Obstetrics and Gynaecology

Women with chronic illnesses face challenges during childbirth and recovery. However, Schizophrenic postpartum women are especially challenged during this period due to inadequate prenatal care, decreased tolerance for pain, and a psychotically distortion of reality 1, 5.  Most of these women experience overwhelming anxiety 1, 2. To handle the clinical needs of these patients, the postpartum nurse must possess excellent clinical skills and utilize all the available resources. The goal is for quality postpartum care and safety for the patient, baby, family, and staff.

Perinatal care in Japan has progressed rapidly in recent decades, remarkably reducing maternal, perinatal and neonatal mortality rates. This is attributable not only to the sustained efforts and dedication of past obstetricians and midwives, but also to the collective results achieved by the Japan Society of Obstetrics and Gynecology and healthcare administration, including research on advanced medical care, education, medical care improvements and establishing perinatal care centers. Although the maternal mortality rate was in steady decline until 2007 (3.1/100 000 births), it repeatedly fluctuated thereafter, plateauing at 3.4 per 100 000 births in 2013 and 2.7 per 100 000 births in 2014. Thus, the Perinatology Committee has analyzed the current situation of maternal deaths and has proposed countermeasures to reduce such death. The items deliberated upon by related subcommittees in 2015 are presented herein. The addition of indications for 'fibrinogen concentrate', 'ep...

Background: Studies have identified a high prevalence of psychological disorders among pregnant women; few studies have explored this association in this environment. Aims and objectives: the study is aimed at determining the prevalence and correlates of psychological morbidity in a group of pregnant women. Method: Two hundred and thirty-seven pregnant women were recruited for the study. They were assessed with a socio-demographic questionnaire (including obstetric history), the General Health Questionnaire-12 (GHQ-12) and the Insomnia Severity Index (ISI) questionnaire. Results: The prevalence of psychological morbidity among the pregnant women was 36.7%, and the major factors associated with morbidity were insomnia and having previous abortions. Conclusion: Pregnant women are a vulnerable group to psychological morbidity and will require psychological support.

Introduction The World Health Organization (WHO) defined stillbirth as the death of a fetus with a birth weight of at least 500g or if birth weight is unavailable [1,2], a gestational age beyond the age of viability. The stillbirth rate, as the perinatal mortality rate, is an important indicator of the quality of antenatal care and obstetric care during labor and delivery [3]. Knowledge of the causes and risk factors of this unfortunate problem will help in designing preventive measures to reduce its incidence [4]. Stillbirths are common and devastating, and in developed countries, about one-third has been shown to be of unknown or unexplained origin [5]. Some Abstract Background: Stillbirths have always been a contributor to psychological morbidity amongst women. Diabetes mellitus remains a significant risk factor for its occurrence. Knowledge of the causes and risk factors of this unfortunate problem will help in designing preventive measures to reduce its incidence.

We describe a unique case of a 67-year-old patient with primary uterine rhabdomyosarcoma with a history of breast cancer and gastrointestinal stromal tumor of the stomach. Uterine rhabdomyosarcoma was diagnosed in our patient during adjuvant treatment of breast cancer with anastrozole. To the best of our knowledge, the development of primary uterine rhabdomyosarcoma has never been described in patients treated with anastrozole. Due to the suggested causative role of tamoxifen in the development of uterine sarcomas, it is interesting to analyze whether the new drug, anastrozole, exerts any pathogenic effect on the development of uterine sarocomas.

The deficiency of vitamin D is prevalent in India to the extent that it is almost reaching up to an epidemic. In a population where the deficiency of vitamin D already prevails, together with low dietary intake of calcium, there is worsening of the situation during pregnancy as calcium is needed by the developing fetus. Globally, it was reported that the prevalence of Vitamin D deficiency during pregnancy to be in range of 18-84%, depending upon the country and its social and cultural practices, clothing etc. The Endocrine society of India also recommends screening of people at risk including pregnant & lactating women. Keeping these things in mind, the present study was conducted with the aim to estimate the levels of vitamin D in 100 pregnant women and its seasonal variation. It was observed that majority of the pregnant females present with vitamin D deficiency and only a few pregnant females have sufficient vitamin D levels. Also, the deficiency was more during the winter season as compared to the summer season. Thus, there is a need for early detection of hypovitaminosis D during pregnancy and its supplementation along with intake of foods fortified with vitamin D.

