The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019... more The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019. The causative virus was identified from throat swab samples in the Chinese Centre for Disease Control and Prevention (CCDC) on January 7, 2020, and it was named severe acute respiratory syndrome coronavirus (SARS-CoV-2). Subsequently, World Health Organization (WHO) renamed it COVID-19. COVID-19 was a highly infectious newly discovered coronavirus, which led to a worldwide pandemic. It has shown an equal number of cases between men and women, but a lower mortality rate in women. Materials and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology of GMC, Srinagar, comparing the total number of emergency admissions including obstetric emergencies, such as ectopic pregnancy, intrauterine device (IUD), severe anemia, eclampsia, abruption, obstructed labor, and postpartum hemorrhage (PPH) during a period of 6 months from March 2020 to August 2020 with that from March 2019 to August 2019. Results: A total of 13,784 patients were admitted over a period of 6 months from March 2020 to August 2020, and there was a significant decline in the admissions as compared to pre-COVID-19 period of March 2019 to August 2019 (p-value, 0.007). The COVID-19 lockdown greatly reduced the rate of admission to gynecological and obstetric emergencies. This reduction allowed for more effective and efficient use of emergency services and will inspire policymakers to implement policies for efficient utilization of emergency services in the future.
International journal of applied research, Jun 1, 2020
Background: Emergency peripartum hysterectomy is one of the most dramatic operative procedures in... more Background: Emergency peripartum hysterectomy is one of the most dramatic operative procedures in modern obstetrics. The reported incidence is 0.24 to 8.9 per 1000 deliveries. Previously uterine atony was the most common indication for emergency hysterectomy but the recent studies have shown a shift towards abnormal placentation. Objectives: To evaluate the clinical indications and incidence of emergency peripartum hysterectomy. Methods: We retrospectively analyzed the number of women who underwent emergency peripartum hysterectomy in the hospital from January 2016-2018. Post-operative maternal and foetal complication were also evaluated. The surgical procedures, type of anesthesia, and the subsequent treatment, complications of hysterectomy, amount of blood transfused, need for ICU stay and total days of hospitalization were noted. Results: Emergency peripartum hysterectomy was performed in 131 women. The incidence of emergency peripartum hysterectomy was 2.89/1000 deliveries. Emergency peripartum hysterectomy was performed in 78.62% cases (103 women) after cesarean delivery and 21.37% cases (28 women) after vaginal delivery. Subtotal hysterectomy was performed in 75.57% cases (99 women) and total hysterectomy was performed in 24.43% cases (32 women). The main indication for performing emergency peripartum hysterectomy was placenta praevia with accreta in 67 women (51.14%), uterine rupture in 31 women (29.66%), uterine atony not responsive to conservative treatment in 20 women (51.26%) and broad ligament hematoma in 13 women (9.92%). The indications of peripartum hysterectomy have changed especially in the setting of rising caesarean rate all over the world. The possibility of the morbid adherence of placenta in presence of previous LSCS should always be kept in mind.
International journal of contemporary medical research, Jul 1, 2020
Introduction: Hypertensive disorders of pregnancy comprise a spectrum of diseases that include ch... more Introduction: Hypertensive disorders of pregnancy comprise a spectrum of diseases that include chronic hypertension, gestational hypertension, preeclampsia, eclampsia and HELLP syndrome-are uniquely challenging as its pathology and management simultaneously affects both the mother and baby. Preeclampsia (PE) is an important cause of maternal and perinatal morbidity and mortality and is a most feared complication of pregnancy. In India the incidence of PE is reported to be 2%-8%. Material and methods: In this study 200 pregnant women were enrolled from March 2018 -November 2019 for a period of 21 months in Lalla Ded hospital department of Obstetrics and Gynaecology Government Medical College Srinagar. Inclusion criteria, first trimester of pregnancy (8 -12 weeks), singleton gestation, pregnancies with aneuploidies ruled out. A detailed history taking and examination was done. History regarding their age, parity, smoking and past medical history of hypertension was taken and their mean arterial pressure (MAP) was taken. Results: In our study out of 200 patients enrolled in first trimester 14 developed Pre Eclampsia (PE) in third trimester. Out of which majority were in the age group of 15-20 years (10%) and > 35 years (9%), 12.7%were nulliparous, 15.5% had a MAP of more than 89 mmHg, 11.5% of them were smokers majority, 10% of them had past history of hypertension and 30.7% of them had BMI of more than 30 kg/ m 2 . Conclusion: It can be concluded from the study that these risk factors can be used as a screening method for preeclampsia prediction and its early diagnosis, thus allowing time for intervention and thereby decreasing maternal mortality and morbidity.
