Audit of caesarean deliveries in a tertiary care rural hospital of Bangalore, Karnataka, India

Background: Due to the rise in caesarean section rates Robsons classification system was adopted by WHO as a global standard to asses and audit the caesarean section rates within different hospitals, to reduce the caesarean section rates and the associated complications and also improve patient care along with it. The aim of the present study is to audit the number of caesarean deliveries in the hospital. Objective were to audit the caesarean deliveries in the institution using Robsons classification system as the starting point to find the contributing factors responsible for the caesarean section rates.Methods: This retrospective hospital-based study was conducted at MVJMC and RH. The study included all pregnant patients undergoing caesarean section during the period of one year from March 2023 to February 2024. All the data was entered into Microsoft excel, sheet, which was then classified according to Robson抯 classification system.Results: In our study we noted that the highest percent of caesarean deliveries was noted among multigravida which contributed about 66.5 of the total caesarean deliveries and according to classification 35% of the caesarean deliveries was noted in group 3 with multiparous women of more than 37 weeks in spontaneous labour. Conclusions: Globally accepted Robsons classification should be used for regular audits among hospitals to curb the caesarean section and its associated maternal and perinatal complications in order to improve patient care.

Overview of fetomaternal outcome in twin gestation

Background: Twin pregnancy, involving the presence of two fetuses in the uterus, has intrigued humanity across history. Key challenges presented by twin pregnancies include prematurity, low birth weight (LBW), intrauterine growth restriction (IUGR), birth trauma, asphyxia, and congenital anomalies. Preterm delivery poses the most significant risk, contributing to elevated perinatal mortality, neonatal morbidity, and long-term health issues for twins.Methods: Retrospective study at Smt NHL Municipal Medical College analyzed 80 twin pregnancies from July 2022 to January 2024. Data included patient demographics, complications, and neonatal outcomes, informing findings through data analysis.Results: In this study, the majority were under 30 years old (56%) and primigravida (68%), with 48% having a BMI over 30. Common complications included preterm labor (70%), pregnancy-induced hypertension (27.5%), and gestational diabetes (20%). Most twin pregnancies were dichorionic diamniotic (80%). Caesarean section rate was 47.5%. Deliveries mostly occurred between 33-36 weeks gestation, with cephalic-cephalic presentation being most common (40%). Neonatal complications were primarily prematurity (50%), resulting in high NICU admissions (62%) and a neonatal death rate of 13.76%.Conclusions: Multiple pregnancies require early diagnosis and vigilant care to reduce maternal and perinatal risks. Access to skilled healthcare providers and advanced facilities is crucial. Antenatal care must be strengthened for timely referrals. Ultrasonography aids early complication detection. Further advancements and awareness are essential for improved outcomes.

Feto-maternal outcome in term and late term pregnancies following induction of labour with misoprostol

Background: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of achieving vaginal delivery of the feto-placental unit. It is a common obstetric procedure which is indicated when the benefits to mother or fetus outweigh the benefits of continuing the pregnancy. Most common indication for induction is postdated pregnancy.Methods: Longitudinal Study carried out in department of obstetrics and gynaecology, RIMS, Imphal, Manipur, conducted for duration of two calendar years, with effect from January 2021 in 168 primigravidas who had reached full term or late term pregnancy admitted in ante-natal ward of RIMS, Obstetrics and Gynaecology department.Results: Study was conducted on 168 pregnant women, most of the participants belonged to the age group of 18-34 years (77.9%). Vaginal delivery was the most common mode of delivery (64.8%). Most of the babies (72%) delivered were having birth weight of between 2.5 kg to 3.9 kg. PPH and uterine hyperstimulation are comparatively more in the late term pregnancy as compared to full term pregnancy. Meconium-stained liquor was slightly more in late term pregnancy group as compared to full term pregnancy. Babies delivered by full term pregnant women were having better APGAR score in 1 minute and 5 minutes than the babies delivered by late term pregnancy.Conclusions: Late term Pregnancy is comparatively common in low socio-economic group. The CS rate is comparatively high in Late term pregnancy as compared to Full Term Pregnancy. Poor APGAR score is highly associated with Late term Pregnancy outcome.