Background: Anaemia in pregnancy is the leading medical disorder in developing countries like India. Women with severe anemia in labor is a challenging situation for the obstetrician with increased maternal and perinatal morbidity and mortality. It has multifactorial etiology, Main cause of anemia in obstetrics is iron deficiency. There are specific risks for the mother like preterm labour pain, IUGR baby, preeclampsia, antepartum haemorrhage, sepsis etc and the fetus such as prematurity, low birth weight, birth asphyxia etc. Aim and Objectives: To determine the socio-demographic variables and also the maternal and perinatal outcomes of pregnant women admitted to labour room with severe anemia (Hb <7gm%) late in pregnancy. Results: It was seen that out of 50 severely anemic women, 82% had Hb between 4-7 gm% and 18% had Hb < 4gm%. Severe anemia is seen in 82% unbooked patients and only in 18% booked patients. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, mortality in anemic group as compared to non anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admission, low birth weight among the anemic group as compared to non anemic group. Conclusions: Severely anemic women reporting in labor had significantly high maternal and perinatal morbidity and mortality. Even a minor blood loss is much devastating for such patients. Extrapolating our observations, it can be said that a close vigilance, anticipation of complications and appropriate care and interventions during labor and puerperium will help in improving outcomes in these severely anemic women. Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy.

L’assistenza durante il travaglio può influenzare la donna a livello fisico e psicologico, oltre che la salute del suo bambino a breve e lungo termine. Una comunicazione efficace, il supporto e l’empatia da parte dell’equipe, così come il rispetto delle preferenze della donna, può aiutarla ad avere il controllo di quanto accade, rendendo la nascita una esperienza positiva per lei e per chi l’accompagna in questo percorso.

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of "maternal separation". Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.

Background: More than half of all maternal deaths occur within 24 hrs. of delivery and most commonly occur from excessive blood loss. PPH is the most significant direct cause of maternal mortality in low resource countries, accounting for approximately 30% of maternal deaths worldwide and is one of the most preventable. This study finds out to use of oral misoprostol in active management of the third stage of labour. Objective: To use oral misoprostol for active management of the third stage of labour. Method: An Observational cross-sectional study was carried out Obstetrics & Gynaecology indoor Department of BSMMU, from November '2013 to April' 2014, 100 cases were included in this study. Detailed information's were obtained in each cases according to protocol. Complete history was taken either from patient or accompanying attendants. Thorough clinical examination was done. Relevant investigations report was collected. All the information's were recorded in the fixed protocol. Collected data was classified, edited, coded and entered into the computer for statistical analysis by using SPSS. RESULTS: In present study 100 cases were included, the mean age was 27.64(±4.25) years, minimum age was 20 years and maximum age was 40 years. Twenty seven percent were come from lower socioeconomic class, 69% came from middle class and only 04% came from upper socioeconomic class. Thirty four percent were primi para, 49% were 1-3 para and 07% were > 3 para. Mean duration of third stage of labour 7.49(±2.82) min. Six percent need additional oxytocics and 94% do not need additional drug. Pre delivery mean systolic blood pressure was 119.3 ±10.4 mm of Hg and mean diastolic blood pressure was 69.57 ± 6.23 mm of Hg. Mean Hb% level was 12.1 ± 1.3 g/dl and minimum level was 7.5 g/dl and 13.8 g/dl. 06% patients had blood loss > 500 ml. No side effects such as vomiting diarrhea. However, shivering occurred 08%, fever 07% and nausea was found 03% patients. Conclusion: Oral misoprostol is safe with fewer side effects and can be used even in hypertensive patients for prevention of PPH. It was mainly associated with fever and shivering as side effect which are easily manageable.

