6.53 (±0.96) of 7 for enjoyment and 6.17 (±1.13) for education. Attendees identified teamwork and communication (49%) as the most helpful learning domain, with patient flow (43%) being second and basics of how the ED worked (31%) being third. The respondents self-identified top areas of learning as resource management (38.9%), improved understanding of various provider roles in the ED (33%), and improved communication skills (33%). CONCLUSION: Medical learners identified GridlockED to be an educational and enjoyable learning experience. Attendees reported that playing this serious game assisted with learning about health systems and communication.
RESUMEN
BACKGROUND: The etiology and pathophysiology of hypertensive disorders of pregnancy remains enigmatic, and till date, no test can accurately predict it. Early screening may allow vigilant antenatal surveillance, timely delivery and thus substantially reduce maternal and perinatal morbidity and mortality. Our study aims to evaluate the predictive value of uterine artery mean pulsatility index (PI) at 11-14 weeks and find a reference value for hypertensive disorders of pregnancy. METHODS: A prospective study of 240 antenatal women using non-probability simple random sampling was carried out in a tertiary care center. Mean uterine artery PI was obtained at 11-14 weeks of gestation. Pregnancies were followed till delivery and 7 days postpartum. The major end point was development of hypertensive disorders of pregnancy. Maternal and neonatal outcomes were also assessed. RESULTS: The predictability of uterine artery mean pulsatility index (PI) at 11-14 weeks for hypertensive disorders of pregnancy was significantly high with an odds ratio of 174.45 (95% CI 65.31-549.13; p < 0.0001), sensitivity (89.3%), specificity (95.8%), positive predictive value(90.5%) and negative predictive value (95.1%). CONCLUSION: Uterine artery mean PI at 11-14 weeks of gestation is a cost-effective predictive test for hypertensive disorders of pregnancy, and the recommended reference value for Indian population of is 2.28.
