Labor Room Research Articles

IJCM_252A: An Assessment of Functioning of Health and Wellness Centres - Sub Health Centres (HWC-SHC) in Raipur District.

Background: The National Health Policy 2017 has envisioned the integration of Health and Wellness Centers (HWCs) into India’s healthcare system as part of Ayushman Bharat. In February 2018, the Indian Government declared the transformation of 1,50,000 existing Sub Health Centers and Primary Health Centers into Health and Wellness Centers (HWCs) to provide Comprehensive Primary Health Care (CPHC). Health and Wellness Centres have an important role in the prevention of several diseases and health promotion and in undertaking public health functions in the community to strengthen the frontline workers and community platforms. Objective: To assess the availability of Infrastructure and 12 comprehensive primary health care services in study centres (HWC-SHC) in Raipur district Methodology: This is a cross-sectional observational study conducted in the 32 Health and wellness centre-sub centres of Raipur district, Chhattisgarh. In the Raipur district, there are 4 blocks and from each block, 25% of the study centres (HWC-SHC) are selected by simple random sampling. Semi- structured assessment tool with the reference of Government of India Operational Guidelines was used which consisted of checklist regarding Physical Infrastructure, Human Resource, Medicine, Diagnostic, IT component and 12 comprehensive primary health care services. The data was collected and analysis is being done by using SPSS software. Results: Out of 32 HWC-SHCs, 6 (18.75% ) were catering the services for the population as per the norms i.e. 3000- 5000. In the present study, 19 (59.4%) boundary wall, and 21 (65.6%) of SCs had wellness space. There were 31 (96.9%) of SCs had labor room, and 14 (43.8 %) had newborn care corner (NBCC). In this study, 21.9% Grievance board and 100% of IEC were present at the studied subcentres. It was observed that 31(96.9%) SCs had water, 27 (84.4%) had electricity supply and 1 (3.1%) of SCs had power backup. Separate public utilities for males and females were available in 2(6.3%) of the study centres. Out of the study sub-centre, 28 (87.5%) residential facilities were available, out of which 24 (85%) were occupied. For diagnostic services, 53.1 % of study centres have sickle- cell rapid tests and none of the centres have VIA for Screening of cervical cancer. Conclusion: The finding of the study shows that there is a scarcity in the physical infrastructure, Human resource and lab-diagnostic services at the studied centres. The major factor contributing to the non-utilization of health services at the SCs was the lack of adequate infrastructure, and logistics available at these centres.

Frequency of major congenital malformations in neonates born in three tertiary care hospitals of Pakistan.

Objective: To assess the frequency of major congenital anomalies in newborns delivered in three different hospitals of Pakistan. Study Design: Cross Sectional study. Setting: Department of Pediatrics Hameed Latif Teaching Hospital, Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Period: Jan 2023 to November 2023. Methods: 205 neonates who met the inclusion criteria were included in the study from labour room of Hameed Latif Teaching Hospital Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Informed consent was obtained from parents. Demographic variables (name of mother, gender, birthweight and gestational age at birth) were recorded. Then neonates were admitted in NICU and evaluated for presence of congenital malformations including cardiovascular system defects, limbs anomalies, genitourinary system, central nervous system and chromosomal anomalies. All data was entered in specially designed performa. Results: We found that overall gestational age was greater than 32 weeks with mean age of 37.190±2.00 weeks. Mean birth weight was 2.938±0.31 Kg. Frequency and %age of patients according to gender was 60% males and 40% females. Major congenital malformation was seen in 2.9% patients. Among infants with major congenital malformations, cardiovascular system defects were seen in 33.3% infants, limb anomalies 16.7%, genitourinary system 16.7% and central nervous system defects were 33.3%. Parents of 67.7% of cases were cousins. It was observed that only 32.3% of the mothers had taken the recommended daily dose of folic acid in antenatal period. Conclusion: Central nervous system and cardiovascular system defects were the most prominent anomalies detected. Prenatal diagnosis may be helpful in decreasing mortality by offering early termination.

