ORIGINAL RESEARCH ARTICLE | Nov. 7, 2019
Antepartum Hemorrhage at Tertiary Care Hospital- A Retrospective Study of Maternal and Fetal Outcome
Dr. N Chandra Prabha, Dr. Anisha G, D. Anvitha, Dr. G.Soumini
Page no 260-265
Antepartum Hemorrhage (APH) has always been one of the most feared obstetric emergencies which contribute to significant maternal and perinatal mortality and morbidity. Aims and objectives: To determine the causes of Antepartum Hemorrhage. To study the maternal and fetal outcome in various types of antepartum hemorrhage. Methods: It is a study conducted in OPD,Labour room and Intensive Care Unit(ICU) admissions in Department of Obstetrics and Gynaecology, Government General Hospital, Kakinada over a period of one year from April 2018 to March 2019 were analysed retrospectively. All cases of APH with gestational age more than 28 weeks whether diagnosed previously or during antental visits or during delivery, referred from other hospitals, emergency admissions are included in the study. Data was statistically analysed using SPSS 20 software. Results: The present study included 70 patients who was diagnosed as having placenta previa, abruptio placentae or APH due to undetermined causes presented with or without bleeding per vaginum in OPD, labour room,ICU. Majority of the patients (57.1%) had Placent previa while 41.4% had abruptio placentae; one case of APH is due to undetermined cause. Most of the cases of APH (64.3%) belong to the mean age group of 20-24 years both in placenta previa(57.5%) and abruptio placenta(75.9%) .65% of the cases are unbooked cases in placenta previa and 72.4% of the cases are unbooked cases in abruptio placenta. 90% of the cases of placenta previa are delivered by Caesarean section.55.8% of the cases of abruptio placenta are delivered by vaginal route.
ORIGINAL RESEARCH ARTICLE | Nov. 12, 2019
Recurrent Pregnancy Loss is Associated with Increased Red Cell Distribution Width and Platelet Distribution Width
Mansa kumawat, Huma Jahan, Rashmi
Page no 266-268
Background: The aim was to compare platelet distribution width and red cell distribution width between pregnant women with a history of recurrent pregnancy loss and pregnant women without a history of pregnancy loss. Methods: This was a prospective study to the evaluation of 70 pregnant women with a history of recurrent pregnancy loss and 70 pregnant women without a history of pregnancy loss in the first trimester. Results: It was observed that the mean RDW-SD of cases is higher i.e. 48.94 + 5.78 than controls i.e. 42.87 + 4.49. The mean RDW-CV values of cases and controls. It was observed that the mean RDW-CV of cases is higher i.e. 16.90 + 1.86 than controls i.e. 14.93 + 1.02. It was observed that the mean PDW of cases is higher i.e. 16.07 + 1.45 than controls i.e. 12.89 + 1.00. Conclusions: An increased platelet distribution width and red cell distribution width with recurrent pregnancy loss.
ORIGINAL RESEARCH ARTICLE | Nov. 12, 2019
Comparative Study of 25 µg Vaginal Misoprostol V/S Cerviprime Gel for Induction of Labour at Term
Huma Jahan, Mansa kumawat, Rashmi
Page no 269-271
Background: Induction of labour is an intervention that artificially initiates uterine contractions leading to progressive dilatation and effacement of cervix and expulsion of fetus prior to spontaneous onset of labour. Methods: This study was carried out in Labour ward at Apollo BGS Hospitals, a tertiary health care centre in Kuvempunagar, Mysore. 50 patients with an indication for induction of labour was receive 0.5 mg intracervical dinoprostonegel and repeated for a maximum of 3 doses every 6 hours as needed. 50 patient with an indication for labour induction was receive with 20ml [20 microgm] oral misoprostol solution and repeated every 2 hourly until adequate uterine contractions occurred [3 contractions per 10 min lasting 30-40 second]. Results: The average number of cerviprime gel doses given per patient was 1.42 ± 0.6417, whereas the average number of oral misoprostol solution doses given per patient was 4.52±1.2162 (p < 0.001). Conclusion: In conclusion, we found that both misoprostol and dinoprostone are useful and safe drugs for cervical ripening and labour induction when used at flexible doses and at intervals of 6 hours between doses in a low-risk population with unfavourable cervices. However, misoprostol offers the advantages of more rapid labour and less cost.