Zenodo (CERN European Organization for Nuclear Research), Feb 10, 2023
Postpartum haemorrhage (PPH) is a lifethreatening condition and remains a leading cause of matern... more Postpartum haemorrhage (PPH) is a lifethreatening condition and remains a leading cause of maternal mortality. Embolization is an effective therapeutic strategy for PPH with the advantages of being fast, repeatable, and the possibility of fertility preservation. A young 30 year old female P2L2 presented to our department with secondary postpartum haemorrhage initially managed conservatively followed by coil embolization and finally hysterectomy after the failure of conservative and embolization procedure.
International journal of scientific and research publications, May 18, 2020
The aim of maternity care is the birth of a healthy baby to a healthy mother. Despite all efforts... more The aim of maternity care is the birth of a healthy baby to a healthy mother. Despite all efforts birth asphyxia occurs in 2 per 1000 births in developed countries and is almost 10 times higher in developing countries. In order to assess the fetal wellbeing, several antepartum surveillance tests have been devised. The most commonly used surveillance method is Cardiotocography (CTG). This prospective observational study was conducted in the Post graduate department of Gynecology and Obstetrics of GMC Srinagar associated Lalla Ded Hospital over a period of one and a half year from December 2017 to August 2019. Two hundred and fifty one primigravidae with low risk pregnancies at term in early labour were subjected to admission CTG. They were followed during the course of labour and their mode of delivery and perinatal outcome was assessed. All women gave written and informed consent before being included in the study. This included Primigravidae with singleton term pregnancy, non-anomalous baby,with intact membranes admitted in early labour. The parameters that were studied were age of the patients, gestational age,CTG changes (According to FIGO criteria for CTG Interpretation),Presence of Meconium, cord around neck at the time of delivery,Mode of delivery, APGAR Score at 0, 1 and 5 Minutes and need for admission in NICU. CTG parameters studied were Fetal heart rate, Baseline variability, Accelerations and Decelerations. The cardiotocogram was interpreted as per FIGO guidelines. In our study, maximum number of women (64.14%) were in the age group of 25-30 yrs and 96(38.25%) women had gestational age of 40 weeks, followed by 39 weeks in 87(34.66%), 38 weeks in 41(16.33%) and 37 weeks in 27(10.76%). Out of total 251 women, 94 women (37.45%) had Cat 1 CTG, 78 women (31.08%) had Cat 2 CTG and 79(31.47%) women had Cat 3 CTG. Of all these women 123(49%) delivered vaginally where as 128 (51%) delivered through Cesarean section (CS). In women with Cat 1 CTG (93.62%) delivered vaginally and 6.38% were delivered by CS as 4 of them had non-progression of labour, 1 had meconium stained liquor and 1 had non-descent of head. In women with Cat 2 CTG no significant difference was seen in mode of delivery as 42.31% delivered by NVD and 57.69% by LSCS. In women with Cat 3 CTG almost all (97.47%) were delivered by LSCS. However 2 of these women delivered vaginally while awaiting surgery. Thus, as the category of CTG changed from 1 to 3, the mode of delivery changed from NVD to LSCS and the results were statistically significant (Pearson Chi
To study the current status of gestational trophoblastic neoplasms (GTN) . The records of cases o... more To study the current status of gestational trophoblastic neoplasms (GTN) . The records of cases of GTN managed over a period of 10 years from 1994 to 2003 were analyzed retrospectively. During the study period there were 99 histopathologically proved cases of GTN, constituting 0.27% of the obstetric admissions and 0.29% of births; 88 (88.88%) were cases of hydatidiform mole, eight (8.7%) of invasive mole, and three (3.03%) of choriocarcinoma. Case fatality was 2.02%. Most of the cases who were given chemotherapy responded well to methotrexate alone, but in cases of persistant disease (2.2%) etoposide and actinomycin were added and a good response was obtained. Of the 11 cases in whom chemotherapy was given only two (18.18%) needed multidrug therapy. If recognized in time and treated appropriately GTN is amenable to treatment with good cure rates. However there are inherent problems and high risk factors which lead to fatality.