Outcome of Severe Anemia in Pregnancy; Experience at a Tertiary Care Hospital

Objective: The study was aimed at observing demographic diversity among pregnant women admitted to the labour room with Hemoglobin of less than 7gm/dl. It also observed perinatal and maternal outcomes and their associated complications. Study Design: Retrospective observational study. Settings: Gynae Unit I, Jinnah Hospital, Lahore Pakistan. Duration: 1st January 2022 to 30th June 2022. Methods: It is a retrospective observational study carried out in Gynae Unit I, Jinnah Hospital Lahore in between 1st January 2022 to 30th June 2022. All Patients presenting with Hemoglobin less than 7gm/dl and admitted in the Labour room were included in the study, and followed until delivery. A predesigned performa was filled for each of the 63 patients after their consent. Results: During the study period, 2130 deliveries were carried out in the labour room, out of which 63 patients had a recorded level of Hemoglobin below 7gm/dl. The prevalence of severe anemia in our study was 2.9%. Most patients (51) were in the age group 20-35 years. Majority of the patients (45) were un-booked while only 18 were booked patients. 40 patients were in the gestational age group of 34-37 weeks. 30 were gravida 2-5, 25 of parity more than 5 and only 13 primigravida’s. 29 out of 63 patients had no complications while 34 had complications. Conclusion: Severe Anemia is a preventable cause, the focus needs to be on early and proper antenatal check-up’s, early diagnosis, and timely referral from rural and less equipped medical centres to better equipped hospitals.

Traumatic perinatal events and educational needs of labor and delivery room nurses in Korea: a cross-sectional survey.

The present study investigated experiences of traumatic perinatal events, the provision of related education, and educational needs of nurses working in the labor and delivery room (LDR). Nurses working in the LDRs of six institutions and two nurse portal sites were invited to participate in the survey, delivered on paper or online. The data were collected from October 1 to November 25, 2022. Data from 129 nurses were analyzed using frequency, the chi-square test, the Fisher exact test, the t-test, and analysis of variance. Virtually all participants (98.6%) reported having experienced at least one traumatic perinatal event (dystocia, postpartum hemorrhage, neonatal congenital anomalies, severe maternal or neonatal injury, stillbirth, and maternal or neonatal death) while working in the LDR. The most shocking traumatic perinatal event experienced was the maternal or neonatal death (40.3%), but 24.8% of participants did not recall ever receiving education on the topic. About 63% of participants experienced traumatic perinatal events within a year of working in the LDR. The average score for education needs regarding traumatic perinatal events was 3.67±0.37 out of 4, and participants preferred simulation education as the most effective educational method. Since most of the participants had experienced various traumatic perinatal events in the early stages of working in the LDR and expressed a high level of need for education on traumatic perinatal events, it is necessary to provide more effective stimulation education programs in the early period of work in the LDR.

Effect of Murrotal Al-Qur’an Audio on First Stage Labor Pain among Maternity Women

The purpose of this study is to determine the effect of Murrotal Al-quran Audio on first stage labor pain among maternity women in Prof. dr. J. A Latumeten Hospital Maluku Province, Indonesia. The study design is quasy experimental. The population is all maternity women who were in the first stage labor in Januari 2022 which consisted of 68 women. 30 women were selected purposively and agreed to join the study. The inclusion criteria are muslim women who had no hearing problems and labor complication. The intervention was an audio of Murrotal Al-quran Surah Ar-Rahman for 30 minutes. A numeric rating scale was used to measure the pain level before and after intervention. The bivariate analysis was done by Mann Whitney test. The results show that majority of women (60%) experienced a moderate level of pain before and after intervention in the control group. While, in the experiment group, majority of women (60%) experienced moderate level of pain before intervention and majority of them (66,6%) experienced mild level of pain after intervention. The bivariate analysis shows that there was a significant difference of pain score between experiment and control group after intervention (p= .005). In addition, there was a significant difference of pain score before and after intervention in the experiment group (p= .005). There was an effect of Murrotal Al-quran Audio on first stage labor pain among maternity women in Prof. dr. J. A Latumeten Hospital Maluku Province, Indonesia in 2022. The Murrotal Al-quran Audio is effective to decrease labor pain among maternity women. Nurses and midwives who work in the labor room are urged to implement the murroral Al-quran Audio to help maternity women in decreasing labor pain.

