Birthing Position: The Impact on Second Stage of Labor— A Randomized Parallel Trial Shobha Shiragur, Sannidhi Jain, Rajasri G Yaliwal, Shailaja R Bidri Journal of South Asian Federation of Obstetrics and Gynaecology, 2025 Aim and background: Birthing positions are different positions that a pregnant woman can adopt during the second stage of labor (SSL).It advantageous for the baby's easy passage as well as for the mother's well-being.Both flexible sacrum positions and non-flexible sacrum positions help in the easy passage of the baby and help to reduce the duration of SSL. Aims:Primary outcome: To assess and compare labor in terms of duration of SSL, perineal tear, and intensity of pain.Secondary outcome: To assess the APGAR score in neonates and postpartum blood loss.Materials and methods: It is a randomized parallel study was conducted in the tertiary care center over 8 months.Clinical data like duration of SSL, degrees of perineal tear, neonatal APGAR score, blood loss, and pain intensity were analyzed.A total of 140 primigravida were studied, and they were divided into the squatting and lateral groups.Participants in the squatting group were assigned the squatting position, while those in the lateral group were assigned the lateral position during the SSL.Results: Women in the flexible sacrum position had a shorter duration of SSL; the mean duration for the squatting position was 25.93 minutes, while the lateral position was 32.95 minutes (p > 0.001).The lateral position had a higher incidence of first-degree perineal tears (p > 0.001).There was no statistically significant difference in other parameters like intensity of pain, immediate neonatal outcomes (APGAR score), and blood loss. Conclusion:The duration of the SSL takes less time in the squatting position than compared to the lateral position.There was no statistically significant difference in other parameters like intensity of pain, neonatal APGAR score, and blood loss.
Safety and efficacy of adding single dose adjunctive azithromycin prophylaxis for emergency cesarean delivery Nannuri Vindhyavali, Shobha Shiragur, Shailaja R Bidri, Shreedevi Kori, Rajasri G Yaliwal Indian Journal of Obstetrics and Gynecology Research, 2025 Safety and efficacy of adding single dose adjunctive azithromycin prophylaxis for emergency cesarean delivery - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2025.040, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res
Early diagnosis of gestational diabetes mellitus by HbA1c as a predictor-Prospective observational study Paleti Leela Lavanya, Shobha Shiragur, Shailaja R Bidri, Aruna Mallangouda Biradar, Shreedevi Kori Indian Journal of Obstetrics and Gynecology Research, 2025 Medical Publisher in Delhi, India - IP Innovative Publication Pvt Limited, Medical Journals Publication, Open Access Journals, Print Journals,Indian Journals, Surgery, Microbiology, Anaesthesia, Anatomy Biochemistry Books and Journals, Skills for Employability,Best Journal Publishers-IP Innovative Publication Pvt Limit
Ruptured Ectopic Pregnancy at Tertiary Care Centre: A Cross-sectional Study Shobha Shiragur, Preeti Patil, Praveen Ganganahalli, Muttappa Gudadinni, Shailaja Bidri, Aruna Biradar, Rajasri Yaliwal International Journal of Women S Health and Reproduction Sciences, 2023 Objectives: Ectopic pregnancy (EP) is the leading cause of early pregnancy accounting for 10-15% of pregnancy-related deaths. It is life-threatening condition where the majority of them present late. This study aims to evaluate the incidence, risk factors, clinical features, diagnosis, and management of EP in the tertiary care center. Materials and Methods: This study conducted a retrospective analysis of electronic medical records from June 2015 to June 2020, focusing on participants in the age group of 18 to 45 years, to examine the occurrence of EP. The data were analysed with simple descriptive statistics and presented in frequency tables and charts of age group, parity, anemia grades, risk factors and presenting symptoms. Results: The incidence of EP in the current study was 0.38%. In the present study, 73.8% of women were of 20–30-year-old. In this study, 54.1% of women had a history of pelvic inflammatory disease (PID). Prior EP was seen in 19.7 % of cases. 16.4% of participants had a prior history of tubectomy and 19.7% had a previous history of infertility treatment, and 21.3% had a previous history of lower segment caesarean section (LSCS). In the present study, 65.5% of women presented with amenorrhea of 4-8 week, and 95% had abdominal pain. In the present study, common site was the right fallopian tube in 73.9% of cases. In this study, all cases need surgical management most common procedure carried out was salpingectomy. intensive care unit (ICU) admission was needed in 26.2% of cases, and no mortality was seen in our study. Conclusions: EP is a serious and potentially life-threatening condition. Early diagnosis and prompt management are crucial in reducing maternal mortality and morbidity rates.
Randomised control trial of 3 iu intravenous oxytocin bolus with 7 iu oxytocin infusion versus 10 iu intramuscular oxytocin in the third stage of labour in the prevention of postpartum hemorrhage Aruna Biradar, Rajasri G Yaliwal, Shreedevi Kori, Sangamesh Mathapati, Shobha Shiragur, et al. International Journal of Women S Health and Reproduction Sciences, 2021 Objectives: Intravenous (IV) oxytocin during vaginal delivery has been rarely used since an intramuscular (IM) route or IV infusion have been preferred in this regard. The trial aimed to compare the low-dose IV bolus 3 IU of oxytocin, along with 7 IU oxytocin infusion with 10 IU oxytocin infusion in cesarean section. Materials and Methods: A parallel control randomized study was conducted on a total of 320 consenting term pregnant women based on the inclusion criteria. The participants were randomized into either 3 IU IV bolus and 7 IU infusion of oxytocin or 10 IU of IM oxytocin following vaginal delivery. The difference in pre- and post-delivery hemoglobin (Hb) levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, and the need for additional uterotonics and blood transfusions were assessed based on the aim of the study. Results: Based on the results, more women with severe blood loss were found in the IM oxytocin group in comparison to the IV bolus with infusion group following vaginal delivery. In addition, more women had a drop in the Hb of 3 gm/dL in the IM oxytocin group compared to the IV bolus-infusion group (11% vs. 4%, odds ratio=0.768, P=0.469) although there was no statistical significance in this respect. The tone of the uterus was firmer in the IV bolus with infusion group at 3 and 5 minutes. Eventually, the difference in hemodynamic changes, side effects, and the need for additional uterotonics or blood transfusions was not significant. Conclusions: In general, an IV bolus of 3 IU with a 7 IU infusion of oxytocin is as safe as and more effective than the IM injection of 10 IU of oxytocin at the time of vaginal delivery for the prevention of postpartum hemorrhage.