ORIGINAL RESEARCH ARTICLE | Nov. 12, 2019
Comparative Study of Maternal and Fetal Outcome between Low and Normal Amniotic Fluid Index
Swati, Lila Vyas
Page no 272-276
Background: Amniotic fluid is a clear, slightly yellowish liquid that surrounds the fetus during pregnancy. It is contained in the amniotic sac. During pregnancy, it acts as a shock absorber, maintains even temperature, allows for growth and free movement of the fetus and prevents adhesion between fetal parts and amniotic sac. The aim was to study fetal and maternal out come in cases of low AFI and normal AFI. Methods: A hospital based Prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur from April 2017 to September 2018. Study conducted on 110 pregnant women at term (37-40 weeks) attending antenatal clinic. They were divided in to two groups. Group-A comprising 55 patients with AFI >5 cm and Group-B comprising 55 Patients with AFI less than 5 cm or equal to 5 cm. Results: In our study, Out of 55 oligohydramnios patients, 43.64%(24) were induced, 27.27% (15) were augmented & 29.09%(16) were left for spontaneous progression of labor & out of 55 normal AFI patients 58.18%(32) patients were induced, 29.09%(16) were augmented, 12.73%(7) were left for spontaneous progression of labor. Mean Apgar score at 1 & 5 minute of birth is comparatively low in oligohydramnios patient & nursery admission was more, but only short term neonatal morbidity was seen. No long term consequences were present in these babies. Conclusion: An AFI ≤5 cm detected at term that was at or after 37 completed weeks of gestation in a low risk pregnancy was an indicator of poor perinatal outcome. Oligohydramnios was being detected more frequently now-adays due to ready availability of ultrasonography these days.
ORIGINAL RESEARCH ARTICLE | Nov. 20, 2019
Clinical Study Regardingthe Significance of Doppler & Modified Biophysical Profile in the Management of Post Dated Pregnancy
R.K. Talukdar, Nabanita Deka, Moohibul Rahman
Page no 277-283
Background: Prolonged gestation complicates 5% to 10% of all pregnancies and confers increased risk to both the fetus and mother. In the west about 18% of all singleton pregnancies persist > 41 weeks, 10%, >42 weeks and 4% (range, 2% to 7%) > 43 weeks without any obstetric intervention. The risks for prolonged and post-term pregnancy include obesity, nulliparity, maternal age >30 years. Racial and ethnic differences have also been cited to be the reasons for higher risk of prolonged and post-term pregnancy. Methods: A prospective study was carried out at Department of Obstetrics and Gynaecology, Gauhati Medical College & Hospital, Guwahati, Assam. 300 patients were selected and divided into three groups and were followed up with Doppler and MBPP till the delivery. Data so collected was subjected to Statistical analysis. Results: Majority of women enrolled in the study were aged around 25 years, multigravida (58%) and the study and control groups were matched demographically. The Doppler & modified biophysical profile was recorded in study and control group. Rate of caesarean delivery in spontaneous & induced, Baby NICU admission &mortality. Conclusions: This study had showed that its use can predict adverse perinatal outcome in low risk pregnancy in prediction of asphyxia. Hence our study recommends use of combimed Cerebroplacental ratio & MBPP has better sensitivity in postdated pregnancy to predict adverse perinatal outcome.