Foeto-maternal outcome in pregnancy with and without heart disease: a comparative cross-sectional study in a tertiary care hospital

Background: Pregnant women with underlying heart disease are at increased risk for adverse maternal, obstetric, and neonatal outcomes. One can successfully treat the majority of these incidents if detected early by accurate individual risk assessment and careful follow-up. The aim and objectives of this study were to compare the foeto-maternal outcome in pregnancy with and without heart diseases with period of gestation >32 weeks.Methods: This study was carried out in a tertiary care teaching hospital of Imphal, the capital city of Manipur, using a standard-questionnaires among patients admitted. Data was analysed using SPSS 21.0 with statistical significance set at p<0.05.Results: Study was conducted on 112 pregnant women. The prevalence of heart disease was higher (71.4%) among the primiparous women. Highest occurrence of heart disease (66.1%) was seen in the housewife group. There was increased incidence of pre-term deliveries among pregnant women with heart disease (26.8%). Caesarean section (62.5%) and maternal complications (42.9%) were found to be higher among the pregnant women with heart disease. The incidence of NICU admission of babies was higher among mothers with heart disease (17.9%) compare to 5.4% in mothers without heart disease.Conclusions: Early detection by accurate individual risk assessment and careful follow-up are key to improving outcomes.

Analysis of maternal and foetal outcome of post-dated pregnancy in a tertiary care centre

Background: Managing pregnancy with post-dates is becoming a challenging issue due to increasing fetal morbidity and mortality. The study aimed to analyse the maternal and fetal outcomes of post-term pregnancies among Indian women, considering their earlier fetal maturation. Conducted over 18 months with 100 cases, the prospective observational study focused on pregnant mothers at or beyond 40 weeks gestational age, excluding those with certain medical complications.Methods: After obtaining approval from the ethics committee and informed consent from eligible participants, detailed histories and examinations were conducted, with close monitoring until delivery and postnatal care. Inclusive criteria encompassed singleton pregnancies with cephalic presentation, while exclusions included non-cephalic presentation, congenital anomalies, and various medical complications.Results: Revealed a predominance of primigravida women aged 20 to 35 years at 40 to 40 weeks and 6 days gestation. Spontaneous delivery occurred in 58%, with 90% delivering vaginally, while all multigravida births were vaginal post-induction. Cesarean sections were performed in 14%, primarily due to failed induction followed by fetal distress. Meconium-stained liquor was most prevalent at 42 weeks or later, correlating with higher perinatal mortality and NICU admissions in infants born beyond 42 weeks.Conclusions: Vigilant monitoring proved crucial in averting fetal jeopardy, emphasizing the importance of timely interventions to mitigate complications associated with post-term pregnancies. This study sheds light on the unique considerations and outcomes of post-dated pregnancies in the Indian population, contributing valuable insights for maternal and neonatal care in similar settings.

Excessive maternal iced-tea intake-reversible cause of premature ductus arteriosus constriction

Premature ductus arteriosus constriction is a rare entity associated with high neonatal morbidity and mortality. Most cases are idiopathic, with the major known cause being maternal use of nonsteroidal anti-inflammatory drugs. Polyphenol-rich foods have been proven to have a deleterious fetal hemodynamic effect that can lead to premature ductal constriction. We report a case of a neonate diagnosed with premature ductal arteriosus closure, whose only risk factor was an excessive maternal intake of commercial iced-tea during pregnancy. The authors aim to raise awareness to the impact of polyphenol-rich food consumption on ductus arteriosus, since maternal dietary advice can have a major preventive role. Furthermore, a timely diagnosis and intervention can prevent significant morbidity and mortality.