A randomized control trial of 3 iu iv oxytocin bolus with 7 iu oxytocin infusion versus 10 iu oxytocin infusion during cesarean section for prevention of postpartum hemorrhage Rajasri G Yaliwal, Aruna M Biradar, Prathibha S Dharmarao, Shreedevi S Kori, Subhashchandra R Mudanur, Neelamma G Patil, Shobha S Shiragur, Sangamesh S Mathapati International Journal of Women S Health, 2020 Purpose Oxytocin is the preferred choice for prophylaxis and treatment of postpartum hemorrhage. Intravenous infusion has been a widely accepted route for Oxytocin administration. However, intravenous bolus route is not a readily preferred route due to apprehensions regarding hypotension that it may cause. This trial compares low dose 3 IU intravenous (IV) bolus Oxytocin along with 7 IU Oxytocin in intravenous infusion to 10IU Oxytocin intravenous infusion during cesarean section. Patients and Methods A total of 250 term pregnant women were randomized to either 3 IU intravenous bolus with 7 IU intravenous infusion of Oxytocin or 10IU of intravenous Oxytocin infusion. The difference in pre- and post-operative hemoglobin levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, need for additional uterotonics and need for blood transfusions were assessed. Results There was 6.7% less blood loss in the 3 IU IV bolus Oxytocin with 7 IU Oxytocin infusion group in comparison to the Oxytocin infusion group. The tone of the uterus was firmer in IV bolus Oxytocin with Oxytocin infusion group at 5 minutes (p<0.001) than the Oxytocin infusion group. There was no significant difference in the hemodynamic changes, adverse effects or need for blood transfusions. Conclusion Intravenous bolus of 3 IU Oxytocin along with 7 IU infusion of Oxytocin is as safe and more effective than intravenous infusion of 10 IU of Oxytocin during cesarean section in the prevention of postpartum hemorrhage.
Heat-Stable Carbetocin Versus Oxytocin to Prevent Hemorrhage after Vaginal Birth Mariana Widmer, Gilda Piaggio, Thi M. H. Nguyen, Alfred Osoti, Olorunfemi O. Owa, Sujata Misra, Arri Coomarasamy, Hany Abdel-Aleem, Ashalata A. Mallapur, Zahida Qureshi, Pisake Lumbiganon, Archana B. Patel, Guillermo Carroli, Bukola Fawole, Shivaprasad S. Goudar, Yeshita V. Pujar, James Neilson, G. Justus Hofmeyr, Lin L. Su, Jose Ferreira de Carvalho, Uma Pandey, Kidza Mugerwa, Shobha S. Shiragur, Josaphat Byamugisha, Daniel Giordano, A. Metin Gülmezoglu Obstetrical and Gynecological Survey, 2018 METHODS We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively.
Heat-stable carbetocin versus oxytocin to prevent hemorrhage after vaginal birth Mariana Widmer, Gilda Piaggio, Thi M.H. Nguyen, Alfred Osoti, Olorunfemi O. Owa, Sujata Misra, Arri Coomarasamy, Hany Abdel-Aleem, Ashalata A. Mallapur, Zahida Qureshi, Pisake Lumbiganon, Archana B. Patel, Guillermo Carroli, Bukola Fawole, Shivaprasad S. Goudar, Yeshita V. Pujar, James Neilson, G. Justus Hofmeyr, Lin L. Su, Jose Ferreira de Carvalho, Uma Pandey, Kidza Mugerwa, Shobha S. Shiragur, Josaphat Byamugisha, Daniel Giordano, A. Metin Gülmezoglu New England Journal of Medicine, 2018 BACKGROUND Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat‐stable carbetocin with oxytocin. METHODS We enrolled women across 23 sites in 10 countries in a randomized, double‐blind, noninferiority trial comparing intramuscular injections of heat‐stable carbetocin (at a dose of 100 &mgr;g) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double‐blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively. RESULTS A total of 29,645 women underwent randomization. The frequency of blood loss of at least 500 ml or the use of additional uterotonic agents was 14.5% in the carbetocin group and 14.4% in the oxytocin group (relative risk, 1.01; 95% confidence interval [CI], 0.95 to 1.06), a finding that was consistent with noninferiority. The frequency of blood loss of at least 1000 ml was 1.51% in the carbetocin group and 1.45% in the oxytocin group (relative risk, 1.04; 95% CI, 0.87 to 1.25), with the confidence interval crossing the margin of noninferiority. The use of additional uterotonic agents, interventions to stop bleeding, and adverse effects did not differ significantly between the two groups. CONCLUSIONS Heat‐stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial. (Funded by Merck Sharpe & Dohme; CHAMPION Australian New Zealand Clinical Trials Registry number, ACTRN12614000870651; EudraCT number, 2014‐004445‐26; and Clinical Trials Registry‐India number, CTRI/ 2016/05/006969.)
