Prevalência de nascimentos prematuros como desfechos de infecções pela COVID-19 na gestação / Prevalence of Preterm Birth as an Outcome of COVID-19 Infections during Pregnancy / Prevalencia de nacimientos prematuros producto de la infección por COVID-19 durante el embarazo

Objetivo: estimar a prevalência de nascimento prematuro em gestantes infectadas pela Covid-19, comparar índices de prematuridade entre infectadas e não infectadas e elucidar fatores associados à prematuridade. Métodos: coorte retrospectiva, com coleta de dados por inquérito online, de abril a dezembro de 2022, com mulheres que estiveram gestantes durante a pandemia, com acesso à internet, idade superior a 18 anos e que preencheram o primeiro inquérito online. Protocolo de pesquisa aprovado pelo Comitê de Ética. Resultados: primeiro inquérito respondido por 304 gestantes/puérperas, e o segundo por 82 (27%), compondo a amostra final. O índice de prematuridade no primeiro inquérito foi de 7,2% (n=14), já no segundo, 8,5% (n=7). A infecção pela Covid-19 não foi associada à prematuridade. A prematuridade associou-se a baixo peso, à necessidade de internação em centros de terapia intensiva neonatal e internações após o nascimento. Conclusão: a infecção pela Covid-19 não influenciou no aumento de nascimentos prematuros.

Objective: to estimate the prevalence of preterm birth in pregnant women infected with Covid-19, compare prematurity rates between infected and non-infected, and elucidate factors associated with prematurity. Methods: a retrospective cohort study was conducted using online survey data collected from April to December 2022, involving women who were pregnant during the pandemic, had internet access, were over 18 years old, and completed the initial online survey. The research protocol was approved by the Ethics Committee. Results: the initial survey was completed by 304 pregnant/postpartum women, and the follow-up survey by 82 (27%), comprising the final sample. The preterm birth rate in the initial survey was 7.2% (n=14), and in the follow-up survey, it was 8.5% (n=7). Covid-19 infection was not associated with prematurity. Prematurity was associated with low birth weight, the need for neonatal intensive care unit admission, and postnatal hospitalizations. Conclusion: Covid-19 infection did not influence an increase in preterm births.

Objetivo: estimar la prevalencia de partos prematuros en gestantes infectadas por Covid-19, comparar las tasas de prematuridad entre gestantes infectadas y no infectadas y determinar los factores asociados a la prematuridad. Métodos: estudio de cohorte retrospectivo, con recolección de datos mediante encuesta online, de abril a diciembre de 2022, con mujeres que estuvieron embarazadas durante la pandemia, con acceso a internet, mayores de 18 años y que completaron la primera encuesta online. El protocolo de investigación fue aprobado por el Comité de Ética. Resultados: la primera encuesta fue respondida por 304 gestantes/puérperas, y la segunda por 82 (27%), que conformaron la muestra final. La tasa de prematuridad en la primera encuesta fue del 7,2% (n=14), en la segunda, del 8,5% (n=7). La infección por Covid-19 no se asoció con la prematuridad. La prematuridad se asoció con bajo peso, necesidad de internación en centros de cuidados intensivos neonatales e internaciones después del nacimiento. Conclusión: La infección por Covid-19 no influyó en el aumento de nacimientos prematuros.

Desfechos obstétricos adversos durante a COVID-19: uma série de casos retrospectiva / Adverse obstetric outcomes during COVID-19: a retrospective case series / Resultados obstétricos adversos durante el COVID-19: serie de casos retrospectiva

Objetivo: analisar as características e os desfechos obstétricos adversos em gestantes/puérperas infectadas pelo SARS-CoV-2 em serviço de referência. Método: série de casos retrospectiva entre gestantes com Covid-19 em um hospital universitário em Minas Gerais, Brasil, atendidas no serviço de 2020 a 2021, coletados em abril de 2022, empregando-se estatística descritiva para análise dos dados através do Statistical Package for the Social Science. Resultados: incluídas 26 gestantes, em sua maioria brancas, que tiveram como principais desfechos obstétricos adversos a internação em UTI (43,5%), parto prematuro (34,6%), dado reestratificado de semanas para dias para investigar o encurtamento da gestação, onde constatou-se média de 38,6 dias potenciais de gravidez perdidos dos 280 dias ideais, e ainda 15,4% evoluíram para óbito materno. Conclusão: o estudo proporcionou evidenciar a necessidade de vigilância e atenção às gestantes com foco nos principais desfechos adversos, podendo-se intervir em tempo oportuno para diminuir adversidades.