Successful multiple-dose methotrexate therapy for unruptured repeat ectopic pregnancy with high ?-human chorionic gonadotropin value: a case report

Successfully managing an unruptured ectopic pregnancy necessitates prioritizing the preservation of fertility as the primary objective. Medical management is traditionally considered to be more successful at lower �- human chorionic gonadotropin (HCG) values. However, there is emerging evidence that successful treatment can be achieved with modification of dosage regimen in the presence of high ?-HCG value. We reported the successful management of a case of unruptured repeat ectopic pregnancy in a patient with high ?-HCG. Mrs PA is a 25-year-old G4P0+3 with previous right salpingectomy due to ruptured ectopic gestation who presented with an ultrasound diagnosis of unruptured left tubal ectopic gestation at a gestational age of 6 weeks. The pre-treatment quantitative ?-HCG level was 7066 IU/l. She had multiple dose methotrexate therapy which was well tolerated with normalization of ?-HCG levels within 44 days. Hysterosalpingography done six (6) months post-treatment demonstrated patent left fallopian tube. She subsequently had spontaneous conception of an intrauterine pregnancy 16-months post-treatment. The pregnancy was carried to term and culminated in successful delivery at term. Multiple-dose chemotherapy was successful in this patient with high ?-HCG level with no reported adverse effect.

Sífilis na gestação: conhecimento de gestantes e puérperas / Syphilis in pregnancy: knowledge of pregnant and puerperous women / Sífilis durante el embarazo: conocimientos de las mujeres embarazadas y puérperas

Objetivo: identificar o conhecimento de gestantes e puérperas acerca da sífilis. Método: pesquisa descritiva, com abordagem qualitativa. A coleta de dados ocorreu por meio de instrumento semiestruturado, entre abril a julho de 2021, com 18 gestantes/puérperas com diagnóstico de sífilis na gestação. As respostas foram gravadas e transcritas na íntegra, sendo utilizado para análise a técnica do Discurso do Sujeito Coletivo. Resultados: identificou-se três ideias centrais: 1) Conhecimento sobre a sífilis, 2) Buscando conhecimento sobre a sífilis e 3) Falsa prevenção. O conhecimento das participantes mostrou-se conflitante, pois algumas apresentaram algum conhecimento e outras nenhum, sendo que todas deveriam ter sido orientadas sobre a doença. Considerações finais: identificou-se uma falha no atendimento ofertado nos serviços de saúde. Assim, estratégias voltadas à educação em saúde devem ser incentivadas e implementadas no acompanhamento de pré-natal, ofertando a promoção e prevenção da saúde, a fim de reduzir os casos de sífilis na gestação.

Objective: to identify the knowledge of pregnant and postpartum women about syphilis. Method: descriptive research, with a qualitative approach. Data collection took place using a semi-structured instrument, between April and July 2021, with 18 pregnant/postpartum women diagnosed with syphilis during pregnancy. The responses were recorded and transcribed in full, using the Collective Subject Discourse technique for analysis. Results: three central ideas were identified: 1) Knowledge about syphilis, 2) Seeking knowledge about syphilis and 3) False prevention. The knowledge of the participants was conflicting, as some had some knowledge and others none, and all of them should have been educated about the disease. Final considerations: a flaw in the care offered in health services was identified. Therefore, strategies aimed at health education should be encouraged and implemented in prenatal care, offering health promotion and prevention, in order to reduce cases of syphilis during pregnancy.

Objetivos:identificar el conocimiento de las mujeres embarazadas y puérperas sobre la sífilis. Método: investigación descriptiva, con enfoque cualitativo. La recolección de datos se realizó mediante un instrumento semiestructurado, entre abril y julio de 2021, con 18 mujeres embarazadas/puérperas diagnosticadas con sífilis durante el embarazo. Las respuestas fueron grabadas y transcritas en su totalidad, utilizando para su análisis la técnica del Discurso del Sujeto Colectivo. Resultados: se identificaron tres ideas centrales: 1) Conocimiento sobre sífilis, 2) Búsqueda de conocimiento sobre sífilis y 3) Falsa prevención. El conocimiento de los participantes fue contradictorio, ya que algunos tenían algún conocimiento y otros ninguno, y todos deberían haber sido educados sobre la enfermedad. Consideraciones finales: se identificó una falla en la atención ofrecida en los servicios de salud. Por lo tanto, se deben fomentar e implementar estrategias orientadas a la educación en salud en la atención prenatal, ofreciendo promoción y prevención de la salud, con el fin de reducir los casos de sífilis durante el embarazo.

