Antenatal Patients Research Articles

Knowledge Perception and Utilisation of Labour Analgesia Among Antenatal Clinic Attendees in a Tertiary Centre in Makurdi, North-Central Nigeria

Abstract Background: Labour pain management forms an integral part of modern obstetric practice. Despite the availability of various forms of obstetric analgesia in Nigeria, reports indicate poor knowledge, awareness, and utilisation of labour analgesia among the obstetric population. Objective: To determine the knowledge, perception, utilisation, and factors affecting utilisation of labour analgesia among antenatal clinic attendees at the Federal Medical Centre (FMC), Makurdi. Materials and Methods: This was an analytical cross-sectional study conducted among 421 consecutively consenting antenatal patients in the Department of Obstetrics and Gynaecology at the FMC, Makurdi, between March 1 to July 31, 2023. Data were collected using an interviewer-guided questionnaire, analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and results were presented in textual form and tables. Results: About 47% (199) of the study participants perceived labour pain as the worst possible pain. Only 18.3% (77) of the study participants were knowledgeable about labour analgesia, while just 6.4% (27) of the study participants had ever used it. On multiple logistics regression, the knowledge of labour pain relief (adjusted odd’s ratio [aOR] 0.090, CI = 0.038−0.215, P < 0.001) and mode of previous delivery (aOR 0.292, CI = 0.114−0.750, P < 0.011) were the factors affecting the utilisation of labour analgesia among study participants. Conclusion: There is poor knowledge and utilisation of labour analgesia among antenatal patients. Incorporation of labour analgesia into existing protocols and enhancing health education on labour analgesia as part of antenatal health talks can create awareness of labour analgesia among antenatal patients.

Comparison of State-Trait Anxiety and Fear of Childbirth According to Attachment Styles of Pregnant Women.

Fear of childbirth (FoC) and its extreme form, tokophobia, is a clinical condition that can lead to many negative consequences, and its importance is increasingly understood. This article aims to assess the severity of FoC and anxiety levels according to different attachment styles and to investigate the relationships between these factors. A cross-sectional study was conducted in a state hospital in the largest city in Turkey. Three hundred pregnant women attending the Antenatal Outpatient Clinic were included. A sociodemographic questionnaire, Wijma Delivery Expectancy/Experience Questionnaire-version-A (W-DEQ), Spielberger State-Trait Anxiety Inventory and Adult Attachment Style Scale were administered. 8.1% of participants had tokophobia (W-DEQ sum score ≥85). FoC was significantly higher in pregnant women who had a history of pregnancy loss and past psychiatric history. For multiparous women, adverse birth outcomes were also associated with higher FoC. State and trait anxiety were positively correlated with FoC levels. Regarding the attachment patterns, pregnant women with avoidant attachment styles presented with higher levels of FoC than those with secure attachment styles. In logistic regression analysis, higher anxiety levels, adverse birth outcomes, and insecure attachment styles were found to predict severe and clinical FoC. FoC has a considerable effect on pregnant women, albeit at different clinical levels. Adverse birth outcomes, high anxiety levels, and insecure attachment styles were associated with higher FoC. Therefore, antenatal patients with adverse birth outcomes and higher anxiety levels, which are risk factors for FoC, should be carefully evaluated in terms of tokophobia and referred to mental health professionals when necessary.

Does threatened miscarriage have an influence on maternal & fetal outcomes during pregnancy? - Our experience in Kozhikode, North Kerala