Objective: to analyze the characteristics and adverse obstetric outcomes in pregnant/puerperal women infected by SARS-CoV-2 at a reference service. Method: a retrospective case series conducted among pregnant women with Covid-19 in a university hospital from Minas Gerais, Brazil, treated at the service from 2020 to 2021. The cases were collected in April 2022 employing descriptive statistics for data analysis in the Statistical Package for the Social Science. Results: a total of 26 pregnant women were included, mostly white-skinned, whose main adverse obstetric outcomes were admission to the ICU (43.5%), premature birth (34.6%) and data restratified from weeks to days to investigate shortening of pregnancy, where a mean of 38.6 potential days of pregnancy were lost out of the ideal 280 days, and 15.4% resulted in maternal death. Conclusion: the study provided evidence of the need for surveillance and care for pregnant women with a focus on the main adverse outcomes, enabling timely intervention to reduce adversities.

Objetivo: analizar las características y resultados obstétricos adversos en gestantes/puérperas infectadas por SARS-CoV-2 en un servicio de referencia. Método: serie de casos retrospectiva entre gestantes con Covid-19 en un hospital universitario de Minas Gerais, Brasil, atendidas en el servicio de 2020 a 2021. Los datos se recolectaron en abril de 2022, se utilizó estadística descriptiva para analizar los datos mediante el Statistical Package for the Social Science. Resultados: se incluyeron 26 gestantes, la mayoría de raza blanca, cuyos principales resultados obstétricos adversos fueron ingreso a UCI (43,5%), parto prematuro (34,6%), dato reestratificado de semanas a días para investigar el acortamiento de la gestación, que arrojó como resultado un promedio de 38,6. Se comprobó que se perdieron en promedio 38,6 días potenciales de embarazo de los 280 días ideales, y muerte materna (15,4%). Conclusión: la evidencia que proporcionó el estudio indica que es necesario vigilar y atender a las gestantes enfocándose en los principales resultados adversos, lo que permite intervenir de forma oportuna para reducir adversidades.

The effect of maternal concerns about childbirth and postpartum period on obsessive and compulsive behaviors related to baby care / Efecto de las preocupaciones maternas sobre el parto y el puerperio en las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé

Abstract Introduction. Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother's baby care process. Objective. This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care. Materials and methods. The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales 'Fear of Childbirth and Postpartum Period', and 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care'. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson's correlation, and simple linear regression analysis. Results. A statistically significant and positive correlation was found between participant scores of the 'Fear of Childbirth and Postpartum Period' and the 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care' scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180). Conclusions. Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.

Resumen Introducción. La ansiedad del parto y el posparto es una condición común entre las mujeres embarazadas por la incertidumbre de vivir el embarazo y el parto por primera vez o por previas experiencias negativas. El miedo al parto puede afectar el proceso del cuidado del bebé de la madre. Objetivo. Determinar el efecto de las preocupaciones maternas sobre el parto y el puerperio y su efecto sobre las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé. Materiales y métodos. El estudio se realizó con 260 madres. Los datos fueron recolectados en el formulario de información descriptiva y se usaron la "Escala de miedo al parto y al período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionados con el cuidado del bebé". Los datos fueron evaluados mediante el software SPSS™ mediante el cálculo de porcentajes, promedio, prueba t, ANOVA, correlación de Pearson y análisis de regresión múltiple. Resultados. Se encontró una correlación positiva y estadísticamente significativa entre la "Escala de miedo al parto y del período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionadas con el cuidado del bebé" (p < 0.01). En el modelo creado por análisis de regresión se observó que el 18,0% del cambio en la escala de comportamientos obsesivos-compulsivos estaba explicado por el miedo al parto y al puerperio (R2corregido = 0,180). Conclusiones. En el estudio se determinó que el miedo al parto y al puerperio era moderado. Sin embargo, a medida que aumentaba el puntaje de miedo al parto y al período posparto, también aumentaban los comportamientos obsesivos y compulsivos de las madres en el puerperio relacionados con el cuidado del bebé.