Alcohol consumption during pregnancy by women from southern Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Some maternal characteristics are related to alcohol intake during pregnancy, which irreversibly compromises the maternal-fetal binomial integrity. OBJECTIVES: To identify the frequency, impact, and factors associated with alcohol consumption during pregnancy. DESIGN AND SETTING: A cross-sectional study was performed at the Hospital Materno Infantil Presidente Vargas (HMIPV) in Porto Alegre/RS between March and December 2016. METHODS: A structured questionnaire was administered along with a medical records review. They refer to the maternal sociodemographic and gestational status, alcohol consumption patterns, and characteristics of the fetus/newborn. In the statistical analysis, P values < 0.05 were considered significant. RESULTS: The frequency of alcohol intake was 37.3%; this was characterized by the consumption of fermented beverages (89.3%), especially during the first trimester (79.6%). Risky consumption (high and/or early) occurred for 30.2% of participants. Risk factors associated with maternal alcohol consumption during pregnancy were tobacco use (P < 0.001) and abortion attempt (P = 0.023). Living with a partner (P = 0.002) and planning pregnancy (P = 0.009) were protective factors. Risky consumption was related to all of the aforementioned variables as well as threatened abortion (P = 0.023). CONCLUSIONS: Alcohol intake during pregnancy is common and affects nearly one-third of pregnant women. Knowledge of the population at risk and protective factors is essential for the development of campaigns that seek to reduce consumption and, therefore, its consequences for the mother and fetus.

Perfil e fatores relacionados à sífilis gestacional: revisão integrativa / Profile and factors related to gestational syphilis: integrative review

A sífilis consiste em um grave problema de saúde pública e na gestação pode acarretar complicações para a gestante e recém-nascido. Objetivou-se descrever os principais fatores associados aos casos de sífilis gestacional em brasileiras relatados na literatura. Trata-se de revisão integrativa de artigos publicados entre 2014 e 2023 nas bases de dados BVS, Scielo e PubMed. Utilizou-se os descritores sífilis, gestação e epidemiologia nos idiomas português, inglês e espanhol, aplicando os operadores booleanos AND e OR. Após análise com base nos critérios de inclusão e exclusão e questão norteadora resultou amostra final de vinte artigos. Os resultados demonstraram que há tendência crescente na incidência de sífilis gestacional, além disso, ser jovem, raça não branca, baixas escolaridade e renda estão associados aos casos. A assistência inadequada no pré-natal e não tratamento do parceiro provocam aumento dos casos de sífilis congênita. Conclui-se que é necessário maior destaque para a temática a fim de integrar os serviços de saúde, melhorar os fluxos, acolhimento e assistência, fortalecendo assim, as ações voltadas para prevenção, controle e redução dos casos de sífilis gestacional.

Syphilis is a serious public health problem and during pregnancy it can cause complications for the pregnant woman and newborn. The objective was to describe the main factors associated with cases of gestational syphilis in Brazilian women reported in the literature. This is an integrative review of articles published between 2014 and 2023 in the VHL, Scielo and PubMed databases. The descriptors syphilis, pregnancy and epidemiology were used in Portuguese, English and Spanish, applying the Boolean operators AND and OR. After analysis based on the inclusion and exclusion criteria and guiding question, the final sample of twenty articles resulted. The results demonstrated that there is an increasing trend in the incidence of gestational syphilis, in addition, being young, non-white race, low education and income are associated with cases. Inadequate prenatal care and non-treatment of the partner cause an increase in cases of congenital syphilis. It is concluded that greater emphasis is needed on the topic in order to integrate health services, improve flows, reception and assistance, thus strengthening actions aimed at preventing, controlling and reducing cases of gestational syphilis.

How can we reduce maternal mortality due to preeclampsia? The 4P rule

Abstract In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.