Obstetric patients get admitted to the ICU approximately at 0.1 -0.9% times of all deliveries. Kn... more Obstetric patients get admitted to the ICU approximately at 0.1 -0.9% times of all deliveries. Knowledge of diseases affecting these patients and their outcome is essential for better care. This study aims at evaluating the occurrence, indications, course, interventions and outcome of obstetric patients admitted to the ICU of a tertiary care hospital.
Retrospective Comparative Study Between COVID-19 Positive and COVID-19 Negative Pregnant Women: Maternaland Fetal Outcome
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
Objectives: This retrospective comparative study aims to compare maternal and fetal outcomes in C... more Objectives: This retrospective comparative study aims to compare maternal and fetal outcomes in COVID-19 positive and negative pregnant women. Material and Methods: Our study is a single centre retrospective comparative study conducted in Department of obstetrics and Gynaecology, Lalla Ded hospital, Results: Of the 362 COVID-19 positive pregnant women, 37.6% had a vaginal delivery, and 62.4% underwent LSCS, while in the control group, 70.3% had a vaginal delivery, and 29.7% underwent LSCS. The (mean±SD) gestational age at delivery was (35.2±2.8) weeks in the COVID-19 positive group and (37.4±2.2)weeks in the control group. Preterm labor was signicantly higher in theCOVID19 positive group (p=0.0032), with a rate of 5.5% compared to 2.5% in the control group. The incidence of maternal mortality showed no signicant difference and was 0.6% in the COVID-19 positive group and 0.4% in the control group (p=0.6072). In the perinatal outcomes, there was no signicant difference in the Apgar...
Background: Traumatic brain injury (TBI) is a leading cause of mortality, morbidity, disability, ... more Background: Traumatic brain injury (TBI) is a leading cause of mortality, morbidity, disability, and socioeconomic losses in the Indian subcontinent. For policy making, there is a lack of reliable and larger data regarding traumatic brain injuries in our setting. Aim: In our study an attempt was made to analyze and assess the clinical characteristics of patients with traumatic brain injuries admitted in Surgical Intensive Care Unit of SMHS hospital Srinagar. Materials and Methods: In this observational study, 89 patients of TBI admitted in SICU during study period were enrolled, after obtaining ethical clearance from institutional ethical clearancecommittee. All the study patients were followed up in SICU on daily basis. All thedata required for study was recorded from the patient’s clinical notes as per studyprotocol. Outcome of patients was assessed in terms of survival at discharge from SICU. Results: Majority of the TBI patients requiring ICU admission had Severe TBI (64%). Allt...
METHOD(S) : The records of cases of GTN managed over a period of 10 years from 1994 to 2003 were ... more METHOD(S) : The records of cases of GTN managed over a period of 10 years from 1994 to 2003 were analyzed retrospectively. RESULT(S) : During the study period there were 99 histopathologically proved cases of GTN, constituting 0.27% of the obstetric admissions and 0.29% of births; 88 (88.88%) were cases of hydatidiform mole, eight (8.7%) of invasive mole, and three (3.03%) of choriocarcino ma. Case fatality was 2.02%. Most of the cases who were given chemotherapy responded well to methotrexate alone, but in cases of persistant disease (2.2%) etoposide and actinomycin were added and a good response was obtained. Of the 11 cases in whom chemotherapy was given only two (18.18%) needed multidrug therapy. CONCLUSION(S) : If recognized in time and treated appropriately GTN is amenable to treatment with good cure rates. However there are inherent problems and high risk factors which lead to fatality.