Maternal and perinatal outcome in placenta previa

Background: Placenta previa is a serious and life-threatening pregnancy complication characterized by bleeding originating from the placental site located in the lower uterine segment. This condition typically occurs during the latter half of pregnancy when the lower uterine segment undergoes stretching.Methods: This study is a retrospective observational study of total 30 cases of placenta previa from October 2022 to February 2024 at the department of obstetrics and gynecology at SVP Hospital, tertiary center, western Ahmedabad. All women with placenta previa included in this study except patients suffering from any other bleeding disorder. These women were analyzed with age, parity, gestational age, past history of bleeding, clinical features at presentation, blood transfusion, period of gestation at time of delivery, mode of delivery and perinatal outcome.Results: In present study 30 cases were taken. Majority were registered 66.7% (20), age group between 21 to 30 year patients 87% (26), multiparous 73.4% (22) patients. Most common risk factor is caesarean section 20% (6) followed by D&E 16.6% (5). Common complications include 33.33% (10) postpartum haemorrhage.Conclusions: Placenta previa is a major risk factor for adverse maternal and perinatal outcome. Good antenatal care, early diagnosis, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and nicu services can improve maternal and neonatal outcome in high risk cases.

Association of breastfeeding related musculoskeletal pain, sleep quality and physical activity among postpartum women: a literature review

Women often report musculoskeletal ailments during perinatal period resulting in less sleep hours and decline in physical activity. It has been speculated that physical activity can lower the frequency of muscular pain and enhance good quality sleep among women. Hence, the review aimed to investigate the association of breastfeeding related musculoskeletal pain, sleep quality and physical activity thus refining quality of life among women. Literature search was performed using search strategy on PubMed, Scopus and Pedro databases during 2019-2023. A total 54,037 articles were found via database searching out of which only 16 studies were relevant meeting the inclusion criteria. All the studies found that breastfeeding related musculoskeletal pain, sleep quality and physical activity are associated with each other. To lower the incidence of muscular pain and improve sleep quality, physical activity can be incorporated thus preventing occurrence of future complications. Hence, it has been suggested that physical activity is key solution of emerging musculoskeletal pain and broken sleep quality. Evidence from this literature supports that prenatal education emphasizing necessity of physical activity should be routinely integrated into maternal care in an effort to reduce chances of future complications.

Factores asociados al rechazo de contracepción posparto en un Hospital Público / Factors associated with postpartum contraceptive refusal in a public hospital, 2021

Objetivo: Determinar los factores asociados al rechazo de la contracepción posparto en un Hospital Público, 2021. Métodos: Estudio observacional, analítico, transversal; incluyó 251 puérperas inmediatas atendidas en un Hospital Público entre mayo y junio del 2021. La variable principal fue rechazo de la contracepción posparto y factores asociados: sociodemográficos, obstétricos, personal-cultural, institucional. Se usó un cuestionario válido y confiable. Además, la prueba Chi cuadrado de Pearson y Regresión de Poisson para el análisis estadístico y se tuvo aprobación de Comité de Ética. Resultados: El 16,7 % rechazó los contraceptivos modernos. El nivel educativo bajo (p < 0,011; RPa: 4,51; IC: 1,42-14,35), la percepción de una mala situación económica (p = 0,001; RPa: 3,65; IC: 1,72-7,76), las complicaciones durante el trabajo de parto y dos horas posparto (p = 0,041; RPa: 8,16; IC: 1,09-61,19), el embarazo planificado (p = 0,002; RPa: 2,51; IC: 1,38-4,55), la experiencia negativa de contracepción (p = 0,000; RPa: 11,26; IC: 5,85-21,66), la actitud negativa de la pareja (p = 0,006; RPa: 4,90; IC: 1,57-15,31) y la percepción de conocimiento insuficiente sobre contracepción (p = 0,049; RPa: 0,53; IC: 0,28-0,996); se asociaron al rechazo de contracepción en el posparto. Conclusión: El nivel educativo bajo, la percepción de una mala situación económica, las complicaciones durante el trabajo de parto y dos horas posparto, el embarazo planificado, la experiencia negativa de contracepción, la actitud negativa de la pareja, se asocian al rechazo de contracepción posparto; la percepción de conocimiento insuficiente sobre contracepción se asoció a la disminución de rechazo(AU)