Vivências de mulheres que experienciaram o nascimento de um filho durante a pandemia da Covid-19 / Experiences of women who experienced the birth of a child during the Covid-19 pandemic / Experiencias de mujeres que vivieron el nacimiento de un hijo durante la pandemia del Covid-19

Objetivo: Aprender como foi experienciar o nascimento de um filho durante a pandemia da COVID-19. Método: estudo qualitativo cujos dados foram coletados em setembro de 2021, mediante entrevistas semi-estruturadas, audiogravadas, com 11 mães e submetidos à análise de conteúdo, modalidade temática. Resultados: emergiram duas categorias, as quais mostram que o nascimento do filho durante a pandemia foi vivenciado de forma restritiva o que suscitou sentimentos como medo, ansiedade, preocupação, frustração, mas também de alívio, felicidade e superação. A possibilidade de usar recursos das mídias sociais para contatos com amigos e familiares constituiu fonte de apoio informacional e emocional. Considerações finais: O apoio da rede social, ainda que de forma virtual, foi fundamental para o enfrentamento das adversidades do período. Entre as estratégias adotadas estão o apoio da família e as redes sociais, de modo a minimizar o isolamento.

Objective: to understand what it was like to experience the birth of a child during the COVID-19 pandemic. Method: qualitative study whose data were collected in September 2021, through semi-structured, audio-recorded interviews with 11 mothers and submitted to content analysis, thematic modality. Results: two categories emerged, which show that the birth of the child during the pandemic was experienced in a restrictive way, which aroused feelings such as fear, anxiety, worry, frustration, but also relief, happiness and overcoming. The possibility of using social media resources to contact friends and family was a source of informational and emotional support. Final considerations: The support of the social network, even if it was virtual, was fundamental to face the adversities of the period, some strategies were adopted, such as family support and social networks as a way to minimize isolation.

Objetivo: comprender cómo fue vivir el nacimiento de un niño durante la pandemia de COVID-19. Método: estudio cualitativo cuyos datos fueron recolectados en septiembre de 2021, a través de entrevistas semiestructuradas, grabadas en audio con 11 madres y sometidas a análisis de contenido, modalidad temática. Resultados: surgieron dos categorías, que muestran que el nacimiento del niño durante la pandemia fue vivido de forma restrictiva, lo que despertó sentimientos como miedo, ansiedad, preocupación, frustración, pero también alivio, felicidad y superación. La posibilidad de utilizar los recursos de las redes sociales para contactar a amigos y familiares fue una fuente de apoyo informativo y emocional. Consideraciones finales: El apoyo de la red social, aunque sea virtual, fue fundamental para enfrentar las adversidades del período, se adoptaron algunas estrategias, como el apoyo familiar y las redes sociales como forma de minimizar el aislamiento.

A rapid and sensitive High-Performance Liquid Chromatography method with fluorescence detection for quantification of melatonin in small volume rat plasma samples: application to a preclinical study to determine the oral pharmacokinetics of melatonin under gestational conditions

Abstract A novel, simple and sensitive high-performance liquid chromatography with fluorescence detection method was developed and validated for the characterization of the preclinical pharmacokinetics of melatonin under pregnant conditions. Plasma samples (25 µL) were treated with 30 µL of ethanol absolute (containing the internal standard, IS). After a centrifugation process, aliquots of supernant (5 µL) were injected into the chromatographic system. Compounds were eluted on a Xbridge C18 (150 mm x 4.6 mm i.d., 5 µm particle size) maintained at 30°C. The mobile phase consisted in a mixture of aqueous solution of 0.4% phosphoric acid and acetonitrile (70:30 v/v). The wavelengths were set at 305 nm (excitation) and 408 nm (emission) and the total analysis time was 8 min/sample. All validation tests were obtained with accuracy and precision, according to FDA guidelines, over the concentration range of 0.005-20 µg/mL. Pharmacokinetic study showed that melatonin systemic exposure increased from day 14, with a significant difference at 19 days of gestation compared to the control group. Our findings suggest a decreased metabolism of melatonin as result of temporary physiological changes that occur throughout pregnancy. However, other maternal physiological changes cannot be ruled out.

