The position in which the woman delivers has a lot of impact on the ease of delivery. Women's satisfaction with their birthing experience and the care they receive is significantly impacted by the ...fact that giving birth is frequently a challenging experience. Birthing positions refer to various postures which can be assumed at the time of delivery by a pregnant woman. Currently, the majority of women give birth either while lying flat on their backs or in a semi-sitting position. Upright positions, which include standing, sitting, or squatting along with side-lying and hands-and-knees, are less common birth positions. Doctors, nurses, and midwives are among the most important healthcare professionals, having a significant influence in deciding which position the woman will give birth in and on the physiological and psychological effects of the experience of a woman in labor. There isn't much research to back up the best position for mothers during the second stage of labor. This review article aims to review and compare the advantages and risks of common birthing positions and know about the knowledge of alternative birthing positions among pregnant women.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that remains underdiagnosed in pregnancy and can cause severe maternal and fetal complications. The prevalence of OSA in pregnancy ...had a wide variation and increases with increasing gestation. At-risk women are those with increased body mass index (BMI), increasing age, and chronic hypertension. Screening can be done by polysomnography but as it is expensive and necessitate overnight hospital stay, makes it even harder to diagnose and leads to delay in treatment. Once diagnosed, continuous positive airway pressure (CPAP) is the gold standard treatment. Early diagnosis and effective treatment can considerably improve the outcome. This review aims to discuss the diagnosis, treatment, and prognosis of OSA in pregnancy.
Post-traumatic stress disorder (PTSD) is a mental disorder that produces crippling anxiety and occurs in response to an extreme, traumatic stressor. Compared to the prevalence of PTSD in the general ...population, the prevalence of PTSD in at-risk populations (e.g., army veterans, those affected by environmental calamities, and others) can reach up to threefold. The conventional treatment of PTSD involves using SSRIs (serotonin reuptake inhibitors) and other anti-depressants along with psychotherapy such as debriefing and CBT (cognitive behavioral therapy). Due to increasing resistance to conventional treatment, more novel treatment options, such as stellate ganglion block shots and neuromodulation, are being explored. These neuromodulation techniques include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDS), and deep brain stimulation (DBS). The rationale behind employing these techniques in refractory PTSD is the altered neurocircuitry seen in PTSD patients, which can be visualized on imaging. Studies involving the use of DBS for PTSD primarily target specific areas in the brain: the amygdala, the prefrontal cortex, the hippocampus, and the hypothalamus. This article aims to provide a brief overview of the various neuromodulation techniques currently employed in the management of treatment-resistant PTSD and an in-depth review of the available literature on animal models in which DBS for PTSD has been researched. We also shed light on the human clinical trials conducted for the same.
Background The administration of adequate analgesia post-operatively has been associated with fewer cardiopulmonary complications, lower morbidity and mortality, lower healthcare costs, and higher ...patient satisfaction. One of the most effective ways to raise the standard of healthcare would be standardization of multimodal analgesia with enhanced recovery after surgery. Adjuncts to spinal anesthetists can achieve a better post-operative pain relief with less doses of rescue analgesia. Methods This was a prospective, randomized trial conducted on 60 women undergoing abdominal hysterectomy under spinal anesthesia. We evaluated the impact of adding 0.5 mL (2.5 mg) of intrathecal midazolam versus 25 mcg of intrathecal fentanyl (0.5 mL) with 2.5 mL injection of 0.5% bupivacaine (hyperbaric) (12.5 mg). The outcomes were prolongation of analgesia in the post-operative period, onset and duration of sensory and motor blockade, stable hemodynamics, and any adverse reactions to the study drugs. Results The two groups, group M (midazolam + hyperbaric bupivacaine) and group F (fentanyl + hyperbaric bupivacaine), had similar distribution for age, weight, and type and duration of surgical procedure. Both groups had stable vital parameters and experienced a similar onset of sensory and motor blockade. Intraoperative modified Ramsay sedation score was better in group M in comparison to group F. However, mean of elapsed time of two-segment regression of sensory block, from T12 to L1 level, and mean time to regression, from Bromage score 3 to 2, were longer in group F. Group F also had a better visual analogue scale (VAS) score in the post-operative period than group M, and group F experienced a longer average post-operative analgesic duration (lasting for 367.73 minutes) as compared to group M (lasting for 254.9 minutes), having a difference that was of statistical significance (p < 0.001). No substantial adverse reactions were seen in either group. Conclusion The duration of post-operative analgesia is significantly prolonged when 25 mcg of adjuvant intrathecal fentanyl is used with 0.5% bupivacaine (hyperbaric) as compared to intrathecal midazolam 0.5 mL (2.5 mg) in women undergoing abdominal hysterectomy under spinal anesthesia. Both fentanyl and midazolam have minimal adverse reactions and are safe to use as adjuvants to 0.5% of bupivacaine (hyperbaric) in surgeries conducted in the lower abdomen.