Objective: To determine the factors associated with the refusal of postpartum contraception in a Public Hospital, 2021. Methods: Observational, analytical, cross-sectional study; included 251 immediate postpartum women treated in a Public Hospital between May and June 2021. The main variable was rejection of postpartum contraception and associated factors: sociodemographic, obstetric, personal-cultural, and institutional. A valid and reliable questionnaire was used. In addition, Pearson's Chi-square test and Poisson's regression were used for statistical analysis and the Ethics Committee was approved. Results: 16.7% rejected modern contraceptives. Low educational level (p < 0.011; PRa: 4.51; CI: 1.42-14.35), the perception of a bad economic situation (p = 0.001; RPa: 3.65; CI: 1.72-7.76), complications during labor and two hours postpartum (p = 0.041; PRa: 8.16; CI: 1.09-61.19), planned pregnancy (p = 0.002; PRa: 2.51; CI: 1.38-4.55), negative experience of contraception (p = 0.000; PRa: 11.26; CI: 5.85-21.66), the negative attitude of the partner (p = 0.006; RPa: 4.90; CI: 1.57-15.31) and the perception of insufficient knowledge about contraception (p = 0.049; RPa: 0.53; CI: 0.28-0.996); were associated with contraceptive rejection in the postpartum period. Conclusion: Low educational level, perception of a poor economic situation, complications during labor and two hours postpartum, planned pregnancy, negative contraceptive experience, negative partner attitude, are associated with postpartum contraceptive rejection; The perception of insufficient knowledge about contraception was associated with a decrease in rejection(AU)

Predictors of immediate postpartum anemia among singleton postpartum women, Dire Dawas, Ethiopia: hospital based cross sectional study

Background: Immediate postpartum anemia is a condition where hemoglobin concentrations are lower than normal, which complicates maternal lives, including death. But so far, studies across Ethiopia have been inconsistent and lacking in the study area. Therefore, this study was aimed at assessing the magnitude and predictors of immediate postpartum anemia among singleton postpartum women which could help in interventions. Methods: A cross-sectional study was conducted in May 2022 in the public hospitals in Dire Dawa, Ethiopia. Participants were selected using a systematic random sampling technique. Data were collected using a structured questionnaire and medical card review, entered into EPI DATA (version 3.1) and analyzed using statistical package for the social sciences (SPSS) (version 22). A p value of 0.05 or less at multivariate with 95% confidence intervals was considered statistically significant. Results: Of 476 participants, 26.9% had immediate postpartum anemia and significantly associated with lack of formal education (AOR=3.01, 95% CI: 1.12–8.08), unemployment (AOR=2.72, 95% CI: 1.02–7.21), number of ANC visits (AOR=2.40, 95% CI: 1.32–4.30), instrumental delivery (AOR=3.70, 95% CI: 1.952–6.86), pre-delivery anemia (AOR=2.96, 95% CI: 1.48–5.91), gastro-intestinal parasites (AOR=3.23, 95% CI: 1.37–7.59), low dietary diversity (AOR=3.10, 95% CI: 1.65–5.79), and no iron supplementation during pregnancy (AOR=2.69, 95% CI:1.10–6.58). Conclusions: Almost one in four singleton postpartum women had immediate postpartum anemia. Findings indicate a public health problem and interventions need on risk factors.