Fetomaternal outcome in patients of decreased fetal movements after thirty-four weeks of gestation

Background: Maternal perception of decreased fetal movements is a cause of concern and common reason for visits to the antenatal clinic or delivery room. Several studies have shown that a reduction or cessation of fetal movements may result in poor pregnancy outcome and magnified increased risks of serious perinatal morbidity and mortality. Aim and objectives were to determine the correlation between decreased daily fetal movement counts, NST, USG and Colour Doppler with maternal and fetal outcome.Methods: This study was a prospective observational study, conducted in department of obstetrics and gynecology at Surat municipal institute medical education and research medical college from January 2020 to June 2021.Results: The study group consisted of 83 patients between 34 to 40 weeks of gestation with Decreased fetal movements. 60.24% patients belonged to age group between 21-25 years. 60.22% patients were multigravida.87.95% patients were full term, 59.09% patients presented between 12-24 hours of duration with complain of decreased fetal movements. In view of NST results, 72.29% patients had reactive-NST. In ultrasonography, 27.10% had AFI <5 cm and 72.90% had AFI >5 cm & all patients had normal color Doppler study. 60 patients had induced labor. 68.67% patients delivered vaginally. 42.10% of vaginal deliveries, 80% of Instrumental vaginal deliveries and 75% of LSCS had Meconium-stained liquor. 81.92% babies had APGAR score of >7 at birth. 84.33% had birth weight more than 2.5 kg 68.18% babies were admitted in NICU due to Meconium aspiration syndrome, followed by respiratory distress syndrome in 18.18% and birth asphyxia in 13.63% babies.Conclusions: Decreased fetal movement is a frequently occurring antenatal presentation, associated with poor perinatal outcomes. Daily fetal movement counts are very effective, cheap and reliable method to diagnose fetal compromise early. Methods like NST, USG and Colour Doppler study are helpful in the identification of causes and timely management of the patient with decreased fetal movements and helpful to diagnose the fetus at risk and their timely delivery.

Outcomes of early first trimester medical termination of pregnancy: retrospective study

Background: Unsafe abortion is a major public health problem. Globally, 20 million unsafe abortions occur each year, accounting for 13% of all maternal deaths. According to WHO, 56% of abortions in developing countries are still unsafe even though medical abortion methods have been used for over a decade. The main objective of the present study is to compare the efficacy, acceptability, side effects and factors affecting the outcome of early medical abortion with oral and vaginal misoprostol after oral mifepristone in inducing early medical abortion up to 8 weeks of gestation.Methods: A one-year retrospective, observational study was conducted. A total of 82 post-MTP patients were included in this study. Data retrieved from the hospital database was tabulated and analysed.Results: The majority of women who underwent the procedure fell into the age group of 26-30 years (32.9%), on observing the parity of the mothers a whopping 82.9% were multiparous. The finished family (41.5%) was the most common reason for MTP. The incidence of RPOC in the study group was 31.7%. About 26.8% of the patients did not come back for follow-up.Conclusions: The majority of women who underwent the procedure fell into the age group of 26-30 years (32.9%), on observing the parity of the mothers a whopping 82.9% were multiparous. The finished family (41.5%) was the most common reason for MTP. The incidence of RPOC in the study group was 31.7%. About 26.8% of the patients did not come back for follow-up.

A cross-sectional study to assess hypothyroid status of pregnant women at 12–16 weeks of gestation

Background: Physiological changes occur during pregnancy. These changes include metabolic, hematologic, cardiovascular, renal, and respiratory changes. In some cases, these changes may alter and lead to complications which result in adverse pregnancy outcomes. In India, hypothyroidism in pregnancy has a prevalence of 4.8–11%. Aims and Objectives: The aim of this study was to estimate the prevalence of hypothyroidism in pregnant women at 12–16 weeks of gestation. Materials and Methods: A cross-sectional study was planned on pregnant women attending the ANC clinic of Outpatient Department of Obstetrics and Gynecology at K.L. E’S Dr Prabhakar Kore Hospital and Medical Research Center Belagavi. Serum thyroid stimulating hormone (TSH) was estimated in the study participants. Serum TSH levels >4.5 ?IU/ml were labeled as hypothyroid pregnant women. Results: In our study, the prevalence of hypothyroidism was observed to be 8.68%. Conclusion: Hence, we conclude that all pregnant women should be screened for hypothyroidism at earlier weeks of gestation.