ORIGINAL RESEARCH ARTICLE | Nov. 28, 2019
Rhesus Negative Mother and Perinatal Outcome
Alakananda, Meghna Das, Manali Paul
Page no 284-387
Background: Rhesus incompatibility is a preventable cause for severe neonatal hyperbilirubinemia, hydrops fetalis and still births. The prevalence of the Rh-negative blood group among Indian woman varies from 2%-5%. Despite declining the incidence of Rhesus incompatibility, due to availability of anti-D immunoglobulin, and improved antenatal care of the Rh-negative pregnant woman, it still accounts for a significant proportion of neonatal hyperbilirubinemia and morbidity. Objectives: To study the perinatal outcome in Rhesus negative Pregnancies. Methodology: This prospective observational study was conducted in a tertiary hospital. Women with Rh Negative Blood group admitted for delivery were enrolled. Baby’s Blood Group, Birth weight, TSB levels, duration of phototherapy or exchange transfusion, duration of NICU admission, and other investigations were recorded in a predesigned, pretested proforma. Conclusion: Over the 20th century, Rh isoimmunization was clinically recognized, its pathophysiology was understood, its treatment was established, and preventive measures were created to eliminate it. Awareness should be increased amongst health care providers regarding RAADP and prophylaxis after MTP, abortion, ectopic pregnancy in Rh negative blood group, and importance of Antenatal Care and importance of Rh typing in pregnancy.
Heart disease is a major cause of mortality and morbidity in pregnant women. It is reported in 0.2 to 4% of all pregnancies. The incidence of heart disease in pregnancy has increased in the last two decades due to better surgical treatment for congenital heart disease, due to which more number of women are surviving to reach adulthood and opting to conceive and continue pregnancy. Pregnancy is associated with major physiological adaptations in to ensure adequate blood supply to uterus and to ensure blood supply to growing fetus. The net result is increase in cardiac output, plasma volume, heart rate and decrease in systemic vascular resistance. Risk assessment in pregnancy is based on CARPREG scoring system. Patient should be informed about the increased chance of miscarriage, prematurity and fetal growth restriction. If pregnant female is on warfarin it needs to be switched to heparin at pregnancy detection and again at 36 weeks. In general, vaginal delivery is preferred and delivery should occur in tertiary centres with readily available team of cardiologist, anesthetist, senior obstetrician and neonatologist.
ORIGINAL RESEARCH ARTICLE | Nov. 30, 2019
Retrospective Study of Risk Factors for Abruptio Placenta and Assessing Maternal and Fetal Outcome
K.Sravani, K. Madhavi
Page no 293-297
Aims: Abruptio placenta which is a major cause of maternal morbidity and perinatal mortality globally is of serious concern in the developing world. We retrospectively analysed the abruptio placenta cases and evaluated its impact on maternal and fetal outcomes. Materials and methods: This is a retrospective study conducted in department of Obstetrics and Gynaecology at GGH, KADAPA from April 2018 to June 2019. Patients of abruptio placenta with more than 28 weeks of gestation, presenting with antepartum haemorrhage and their maternal and fetal outcome is evaluated. Results: In our study period we encountered 30 abruptio placenta cases. In 30 patients 11(36%) patients were presented with preeclampsia, 18(60%) patients were multiparous, and almost all the patients were having anaemia. These were considered as risk factors for abruptio placenta. All the cases were referred from nearby PHC to our tertiary care hospital, GGH, KADAPA. In our study 3(10%) patients developed complications, in that 2(6.6%) patients developed Disseminated Intravascular Coagulation (DIC) and 1(3.33%) patient had acute kidney injury and no maternal deaths encountered in our study. Regarding fetal outcome 22(73.33%) patients presented with IUFD by the time of presentation to the hospital and 1(3.33%) stillbirth, 2(6.6%) babies admitted in SNCU and 5(16.66%) were having good Apgar. Conclusion: We observed that higher incidence of anaemia, multiparity and preeclampsia as risk factors in our study population. We need to motivate public regarding the importance of antenatal care, improvement in nutritional status and create awareness about family planning practices. We noticed that early identification and intervention can prevent maternal and perinatal mortality.