Acceptance and factors linked with postpartum IUCD use in women delivering at a tertiary care hospital

Background: Postpartum intrauterine contraceptive devices (PPIUCD) offer highly effective, reliable, non-hormonal, and immediately reversible contraception, with no adverse impact on lactation. Despite these advantages, their acceptance remains low, with factors influencing rejection not fully understood, particularly in specific regions like Vadodara. This study aimed to assess the acceptability and associated factors of immediate PPIUCD use among women in SSG hospital, Vadodara.Methods: A cross-sectional study was conducted from 1st to 30th March 2024, involving 170 postpartum women in SSG hospital, Vadodara. Participants were selected using a systematic approach, and data were collected through structured questionnaires.Results: Acceptance of immediate PPIUCD usage was found to be 12.7%. Reasons for non-acceptance included concerns about complications (24.8%), bad experience in the past (10?), and husband抯 refusal (17.7%). Women with secondary education were more likely to accept PPIUCD, as were those who attended four or more antenatal care visits.Conclusions: Despite the benefits of immediate PPIUCD, its acceptance remains low, influenced by educational level, concerns about complications, and cultural factors such as male partner抯 refusal and religious beliefs. Enhancing women抯 education and providing effective counselling during antenatal care visits are crucial for addressing misconceptions and fears surrounding PPIUCD, thereby promoting its utilization in postpartum family planning.

Postpartum inferior vena cava thrombosis: a case report

Inferior vena cava thrombosis (IVCT) is an important cause of morbidity and is one of the direct causes of maternal death after delivery in developed countries. The risk of venous thromboembolism (VTE) is present throughout the pregnancy and is maximal during postpartum, especially after twin delivery. Most of the signs and symptoms of deep vein thrombosis (DVT) overlap those of normal pregnancy causing difficulty in diagnosis. We report a case of 32-year-old primigravida who developed IVCT in postoperative period following caesarean section for twin delivery at term gestation. This was diagnosed by ultrasound on evaluation for her leg pain. She was initiated on anticoagulation that was continued for a period of six months. She is on regular follow up. IVCT is rare but recognition of signs and symptoms is fundamental to start adequate therapy and avoid potential serious sequelae.

Acute postpartum pleural effusion causing distress for patient and obstetrician

A 31-year-old Gravida 5 Para 2 Live 2 Abortion 2, without comorbidities, underwent spontaneous vaginal delivery at term. She was asymptomatic in postpartum and had puerperal sterilization under low risk on postnatal day 4. After fourteen hours of surgery, she experienced an acute onset of breathlessness, tachypnea, and orthopnoea. Workup revealed right-sided pleural effusion filling three-fourths of the cavity with consolidation on chest X- ray. Therapeutic thoracocentesis was performed draining 600 ml of straw-coloured fluid. She was started on the Piperacillin tazobactam combination. Due to the repeated collection and persistent symptoms, a continuous intercostal drain was placed after 4 days. Due to persistent fever spikes, antibiotics were stepped up to Linezolid and Meropenem. A negative result on the Mantoux test, CBNAAT, and IGRA test was obtained. ANA profiling revealed the presence of non-specific KU antibodies. Symptomatic improvement was noted, and the ICD was subsequently removed after 6 days of insertion. Pregnancy is an immunosuppressive state. Rapid reversal of this state in postpartum results in a flare-up of quiescent infection. Even auto-immune diseases flare up in postpartum. Understanding this phenomenon of immune reconstitution syndrome and its impact will help in the management planning of postpartum women without dilemmas.

Screening for postpartum depression among postnatal mothers using Edinburgh postpartum depression scale

Background: The postpartum period, marked by joy and various emotions, can also give rise to postpartum blues and, in severe cases, postpartum depression (PPD). Recognizing the importance of early detection, this study employed the Edinburgh postnatal depression scale (EPDS) to identify and raise awareness about PPD among postnatal women.Methods: A cross-sectional study at Chettinad Health Research Institute included 100 postnatal women. The EPDS questionnaire was used, and statistical analyses explored associations and predictors of PPD.Results: Demographic characteristics, EPDS scores, and prevalence of PPD were assessed. 50% exhibited EPDS scores ? 13, indicating PPD presence. No significant associations were found between age, delivery method, or gestational age and EPDS scores, but pre-existing medical conditions were linked to higher scores.Conclusions: This study provides insights into the multifaceted nature of PPD, emphasizing the need for tailored interventions and ongoing research to support postnatal women. The prevalence observed underscores the urgency for awareness and timely interventions to alleviate the burden of PPD on mothers and families.

