ABSTRACT
Background & objectives: Government of India (GoI) released operational guidelines for maternal near miss-review (MNM-R) in 2014 for use by programme managers of public health system to assist them for conducting MNM-R. The objective of the present study was to review the incidence and factors influencing MNM events in two tertiary hospitals of Maharashtra, India, as per the operational guidelines of the GoI released in 2014 and identify delays based on three-delay model to prevent such events in future. Methods: This prospective observational study was conducted in two tertiary hospitals of Maharashtra, from July 2018 to November 2020. All women during pregnancy, childbirth or postpartum upto 42 days meeting the eligibility criteria of MNM as per the 2014 GoI guidelines were included as cases (n=228), interviewed and discussed during the monthly MNM meetings at these hospitals. Results: The incidence of MNM was 11/1000 live births; the ratio of MNM to maternal deaths was 1.2:1. Leading causes of MNM were haemorrhage (36.4%) and hypertensive disorders of pregnancy (30.3%). Haemorrhage was maximum (70.6%) in abortion and ectopic pregnancies. Majority of the women (80.2%) were anaemic, of whom 32.4 per cent had severe anaemia. Eighty six per cent of women included in the study had MNM events at the time of admission and 81 per cent were referred from lower facilities. Level one and two delays were reported by 52.6 and 32.5 per cent of women, respectively. Level three delay at referral centres and at tertiary hospitals was reported by 69.7 and 48.2 per cent of women, respectively. Interpretation & conclusions: The findings of this study suggest that MNM-R should be undertaken at all tertiary hospitals in India as per GoI guidelines to identify gaps based on three-delay model. These hospitals should implement interventions as per the identified gaps with emphasis on strengthening the infrastructure, facilities and manpower at the first-referral units.
ABSTRACT
Background: Hepatitis E is usually a self-limited viral infection in men and non-pregnant women, but during pregnancy it is associated with high maternal and perinatal mortality. This needs to be studied for early diagnosis and better management.Methods: The study commenced after the approval of Institutional Ethics Committee. This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology and Department of Medical Intensive Care Unit in present tertiary care hospital between February 2012 and July 2017. An analysis of 120 cases was made over a period of five years.Results: In this study the incidence of pregnant patients with hepatitis E was 3.09 per 1000 deliveries. It was found that majority of the patients which were diagnosed with hepatitis E were young and belonged to the age group of 21-25 years. Most of the affected patients were primigravida with increasing severity of the disease in their third trimester. The maternal morbidity was 51% with a mortality rate of 20%. The percentage of still birth was 25.64% with increased incidence of preterm deliveries and poor perinatal outcome.Conclusions: Early diagnosis and rapid management of the complications such as correction of abnormal coagulation and supportive management is the best treatment available at present. ICU admission and with strict maternal and foetal monitoring can help improve the outcome and thereby reducing the maternal and perinatal mortality.
ABSTRACT
Camylofin dihydrochloride is an anti-spasmodic drug available in India and other Latin American and African countries, for the treatment of abdominal colic and for acceleration of labor. Although, the drug has been in use for over six decades, with multiple citations in academic text books of repute, treatment protocols, and multiple research publications, there is no consolidated published information on the pharmacology and clinical details of camylofin. This drug statement/monograph is an attempt to collate and present scientific information that will come in handy to practicing obstetricians and gynaecologists, as well as other primary care physicians, when treating cases of abdominal colic or managing prolonged labor. Approved clinical indications, clinical pharmacology, dosage, contraindications, precautions, drug interactions, adverse effects, overdose and clinical evidence in different indications are covered herein.
ABSTRACT
Anti-spasmodic drugs like camylofin are used in obstetrics and gynaecological practice for broadly two conditions - spasmodic abdominal pain and management of prolonged labor. Camylofin has been in use in India for almost six decades. As a spasmolytic, camylofin has demonstrated good efficacy and tolerability, both in the management of abdominal spasmodic pain and in augmentation of labor. Literature evidences has suggested that camylofin has demonstrated a statistically significant superiority, such as higher spasmolytic potency compared to other anti-spasmodics like drotaverine, hyoscine and valethamate. In some studies, camylofin maintained the superior efficacy, despite being given as a single dose compared to repeat doses of comparator drugs. Also, in augmentation of labor, camylofin single dose demonstrated superior efficacy when the comparator arm was given a combination of two anti-spasmodic drugs i.e. hyoscine and valethamate in three doses at hourly intervals. Clinical studies in abdominal colic pain revealed significant superiority of the camylofin-paracetamol combination over dicylomine paracetamol combination, this despite the camylofin combination containing 300mg paracetamol as compared to the dicyclomine combination containing 500mg paracetamol. Similar results, highlighting better outcomes in abdominal colic of different types, was shown in studies comparing camylofin-diclofenac combination compared with hyoscine (in renal colic) and also camylofin-mefenamic acid combination compared with dicyclomine-mefenamic acid combination (in menstrual colic). All the above clinical study results resonate in the findings of a recent survey with gynaecologists across the country, which showed that camylofin is considered as the anti-spasmodic most suitable for female patients compared to drotaverine, dicyclomine and hyoscine. Given the availability of strong clinical trial data in Indian women patients, camylofin along with its combinations holds a strong place in the armamentarium of practicing obstetricians and gynaecologists and can be a preferred choice of therapy in treatment protocols of abdominal spasmodic pain and augmentation of labor.