Department of OBG

Impact Of Music Therapy On Pregnant Women In Labour

Fri, 01 Jan 2021 00:00:00 GMT

Impact Of Music Therapy On Pregnant Women In Labour Padma Sruthi, P INTRODUCTION Labor and child birth includes intense physical, emotional, psychological, social, cultural elements that may be critical to an individual woman’s experience of this major life event. Labour pain can induce stress and anxiety in pregnant women which can induce many physiological and psychological body responses in pregnant women like an increase in cardiac output, blood pressure, respiratory rate, oxygen consumption, catecholamine, cortisol, and glucagon level, which can lead to harmful effects on the body. Intervention for pain and discomfort during labor is a major part of modern obstetric care. Music interventions may decrease anxiety and physiological indices related to anxiety. Music heals the soul and also influences immune and endocrine function. It is a non-pharmacological modality that is non-invasive, cost-effective, easily accessible to all social group. So this study was conducted to know the impact of music therapy as a holistic approach to enhance comfort, reduce pain perception, and support emotional well-being during labour. MATERIALS AND METHODS This prospective interventional study, conducted from September 2022 to May 2024, examined the effects of music therapy on pregnant women in active labour. The study included 200 participants divided into two groups: an interventional group receiving music therapy and a control group. The interventional group underwent two 20-minute sessions of non-lyrical, instrumental classical (Behagrag) music with a 10-minute gap. The control group received routine obstetric care. Both groups were assessed for pain with Visual analogue scale, clinical parameters, cardiotocography, and serum cortisol levels at baseline, 20 minutes and at 50 minutes. Data was analysed using JMP-SAS Software. A p-value <0.05 was considered statistically significant. RESULTS This study examined the effects of music therapy during labour on 200 pregnant women (100 in each group). Key findings include significantly lower serum cortisol levels in the music group at 50 minutes (23.83 ± 12.31 vs. 36.06 ± 14.15, p<0.00001), and lower pain scores on the Visual Analog Scale at 50 minutes (6.87 ± 0.86 vs. 8.69 ± 0.59, p<0.00001). The music group had significantly lower DBP at 20 minutes (p = 0.043749) and 50 minutes (p = 0.000934). Although not statistically significant, a trend towards better fetal outcomes was also observed in the music group. However, no significant differences were found in various maternal parameters between the groups. CONCLUSION In conclusion, this prospective interventional study demonstrates that music therapy during labour may benefit fetal well-being and maternal stress levels. The music group exhibited a significantly reduced pain and anxiety during labour demonstrated by Lower visual analogue scores , lower serum cortisol levels than the control group. These results suggest the potential benefits of music therapy in reducing stress and pain during labour. This study demonstrates significant decrease in diastolic blood pressure levels, Further research is required to determine the effects of music therapy in pre eclampsia patients. These findings suggest that music therapy could be a potential non-pharmacological intervention to promote fetal well-being and reduce maternal stress during labour. Further research with larger sample sizes and targeted interventions is warranted to clarify the relationship between music therapy and various maternal and fetal outcomes during labour.

Safety And Efficacy Of Adding Single Dose Adjunctive Azithromycin Prophylaxis For Emergency Cesarean Delivery