Bladder endometriosis, a rare but well-known condition with a high risk of morbidity, affects the bladder. A 43-year-old woman presented with a history of recurrent cyclical discomfort during ...urination. The patient had undergone a non descent vaginal hysterectomy to address the same symptom. Upon examination, a nodule was discovered between the bladder and vaginal vault. The diagnosis of bladder endometriosis was confirmed through cystoscopy and an Magnetic Resonance Imaging (MRI). The nodule was removed via transurethal resection, and histology confirmed it as endometriosis. After 12 months of follow-up, the patient's postoperative symptoms had completely resolved. Hormonal therapy was initiated, and there were no residual urinary symptoms, chronic pain, or cyclical pain. Women reporting urinary symptoms, particularly those with a history of pelvic surgery, should undergo evaluation for bladder endometriosis. The diagnosis of bladder endometriosis should be considered in women experiencing dysuria and bladder discomfort. A high index of suspicion is required to establish the diagnosis.
Background and objective Preeclampsia is a major contributor to morbidity and mortality among pregnant women and leads to poor fetomaternal outcomes. Predicting fetal and maternal health outcomes ...will enable early interventions so as to reduce further damage. Various biochemical tests like beta-human chorionic gonadotropin (β-HCG), inhibin A, activin A, pregnancy-associated plasma protein-A (PAPP-A), fetal DNA, and color Doppler have been studied for their ability to predict fetal and maternal health outcomes; however, most of these tests are complex and costly. Among the many variables that indicate the severity of outcomes in hypertensive disorders of pregnancy, the urinary protein-to-creatinine ratio (UPCR) is an important index. The aim of the study was to find out the association between UPCR and fetomaternal outcomes in preeclampsia. Material and methods A prospective observational study was conducted among 141 women with preeclampsia presenting with proteinuria, who were divided into two groups: 11% with UPCR <0.3 and 89% with UPCR ≥0.3. These patients were followed up till delivery to look for maternal and fetal outcomes. Results The sensitivity of UPCR for predicting adverse maternal outcomes was 79.37% (95% CI: 71.25-86.06), specificity was 46.67% (95% CI: 21.27-73.41), positive predictive value (PPV) was 92.59% (95% CI: 88.53-95.29), negative predictive value (NPV) was 21.21% (95% CI: 12.43-33.81), and the accuracy was 75.79% (95% CI: 67.97-82.69); for adverse fetal outcomes, the sensitivity was 76.98% (95% CI: 68.65-84.01), specificity was 13.33% (95% CI: 1.66-40.46), PPV was 88.18% (95% CI: 85.69-90.29), NPV was 6.45% (95% CI: 1.79-20.67), and the accuracy was 70.21% (95% CI: 61.94-77.62). Conclusion Based on our findings, UPCR is a simple laboratory tool that can help predict abnormal fetomaternal outcomes in preeclampsia with good sensitivity and PPV and can be used as an adjunct to assist in clinical decisions.
Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In ...episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used for episiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bath is a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focus on infrared lamp therapy and sitz baths.