PROFILE OF INDUCED LABOUR IN UNCOMPLICATED PREGNANCIES WITH UNFAVOURABLE MODIFIEDS BISHOP SCORE IN A TERTIARY CARE CENTRE

Background: Induction of Labor is a non-spontaneous initiation of uterine contractions before onset of spontaneous labour that results in progressive dilatation with effacement of cervix and further descent of the presenting part of fetus, leading to safe vaginal delivery of the baby. ACOG has an extensive list of recommendations on delivery timing for various complicated and uncomplicated pregnancies. Pharmacological methods are most commonly deployed for induction in patients with poor bishopÂ’s score. The aim of this study is to determine maternal and perinatal outcome in induced labour in medically uncomplicated pregnancies. Methods: This is a hospital based retrospective observational study conducted for a duration of 11 months on 422 patients admitted in our labour room with unfavourable modified bishops score given induction of labour for various reasons after ruling out any contraindication for vaginal delivery. Results: In our study of 422 participants, majorities was term pregnancies (93.36%) and were induced by dinoprostone gel. Most common indication for IOL was postdated pregnancy (36.49%) and 67.3% patients underwent vaginal delivery. 27.7% of all vaginal deliveries required additional doses of dinoprostone. Most common indication for emergency caesarian section was FIOL (63.77%). All neonates were born alive and 32.46% neonates got admitted in NICU, most common indication being neonatal jaundice.42.42% cases developed complication of induction most common being MSL(17.54%). Conclusion: Induction of labor is beneficial and safe even in uncomplicated pregnancies. Although there is increased incidence of caesarian section, induction should be performed once risk of continuing pregnancy outweighs risk of termination.

Trend of HIV Prevalence in Antenatal Women in a Tertiary Care Hospital in the Western Region of India.

Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding thetrends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and theART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data fornine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positivewere collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouseand children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was adeclining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42remained bookedat our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serveas index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.

Comparing Feto-Maternal Outcomes in Pregnant Women With Normal and Abnormal Liver Function Tests: A Prospective Observational Study.

Pregnant women with abnormal liver function tests (LFTs)require proper evaluation and timely managementto reduce maternal and fetal morbidity and mortality. The present study was done with the objective of determining feto-maternal outcomes in antenatal women with abnormal LFTs and comparing them with antenatal women having normal liver function. The prevalence and possible causes of derangements in LFT were also identified. Pregnant women referred to an antenatal clinic for several reasons pertaining to abnormal liver functions, and those admitted to the labor room for delivery with abnormal LFTs were included in the study. The pregnant women with abnormal LFT were studied prospectively, and they were compared with pregnant women having normal LFT. The fetal and maternal outcomes were also noted. The pregnant women attending the antenatal clinic with a history of pruritus, abdominal pain, jaundice, nausea/vomiting, hypertension ascites, etc. and delivered at our facility were evaluated. One hundred and eight women had abnormal LFT defined by criteria laid down in material and methods. Eighty-seven women with normal LFT were taken for comparison. In the abnormal LFT, the main cause was intrahepatic cholestasis of pregnancy (IHCP). There were 6 (5.5%) maternal deaths in this group and none in the normal LFTs. There were 6 (5.6%) fetal deaths and 4 (4.6%) in the other group (p-value=1). The prevalence of abnormal LFT was 9.11% throughout pregnancy. Increased bilirubin and alkaline phosphatase (ALP) were significantly correlated with maternal mortality, while gestational age at birth, presence of meconium, appearance, pulse, grimace, activity, and respiration (APGAR) score, maternal mortality, and raised alkaline phosphatase level were found to be significantly associated with fetal mortality. Patients with abnormal LFT were significantly associated with maternal morbidity and mortality. However, fetal outcomes in patients with abnormal and normal LFT were similar. Hyperbilirubinemia and raised alanine aminotransferase (ALT) were significant predictors of maternal mortality.

Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka

BackgroundEvidence-based practice (EBP) is an effective approach to improve maternal and newborn outcomes at birth. ObjectiveThis study aimed to assess the current intrapartum practices of a tertiary care hospital in Central Province, Sri Lanka, during vaginal births. The benchmark for this assessment was the World Health Organisation's (WHO) recommendations on intrapartum care for a positive childbirth experience. MethodsAn observational study was conducted at the delivery room of Teaching Hospital, Peradeniya with the participation of 196 labouring women who were selected using systematic random sampling. A non-participant observation checklist covering labour room admission procedures, management of the first, second, and third stages of labour, and immediate care of the newborn and postpartum mother was used for the data collection. The care interventions implemented throughout labour and childbirth were observed and recorded. The data analysis was done using SPSS version 22. ResultsWHO-recommended practices such as providing privacy (33.2%), offering oral fluids (39.3%), and opioids for pain relief (48.5%) were found to be infrequent. Encouraging correct pushing techniques (77.6%), early breastfeeding (83.2%), regular assessment of vaginal bleeding (91.3%), skin-to-skin contact (93.4%), and using prophylactic uterotonics (100.0%) were found to be frequent. However, labour companionship, use of upright positions during labour, women's choice of birth position, and use of manual or relaxation techniques for pain relief were not observed in hospital intrapartum care. ConclusionThe findings of the study indicate that additional attention and monitoring are required to align the current intrapartum care practices with the WHO recommendations. Moreover, the adoption of evidence-based intrapartum care should be encouraged by conveying the standard evidence-based intrapartum care guidelines to the grassroots level healthcare workers to avoid intrapartum interventions.

