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Savita Rani Singhal

Bio: Savita Rani Singhal is an academic researcher from Pt. B.D. Sharma PGIMS Rohtak. The author has contributed to research in topics: Pregnancy & Misoprostol. The author has an hindex of 10, co-authored 62 publications receiving 343 citations.
Topics: Pregnancy, Misoprostol, Medicine, Cervix, Vagina


Papers
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25 Dec 2009
TL;DR: There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care and it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.
Abstract: Background: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Present study was planned to find the maternal and perinatal outcome in patients of severe pre-eclampsia and eclampsia.Methodology:It is a prospective study, carried out on 100 pregnant women admitted with severe pre-eclampsia and eclampsia at a tertiary care referral unit. Detailed history and examination was carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, fundus and 24 hours urine for protein were done. Obstetric management was done as per existing protocol in the department, magnesium sulphate was the drug of choice for controlling convulsions, and blood pressure was controlled either by oral nefidipene or methyl dopa. Maternal and perinatal complications were noted down.Results:M The majority of the patients was unbooked (82%), belonged to lower socioeconomic status (84%) and had rural background (84%). Headache was the most common antecedent symptom (44%) followed by epigastric pain (20%), oliguria (9%), blurring of vision (8%) and ascitis (5%). There was high incidence of maternal complications like PPH (31%), abruption placentae (11%), renal dysfunction (8%), pulmonary edema (8%), pulmonary embolism (4%), HELLP syndrome (2%) and DIC (2%). Maternal mortality was 8% and the causes were pulmonary embolism in four women, DIC in two, HELLP and pulmonary edema in one each. Perinatal complications were also high 71.43% were low birth weight, 66% had preterm delivery, 52.4% babies had birth asphyxia and 28.57% were still born. Maternal and perinatal outcome was much poorer in eclampsia as compared to severe pre-eclampsia.Conclusion: There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care. Good antenatal care could have been prevented severe pre-eclampsia and eclampsia to some extent. Thus it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.

44 citations

Journal Article
TL;DR: There is very high maternal and perinatal morbidity and mortality in APH, particularly in women admitted with the diagnosis of APH.
Abstract: Introduction: Antepartum hemorrhage (APH) is a grave obstetrical emergency. Maternal and perinatal complications in APH are anemia, malpresentatons, postpartum hemorrhage, shock, low birth weight, intrauterine death, and birth asphyxia. Aims And Objectives: Aims of the present study were to find the demographic profile, type of APH, maternal and perinatal complications. Patients And Methods: It is a retrospective study carried out over a period of one year on 226 women admitted with the diagnosis of APH. Results: The incidence of APH was 3.01%. Maternal and perinatal morbidity was very high with increased rates of anemia (100%), cesarean section rate (43.80%), post partum hemorrhage (27.84%), need of blood transfusion (78.77%), puerperal pyrexia (10.61%), coagulation failure (10.61%), low birth weight (83.18%) and birth asphyxia (12.5%). The maternal and perinatal mortality was very high 2.21% and 23.70% respectively. Conclusions: There is very high maternal and perinatal morbidity and mortality in APH.

31 citations

Journal ArticleDOI
TL;DR: An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death with suspicion of non-communicating uterine horn with bicornuate uterus.

29 citations

Journal ArticleDOI
TL;DR: It is concluded that misoprostol is cheaper, stable at room temperature, has shorter IDI and requires less oxytocin in pregnant women especially in developing and tropical countries.
Abstract: A prospective study was carried out at a tertiary care hospital on 100 pregnant women admitted for induction of labour to compare the effect of misoprostol and dinoprostone on the induction of labour. The patients were divided randomly into two groups of 50 each. Group I received 25 microg misoprostol intravaginally every 3 h (maximum dose 200 microg), and Group II received 0.5 mg PGE(2) gel (dinoprostonev) intracervically every 6 h (maximum three doses in 24 h) until good uterine contractions started. The primary outcome measure was vaginal delivery occurring within 24 h of administration of the first dose of either study drug (successful induction). Statistical analysis were conducted using chi(2) test, Fisher exact test, Student's t-test and relative risk (RR) with 95% confidence interval (CI). In the misoprostol group, more patients achieved successful inductions as compared with the dinoprostone group, 80% vs. 62% (P = 0.0473, RR 1.63, 95% CI 0.95-2.81). The mean induction to delivery interval (IDI) was shorter in the misoprostol group, 13.30+/-8.74 (3-40.15) hours, as compared with the dinoprostone group, 18.53+/-11.33 (2-48.07) hours (P = 0.011). Misoprostol was associated with significantly less oxytocin use (18% vs. 50%) as compared with dinoprostone (P = 0.001 RR 0.36, 95% CI 0.19-0.69). In conclusion, although both misoprostol and dinoprostone appear to be effective agents for labour induction, misoprostol is cheaper, stable at room temperature, has shorter IDI and requires less oxytocin. These results make misoprostol superior to dinoprostone for induction of labour especially in developing and tropical countries.

27 citations

Journal ArticleDOI
TL;DR: Two parallel vertical compression sutures (Hayman stitch) placed in the uterus controls bleeding effectively and should be tried first before other complex measures like uterine artery ligation are undertaken particularly for those obstetricians who lack sufficient training and skill.
Abstract: Objectives The present study was planned to access the efficacy of Hayman uterine compression stitch which is easy, can be applied faster and avoids the performance of a lower segment hysterotomy in patients with atonic postpartum hemorrhage. Materials and Methods It is a study carried out from January 2004 to December 2008 at a tertiary care center and included 48 women who had intractable atonic PPH not managed with medical treatment and who were wishing to preserve their fertility. Hayman stitch which is a simplified approach to uterine compression sutures was performed by tying two parallel vertical sutures from just above the bladder reflection to the fundus of the uterus. Results With Hayman stitch hysterectomy was avoided in 93.75% (45 out of the 48) patients with PPH. The postoperative course was uncomplicated, six women conceived spontaneously within 12 month after uterine compression suturing. Four delivered vaginally and two underwent cesarean section in view of fetal distress. The uterine cavity was found to be normal during caesarean section. Conclusion Two parallel vertical compression sutures (Hayman stitch) placed in the uterus controls bleeding effectively. The technique is easy, rapid and requires less skill and this simple procedure be tried first before other complex measures like uterine artery ligation are undertaken particularly for those obstetricians who lack sufficient training and skill.