Journal of South Asian Federation of Obstetrics and Gynaecology, 2021
The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019... more The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019. The causative virus was identified from throat swab samples in the Chinese Centre for Disease Control and Prevention (CCDC) on January 7, 2020, and it was named severe acute respiratory syndrome coronavirus (SARS-CoV-2). Subsequently, World Health Organization (WHO) renamed it COVID-19. COVID-19 was a highly infectious newly discovered coronavirus, which led to a worldwide pandemic. It has shown an equal number of cases between men and women, but a lower mortality rate in women. Materials and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology of GMC, Srinagar, comparing the total number of emergency admissions including obstetric emergencies, such as ectopic pregnancy, intrauterine device (IUD), severe anemia, eclampsia, abruption, obstructed labor, and postpartum hemorrhage (PPH) during a period of 6 months from March 2020 to August 2020 with that from March 2019 to August 2019. Results: A total of 13,784 patients were admitted over a period of 6 months from March 2020 to August 2020, and there was a significant decline in the admissions as compared to pre-COVID-19 period of March 2019 to August 2019 (p-value, 0.007). The COVID-19 lockdown greatly reduced the rate of admission to gynecological and obstetric emergencies. This reduction allowed for more effective and efficient use of emergency services and will inspire policymakers to implement policies for efficient utilization of emergency services in the future.
Introduction: Hypertensive disorders of pregnancy comprise a spectrum of diseases that include ch... more Introduction: Hypertensive disorders of pregnancy comprise a spectrum of diseases that include chronic hypertension, gestational hypertension, preeclampsia, eclampsia and HELLP syndromeare uniquely challenging as its pathology and management simultaneously affects both the mother and baby. Preeclampsia (PE) is an important cause of maternal and perinatal morbidity and mortality and is a most feared complication of pregnancy. In India the incidence of PE is reported to be 2%-8%. Material and methods: In this study 200 pregnant women were enrolled from March 2018 – November 2019 for a period of 21 months in Lalla Ded hospital department of Obstetrics and Gynaecology Government Medical College Srinagar. Inclusion criteria, first trimester of pregnancy (8 – 12 weeks), singleton gestation, pregnancies with aneuploidies ruled out. A detailed history taking and examination was done. History regarding their age, parity, smoking and past medical history of hypertension was taken and their me...
Journal of South Asian Federation of Obstetrics and Gynaecology, 2020
The main aims and objectives of this study were to study efficacy, safety, and quality of life wi... more The main aims and objectives of this study were to study efficacy, safety, and quality of life with combination anticholinergics and desmopressin compared to anticholinergics alone. Materials and methods: A total of 92 patients were randomly assigned to two groups. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 1 month. The patients were followed for 2 weeks to look for undesired side effect and then at 1 month with 3-day voiding diary. IIQ-7 questionnaire score was used to assess changes in voiding symptoms and quality of life. Results: Out of 42 in group I and 50 in group II, one patient in group I and three patients in group II did not follow and were excluded from the study. Baseline parameters between the two groups were statistically similar. Posttreatment parameters such as mean number of voids in first 8 hours decrease from 5.53 to 3.48 in group I vs 5.7 to 2.13 in group II, p valve <0.01. The mean number of urgency episodes in first 8 hours in group I decreased from 4.23 to 3.11 vs 4.68 to 2.29 in group II, p valve <0.01. The mean number of nocturnal voids in group I decreased from 3.55 to 2.48 vs 3.35 to 1.34 in group II, p valve <0.01. The mean IIQ-7 score in group I decreased from 51.10 to 32.8 vs 54.63 to 18.82 in group II, p valve <0.01. Differences were statistically significant. There was statistically insignificant change in serum sodium level posttreatment between group I and group II. Conclusion: Combination of desmopressin and anticholinergics was more effective and safe than anticholinergics alone in the treatment of female patients with overactive bladder. Therefore, desmopressin combined with anticholinergics could be considered feasible and safe method for relief of symptoms in female patients with overactive bladder. However, larger and long-term studies for proper evaluation are warranted.