Postpartum breast complications and breast-feeding practices in a baby-friendly hospital in Bangladesh

Background: Breastfeeding is essential for health of both infants and mothers, but it often encounters challenges such as postpartum breast complications. These issues can adversely affect maternal health and significantly hinder success of breastfeeding practices. Aim of study was to assess postpartum breast complications and breast-feeding practices.Methods: This cross-sectional study was conducted in department of obstetrics and gynaecology, Dhaka medical college hospital, Dhaka, Bangladesh from February 2006 to July 2006. Two hundred patients in the postnatal ward who delivered their babies at DMCH were randomly selected.Result: Among 200 postnatal women, 33.5% experienced breast problems. Women with breast problems were designated as group A and women without breast problems were designated as group B. Most women in groups A and B were aged between 21-30 years with average 24.8 years for both groups. Antenatal check-ups were similar across groups, with breastfeeding advice given to 55.2% in group A and 64.7% in group B pre-lacteal feeds were given to 19.4% of group A and 21.8% of group B neonates, while colostrum was fed to the majority. Most neonates were breastfed within 2 hours. Good breastfeeding position and attachment were observed in most cases. Exclusive breastfeeding was more common in group B (73.7%) than in group A (58.2%). Breast problems in group A included engorgement, lactation insufficiency, and nipple issues.Conclusions: The study reveals that postpartum breast complications, notably breast engorgement and lactation insufficiency, significantly affects the breastfeeding effectiveness of new mothers.

Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica / Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Barreras de acceso a la atención de la salud según la nacionalidad peruana ­ venezolana, en puérperas de un Hospital Público del Perú / Barriers to access to health care according to Peruvian-Venezuelan nationality in postpartum women in a public hospital in Peru

Objetivo: Analizar las barreras de acceso a la atención de la salud según la nacionalidad peruana ­ venezolana, en puérperas de un Hospital Público del Perú, 2022 - 2023. Métodos: Estudio observacional, analítico, prospectivo y transversal; incluyó una muestra de 284 puérperas de nacionalidad peruana y venezolana, del Hospital San Juan de Lurigancho, seleccionadas por muestreo estratificado. La técnica de recolección de datos fue una encuesta y el instrumento un cuestionario válido y confiable. La prueba chi cuadrado de Pearson o exacta de Fisher se usó para determinar la diferencia. La asociación se evaluó con la prueba de regresión de Poisson y el sentido de esta mediante la razón de prevalencia cruda y ajustada. Resultados: El 87,3 % de puérperas fueron peruanas y 12,7 % venezolanas. Las barreras de acceso a la atención de salud más frecuentes en peruanas fueron de disponibilidad: el no contar con todos los servicios necesarios para una atención (p < 0,001) y el de aceptabilidad: sentir que sus creencias o costumbres fueron afectadas (p < 0,001). Las puérperas venezolanas reportaron como barreras de aceptabilidad: haber recibido un trato diferente por ser migrante (p < 0,001) y haber sentido discriminación durante la atención (p = 0,007). Conclusión. Existe diferencia significativa en las barreras de acceso a la atención de la salud en puérperas, presentándose barreras de disponibilidad y aceptabilidad en peruanas y la última en venezolanas(AU)

Objective: Analyze the barriers to access to health care according to Peruvian - Venezuelan nationality in postpartum women in a Public Hospital of Peru 2022 ­ 2023. Methods: Observational, analytical, prospective and cross-sectional study; included a sample of 284 postpartum women of Peruvian and Venezuelan nationality, from the San Juan de Lurigancho Hospital, selected by stratified sampling. The data collection technique was a survey and the instrument was a valid and reliable questionnaire. Pearson's chi-square or Fisher's exact test was used to determine the difference. The association was assessed using the Poisson regression test and the sense of regression using the crude and adjusted prevalence ratio. Results: 87,3 % of postpartum women were Peruvian and 12,7 % Venezuelan. The most frequent barriers to access to health care in Peruvians were availability: not having all the services necessary for care (p < 0,001) and acceptability: feeling that their beliefs or customs were affected (p < 0,001). Venezuelan postpartum women reported as barriers to acceptability: having received different treatment for being a migrant (p < 0,001) and having felt discrimination during care (p = 0,007). Conclusions: There is a significant difference in the barriers to access to health care in postpartum women, with availability and acceptability barriers occurring in Peruvian women and the latter in Venezuelan women(AU)