: Bleeding in early pregnancy is a threat to developing embryo and constitute a significant source of anxiety to both parents, obstetrician. Adverse outcomes included miscarriage, placenta previa, abruption, preeclampsia, caesarean section, preterm labor, and preterm premature rupture of membranes, fetal growth restriction, and low birth weight.: The aim of this study was to find the association between threatened miscarriage and adverse pregnancy outcomes in both mother and fetus. Objective was to compare the pregnancy outcomes in normal patients (controls) and in those with threatened miscarriage (cases).: A 1year prospective study was conducted in Kozhikode; Kerala. The study included 140 antenatal patients who were grouped into 70 cases and 70 controls.: P-value is less than the significance level 0.05. It was found that caesarean section was significantly higher in case (66.2%) than control (42.9%). Pre-term delivery was also found to be higher in case (60.3%) compared to control (15.7%). PPROM was significantly higher in case (11.4%) compared to control (2.9%). Low birth weight was also higher in case (16.2%) than control (1.4%). : There was significant association between threatened miscarriage and outcomes like Preterm Labor, preterm premature rupture of membranes, caesarean section, fetal growth restriction, and low birth weight. There was no significant association between threatened miscarriage and outcomes like miscarriage, placenta previa, placental abruption, preeclampsia.

Comparative study of fetal doppler versus non stress test as predictor of perinatal outcome in high risk pregnancy between 36 to 42 weeks

Pregnancy is a unique physiologically event in a women’s life. The main aim of the study was to compare the efficacy of the Doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies between 36 to 42 weeks.This comparative prospective study was carried out on 200 antenatal patients between 36-42 weeks of pregnancy in Department of Obstetrics & Gynaecology Smt Kashibai Navle Medical College and Hospital a tertiary care center from December 2016 to July 2018.All cases were divided into four groups based on NST and Doppler velocimetry of umbilical artery. Abnormal Doppler studies were found in 12% women. 14% had abnormal NST. Apgar score < 7 at 5 minutes were in 19 fetuses, out of these 15 had abnormal Doppler velocimetry. Average birth weight was low in Group D (1.2kg), where both the tests were abnormal. NICU admissions were 5% in Group A and 100% in Group B and D, where Doppler was abnormal. Mean gestational age was also low in group D. Highest perinatal mortality and neonatal morbidity was seen in women with abnormal umbilical artery Doppler. 6 neonatal deaths occur in Group D and 1 in Group B. In the present study, umbilical artery sensitivity for predicting perinatal morbidity and mortality is 46.1, specificity is 94, PPV is 93 and NPV is 54.Highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal Doppler velocimetry. Group D had the worst perinatal outcome.

Urinary Tract Infection Due to Streptococcus agalactiae - A Missed Clinical Entity: A Study from a Tertiary Care Center in Southern India

: Streptococcus agalactiae (group B Streptococcus or GBS) commonly causes various urinary tract infections (UTIs), including asymptomatic bacteriuria, cystitis, pyelonephritis, urethritis, and urosepsis. While GBS neonatal disease has decreased, its prevalence in non-pregnant adults has risen. However, its role in UTIs among males and non-pregnant women is less documented. This study aims to investigate the prevalence, clinical presentation, antibiotic susceptibility, and risk factors of GBS UTIs. Over 16 months, a prospective study included all patients diagnosed with GBS UTIs. Among 6305 urine specimens tested, 2.1% (N = 134, 95% CI: 0.68% - 4.8%) were positive for GBS, with a notably higher prevalence among pregnant women (73%, N = 79). This prevalence rate significantly exceeded regional reports, as indicated by a z-score exceeding the critical value. Additionally, 50% of positive isolates were from antenatal patients, indicating pregnancy as a significant risk factor (P < 0.0001). All 134 GBS isolates exhibited sensitivity to penicillin, cefotaxime, ofloxacin, and vancomycin. Sensitivity to cotrimoxazole, erythromycin, and clindamycin was 80%, 95%, and 97%, respectively. Treatment varied by case severity. Uncomplicated cases (41.7% antenatal; 33.5% non-pregnant women and adults) received 3rd or 4th generation cephalosporins, while complicated cases (24.6%, N = 33) required intravenous vancomycin due to comorbidities like chronic kidney disease (CKD), renal calculi, diabetes, and obstetric complications. In conclusion, GBS UTIs predominantly affect females, particularly pregnant women, followed by those with chronic conditions like CKD and diabetes mellitus. Routine GBS culture and susceptibility testing are crucial in laboratories to ensure effective UTI management.