Obstetric and perinatal outcome of multiple pregnancy: a retrospective study

Background: Obstetricians and paediatricians are concerned about multiple pregnancy because of its high association with maternal and perinatal morbidity and mortality. This study aims to determine the obstetric and perinatal outcome of multiple pregnancy at a teaching hospital in Southern India.Methods: This retrospective study was conducted in the department of obstetrics and gynecology, Basaweshwar teaching and general hospital, and Sangmeshwar teaching and general hospital, attached to Mahadevappa Rampure medical college, Kalaburagi from August 2020 to August 2022. The analysis included data on 36 women between 20 and 35 years of age, with ? 24 completed weeks gestation, having multiple pregnancy during the study period after applying the exclusion criteria. The data was retrieved from the hospital medical records that included demographic details, complications of pregnancy, and maternal and neonatal outcomes. The data was expressed as frequencies, percentages, mean and standard deviation. Statistical data was analyzed using SPSS 20.0 software. Qualitative data of the maternal problems during intrapartum and postpartum period was done using the test of proportion and chi-square test was applied for significance. Quantitative data was analyzed by t test considering a p value less than 0.05 as statistically significant.Results: There were a total of 36 women with multiple pregnancy with the overall incidence of 12.5 per 1,000 births (1.25%) during the study period. Preterm labour complicated 27.7% of multiple pregnancies, 13.8% of the multiple pregnancies were complicated by severe preeclampsia, 11.1% were complicated by imminent preeclampsia, 8.3% had intrauterine death in 1 of the twins, and 2.7% had oligohydramnios. 33.3% had iron deficiency anaemia, 22.2% had gestational hypertension, and 13.8% had hypothyroidism. There was no maternal morbidity. Majority (55%) were delivered by LSCS, whereas 44.4% were delivered vaginally. Postpartum haemorrhage complicated 5.5% of twin deliveries. The total fetal loss was 2.4%. There was no maternal mortality in our study.Conclusions: There is higher incidence of adverse maternal and perinatal outcomes among multiple pregnancies than singleton pregnancies. This mandates adequate counselling about risks and required monitoring to avoid adverse outcomes.

Vértigo en gestantes: presentación clínica, impacto en la calidad de vida y factores asociados / Vertigo in pregnancy: clinical presentation, impact on quality of life and associated factors

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.

OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.

Carcinoma adrenocortical en mujeres en edad fértil / Adrenocortical carcinoma in women of reproductive age

Resumen Los carcinomas adrenocorticales son tumores infre cuentes, habitualmente hiperfuncionantes y con una supervivencia global pobre. La edad frecuente de pre sentación se describe en adultos entre 40 a 60 años, con predominio en sexo femenino. Se presentan dos casos inusuales de carcinoma adrenal diagnosticados en mujeres en edad fértil. El primero de ellos se descubrió en el segundo trimestre de gestación, con un cuadro de hipercortisolismo y lesión adrenal localizada, que resolvió con resección completa hacia la semana 20. En el segundo, la paciente debutó con manifestaciones clínicas de virilización rápidamente progresiva, sien do el hiperandrogenismo puro el patrón bioquímico hallado. En ambos casos, a pesar de haberse realizado la resección completa, el Ki67 elevado como principal factor pronóstico condujo a categorizarlas como de "alto riesgo de recurrencia". Asimismo, se ha asociado a la gestación y al patrón secretor de glucocorticoides como factores adicionales de mayor riesgo de recurrencia. Este es particularmente elevado dentro de los dos primeros años posteriores al diagnóstico. Existe aún controversia sobre el uso de mitotane adyuvante en estos pacientes, y su inicio está recomendado hasta los tres meses del postquirúrgico. Sin embargo, la evidencia disponible no permite suponer la falta de eficacia si se utiliza fuera de ese período. Los limitantes, como fueron el curso de la gestación y el puerperio inmediato, así como la difi cultad para el acceso a la medicación en nuestro medio, impidieron el inicio precoz del tratamiento adyuvante en ambos casos, aunque surge la inquietud de si aún sería oportuna su instauración.