22 citations


Cited by
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Journal ArticleDOI
TL;DR: Vaginal misoprostol labour induction was associated with less epidural analgesia use, fewer failures to achieve vaginal delivery within 24 hours and more uterine hyperstimulation.
Abstract: Background Misoprostol (Cytotec, Searle) is a prostaglandin E1 analogue widely used for off-label indications such as induction of abortion and of labour. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. Objectives To determine the effects of vaginal misoprostol for third trimester cervical ripening or induction of labour. Search methods The Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008) and bibliographies of relevant papers. We updated this search on 15 February 2012 and added the results to the awaiting classification section. Selection criteria Clinical trials comparing vaginal misoprostol used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. Data collection and analysis We developed a strategy to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. We used fixed-effect Mantel-Haenszel meta-analysis for combining dichotomous data. If we identified substantial heterogeneity (I² greater than 50%), we used a random-effects method. Main results We included 121 trials. The risk of bias must be kept in mind as only 13 trials were double blind. Compared to placebo, misoprostol was associated with reduced failure to achieve vaginal delivery within 24 hours (average relative risk (RR) 0.51, 95% confidence interval (CI) 0.37 to 0.71). Uterine hyperstimulation, without fetal heart rate (FHR) changes, was increased (RR 3.52 95% CI 1.78 to 6.99). Compared with vaginal prostaglandin E2, intracervical prostaglandin E2 and oxytocin, vaginal misoprostol was associated with less epidural analgesia use, fewer failures to achieve vaginal delivery within 24 hours and more uterine hyperstimulation. Compared with vaginal or intracervical prostaglandin E2, oxytocin augmentation was less common with misoprostol and meconium-stained liquor more common. Lower doses of misoprostol compared to higher doses were associated with more need for oxytocin augmentation and less uterine hyperstimulation, with and without FHR changes. We found no information on women's views. Authors' conclusions Vaginal misoprostol in doses above 25 mcg four-hourly was more effective than conventional methods of labour induction, but with more uterine hyperstimulation. Lower doses (25 mcg four-hourly or less) were similar to conventional methods in effectiveness and risks. The authors request information on cases of uterine rupture known to readers. The vaginal route should not be researched further as another Cochrane review has shown that the oral route of administration is preferable to the vaginal route. Professional and governmental bodies should agree guidelines for the use of misoprostol, based on the best available evidence and local circumstances. [Note: The 27 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

472 citations

26 Oct 2013
TL;DR: In this paper, the authors examined temporal trends in severe postpartum hemorrhage, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus.
Abstract: OBJECTIVE Because the diagnosis of postpartum hemorrhage (PPH) depends on the accoucheur's subjective estimate of blood loss and varies according to mode of delivery, we examined temporal trends in severe PPH, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus. STUDY DESIGN We analyzed 8.5 million hospital deliveries in the US Nationwide Inpatient Sample from 1999 to 2008 for temporal trends in, and risk factors for, severe PPH, based on International Classification of Diseases, 9th revision, clinical modification diagnosis and procedure codes. Sequential logistic regression models that account for the stratified random sampling design were used to assess the extent to which changes in risk factors explain the trend in severe PPH. RESULTS Of the total 8,571,209 deliveries, 25,906 (3.0 per 1000) were complicated by severe PPH. The rate rose from 1.9 to 4.2 per 1000 from 1999 to 2008 (P for yearly trend < .0001), with increases in severe atonic and nonatonic PPH, due especially to PPH with transfusion, but also PPH with hysterectomy. Significant risk factors included maternal age ≥35 years (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.5-1.6), multiple pregnancy (aOR, 2.8; 95% CI, 2.6-3.0), fibroids (aOR, 2.0; 95% CI, 1.8-2.2), preeclampsia (aOR, 3.1; 95% CI, 2.9-3.3), amnionitis (aOR, 2.9; 95% CI, 2.5-3.4), placenta previa or abruption (aOR, 7.0; 95% CI, 6.6-7.3), cervical laceration (aOR, 94.0; 95% CI, 87.3-101.2), uterine rupture (aOR, 11.6; 95% CI, 9.7-13.8), instrumental vaginal delivery (aOR, 1.5; 95% CI, 1.4-1.6), and cesarean delivery (aOR, 1.4; 95% CI, 1.3-1.5). Changes in risk factors, however, accounted for only 5.6% of the increase in severe PPH. CONCLUSION A doubling in incidence of severe PPH over 10 years was not explained by contemporaneous changes in studied risk factors.

321 citations

Journal ArticleDOI
TL;DR: Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture are present, and surgical removal before pregnancy is recommended.

262 citations

Book Chapter
01 Jan 2008

216 citations

Journal ArticleDOI
TL;DR: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours and several treatments reduced the odds of caesarean section, but there was considerable uncertainty in treatment rankings.
Abstract: Background More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 µg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 µg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention. Future work Future trials should be powered to detect a method that is more cost-effective than misoprostol solution and report outcomes included in this NMA. Study registration This study is registered as PROSPERO CRD42013005116. Funding The National Institute for Health Research Health Technology Assessment programme.

119 citations