A Comparative Study of Fetal and Maternal Outcomes in Registered and Unregistered Antenatal Cases in a Tertiary Care Center.

Background Antenatal care plays a crucial role in ensuring optimal maternal and neonatal health outcomes. However, disparities in access to prenatal care persist, with a subset of pregnant women failing to register for antenatal care, referred to as "unbooked" or "unregistered" pregnancies. This study aims to investigate the impact of registration status on pregnancy outcomes, considering various demographic, clinical, and socioeconomic factors. Understanding the factors influencing registration status and its implications on maternal and fetal health outcomes is essential for developing targeted interventions to improve prenatal care access and enhance overall pregnancy outcomes. Objective To see the difference in obstetrical complications along with feto-maternal outcomes in both registered and unregistered antenatal cases and to determine the correlation of maternal and fetal outcomes with antenatal care. Materials and methods This two-year observational study at Dr. D.Y. Patil Medical College's Obstetrics and Gynecology IPD in Pimpri, Pune, examined maternal and fetal outcomes in registered and unregistered pregnancies. Consent was obtained, and patients were categorized as registered and unregistered based on the number of antenatal visits. This was an observational prospective cohort study. Data on socioeconomic factors like income and education were analyzed to assess their association with registration status. Maternal outcomes included preterm delivery and complications such as preeclampsia, gestational diabetes, oligohydramnios, premature rupture of membranes, anemia, and postpartum complications. Fetal outcomes included birth weight and NICU admissions. Statistical analyses, including Chi-square tests, Fisher's exact test, and logistic regression, were used to examine relationships between variables and registration status. Results This study analyzed 502 cases, comprising 251 registered and 251 unregistered pregnancies, to investigate the impact of antenatal registration on maternal and fetal outcomes. Significant associations were observed between socioeconomic factors, such as lower income and education levels in unregistered pregnancies.Specifically, 46 (18.3%) unregistered cases were in the lowest income bracket, while 103 (41.0%) were in the lower-middle bracket, and the majority (132, 52.2%) had only completed secondary education. Unregistered pregnancies were linked to a higher prevalence of adverse outcomes, including preterm delivery (101, 40.23%), anemia (178, 70.9%), hypertensive disorders (30, 11.9%), gestational diabetes mellitus (16, 6.37%), fetal growth restriction (39, 15.3%), low birth weight (181, 72.1%), and NICU admissions (112, 44.6%), compared to registered pregnancies. Conclusion In conclusion, this study highlights the significant impact of registration status on pregnancy outcomes, emphasizing the need for comprehensive interventions to improve prenatal care access and to promote maternal and neonatal health equity. By addressing socioeconomic barriers and implementing targeted interventions, healthcare systems can strive towardensuring optimal pregnancy outcomes for all expectant mothers. This is done by ensuring that all antenatal patients are registered for prenatal care by involving a combination of strategies focused on support, education, and accessibility.

Evaluation of a Risk Screening Checklist for Venous Thromboembolism Prophylaxis in a Women and Newborn Hospital.