International Journal of Scientific and Research Publications (IJSRP), 2020
The aim of maternity care is the birth of a healthy baby to a healthy mother. Despite all efforts... more The aim of maternity care is the birth of a healthy baby to a healthy mother. Despite all efforts birth asphyxia occurs in 2 per 1000 births in developed countries and is almost 10 times higher in developing countries. In order to assess the fetal wellbeing, several antepartum surveillance tests have been devised. The most commonly used surveillance method is Cardiotocography (CTG). This prospective observational study was conducted in the Post graduate department of Gynecology and Obstetrics of GMC Srinagar associated Lalla Ded Hospital over a period of one and a half year from December 2017 to August 2019. Two hundred and fifty one primigravidae with low risk pregnancies at term in early labour were subjected to admission CTG. They were followed during the course of labour and their mode of delivery and perinatal outcome was assessed. All women gave written and informed consent before being included in the study. This included Primigravidae with singleton term pregnancy, non-anomalous baby,with intact membranes admitted in early labour. The parameters that were studied were age of the patients, gestational age,CTG changes (According to FIGO criteria for CTG Interpretation),Presence of Meconium, cord around neck at the time of delivery,Mode of delivery, APGAR Score at 0, 1 and 5 Minutes and need for admission in NICU. CTG parameters studied were Fetal heart rate, Baseline variability, Accelerations and Decelerations. The cardiotocogram was interpreted as per FIGO guidelines. In our study, maximum number of women (64.14%) were in the age group of 25-30 yrs and 96(38.25%) women had gestational age of 40 weeks, followed by 39 weeks in 87(34.66%), 38 weeks in 41(16.33%) and 37 weeks in 27(10.76%). Out of total 251 women, 94 women (37.45%) had Cat 1 CTG, 78 women (31.08%) had Cat 2 CTG and 79(31.47%) women had Cat 3 CTG. Of all these women 123(49%) delivered vaginally where as 128 (51%) delivered through Cesarean section (CS). In women with Cat 1 CTG (93.62%) delivered vaginally and 6.38% were delivered by CS as 4 of them had non-progression of labour, 1 had meconium stained liquor and 1 had non-descent of head. In women with Cat 2 CTG no significant difference was seen in mode of delivery as 42.31% delivered by NVD and 57.69% by LSCS. In women with Cat 3 CTG almost all (97.47%) were delivered by LSCS. However 2 of these women delivered vaginally while awaiting surgery. Thus, as the category of CTG changed from 1 to 3, the mode of delivery changed from NVD to LSCS and the results were statistically significant (Pearson Chi
The Internet Journal of Gynecology and Obstetrics, 2009
Objectives: This study was conducted to find doppler velocimetric indices of the uterine and umbi... more Objectives: This study was conducted to find doppler velocimetric indices of the uterine and umbilical artery in normotensive and hypertensive pregnancy and to detect SGA fetuses with abnormal velocimetric index.Study design: Two hundred women of third trimester in antenatal clinic were studied: hypertensive and normotensive 100 each. Baseline investigations and doppler velocimetry of both the uterine arteries and umbilical artery was done. Statistical analysis of data was done using the EPI-info 6 (CDC (US) / WHO). Result: The mean SD ratio of Uterine Artery decreased from 6.15 at 32-34 weeks to 3.06 at 38-40 weeks in the hypertensive group. Abnormal uterine artery doppler findings were reported in 55% of hypertensives. In the hypertensive group 92.10% of cases with SGA babies and 32.25% of cases with AGA babies had abnormal uterine artery Doppler findings.Conclusion: Abnormal doppler findings of the uterine and umbilical are more common in SGA fetuses.
The Internet Journal of Gynecology and Obstetrics, 2010
Introduction:Obstructed labor with high maternal morbidity and mortality is still prevalent in th... more Introduction:Obstructed labor with high maternal morbidity and mortality is still prevalent in the developing world. It is a preventable condition and can be overcome if proper steps are taken at appropriate levels and at appropriate time.Objective: To study the present burden of obstructed labor in a tertiary care Centre in a developing country, its causes and outcome.Materials and methods:Six months prospective study was carried out in Government Lalla Ded Hospital from July 2009 to December 2009. There were 117 cases of obstructed labor amongst a total number of 10862 births during this period in LD hospital. All patients admitted with obstructed labor were included in the study and the outcome of their pregnancy, mode of delivery and complications if any were noted. Results:117 patients of obstructed labor were admitted. CPD was the commonest cause of obstruction (87.18%). Most of the women affected were primigravida within the age group of 25 -30 years. Most of them were delivered by Cesarean Section. There was no maternal mortality, though there were some procedure related complications. Fetal mortality was high (25.64%).Conclusion:Obstructed labor is a preventable condition prevalent in the developing world only. Improving nutrition, antenatal attendance with proper utilization and standard of services will help overcome this condition.
Postplacental intrauterine device insertion at a teaching hospital
Contraception, 2014
To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectiv... more To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program. This was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months. Ninety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences. Postplacental IUD insertions can be safely and effectively performed within a training program. A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.
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