Ultrasound Gel as a Source of Burkholderia cepacia Sepsis Outbreak in Preterm Neonates

Background: In the middle of 2018, we noticed an outbreak of sepsis due to Burkholderia cepacia complex among inborn babies, and this continued till December 2020. These babies were not responding to conventional antibiotic therapy. Aim: To study the clinical profile of neonates with Burkholderia septicemia, to determine its antimicrobial susceptibility patterns, and to identify the source of infection. Materials and methods: This was a retrospective descriptive study conducted in the inborn nursery of the Government Medical College, Thiruvananthapuram for a period of 30 months, from June 2018 to December 2020. All babies whose blood culture was positive for Burkholderia were identified from the records. Microbiological surveillance was done for source identification. Results: Out of the total 2264 neonates admitted during the study period, 84 (3.7%) had Burkholderia cepacia sepsis. The mean gestational age was 31(2) weeks. The most common clinical presentation was feed intolerance (64%) and 12% had a liver abscess. The highest antimicrobial sensitivity was observed for ceftazidime and cotrimoxazole (100%) followed by cefoperazone-sulbactam (98%) and meropenem (94%). The outbreak was controlled by the withdrawal of contaminated muti-use USG gel and the implementation of the practice of single-use sterile USG gel. Conclusions: Gastrointestinal manifestations are predominantly a manifestation in Burkholderia cepacia sepsis and a strong suspicion of liver abscess should be kept in mind. cotrimoxazole and ceftazidime are the best choice of antibiotics. Unsterile ultrasound gel use in the labor room and NICU can be a source of infection

THE STUDY OF MATERNAL OUTCOME FOLLOWING EARLY AND DELAYED CORD CLAMPING IN BIRTHS ASSOCIATED WITH ANEMIA IN PREGNANCY

Aim and Objectives: (The objectives of the study are as follows: 1) To compare the Blood loss in both early cord clamping (ECC) versus delayed cord clamping (DCC) (in the third stage of labor). (2) To compare the third-stage complications following ECC versus of DCC in anemic pregnant females. (3) To compare Maternal hemoglobin and hematocrit at 24 h of delivery in both ECC versus DCC. Methods: This prospective study was carried out in the Department of Obstetrics and Gynaecology in Lady Hardinge Medical College and Associated Hospitals, New Delhi pregnant women. A total of 120 anemic pregnant women between 32 and 40 weeks of gestation admitted in the labour room were enrolled in the study (hemoglobin between 7 and 10.9 g%). Twenty patients were lost to follow-up. Third-stage complications of 46 women who underwent ECC (<60 s) were compared with 54 women who underwent DCC (more than 60 s to <3 min). Maternal hemoglobin and hematocrit at 24 h of delivery were also compared between both groups. Results: The mean blood loss in both the groups was 325±89.287 and 326.85±66.384, comparable statistically with p=0.906. Out of 100 patients enrolled, only two patients had postpartum hemorrhage. Each one belonged to each group (p<0.909). None of the groups had retained placenta showing no statistical significance between two groups (p<1). DCC was not associated with increased risk of third-stage complications whether in cesarean section or vaginal delivery. There were no differences in operative time, post-delivery decrease in hematocrit, rates of postpartum hemorrhage, bleeding complications, maternal blood transfusions, and therapeutic hysterectomy between the two groups. Conclusions: DCC is safe for mother especially in anemic mothers also as it does not increase the mean blood loss and also it has beneficial effect on neonates. No difference in third-stage complications and maternal hemoglobin and hematocrit levels at 24 h in both groups. It should be recommended in routine practice where it is not contraindicated especially in resource-poor settings.

Comparison of oxygen saturation values between term and pre-term neonates.