Fri, 01 Jan 2021 00:00:00 GMT

Safety And Efficacy Of Adding Single Dose Adjunctive Azithromycin Prophylaxis For Emergency Cesarean Delivery Vindhyavali, Nannuri Introduction Cesarean sections have seen a significant increase in India from 17.2% to 21.5% between 2016 and 2021, driven by factors such as increased maternal requests, physician preference, financial incentives, social-cultural and religious reasons, and fear of legal consequences. These surgeries can be lifesaving but can also lead to adverse health outcomes like maternal infection, uterine bleeding, infant respiratory distress, and hypoglycemia. Surgical site infections (SSI) are a prevalent complication in emergency cesarean sections in India, with a prevalence of 5%-10%. Preventive measures include prophylactic antibiotics, aseptic techniques, early skin-to-skin contact, and breastfeeding. A 2014 Cochrane review found that routine antibiotic prophylaxis reduced wound infection, postpartum endometritis, and maternal severe infectious complications by 60% to 70%. Azithromycin is being researched as a possible preventive measure to decrease SSI during cesarean sections. Aim and objectives of the study The study evaluates the safety and effectiveness of single-dose adjunctive Azithromycin prophylaxis for emergency cesarean delivery. It aims to monitor postoperative complications like endometritis, surgical site infections, fever, skin erythema, re-admissions, and hospital stay duration. Secondary objectives include preventing neonatal complications like sepsis, respiratory distress syndrome, and NICU stay durationMaterials and methods This study was conducted at Shri B.M. Patil Medical College Hospital in Vijaypura, India, involving pregnant women with singleton pregnancies and gestational age of 24 weeks or more in labour. The study included patients undergoing emergency cesarean sections, membrane rupture within 12 hours or PROM, and previous cesarean sections. Exclusion criteria included patients unable to provide consent, known allergies to azithromycin, use of azithromycin 7 days before randomisation, chronic conditions, liver diseases, increased serum creatinine level, dialysis patients, cardiomyopathy, pulmonary oedema, electrolyte abnormalities, pre-eclampsia, and PROM more than 12 hours. The study lasted from September 2022 to March 2024, with 520 participants. Statistical analysis was performed using JMP-SAS Software, with results presented as mean ± S.D., counts and percentages, and diagrams. Comparisons were made using independent t-tests, Mann-Whitney U tests, Chi-square test/Fisher's Exact tests, and regression analysis for relative risk. A p-value of <0.05 was considered statistically significant. Results The study revealed several statistically significant differences between Group A, which received azithromycin before a cesarean section, and Group B, which did not. Postoperative symptoms were one key area where the two groups differed. Group B had significantly higher incidences of erythema (p=0.002), induration (p=0.003), and wound discharge (p=0.025) compared to Group A. These findings suggest that the administration of azithromycin prior to surgery may help reduce the occurrence of these postoperative complicationsFurthermore, the follow-up assessments on the 7th and 14th days after surgery showed that Group A had a significantly higher proportion of normal findings than Group B. At the second follow-up on the 7th day, the difference was statistically significant (p=0.041), indicating that patients who received azithromycin were usually more likely to recover. This trend continued at the third follow-up on the 14th day, with Group A having a significantly higher proportion of normal findings (p=0.023) than Group B. The study also found significant differences in NICU admissions and the need for secondary suturing between the two groups. Group B had a significantly higher percentage of NICU admissions (p=0.024) compared to Group A, suggesting that the use of azithromycin before cesarean section may have a protective effect on newborns. Additionally, Group B had a significantly higher percentage of participants requiring secondary suturing (p=0.048) than Group A, indicating that the antibiotic may help reduce the need for additional surgical interventions post cesarean. Conclusion In conclusion, administering azithromycin before cesarean section in Group A was associated with better postoperative outcomes across several key indicators. The group that received the antibiotic had lower rates of postoperative symptoms, abnormal follow-up findings, NICU admissions, and secondary suturing than the group that did not receive azithromycin. These statistically significant differences highlight the potential benefits of azithromycin prophylactically in cesarean section procedures

A Prospective Comparative Study Of Significance Of Two- Dimensional Echocardiography In Hypertensive Disorders Of Pregnancy(Hdp) And Normal Pregnancy And Its Effect On Fetomaternal Outcome

Fri, 01 Jan 2021 00:00:00 GMT

A Prospective Comparative Study Of Significance Of Two- Dimensional Echocardiography In Hypertensive Disorders Of Pregnancy(Hdp) And Normal Pregnancy And Its Effect On Fetomaternal Outcome Madderla, Sowmya Background: This study was conducted to study the echocardiographic changes in pregnant women with HDPs compared to normal pregnant women and also study the correlation between Echocardiographic abnormalities and fetal and maternal outcomes of pregnant women with HDPs and compare this with normal pregnant women. Methods: This prospective observational study was conducted during August 2022- 2024, in 142 women between age group 18 -35yrs with HDPs (Group A) compared with normal singleton pregnancy (Group B) admitted in Shri B.M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India. Results: The findings in women with Hypertensive disorders of Pregnancy demonstrated higher prevalence of Abnormal 2D ECHO findings as compared to normotensive pregnant women. The mean percentage of Ejection Fraction in Group A was significantly lesser (61.52 ± 5.13) as compared to Group B (65.59 ± 4.49); the mean E Wave (0.82 ± 0.45), mean A Wave (0.59 ± 0.35) in women of Group A were significantly higher than that in Group B. The mean Septal e' in Group A was lesser (0.119 ± 0.163) as compared to Group B (0.156 ± 0.133) (p<0.001.) This study also showed significantly higher poor feto-maternal outcomes such as Respiratory Fetal Distress, higher neonatal ICU admissions, Fetal growth retardation and low birth weight and Maternal Outcome like higher need for ICU admission in patients with abnormal echocardiographic findings among HDPs as compared to normotensive women without abnormal 2D ECHO findings. Conclusions: The results of our study will encourage early detection and surveillance of structural and functional cardiovascular abnormalities and management of high risk pregnant women who have high blood pressure.