The venous thromboembolism (VTE) risk screening forms were developed to allow for recording identified risk factors for VTE including thrombophilia, history of VTE, postpartum hemorrhage, and cesarean delivery, and documentation of specific actions taken to mitigate these risks and reduce complications due to VTE. Compliance with hospital guidelines in assessing VTE risk and appropriate prescribing of thromboprophylaxis was evaluated prior to the introduction of VTE risk screening forms (March 2022). Efficacy of the new VTE risk screening forms was also assessed (April 2023). Patient discharge summaries and patient medical records including medication charts were used to review the documentation of VTE risk assessments and details of thromboprophylaxis prescribing. Of 74 postnatal patients, 37.8% had VTE risk assessment documented prior to the introduction of VTE risk screening forms. Of 37 patients identified to be at moderate to high risk of VTE requiring pharmacological prophylaxis, 70.3% (n = 26) were appropriately prescribed pharmacological prophylaxis. After the risk screening forms were introduced, a total of 67 antenatal, postnatal, and gynecologic patients were studied. Of these, 32.8% (n = 22) of patients had all required fields completed appropriately. When using the forms, 26.9% (n = 7) of postnatal and 88% (n = 22) of gynecological patients were rated as medium or high risk, and all received medical review within 24 hours. Pharmacological prophylaxis was indicated in 88% (n = 22) of gynecological, 43.8% (n = 7) of antenatal, and 38.5% (n = 10) of postnatal patients, and all were appropriately prescribed. The guideline review and introduction of VTE risk screening forms was valuable to provide guidance in the risk assessment for VTE and to identify patients requiring prophylaxis.

Acceptance of contraception in couples receiving contraceptive counselling in antenatal period.

Objective: To conduct research in order to determine the effect that antenatal counseling has on the use of contraception during the immediate postpartum period in the conservative society that exists in the rural areas surrounding Lahore, Pakistan. Study Design: Randomized Clinical Trial. Setting: Central Park Teaching Hospital in Lahore, Pakistan. Period: Jan, 2022 to April, 2022. Methods: A random selection was used to divide 400 antenatal patients who were at least 28 weeks along in their pregnancies into two groups. Patients who did not receive antenatal counseling regarding birth control options were included in Group X while patients who received antenatal counseling regarding the use of birth control were included in Group Y. A pre-designed proforma was completed following a written informed consent. Data was analyzed using SPSS 26. Results: Data was collected from 400 females (200 in each group) who visited CPTH. The mean age of the female participants was 27.26 + 4.78 years. Most of the participants lived in extended family systems. Nearly one third of the females was illiterate or has primary level of education. Approximately one-fourth of the females were graduated or above. After first pregnancy, 68% in group I and 86% in group II mentioned that they used contraceptive method, (p = 0.005, statistically significant). After second and fifth pregnancy, effect of counseling was affective and difference was statistically significant. The most common contraceptive method was barrier method followed by injection after first and second pregnancy. Conclusion: Antenatal contraceptive counseling proves to be a highly effective intervention in enhancing the acceptance and utilization of contraceptives within the conservative societies of Pakistan. Health care providers ought to undergo comprehensive training and exhibit unwavering motivation in order to effectively engage in antenatal contraceptive counseling.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan.

Objective This study aimed to assess the indirect impactof the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946)in outpatient obstetric volumes and a 65% increase(pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%)vs 1049 (42.4%) and labor inductionrates 818 (26.6%)vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

SERUM 25 (OH) VITAMIN D AND CALCIUM LEVELS AND ADVERSE MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY INDUCED HYPERTENSION

Objectives: Incidence of hypertensive disorders in pregnancy is about 5–10% of all pregnancies [1]. Pre-eclampsia alone or superimposed on chronic hypertension is the most threatening. This study is done to evaluate the levels of serum 25 (OH) Vitamin D and Calcium in normal antenatal patients and patients with pregnancy-induced hypertension and their effects on perinatal and maternal outcome. Hence, that timely intervention can prevent adverse perinatal and maternal outcomes. Methods: The present prospective observational study was done in the Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from May 2018 to April 2019. The study was conducted on 80 antenatal patients. Patients were divided into two groups with 40 patients in each group. Group I included patients with pregnancy-induced hypertension and Group II included normal antenatal patients. Serum levels of calcium and 25 (OH) Vitamin D were evaluated in both groups. Adverse perinatal and maternal outcomes were assessed in relation to the serum levels of calcium and 25 (OH) Vitamin D in patients with pregnancy-induced hypertension and normal antenatal patients. Categorical variables were analyzed by Chi-square test and Fisher’s exact test. The analysis of continuous variable was done by ANOVA. The data were analyzed using SPSS version 22 and Microsoft Excel. p≤0.05 is taken as statistically significant. Results: The mean value of serum Vitamin D level in Group I was 22.30±6.11 ng/ml and 36.68±9.34 ng/ml in Group II giving p=0.016 which was highly significant. In Group I, mean calcium levels were 8.58±0.63 mg/dl and 9.27±0.40 mg/dl in Group II giving p=0.018 which was highly significant. The Pearson’s correlation coefficient was −0.753 for serum Vitamin D and systolic blood pressure (BP) and the same for serum Vitamin D and diastolic BP with p=0.001 which was highly significant. The Pearson correlation coefficient was −0.537, −0.514 for serum calcium and systolic BP and serum calcium and diastolic BP, respectively, giving p=0.001. Conclusion: Serum levels of 25 (OH) Vitamin D and calcium have a significant relationship with pregnancy-induced hypertension. Low levels of calcium and 25 (OH) Vitamin D cause an increased risk of pregnancy-induced hypertension and supplementation of these reduces the incidence of pregnancy-induced hypertension. Hence, their supplementation can be used as a possible intervention strategy in preventing one of the most common causes of perinatal and maternal morbidity and mortality around the world.