Objective: To determine mean oxygen saturation (SpO2) values in normal newborns and compare mean Spo2 values between term and preterm infants. Study Design: Descriptive Case Series. Setting: Hameed Latif Teaching Hospital Lahore. Period: March 2023 to November 2023. Material & Methods: The study involved 100 neonates from operation theatre and labor room. Informed consent was obtained from parents. Immediately after birth, pulse oximeter was applied and serial monitoring of oxygen saturation was carried out starting at 1 minute and recording values after every 1 minute till 10 minutes of life. Results: There were 50% male and 50% female neonates. The average SpO2 values were 76.13±10.41 at first minute, 89.68±6.62 at 5 minutes & 95.84±3.65 at 10 minutes of life. Mean SpO2 was significantly high in term babies as compared to preterm babies at one minute and 5 minutes. However there was no significant difference in mean SpO2 at 10 minutes in term and preterm babies. Conclusion: The process of transition to normal postnatal oxygen saturation requires more than 5 minutes in healthy newborns. In healthy term newborn, oxygen saturation rises slowly. SpO2 monitoring may help identifying the infants requiring resuscitation to avoid overexposure to high supplemental oxygen after birth. Many newborns have SpO2 <90% during the first 5 minutes of life. This should be considered when choosing SpO2 targets for infants treated with supplemental oxygen in the delivery room.

The effect of thyroid disorders on obstetric and perinatal outcomes: an observational retrospective study in a tertiary care center of north India

Background: The incidence of hypothyroidism in pregnancy is between 0.5-3.5%, hyperthyroidism occurs in about 0.2-0.4%. They are associated with various maternal-fetal complications. Methods: This retrospective observational cohort study was conducted in SMGS Hospital, Jammu, India after ethical clearance. Admitted patients were included over a period of 1 year from January to December 2021. Inclusion criteria was women belonging to any period of gestation admitted to the labour room and woman with established thyroid disorder. Exclusion criteria was women on drugs influencing thyroid functions. Results: 1641 (10.43%) of 15722 women had thyroid disorders. Hypothyroidism in 10.37% (8.99% subclinical and 1.37% overt) and hyperthyroidism in 0.06%. PPROM was seen in 5.9% subclinical, 2.7% overt hypothyroid, none of hyperthyroid group. 7% subclinical, 8.5% overt hypothyroid and 1/10 women in hyperthyroid group had GDM. Abruption seen in 2.5% subclinical, 1.7% overt hypothyroid and none in hyperthyroid. In subclinical group 3.2% had gestational hypertension, 5.2% had preeclampsia and 0.6% had eclampsia. In overt hypothyroid, 2.8% had gestational hypertension, 7.9% preeclampsia and 1.7% eclampsia. In hyperthyroid group, 1/10 had gestational hypertension, 1/10 had preeclampsia. 18.2% subclinical, 14.7% overt hypothyroid, 2/10 in hyperthyroid group had history of abortion. 7% subclinical, 9.6% overt hypothyroid and 0/10 hyperthyroid group had infertility. 25.8% babies born were abnormal in terms of less gestational age at birth, low birth weight, IUGR, low apgar and IUD. 16.5% babies that had low birth weight <2.5 kg. Conclusions: The impact of thyroid disorders warrants routine screening for thyroid dysfunctions in all women in prenatal and antenatal period to predict and prevent adverse maternal-neonatal outcomes.

Should a different Partogram be used for the Trial of Labour in Women with the Previous One Caesarean Section Scar as Compared to Primiparous Women; A Comparative study

Objective: To compare various labour parameters in partogram among primiparous women and women with one previous caesarean section scar Study Design: Comparative cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022. Methodology: This study was conducted on primiparous women and women with one previous scar who were booked cases in our department for antenatal checkups and labour. Patients were divided into two groups for comparison. Group-I were primiparous, while Group-II had one previous scar. All women underwent detailed labour records via conventional partogram in the labour room. Duration of the active phase of labour, duration of the second stage, time to progress by 1 cm and time after the alert line were compared in partograms of both the study groups. Results: A total of 390 women who were either primiparous or had one previous caesarean section were recruited for this study. Of the study participants, 226(42.6%) were primiparous, while 164(57.4%) had one previous caesarean section scar. Statistical analysis revealed that the duration of the active phase of labour, time to progress by 1 cm and time after the alert line were statistically significant (p-value<0.05) in partograms of women in Group-I (primiparous) as compared to those in Group- II (women with one previous scar) (p-value<0.05). Conclusion: The main parameters of the partogram differ significantly among primiparous women and women with one previous caesarean section scar.