Abstract Adrenocortical carcinomas are rare tumors, usually hyperfunctioning, with poor overall survival. Frequent age of presentation is described in adults between 40 and 60 years of age, predominantly female. Two unusual cases of adrenal carcinoma diagnosed in young women are presented. The first one was discovered in the sec ond trimester of gestation, with signs and symptoms of hypercortisolism and localized adrenal lesion, which was resolved with complete resection by week 20 of pregnancy. In the second case, the patient begined with clinical manifestations of rapidly progressive virilization, the biochemical pattern being pure hyperandrogenism. In both cases, despite complete resection, the high Ki67 as the main prognostic factor leaded to categorization as "high risk of recurrence". In addition, pregnancy and glucocorticoid secretory pattern have been associated as additional risk factors of recurrence. This is particularly high within the first two years after diagnosis. There is controversy about the use of adjuvant mitotane in these patients, and the general recommendation is to be started no longer than 3 months after surgery. However, the available evidence does not suggest that its use is ineffective beyond that period. Limitations, such as the course of pregnancy and the immediate puerperium, as well as the difficulty of accessing this medication in our environment, prevented the early initiation of adjuvant treatment with mitotane in both cases, although there is still concern whether its administration would still be appropriate.

Parto culturalmente adecuado desde la perspectiva de enfermería, visión contemporánea y particularidades en pacientes reumáticas

La maternidad es un proceso complejo que se encuentra determinado por factores objetivos y subjetivos. A pesar de ser inherente a todos los seres humanos se ve influenciado por elementos culturales que determinan, en buena medida la conducta de la población para con la maternidad. El objetivo de la presente investigación fue exponer los elementos relacionados con la denominación del parto culturalmente adecuado desde la perspectiva de enfermería basado en un enfoque contemporáneo de la maternidad, atendiendo a las particularidades de la paciente reumática. Se realizó un análisis global de las características básicas y distintivas de la maternidad en distintos continentes, basado en la perspectiva de la atención de enfermería, para ser comparado con el proceso que se desarrolla actualmente en el Ecuador; adicionalmente se prestó atención a los elementos distintivos de la atención en pacientes reumáticas. Los resultados muestran las diferencias existentes en un mismo proceso y evidencian como los elementos culturales son capaces de influenciar el desarrollo y la atención de la maternidad en Ecuador. Se concluye que existen particularidades en Ecuador que son distintivas en la atención de enfermería durante la maternidad; estas se ven influenciadas por las costumbres regionales, pero conservan su identidad evidenciando el papel que juega la interculturalidad en cada uno de los momentos trascendentales de los seres humanos.

Maternity is a complex process that is determined by objective and subjective factors. Despite being inherent to all human beings, it is influenced by cultural elements that largely determine the behavior of the population towards motherhood. The objective of this research was to expose the elements related to the culturally appropriate name of childbirth from the nursing perspective based on a contemporary approach to motherhood, taking into account the particularities of the rheumatic patient. A global analysis of the basic and distinctive characteristics of maternity in different continents was carried out, based on the perspective of nursing care, to be compared with the process currently taking place in Ecuador; Additionally, attention was paid to the distinctive elements of care in rheumatic patients. The results show the differences that exist in the same process and show how cultural elements are capable of influencing the development and care of maternity in Ecuador. It is concluded that there are particularities in Ecuador that are distinctive in nursing care during maternity; These are influenced by regional customs, but retain their identity, evidencing the role that interculturality plays in each of the transcendental moments of human beings.