When addressing resources is not enough: lessons learned from a respectful maternal and neonatal care provider training intervention evaluation in Kenya and Tanzania

BackgroundRespectful Maternal and Neonatal Care (RMNC) maintains and respects a pregnant person’s dignity, privacy, informed choice, and confidentiality free from harm and mistreatment. It strives for a positive pregnancy and post-pregnancy care experiences for pregnant people and their families, avoiding any form of obstetric violence. Though RMNC is now widely accepted as a priority in obstetric care, there is a gap in resources and support tools for healthcare wproviders to clearly understand the issue and change long-established practices such as non-humanized caesarean sections. MSI Reproductive Choices (MSI) manages 31 maternities across 7 countries with a zero-tolerance approach towards disrespectful maternity care and obstetric violence. MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards RMNC. It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches.MethodsThe impact of this training intervention was measured from the healthcare providers’ and patients’ perspectives. Patient experience of (dis)respectful care was collected from a cross-sectional survey of antenatal and postnatal patients attending MSI maternities in Kenya and Tanzania before and following the RMNC training intervention. Healthcare providers completed pre- and post-workshop surveys at day 1, 90 and 180 to measure any changes in their knowledge, attitudes and perception of intended behaviours regarding RMNC.ResultsThe results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training.ConclusionRMNC is a patient-centred care priority in all MSI maternities. The training bridges the gap in resources currently available to support changes in healthcare wproviders’ attitudes and behaviours towards provision of RMNC. Ensuring health system infrastructure supports compassionate obstetric care represents only the first step towards ensuring RMNC. The results from the evaluation of this RMNC provider training intervention demonstrates how healthcare provider knowledge and attitudes may represent a bottleneck to ensuring RMNC that can be overcome using VCAT and behaviour change approaches.

Haematinic Pill Chart Partner – An Innovative Production for the Management of Anaemia in Pregnancy in Perak, Malaysia

Anaemia is one of the most prevalent health problems in the world, affecting almost half a billion women of reproductive age.1 Major recognised contributing factor of anaemia in pregnancy is iron and folate deficiency. Many antenatal patients are not adherent to the iron supplementations prescribed. The objectives of this innovation, Haematinic Pill Chart Partner (HPCP), was to improve compliance of iron supplementation by antenatal anaemic patients, to achieve Hb < 11 gm% at 36 weeks of pregnancy, to provide comprehensive and effective health education to all antenatal patients, to reduce time of consultation as well as to produce a pill chart in a cost effective manner. Time taken for initial doctor’s consultation pre and post HPCP was analysed from the clinic’s antenatal record book. 10 patients in January 2018 (pre-intervention) and 12 patients in January 2019 (post-intervention) were compared. Mean time taken and cost for production of one pill chart were calculated. There was marked reduction in the percentage of antenatal patients with Hb < 11gm% at 36 weeks of pregnancy by 6.9%; from 8.3% in 2018 to only 1.4%. HPCP proved to be comprehensive and effective. 20 patients (100%) were satisfied (Patient’s Satisfaction Survey) and 5 doctors (100%) were satisfied (Doctor’s Satisfaction Survey) using HPCP. There was marked reduction in time taken (26 minutes) for doctor’s consultation. Cost of production of one HPCP was only RM 8.00. HPCP was found to be a very useful, user-friendly, and effective in the management of anaemia in pregnancy in Buntong Health Clinic.