A Case Report on Monochorionic Diamniotic Twin Gestation with Rh Negative Pregnancy

The terms "monochorionic" and "diamniotic" refer to multiple gestations with just one placental disk (or chorion) and two separate amniotic cavities, respectively. Each fetus in a monochorionic diamniotic twin pregnancy has its own amniotic sac in addition to the common placenta. PPROM is the rupture of membranes before the onset of labor and before 37 weeks of gestation. We present a case of a 33-week-old primigravida female with monochorionic diamniotic twin gestation, Rh negative pregnancy, and PPROM who presented to the labour room with a fully dilated cervix, an emergency lower segment caesarean section was performed with prolonged second stage labour, and twins were delivered.

Comparison of Efficacy of Lignocaine Jelly versus Lignocaine Injection during Perineum Repair in Normal Vaginal Delivery

Background: Normal vaginal delivery is frequently associated with perineal trauma that can be iatrogenic (episiotomy) or spontaneous. Episiotomy is the most common surgical procedure in obstetrics being performed in approximately 20% of deliveries
 Objective: To compare the efficacy of lignocaine Jelly versus lignocaine injection during perineum repair after episiotomy in normal vaginal delivery. 
 Methods: Study was done at Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore during September 2020 - Feb 2021. For this randomized control trial, a total of 160 women fulfilling selection criteria were recruited for study from labour room. Informed consent was obtained from each case. Women were then segregated in group A& B and treatment was randomly allotted using lottery method, while in group A 2% lignocaine Jelly was applied on their perineum during active phase of labour at 8-9 cm cervical dilatation, before estimated time of one hour pre delivery. Women in group B were administered 10 ml of 1% lignocaine injection locally at the proposed site of episiotomy just before crowning. Then females were observed for pain and discomfort or adverse reactions during delivery, perineal repair and in immediate post partum period. After 2 hours of delivery, females were asked for perineal pain using visual analogue scale (VAS) then females were followed up in post-delivery wards for 12 hours. After 12 hours, they were discharged and asked for satisfaction of procedure.
 Results: The average ages of the cases among Group-A i.e. Lignocaine Jelly group and Lignocaine injection group (group-B) was 26.20 ± 3.32 years and 26.46 ±3.47 years respectively. The mean gestational age in Lignocaine Jelly group was 38.65 ± 0.90 weeks and in Lignocaine injection group was 38.67 ± 0.87 weeks. The mean BMI in Lignocaine Jelly and injection group was 26.70 ± 1.39 and 26.46 ± 2.20 respectively. Average pain score observed in Lignocaine Jelly was 3.58±1.06, whereas in Lignocaine injection group was 4.39 ± 1.26. There was statistically significant difference in average pain scores as the mean pain score in the Lignocaine Jelly group was lower compared with Lignocaine injection group ( p-value ≤ 0.001). In Lignocaine Jelly group 77(96.2%) females were satisfied while in Lignocaine injection group 68(85%) cases were satisfied, higher satisfaction rate was seen in lignocaine Jelly group, p-value (0.015) 
 Conclusion: Women to whom lignocaine Jelly was applied before episiotomy had less mean VAS Pain Score and higher satisfaction rate during perineal repair than women who were given lignocaine injection for perineal repair. So lignocaine Jelly can be used as a good alternative of local infiltration of lignocaine injection, in term of less pain, less adverse effects and more patient satisfaction during perineal repair of birth process.

The Impact of Breast Crawl on the Effectiveness of Breastfeeding in the First 48 Hours: A Quasi-experimental Study

Background Breast crawl is known to be the most natural, spontaneous, and logical method of initiating breastfeeding; however, not practiced routinely in many labor rooms. Objective The study’s primary objective was to examine the effect of breast crawl on breastfeeding in the first 48 hours. Method 60 mother-infant dyads were included. Thirty infants were assigned to either Group 1 (breast crawl) or Group 2 (standard care) using a quasi-experimental design. All babies were observed for 1 hour. A blinded investigator did the LATCH (Latch Audible Swallowing Type of Nipple Comfort Hold) score and IBFAT (Infant Breast Feeding Assessment Tool) score at 24 and 48 hours. Result Out of 30 babies in the breast crawl group, 25 (83.3%) successfully completed breast crawl. 20 (80%) of 25 babies completed breast crawl within 45 minutes, and 5 (20%) completed within 60 minutes. LATCH and IBFAT scores were significantly higher in the breast crawl group than in the standard care group at 24 and 48 hours ( p > .01). Scores were significantly higher after 48 hours compared to 24 hours in both groups ( p > .01). Conclusion Most babies in the study successfully crawled the breast and took their first feed within 60 minutes. The breast crawl group had better LATCH and IBFAT scores, indicating a positive impact in the early postnatal period.