A case report on caesarean myomectomy

Routine myomectomy at the time of caesarean section has been condemned in the past due to fear of uncontrolled haemorrhage and peripartum hysterectomy. It is still a topic of debate worldwide. However, in recent years, many case studies of caesarean myomectomy have been published validating its safety without any significant complications like excessive blood loss. We describe the case of a 23-year-old nulliparous women at 38 weeks of pregnancy with history of previous abortion. Her ultrasound was suggestive of singleton live intrauterine pregnancy with multiple intramurals and subserosal uterine fibroids seen in fundus, body region, posterior and anterior myometrium with largest fibroid of size 9×6.1 cm. The patient was taken up for elective caesarean section along with caesarean myomectomy. Live baby was delivered and successful myomectomy was done. Prophylactically oxytocin drip was given and intra myometrial carboprost was given to avoid blood loss. Patient was discharged on post-operative day 12 without any complications. Routine myomectomy at the time of caesarean section is not a standard procedure. However, it may be considered a safe option in carefully selected cases in the hands of an experienced obstetrician.

De novo late postpartum preeclampsia: a case report with review of literature

De Novo late postpartum preeclampsia is defined by many authors as new onset postpartum hypertension of ?140/90 mmHg with features of organ system malfunctioning during 48 hours to six weeks of delivery following a normotensive pregnancy and labor. Though a lesser studied condition it is responsible for more number and increased severity of maternal morbidity, mortality, and cause of post-delivery hospital admission. Its exact cause is not yet clearly defined. The incidence is 0.3-27% as noted by many authors. Patients usually present on day 7-10 with severe headaches, neurological symptoms like visual disturbances; symptoms of other organ involvement, and high blood pressure. High suspicion leads to diagnosis. Primary investigations include that for preeclampsia. The principle of management is the reduction of blood pressure, prophylactic anticonvulsants, and diuretic is considered if there are features of fluid overload. She needs constant monitoring. Post delivery women, after discharge, do not avail of home blood pressure monitoring and even the symptoms, to start with are treated with over-the-counter medication. This leads to worsening of the condition. Our patient, a primipara reported to this hospital on the 38th day of normal vaginal delivery following a normotensive pregnancy and delivery, with features of preeclampsia. The aim of publishing this case is for statistical records and create awareness of the condition. Every postpartum woman on discharge from the hospital following a normotensive pregnancy and delivery must be counseled on the significance of home BP monitoring and must consult an obstetrician on developing any new symptoms.

The compression of myometrium and occlusion of uterine artery by COMOC-MG technique for the management of postpartum haemorrhage: clinical perspective from ten cases

Compression of myometrium and occlusion of uterine artery by Dr. Mahesh Gupta (COMOC-MG) technique is an improved B-lynch stitch technique used to control postpartum hemorrhage (PPH). Objective was to study clinical perspective of the COMOC-MG technique on the effect of PPH in Indian women. Data of 10 patients with PPH who were managed by using the COMOC-MG technique in a tertiary care center in Gujarat from April 2022 to December 2022 were retrieved. Baseline characteristics, medical problems and history of women were recorded. Decision to perform COMOC-MG stitch was taken based on the indications such as PPH, per vaginal bleeding and degree of uterine contractility. Out of 10 women, four women had medical problems such as pregnancy-induced hypertension, dysfunctional uterine bleeding and using psychiatric medicines; two women had uterine surgery/ Laparotomy; four women were diagnosed with ailments such as pregnancy induced hypertension (PIH) and hypertension during the third trimester of pregnancy. Indications such as twins during a previous pregnancy, deflexed head, previous lower segment caesarean section (LSCS) with intrauterine growth restriction (IUGR), breech, prim parity, severe oligohydramnios, placental insufficiency and second baby were considered to carry out the CS delivery. Women were managed by COMOC-MG stitch followed by Misoprostol tablets; Carbetocin, Oxytocin, Methylergometrine and Carboprost injections to control PPH. Mean time between uterine closure to COMOC-MG was 10 min. COMOC-MG stitch resulted in good outcomes in seven patients except one patient had atonic PPH. Out of ten patients, one patient required a hysterectomy and three patients required blood transfusion. COMOC-MG stitch is an easy, simple method to control PPH.