Abdominal hysterectomy due to uterine rupture causing bilateral ureterovaginal fistula: A rare case report

Abstract Ureterovaginal fistula (UVF) is defined as abnormal communication between ureter and vagina. Although documented after radical hysterectomy, post radiation and retained pessary incidence of bilateral UVF is still very rare. We have documented a case report of a multipara woman presented with persistent urinary leakage following an emergency hysterectomy for obstructed labor. After evaluation with imaging there was bilateral hydroureterophrosis with dense purulent collection mixed with contrast in the vesicular area with lower end of ureter draining in the vaginal vault with preserved renal function. During exploration both ureters were dilated. Instillation dye in both ureters showed extravasation in vagina. After ligating distal ends modified Lich-Gregoir technique done over double J (DJ) stents. DJ removed after 3 months. Bilateral UVF is only 5%–10% of all ureteric injury. Aggressive blind clamping, excessive hemorrhage, distorted anatomy, malignancy and surgeons experience play a crucial role. Obstetric cause is the prime factor. Preventing measures like proper screening of antenatal patients, early detection of high-risk pregnancy, supervised caesarean section should be taken to avoid ureteric injuries

Bacterial profile, antimicrobial susceptibility pattern and associated risk factors of urinary tract infection among pregnant women attending tertiary care hospital in Rawalpindi

The study objective to enhance treatment effectiveness by assessing risk factors, bacterial profiles, and antimicrobial susceptibility of uropathogens in pregnant women. During the period from March 2023 to August 2023, we examined 210 urine samples obtained frompregnant women. The samples were subjected to uropathogens isolation, identification and susceptibility testing against thirteen antibiotic classes using the Kirby Bauer disk diffusion method, following standard procedures, to identify uropathogens in cases of significant bacteriuria. In our study there is no significant link found between age, educational level, socioeconomic status, and parity in relation to UTI during pregnancy. In 42% of the samples with significant bacteriuria, Escherichia coli emerged as the predominant uropathogens, followed by Pseudomonas aeruginosa, Staphylococcus saprophyticus, and Klebsiella pneumoniae, in that order. E. coli displayed the greatest resistance to ciprofloxacin and ceftazidime, yet demonstrated high susceptibility to meropenem, imipenem, fosfomycin,and amikacin. Furthermore, a significant portion of K. pneumonia isolates exhibited resistance to ceftazidime and ciprofloxacin. For S. saprophytic, resistance was observed against penicillin and gentamicin, although they displayed 100% sensitivity to vancomycin and 81.2% sensitivity to Nitrofurantoin. The current study findings revealed that factors influencing pregnant women's UTI risk, include age, literacy, residence, multigravida, multipara, infection history, and trimester status. Access to clean water sources also played a role, highlighting the importance of addressing these variables in maternal health toreduce UTI incidence. Screening antenatal patients for UTIs is imperative, and it is advisable to conduct regular screenings for pregnant women. This practice helps monitor uropathogens sensitivity patterns and facilitates the development of antibiotic protocols based on local susceptibility data.

