Status of maternal and new born care at first referral units in the state of West Bengal.
ABSTRACT A study was conducted in 12 First Referral Units (FRUs), selected through multistage sampling, from 6 districts of West Bengal. Infrastructure facilities, record keeping, referral system and MCH indicators related to newborn care were documented. Data was collected by review of records, interview and observation using a pre-designed proforma. Inadequate infrastructure facilities (e.g. no sanctioned posts of specialists, no blood bank at rural hospitals declared as First Referral Units etc.); poor utilization of equipment like neonatal resuscitation sets, radiant warmer etc, lack of training of the service providers were evident. Records/registers were available but incomplete. Referral system was found to be almost nonexistent. Most of the deliveries (86.1%) were normal delivery. Deliveries (87.71%) and immediate neonatal resuscitation (94.9%) were done mostly by nursing personnel. Institution based maternal, perinatal and early neonatal mortality rates were found to be 5.6, 62.4 and 25.2 per 1000 live births respectively. Eclampsia (48.9%), hemorrhage (17.7%), puerperal sepsis (7.1%) were reported to be major causes of maternal mortality. Common causes of early neonatal mortality were birth asphyxia (54.3%), sepsis (14.6%) and prematurity/LBW (12.4%).
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ABSTRACT: To study the impact of nonobstetric genital tract injury (NOGTI) in rural India. A prospective observational study of 52 consecutive women admitted with NOGTIs caused by voluntary coitus or accidental injury. Details of the causes of trauma, clinical presentations, and management were recorded. A total of 17 women (32.7%) presented with coital trauma, while 35 women (67.3%) sustained noncoital injuries: bicycle/automobile accidents (10); fall from height (7); cattle horn injury (7); straddle-type trauma (6); leech bites (3); and vaginal foreign bodies (2). Most women had multiple injuries; 15 women developed vulvar hematomas and 3 had anorectal lacerations. Management included immediate resuscitation along with primary repair of injuries, evacuation of vulvar hematomas, and removal of vaginal foreign bodies. Fifteen women (28.8%) required blood transfusions; none of the women died. Severe hemorrhage caused by NOGTIs is potentially fatal in rural settings if treatment is delayed. Prompt resuscitation, early referral, and appropriate surgical intervention can avert both morbidity and mortality.International Journal of Gynecology & Obstetrics 08/2008; 103(1):26-9. DOI:10.1016/j.ijgo.2008.04.026 · 1.56 Impact Factor
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ABSTRACT: To study the causes, burden, and impact of pregnancy-related acute renal failure (PRARF) in a low-resource setting. A prospective observational study of consecutive women admitted to the Seth Sukhlal Karnani Memorial Hospital, Kolkata, India, with PRARF between February 1, 2007, and May 31, 2009, was conducted. The information collected included causes and predisposing conditions leading to PRARF, clinical presentations, medical and obstetric management-including need for dialysis-and maternal outcome. The leading causes of PRARF among the 57 participants were sepsis 19 (33.3%), hemorrhage 16 (28.1%), and hypertensive disorders 15 (26.3%). The condition occurred in 11 (19.3%) cases before 20 weeks of gestation, 6 (10.5%) cases after 20 weeks of gestation, and 40 (70.2%) cases during puerperium. Most women were from rural areas and received inadequate prenatal care. Although 40 women had PRARF during puerperium, the precipitating event mostly started during the process of labor/delivery. Despite multidisciplinary care, mortality was high (28.1%); cause-specific fatality was highest with sepsis (36.8%) and hemorrhage (25.0%). Many women who survived experienced prolonged morbidity. Pregnancy-related acute renal failure is potentially fatal but largely preventable. Universal prenatal care and greater access to emergency obstetric services, especially in rural India, could avert PRARF and its consequences.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 12/2010; 111(3):213-6. DOI:10.1016/j.ijgo.2010.06.026 · 1.56 Impact Factor