AIM:
Aim of the study was to assess the recovery and quality of sexual activity of women during postpartum, in relation to delivery.
METHODS:
We recruited 200 women at 8 weeks after delivery. For each patient we recorded mode of delivery, age, body mass index (BMI), parity and test Female Sexual Function Index (FSFI) score.
RESULTS:
Sixty-four women (32%) had spontaneous deliveries without episiotomy, 48 (24%) had it with episiotomy, 88 (44%) had caesarean sections. The analysis of variance (ANOVA) test showed no significant differences among the 3 groups for age, BMI, parity. The test FSFI evidenced 68 cases (34%) of Regular Female Sexual Function (RFSF) and 132 (66%) of Female Sexual Dysfunction (FSD). The ANOVA test showed significant differences among the 3 groups in RFSF (F [2, 14]=8.075, P=0.005), but not in FSD (F [2, 30]=2.646, P=0.087). In RFSF, FSFI score was higher in women who had vaginal delivery with episiotomy compared with the other two groups. Conversely, in FSD (both with or without resumed sexual activity at 8 weeks postpartum) we evidenced that patients who had vaginal delivery with episiotomy showed lower FSFI score than the other two groups, with a decrease in lubrication, orgasm and satisfaction scores. Furthermore, we observed that most of the RFSF patients had a job and breastfed.
CONCLUSION:
Our results did not evidence a direct and significant correlation between mode of delivery and onset of female postpartum sexual dysfunction, even if FSD patients who underwent episiotomy during delivery markedly showed low FSFI scores.

Simple guide to improve clinical practice in Obstetric Care. The presentation highlights Skill number six (Vaginal Examination) which many primary health care practitioners lack knowledge of in Obstetric care. It is especially suitable for practitioners working in rural health facilities.

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Background: Many women in countries in the global North access digital media information sources during pregnancy and the early years of motherhood. These include websites, blogs, online discussion forums, apps and social media platforms. Little previous research has sought to investigate in detail how women use the diverse range of digital media now available to them and what types of information they value. A qualitative study using focus groups was conducted to address these issues. Methods: Four focus groups were held in Sydney, Australia, including a total of 36 women who were either pregnant or had given birth in the previous three years. The participants were asked to talk about the types of digital media they used for pregnancy and parenting purposes, why they used them and in what ways they found them useful or helpful (or not). Group discussions were transcribed and thematically analysed, identifying the dominant information characteristics identified by women as valuable and useful.

Introduction: Labour is one of the most exciting and important events of woman’s life, but often are accompanied by fear related to childbirth. The birth experience is a joyous event; yet, for the first-time mother and her partner is one which can produce fear, anxiety, and a roller coaster of emotions. Once labour commences, doulas are emotionally supportive by being physically present during the entire labour process.
Objective: To assess the effectiveness of doula care on level of anxiety among labouring mothers admitted in CLR, Nehru Hospital, PGIMER, Chandigarh.
Methodology: A quasi-experimental design was used and 120 labouring mothers from CLR, Nehru hospital, PGIMER, Chandigarh were selected by using purposive sampling technique from 25th July to 15th September 2019. The tools used for data collection was interview schedule composed of socio-demographic and obstetrical profile and state and trait anxiety inventory used for the assessment of anxiety level. Level of anxiety was assessed in the experimental group after implementing the doula care (psychological support by doula as a birth companion, effleurage massage, breathing exercises, and positioning) and in the control group after giving routine care.
Results: The pre-test showed no difference in anxiety level among both the groups. (p>0.05). In the post-test there was significantly low anxiety level in experimental group as compared to control group as shown by Mann-Whitney and Wilcoxon Test (p<0.05).
Conclusion: It is concluded that doula care is effective in reduction of anxiety during labour.

A prospective analytical study was done on Eight hundred sixty nine antenatal women with singleton pregnancy at 36-38 weeks of gestation. Apart from history taking and examination maternal serum TSH and FT4 were measured. Thirty five subclinical hypothyroid mothers were noted and they were compared with 105 euthyroid pregnant women as control matched to the case in relation to age parity and ethnicity. Mother was followed up till discharge from hospital. Newborn weight, Apgar score and serum TSH after 48 hours of birth to 7 days was measured. Maternal obstetrical and perinatal outcomes were noted.  The prevalence of subclinical hypothyroidism was 4.38%. Adverse maternal outcome in subclinical hypothyroidism was associated with preeclampsia (17.14 vs. 1.90%), placental abruption (8.57 vs. 0.95%) as compared to euthyroid pregnant women. Adverse fetal outcome in subclinical hypothyroidism includes LBW (33.33 vs. 26.67%), IUGR (14.29 vs.0.95), still born (14.29 vs. 0.00%), jaundice (13.33 vs. 1.90%), and RDS (10.00 vs. 0.95%) as opposed to euthyroid women. Subclinical hypothyroidism associated with pregnancy can result in poor obstetric outcome and neonatal complications occur more frequently.