Effects of Stretching Exercises and Myofascial Pain Release on Pain and Sleep Quality in Antenatal Restless Leg Syndrome

Background: Restless Leg Syndrome (RLS) is a condition that plagues many, causing an irresistible urge to move the legs, especially during periods of rest. This condition can be particularly challenging for pregnant women, impacting their sleep quality and overall well-being. Recognizing the need for effective, non-pharmacological interventions, this study delves into comparing the efficacy of two widely used therapies: stretching exercises and myofascial pain release (MPR). Objective: The primary aim was to evaluate and compare the effects of stretching exercises and myofascial pain release on pain reduction and sleep quality improvement in antenatal RLS patients. Methods: Conducted at the gynecology clinic of Khalid Farooqi Memorial Hospital, Hafizabad, this randomized clinical trial enlisted 22 participants, divided into control (n=11) and case (n=11) groups. The case group underwent stretching exercises coupled with infra-red therapy, while the control group received MPR and infra-red therapy. Both interventions were administered twice weekly for eight weeks. Outcomes were measured using the Numeric Pain Rating Scale (NPRS) and Pittsburgh Sleep Quality Index (PSQI) at baseline, 4th, and 8th weeks. Data analysis was performed using SPSS 25, employing Shapiro-Wilk, repeated measure ANOVA, and one-way ANOVA tests. Results: Initially, both groups exhibited moderate to severe symptoms. Post-treatment, significant improvements were noted. After 8 weeks of treatment, the study revealed that pregnant women with antenatal restless leg syndrome (RLS) responded better to stretching exercises (Group A) than to myofascial pain release (Group B). Initially, participants in both groups experienced moderate to severe pain and poor sleep quality. By the end of the study, Group A demonstrated significant improvement, with 9 out of 11 participants experiencing minimal pain and 8 out of 11 reporting greatly enhanced sleep quality. While Group B also improved, the results were less significant. This underscores the potential of stretching exercises as a more effective intervention for reducing pain and improving sleep in antenatal RLS. Conclusion: Stretching exercises were found to be more effective than myofascial pain release in reducing pain and improving sleep quality among antenatal RLS patients. Given these findings, healthcare professionals are encouraged to consider stretching exercises as a preferred intervention for RLS symptoms during pregnancy.

Study of Various Demographical Factors of Anemia and its Prevalence amongst Antenatal OPD Patients Visiting a Private Medical College in Saharanpur, Uttar Pradesh

Study of Various Demographical Factors of Anemia and its Prevalence amongst Antenatal OPD Patients Visiting a Private Medical College in Saharanpur, Uttar Pradesh

Asymptomatic Bacteriuria in Pregnancy Causes and Incidence

OBJECTIVES This study aims to provide an understanding of asymptomatic bacteriuria in pregnancy by examining its frequency, causative agent, and potential strategies for detection and management. METHODOLOGY A cross-sectional study was conducted in the Department of Obstetrics and Gynecology, PGMI Hayatabad Medical Complex, Peshawar, from July to December 2022. The study included 117 antenatal patients with varying gestational periods attending the OPD. Patients with a history of antibiotic therapy, urinary frequency and dysuria, vaginal discharge, renal tract anomalies, and medical disorders were excluded. Demographic details were recorded, and urine samples were collected and cultured. Data was analyzed using SPSS version 22. RESULTSThe incidence of asymptomatic bacteriuria was 25.5%, among 117 women, with E. coli (53.3%) the most common pathogen responsible for the infection, followed by Klebsiella (36.7%) and staphylococcus (10%).CONCLUSIONBacteriuria without causing any symptoms is quite common in pregnancy. Simple measures like screening early in pregnancy can timely detect positive cases and with targeted treatment, both maternal and neonatal morbidity can be curtailed.