Prevalence of postpartum depression and associated risk factors in tertiary health care centre

Background: Postpartum depression (PPD) is defined as a depressive episode occurring during pregnancy or until 4-weeks post-childbirth. It is essential to diagnose postpartum depression since it can disrupt normal maternal and infant bonding and have a negative impact on both the short and long-term development of children. To determine the prevalence of postpartum depression and the associated risk factors in women delivering in a tertiary health care centre.Methods: A prospective observational study was conducted in a tertiary health care centre from January 2021 to June 2022 for a period of 18 months. Pregnant women were assessed using the Edinburgh postnatal depression scale (EPDS) at 2-3 days postpartum and at 6 weeks postpartum. The cut-off score for detecting major depression is a score greater than or equal to 13.Results: The study included 204 women, of which postpartum depression was present in 28 women. The prevalence of postpartum depression in this study group is 13.7%. Unplanned pregnancy, neonatal intensive care unit (NICU) admission of newborns, preterm delivery, lack of support from family, complications during pregnancy or birth, and delayed breastfeeding were significantly associated with postpartum depression.Conclusions: Psychological and emotional well-being should also be given priority in addition to the physical well-being of women. All women who are at high risk should be screened so that PPD can be detected earlier, and support should be extended in the form of counselling and treatment.

Maternal and fetal outcome in second stage caesarean section: a retrospective study

Background: This study aims to observe the maternal and neonatal outcomes of caesarean delivery performed in the second stage of labor.Methods: This was retrospective observational study conducted at Cheluvamba hospital, Mysore medical college, Mysore, in the department of Obstetrics and Gynaecology. All second stage caesarean sections performed between January 2023 to June 2023 were analyzed in terms of incidence, indications of caesarean-section, intra-operative and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 4194 deliveries. Out of this 1771 deliveries were done by caesarean section. Out of them 48 were 2nd stage caesarean sections contributing to 2.71% of total sections. Patwardhan method was used in 41.6% cases for delivery of deeply engaged head. Intra-operative complications were higher in terms of atonic pph (25%), hematuria (16.66 %). 14% cases had postoperative fever and 41.6% cases need prolonged catheterization. 20.83% babies required NICU admissions and neonatal death was 4.16%.Conclusions: Caesarean section in the 2nd stage of labour is associated with increased maternal and neonatal morbidity. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

Efficacy of early versus late postpartum DIPSI test in gestational diabetes mellitus women for follow up

Background: The present study aimed to evaluate if postpartum gestational diabetes mellitus (GDM) screening can be performed during immediate post-delivery 72 hrs instead of six weeks postpartum for follow-up.Methods: Total 150 GDM patients were included. The sample size was calculated as 150 with Nimaster2.0 software. GDM patients are enrolled after meeting the exclusion criteria for the study. The GDM diagnosis was made by DIPSI test and treated as per guidelines. After delivery, the Dipsi test was done on PND-3 (PP1). Furthermore, all were kept on LSM irrespective of the glycaemic level DIPSI test was repeated in all Patients after 45 days (PP2).Results: All 150 patients had a DIPSI test on 3rd day post-partum (PP1) and repeat test at 45 days (PP2)., Of these, 60 patients (40%) showed negative DIPSI test on P1 and all remained in Group 1, with 63 patients having negative DIPSI test on PP2. 50 patients (33.3%) had blood glucose between 140-199 mg (Group 2) on PP1 and increased to 53 patients in PP2 in 45 days. 40 patients had diabetic (26.6%) value (Group 3) in PP1, and out of them 34 (22.6%) remained in group 3 in PP2 after 45 days post-partum.Conclusions: This pilot study shows that nearly 60% of the GDM patient have either IGT or diabetic value following delivery on 3rd day of PP1 and almost similar results in PP2. Hence, we can do the postpartum screening on the postpartum 3rd day and need not wait for 6 wks when more than 50% is lost for follow-up. This study shows among GDM 60% of them have underlying beta cell dysfunction.