Improving Early Initiation of Skin-to-Skin Contact Among Newborns Delivered Vaginally at a Tertiary Care Hospital: A Quality Improvement Study

Introduction WHO and UNICEF recommend initiating early skin-to-skin contact (SSC) of newborns as an important intervention to reduce neonatal mortality. In India, it has been reported that only 15% of babies receive early SSC, and at our institution, only 22% of stable babies delivered vaginally were receiving SSC at birth. Aim To increase the early initiation of SSC practice in neonates born through vaginal delivery ≥36 weeks from the observed baseline of 22% to ≥85% over 3 months. Methods The study was conducted in the labor room of a tertiary care hospital over 3 months (December 2022 to February 2023) and a sustenance phase from April 2023 to June 2023. A root cause analysis was done using the fishbone framework, focusing on barriers related to mothers, hospital staff, policy, place, and practices. Based on this, a comprehensive early initiation of SSC intervention was planned utilizing Plan-Do-Study-Act cycles. Results At the end of the three months, we achieved 100% compliance in the early initiation of SSC from a baseline of 22%, and the same compliance was maintained during the sustenance phase. The line chart used for interpretation showed an increase in compliance and increased duration of SSC till early initiation of breastfeeding was established.

Assessment of Skills of Health Care Professionals Posted in Labour Room and Maternity OTs Based on OSCE (Objective Structured Clinical Examination) Using LaQshya Guidelines

Background: Present study attempts to assess the skills of staff including Doctors and nurses posted in labourroom and maternity OTs based on OSCE (Objective Structured Clinical Examination) as mentioned in LaQshyaguidelines in selected areas of Indore and Ujjain district (M.P) regarding the management of normal labour, theactive management of third stage of labour, Newborn Resuscitation, management of PPH due to atonic uterus andmanagement of eclampsia. Even in these parameters many sub-parameters were studied.Materials and Methods: Pre designed semi structured Observation checklist for Health care providers regardingskill assessment of the staff based on OSCE guideline was used to assess Health care providers including Doctors,Staff nurses/ANMs, who are providing MCH services in LR (Labour room) and maternity OT of the selectedhospitals of Indore and Ujjain district.Results: Most of the manoeuvres were better performed by staff nurses posted in CHCs rather than those postedin PHCs. Breathing assessment of baby was lacking among staff nurses of both CHCs and PHCs and needed to betackled with by a reorientation training of paramedical staff in critical care. Decision to transfer (is usually afterConsultation with the in charge, hence it is usually the Medical officers prerogative) and bimanual compression/aortic compression/condom tamponade to control bleeding was done exclusively by MOs.Conclusion: OSCE helped to assess the skills of the staff of maternity wing in a comprehensive manner and waswell appreciated by the staff. Such OSCE modules should be developed and regularly used and updated to assessthe clinical skill of the staff in the maternity wing of any health centre or hospital.

Mobility as an Effective Non-pharmacological Method for Parturition: A Pilot Study

Background Childbirth is a transformative process. Modern healthcare offers pharmacological and non-pharmacological interventions for safe and improved childbirth experience. Studies have found that maternal mobility during the first stage of labour has a significant effect on maternal and child outcomes. A pilot study was done to find the effect of mobility during the first stage of labour on maternal satisfaction and foetal outcome. Method An experimental study was done with 60 primigravida women with uncomplicated antenatal history reporting to the labour room of a tertiary care government hospital in Delhi chosen as study participants. Validated and reliable tools were used to measure labour, maternal and neonatal outcomes within 24 h post-delivery. Results The results showed that there was an impact on mobility intervention during the first stage of labour on parturition ( p = .03) and significant maternal satisfaction ( p = .001). However, the neonatal outcome of both groups was not significant. Conclusion Mobility was an effective non-pharmacological intervention for enhancing parturition and maternal satisfaction. Mobility during the first stage of labour can be recommended for practice guidelines for all midwives in the labour room as a protocol.