A Randomised Parallel-Group Trial For Comparison Of Safety And Efficacy Of Oral Nifedipine Retard Versus Intravenous Labetalol In Management Of Hypertensive Emergencies Of Pregnancy

Fri, 01 Jan 2021 00:00:00 GMT

A Randomised Parallel-Group Trial For Comparison Of Safety And Efficacy Of Oral Nifedipine Retard Versus Intravenous Labetalol In Management Of Hypertensive Emergencies Of Pregnancy Sudeepthi, Chethy Background: Pre-eclampsia is a complication of pregnancy that is associated with substantial maternal and fetal morbidity and mortality. The disease presents with new-onset hypertension and often proteinuria in the mother, which can progress to multi-organ dysfunction, including hepatic, renal and cerebral disease, if the fetus and placenta are not delivered. Treating of severely increased blood pressure is widely recommended to reduce the risk for maternal complications. Regimens for the acute treatment of severe hypertension typically include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low resource environments. Aims and objectives: To compare the safety and efficacy of oral Nifedipine retard to intravenous Labetalol in the management of hypertensive emergencies of pregnancy. Methodology: A Randomized parallel group comparative study was conducted in Department of Obstetrics and Gynecology of Shri B.M Patil Medical College And Research Centre, Vijaypura. A total of 104 pregnant women with Hypertensive emergencies attending outpatient department were included and divided into 2 groups with 52 each in group A which was given IV labetalol and group B with oral Nifedipine retard 20mg. IV Labetalol group received 20mg initially followed by escalating doses of 40m and 80mg up to maximum of 5 doses every 15min up to target blood pressure is reached. Group B received Oral Nifedipine retard (Extended release) 20mg initially followed by repeated doses of 20mg every 30 minutes maximum of 5 doses until desired target blood pressure was reached. (SBP <150 mm Hg and DBP between 80-100 mm Hg). During the study, vitals are monitored closely and the maternal blood pressures will be recorded at every 15 minutes to achieve target blood pressure. Then at every 30 minutes for the next 2 hours followed by hourly monitoring and recording any adverse effect of the drugs. Results: The present study showed the maximum age group were in between 18-24 year of age. In this study mean of SBP enrollment of IV Labetalol and Oral Nifedipine retard was 169.42±13.197 and 163.48±5.363 respectively and Mean DBP of IV Labetalol and Oral Nifedipine retard was 112.69±7.440 and 112.60±5.154 respectively. Proteinuria and oedema were more in IV Labetalol than in Oral Nifedipine retard group. Mean dose of IV Labetalol and Oral Nifedipine was 70±42.565 and 33.17±13.137 respectively. A highly significant (p value 0.001) results with mean of total number of doses given in IV Labetalol and Oral Nifedipine was 2.06±.669 and 1.73±.630 were obtained respectively. Mean SBP after 15 min, 30 min, 45 min, 60 min, 75 min and 90 min in group A and group B was 155.10±13.172 and 158.54±5.301, 143.64±12.776 and 149.48±7.883, 141.67±16.967 and 148.47±6.601, 138±16.745 and 140.96±8.126, 136±11.256 and 138.40±6.066 and 132±13.246 and136±7.071 respectively. Results were found to be significant. Mean DBP after 15 min, 30 min, 45 min, 60 min, 75 min and 90 min was in group A and group B was 100.78±7.441 and 107.37±6.630, 92.73±8.174 and 98.63±7.659, 90.83±9.962 and 98.17±6.412, 86±6.783 and 90.56±5.938, 84±8.567 and 88.40±3.209 and 82 ±9.563 and 86±8.960 respectively. Results were found to be significant. Mean target SBP of IV Labetalol and Oral Nifedipine was 139.42±8.498 and 139.12±6.379 respectively. Mean target DBP of IV Labetalol and Oral Nifedipine was 89.42±6.076 and 89.52±4.672 respectively. Most of the patients 35(67.3%) of IV Labetalol and 30(57.5%) of Oral Nifedipine group B did not had any side effects. 7(13.4%) patients had Headache and 2(3.9%) patients had abdominal pain side effect in IV Labetalol and 12(23%) had tachycardia in Oral Nifedipine. Results were found to be significant (P value0.04) when comparing side effect in IV Labetalol and Oral Nifedipine. Conclusion: The blood pressure can be effectively controlled with the use of Labetalol in the dosage used which was observed in cases of moderate to severe pregnancy- induced hypertension. IV labetalol is safe drug and effective drug in management of hypertension in pregnancy.