Gestation or Pregnancy is an important part of female reproductive cycle all over the world. It normally consists of three trimesters and care should be taken during each trimester for safe delivery of the offspring into the world. This study sought to investigate if pineapple induces miscarriage or not. Freshly harvested A. comosus fruits were purchased from a local market in Orita-Challenge Area of Ibadan. The back was peeled off and the juice in the fruit was extracted. Thirty fertile male and thirty female Wistar rats were used for this study. After seven days acclimatization, the female rats were separated into its individual cages and had estrus synchronization using Diethylstilbestrol dissolved in paraffin oil and administered at the dose of 1 mg/kg body weight. A male was then introduced into each cage for mating. On the 7 th day vaginal smear of each of the female rats was made on a clean glass slide by carefully inserting a cotton-tipped swab moistened with normal saline into the vaginal cavity of the rats and rolled gently against the wall before withdrawal. The smear was stained with Giemsa and observed under microscope to check for presence of protein coagulates. After confirmation of pregnancy, the pregnant rats were grouped into four. Group A was treated with normal saline, groups B, C and D were treated with undiluted A. comosus fruit juice for 24, 48 and 72 hours respectively. The animals were then observed daily till they littered. In vitro effect of the fruit on isolated rat uteri was determined using standard method. No abortion was observed all through the period of pregnancy following administration of A. comosus fruit juice as all the pregnant rats appeared physically healthy and successfully littered at the end of pregnancy. A. comosus fruit induced multiple contractions of the pregnant rat uteri following in vitro administrations but did not induce abortion when administered to pregnant rats. This suggests that pineapple fruit contains active agents which could be isolated and processed into pure utero-tonic agents for use by routes other than the oral. Hence, the consumption of pineapple remains relatively safe in pregnancy.

El reto de trabajar en la donación de sangre, por la urgencia y riesgo que implica, permite articular proyectos intersectoriales desde una Universidad comprometida con la sociedad. Objetivo: incrementar la cobertura de donación voluntaria, continua y altruista de sangre, en la Provincia de Santa Santa Elena, Ecuador 2015-2017. Metodología: Mediante estrategias de promoción de salud implementadas por estudiantes y docentes de Enfermería de cuarto a sexto semestre de la Universidad Península de Santa Elena, en colaboración con el Ministerio de Salud Pública y dos Bancos de Sangre autorizados, se capta 0,5% de la población elegible como donantes, 17% de los cuales son continuos; la mayoría, jóvenes estudiantes motivados y reclutados a través de la comunicación interpersonal con sus pares promotores de donación de sangre (90%). Disminuir donantes fallidos, promoviendo un cambio en la idiosincrasia de la comunidad enfocado al autocuidado. Se evidencia 37% de impacto en las estrategias implementadas, denotando la necesaria corrección de procesos administrativos en organismos a cargo del manejo de tal actividad, para lograr avances significativos, como disminución de muertes relacionadas a complicaciones de embarazo, parto y puerperio, que significan 16% de transfusiones realizadas en ese período.
Palabras claves: enfermería, sangre, promoción, donación, riesgo.

Picking up from where John F. Benton left off in his 1985 study announcing the discovery of the *Practica* of Trota of Salerno, the present investigation brings together all known evidence for the writings and precepts of this early 12th-century Salernitan healer, for whom we have no other contemporary evidence beyond these writings themselves.  Using the evidence of the *Practica secundum Trotam* (“Practical Medicine According to Trota”) as well as the compendium *De egritudinum curatione* (a collection of excerpts from the works of seven Salernitan “masters,” including Trota) and the *De curis mulierum* (“On Treatments for Women”) and even an Anglo-Norman text which purports to record the teachings of Trota, I argue that collation of this evidence shows that Trota's oeuvre was probably much larger than previously suspected. Trota’s historicity was already established by Benton, and she can now be clearly distinguished from the textual fiction “Trotula,” which is in reality just the title of an ensemble of the *De curis mulierum* and two other, unrelated texts of likely male authorship. The present study offers further circumstantial evidence about the historic Trota, suggesting that it is possible to place her in the early 12th century. She was to some extent aware of and in dialogue with fellow male practitioners in Salerno, but she remained peripheral to the general trends toward theory and sophisticated pharmacopeia that characterized the work of her male contemporaries. The study includes editions and translations of excerpts of Trota’s authentic works and other *testimonia*.