High diversity in the vaginal microbiome in women following preterm premature rupture of membranes and its effect on fetomaternal outcome

Background: Premature rupture of the membranes (PROM) complicates 3% of pregnancies and its associated with adverse perinatal outcome. Methods: This was a case control study conducted over a period of two years. Our aim was to evaluate the bacterial colonization of genital tract of antenatal patients who presented with preterm premature rupture of membranes and their maternal and neonatal complications. We studied 6023 patients during our study period among which 156 patients presented with preterm premature rupture of membranes. Results: PPROM was found more commonly among age 25-30 years (46.79%) with p<0.001. Out of 156 pregnant women with PPROM, only 16 patients (10.26%) developed clinical chorioamnionitis. We observed that 43.59% patients (n=68) with PPROM underwent LSCS which was significantly higher than control group (19.93%). Among them 81.41% (n=127) of the patients delivered within 24 hours of admission. Among 156 patients, 94 (59.12%) mothers had babies with birth weight ranging between 1.5-2.5 kg as compared to control group where 30.51% mothers had low birth weight babies. The difference was statistically significant. Approximately 18.24% babies developed respiratory distress syndrome requiring ICU care in study group as compared to 3.03% in control group and the difference was statistically significant. Conclusions: It is important to diagnose the PPROM early and manage the patient until delivery for better outcome. Timely intervention after proper analysis of risk and benefit of early termination helps in reducing adverse perinatal outcomes, reduced NICU admissions and unnecessary interventions for neonates.

Cervical ripening with vaginal Misoprostol plus Hyoscine-N-Butylbromide versus vaginal Misoprostol alone among pregnant women: a double-blind randomised controlled trial.

To compare cervical ripening time with the use of vaginal Misoprostol plus Hyoscine-N-Butylbromide, with vaginal Misoprostol alone. A double-blind randomized controlled trial with Pan-African Clinical Trials Registry (PACTR) approval number PACTR202112821475292. Federal Medical Centre, Asaba, Nigeria. A total of 126 eligible antenatal patients for cervical ripening were enrolled. Participants in Group A had 25µg of vaginal misoprostol with 1ml of intramuscular placebo, and those in Group B had 25µg of vaginal misoprostol with 20mg of Intramuscular Hyoscine (1 ml). Oxytocin infusion was used when indicated, and the labour was supervised as per departmental protocol. Cervical ripening time. The mean cervical ripening time was statistically significantly shorter in the hyoscine group (8.48±4.36 hours) than in the placebo group (11.40±7.33 hours); p-value 0.02, 95% CI 0.80-5.05. There was no statistically significant difference in the mean induction-delivery interval in Group A (7.38±5.28 hours) compared to Group B (7.75±5.04 hours), with a value of 0.54. The mode of delivery was comparable. However, women in Group B (53, 84.1%) achieved more vaginal deliveries than women in Group A (50, 79.4%); p-value 0.49. Thirteen women in Group A (20.6%) had a caesarean section, while ten women (15.9%) in Group B had a caesarean section (p-value 0.49, RR 0.94, CI 0.80-1.11). Adverse maternal and neonatal outcomes were not statistically significant between the two groups. Intramuscular hyoscine was effective in reducing cervical ripening time when used as an adjunct to vaginal Misoprostol, with no significant adverse maternal or neonatal outcome. None declared.

Anemia profiling in antenatal women at a tertiary care center in northern India: An observational study

: Anemia is a common health issue during pregnancy, with various factors influencing its occurrence. Iron deficiency often leads to iron deficiency anemia (IDA), significantly impacting maternal and fetal health.: This study aims to investigate the complete blood count and nutritional status, including serum iron profile, vitamin B12, and folate levels in antenatal patients. : The study involved 160 participants, predominantly from rural areas. The severity of anemia among the participants was classified according to WHO guidelines.: Iron deficiency was observed in 33.75% of women, folate deficiency in 20%, and vitamin B12 deficiency in 11.25%. Some women exhibited a combination of deficiencies. The average hemoglobin level was found to be 8.69 g/dL, and the mean iron level was 35.95 µg/dL. The average ferritin levels were observed to be 49.65 ng/mL. Lastly, the Vitamin B12 and folate levels averaged at 130.21 pg/mL and 14.76 ng/mL respectively.: These findings provide valuable insights into the nutritional status of pregnant women and highlight the need for targeted interventions to address micronutrient deficiencies during pregnancy.