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Objective To Asses and develop an indigenous protocol to optimize labour outcome, as Programmed Labor. Design Open, prospective (Between January 2000 to December 2007), randomized, parallel group, monocentric, comparative matching trial. Settings Labor rooms at Nowrosjee Wadia Maternity, Mumbai. Selection criteria 200 patients in each group, aged between 21-30, as low-risk parturient. Intervention Partography, Oxytocin, Primiprost, Pentazocin, Dizepam, Tramadol, Drotin, Ketamine. Outcome parameters Satisfactory obstetric outcome, progressive labor of shorter duration, less blood loss and pain relief. Results Study group had mean shorter duration of active labor as 3.5 hrs compared to controls of 5.2 hrs. Excellant pain relief was of 24 and 62% of substantial relief in comparison to 32% only in other group with no patient falling in excellent group. Second stage of labor was reduced by half (26 to 48 meters) and lesser third stage blood loss. Conclusions Programmed labor with indigenous protocol developed and practiced, results in progressive, shorter, and comfortable labors with lesser blood loss.

The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.

BACKGROUNDThe aim of the study is to determine the current practices in the medical college institutions pan India for testing for Hyperglycaemia in Pregnancy (HIP) to detect gestational diabetes and highlight areas that need additional attention in order to ensure adherence to current national guidelines. MATERIALS AND METHODSQuestionnaires were used to obtain information regarding the testing strategy for hyperglycaemia in pregnancy. The questionnaires were filled out by the teaching faculty of the OB/GYN departments of 47 medical college institutions in India. The perceptions regarding the prevalence of diabetes in pregnancy in India and the needs for capacity building were assessed. RESULTSForty seven respondents answered the questionnaires. The majority of respondents (95.83%) reported that all pregnant women were offered (universal) testing for hyperglycaemia in pregnancy and 37.5% reported that women were screened both in early and midtrimester of pregnancy. Most reported that testing for HIP took place once at booking, irrespective of the gestational age (39.58%). Thirty three (70.21%) respondents reported using the single-step nonfasting method to diagnose hyperglycaemia. Furthermore, 21.28% of respondents reported using a glucometer to determine the concentration of blood glucose in plasma, while 68.08% reported using a lab analyser. The instructions for the testing were offered by consultants and postgraduates in a vast majority of cases (87.5%). The staff communicated with the women in a significantly less number of cases (12.5%). 65.96% of respondents felt that all women readily agreed to follow this advice. The majority of respondents (89.35%) reported having noticed an increase in the number of women with hyperglycaemia. Furthermore, 91% of all the respondents felt there was a need to train medical personnel to test and manage hyperglycaemia. CONCLUSIONOur study confirms the continued wide variability in testing for HIP in India with respect to timing and frequency. It highlights the need for training initiatives to improve adherence to national guidelines. Clinical Significance-Increasing adherence to and awareness of national guidelines has the potential to result in earlier diagnosis and management of HIP. This would have an impact, which would improve pregnancy outcomes, maternal and neonatal health both in the short term as well as long term. Building the capacity of the available resource pool of healthcare providers including the staff nurses would empower them by for better communication. This would improve compliance for testing and follow up.

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