The role of non-stress test as a method to evaluate the outcome of high-risk pregnancy: a tertiary care center experience

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests.

Low Dose Ketamine in Labour Analgesia

Introduction: Ketamine is dissociative anaesthesia- acombination of profound analgesia with superficial sleep.This state is characterized by spontaneous ventilation, relativepreservation of airway reflexes and hemodynamic stability.The present study was designed to evaluate the efficacy ofprogrammed labour protocol in proving shorter, safer andrelatively pain free deliveries.Material and methods: This study was a randomised controltrial done in The Department of Obstetrics and Gynaecology,Rohailkhand Medical College and Hospital for a span of oneyear (October 2016 to September 2017).Result: In our study, the duration of labour, induction deliveryinterval was significantly reduced. Pain relief was excellent instudy group.Conclusion: Ketamine’s site of action appears to be primarilyin the thalamus and limbic systems, acting as N- methyl Daspartate receptor non- competitive antagonist. It does notsuppress respiratory drive unless high dosage are used, orsmall dosage given rapidly. Intravenous ketamine in low doseappears to be safe laternative to epidural analgesia.

Comparative Study of Serum Lipid Profile in Normotensive Pregnant Women and in Patients with Pre-Eclampsia- A Case Control Study.

Background: The objective of the present study was to compare the changes in serum lipid profile in normal pregnant women with those in patients with pre-eclampsia. Methods: In this study total 140 study subjects were evaluated, 70 normotensive pregnant women as a control group and 70 pre-eclamptic patients as a study group. Study Subjects were between the age group of 20-35 years and in the second and third trimester of pregnancy. Fasting blood samples were collected and serum level of Triglycerides (TG), Total Cholesterol (TC), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL) were measured by enzymatic colorimetric method. Results: There was a significant rise in TC, TG, LDL and VLDL and significant decrease in HDL level in pre-eclamptic group as compared to normal pregnant women.Conclusion: The findings of the present study are consistent with previous studies suggesting an altered lipid profile has a potential role in the genesis of endothelial dysfunction and expression of pre-eclampsia.

Role of Bacterial Vaginosis in Patients with Idiopathic Pre- Term Labour.

Background: To find out the correlation of bacterial vaginosis (BV) in idiopathic preterm labour and find its association with an adverse pregnancy outcome in patients with idiopathic preterm labour. Methods: This is a comparative study, comprising of 150 pregnant females in study group admitted with preterm labour without any obvious cause and 150 pregnant women with singleton pregnancy at term in the control group. Both the groups were tested for BV by using Amsel's criteria and Nugent's criteria. Diagnosis of BV was stamped based on gram staining of vaginal discharge smear. All patients were followed till delivery. Results: In the study group, significantly large number of women tested positive for BV on gram staining of vaginal discharge as compared to control group (20.6% vs 8.0%). In the study group, an adverse pregnancy outcome in the form of preterm delivery (<37 weeks) was noted in 93.4% women testing positive for BV and only in 47.9% women testing negative for BV. The majority of women with BV +ve were more likely to deliver before or at 34 weeks (58.06%) compared to women with BV-ve (14.28%).Conclusion: BV was significantly associated with preterm labour and preterm delivery and adverse perinatal outcomes.

Increasing incidence of multidrug resistant Pseudomonas aeruginosa in inpatients of a tertiary care hospital.

Background: Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections. Methods: A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method. Results: The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers. Conclusion: The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.

Perinatal outcome in pregnancy induced hypertension.

Perinatal outcome and the factors affecting it were studied in 140 pregnant women with hypertension. Perinatal mortality rate (PNM) was 140/1000 and the stillbirth rate was 8.7%. In severe hypertension PNM was 52.3% and all perinatal deaths were 8.7%, when the serum uric acid level were more than 4.5 mg%.

Perinatal outcome of pregnancies complicated by threatened abortion.

One hundred and two cases of viable pregnancies with threatened abortion were studied in the department of obstetrics and gynaecology, Kamla Nehru Hospital, IG Medical College, Shimla between November 1987 and February 1989 and their perinatal outcome was evaluated. The pregnancies continued beyond 28 weeks in 61.7% of the cases. The incidence of prematurity was 19.0%. The incidence of low birth weight (LBW) babies was 23.8%. Apgar score was less than 7 in 22.3%. The incidence of neonatal complications was 25.3%. There was no perinatal mortality. In a control group of 50 cases, the incidence of prematurity and LBW was 8% and 4% respectively. Apgar score less than 7 was noted in 4% and neonatal complications were observed only in 4% of newborns.

Gynaecological neoplasms in postmenopausal women of Himachal Pradesh.

A controlled prospective study was conducted on 300 postmenopausal women attending the Kamla Nehru Hospital from November, 1990 to August, 1992. The incidence of gynaecological neoplasms was 31.3% in both the study group (300 postmenopausal women) and the control group (300 premenopausal women). The incidence of malignant neoplasms was 24.6% in study group and 8.6% in control group. This difference was highly significant (p < 0.001). Carcinoma cervix (16%) was the commonest gynaecological malignancy followed by ovarian cancer (6%). The incidence of benign neoplasms was lower in the study group (6.6%) as compared to the control (22.6%).