Polycystic ovary syndrome (PCOS) is the most widespread and diverse endocrine health issue affecting many adolescent-aged women globally. It is the most frequent illness in reproductive-aged women. ...According to the Rotterdam criteria, two out of three elements: oligo-anovulation, hyperandrogenism, and polycystic ovaries (defined as having at least one ovary with an ovarian volume > 10 mL and/or 12 or more follicles measuring 2 to 9 mm in diameter) are present in PCOS. Conducted studies show epigenetics, environmental toxins, stress, and food as external factors as well as inflammation, oxidative stress, hyperandrogenism, insulin resistance, and obesity as internal factors related to PCOS. Although a portion of the mechanism associated with the occurrence of PCOS has been identified, there is still much to learn about the exact etiology and pathophysiology. The main debate covers the best ways to diagnose and treat this disease in adolescents. Early detection is crucial because of the disease's long-term effects on metabolic and reproductive health. Before beginning treatment for this group of young women, a firm diagnosis may not be made. Various criteria are used to diagnose PCOS patients. A person with PCOS has a chance of developing several comorbidities and health effects. PCOS patients are at risk of cardiac diseases, metabolic syndromes, resistance to insulin, infertility, and many more. There are numerous medications available for PCOS therapy that need a methodical approach. However, changing one's lifestyle should come first. There is proof in the support of the usage of several medications for PCOS, including mucolytic agents, Hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors, gliptins (oral diabetic medication), glucose-like peptide-1 receptor analogues, glitazones, and sodium-glucose cotransporter protein-2 (SGLT2) inhibitors. A comprehensive, systematic, schematic therapy approach is crucial for the treatment of PCOS.
Immature teratoma is a rare type of germ cell tumor containing embryonic tissues that may be malignant. It usually occurs in young women and affects the ovaries. Teratomas exhibit benign clinical ...behavior, but they can return as teratomas or with malignant components, and in a small subset of individuals, the prognosis may be deadly. We will discuss a case of a 9-year-old female child who presented with pain and a huge lump in the lower abdomen that was suggestive of an ovarian dermoid cyst or a germ cell tumor on computed tomography (CT) abdomen pelvis and underwent exploratory laparotomy and debulking surgery. Histopathology results indicated that she had a grade 3 immature teratoma. Postoperatively, the patient received 3 cycles of bleomycin, etoposide, and cisplatin (BEP) as adjuvant chemotherapy with a good response. She is currently under regular follow-up and has no evidence of recurrence or metastasis. This case illustrates the importance of early diagnosis and treatment of immature teratoma, which can be cured with surgery and chemotherapy. It also highlights the challenges of managing such a large tumor in a pediatric patient.
Background Polycystic ovarian syndrome (PCOS), which affects women of reproductive age, is the most prevalent endocrine disorder. Signs of excessive androgen, irregular menses, prolonged anovulation, ...and infertility are characteristics of the clinical phenotype. Women with PCOS are more likely to have diabetes, obesity, dyslipidemia, hypertension, anxiety, and depression. PCOS affects women's health starting before conception and continuing through their post-menopausal years. Methods Ninety-six study subjects were recruited from women visiting the gynaecology clinic according to the Rotterdam criteria for PCOS. Study subjects were then divided into lean and obese groups according to their body mass index (BMI). Demographic data, and obstetrical and gynaecological history were obtained including marital status, menstrual cycle regularity, recent abnormal weight gain (in the preceding six months), and subfertility. To identify any clinical signs of hyperandrogenism such as acne, acanthosis nigricans, or hirsutism, a general and systemic examination was conducted. Data were analyzed after the clinico-metabolic profile was assessed, compared, and contrasted between the two groups. Results The findings showed a significant correlation between obese women with PCOS and the clinical profile of PCOS i.e. menstrual irregularities, acne vulgaris, acanthosis nigricans and hirsutism; the waist-hip ratio was higher in both groups. Higher levels of fasting insulin, fasting glucose: insulin ratio, postprandial sugars, homeostasis model assessment of insulin resistance (HOMA-IR) index, total testosterone, free testosterone, and luteinizing hormone/follicle-stimulating hormone (LH: FSH) ratio were seen in obese women with PCOS, whereas the levels of fasting glucose, serum triglycerides, serum high-density lipoprotein cholesterol (HDL) were higher in all the study subjects irrespective of BMI. Conclusion The study showed that women with PCOS have a deranged metabolic profile like abnormal blood sugar, insulin resistance (IR), and hyperandrogenemia with clinical derangements like irregular menses, subfertility, and recent weight gain more frequently with higher BMI.
