Progesterone supplementation for prevention of preterm birth.

Objective: To study the efficacy of Progesterone supplementation for prevention of preterm birth. Study Design: Descriptive Interventional Study. Setting: Department of Obstetrics and Gynecology at Independent University Hospital, Faisalabad. Period: January 2018 to December 2020. Material & Methods: Data collected by using Non probability consecutive sampling techniques. Total 156 patients were included in study. Data was collected after informed consent, on pre designed proforma. Patient presented in 1st trimester and having previous history spontaneous preterm labour and recurrent miscarriages. We included patient presenting after 24 weeks of pregnancy and patient having threatened or actual preterm labour. Results: Among 156 patients, more than 82% of patient were delivered after 34 weeks of gestation and 18% were delivered before 34 weeks of gestation. Fetal outcome was very good in those patients who were delivered after 34 weeks of gestation with the use of Prophylactic progesterone therapy. Conclusion: Prophylactic use of progesterone helps in prolongation of pregnancy beyond 36 weeks and also help in decreasing the morbidity associated with premature delivery.

A case report on placental chorioangioma

Chorioangioma is the term used to describe an abnormal proliferation of vessels arising from chorionic tissue, which is most commonly observed in the third, and less frequently in the second trimester of pregnancy as a solitary nodule or, less commonly, as multiple nodules. We here report a case of placental chorioangioma which presented as a case of preterm labour. 21 year old primigravida presented to us at 26 weeks of gestation with history of PV leak and pain in abdomen. Ultrasound showed a single live foetus corresponding to 24-26 weeks of gestation with amniotic fluid index (AFI): 5 cm (oligohydramnios) there was evidence of 58×42 mm heterogeneously hypoechoic lesion noted over placenta likely s/o chorioangioma. Patient went into spontaneous preterm labour on day 5 and delivered vaginally. Placenta weighted 700 gm. A globular mass of size 6×7 cm was attached to foetal surface of placenta with a pedicle with confirmed the finding of ultrasonography. Placental chorioangioma is associated with high rates of perinatal complications. Most complications may appear early and delivery is problematic due to prematurity. Thus better prenatal investigations and regular follow up is required for early diagnosis and treatment.

Compare safety and efficacy of intramuscular progesterone versus vaginal progesterone in prevention of preterm labour

Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies. It was a prospective randomize control study. All the cases with inclusion and exclusion criteria were selected during the study period. The subjects were randomized into two groups with group A received vaginal micronized progesteron and group B intramuscular 17a hydroxyprogesteron caproate. Total of 100 cases were included in this study. All preterm pregnancy of more than 20 weeks were considered in this study. Initial nefidipine 10 mg, 4 tablets 15 min apart was given for tocolytic activity for 48 hours. Injection bethamethasone 12 mg I.M 2 doses in a duration of 24 hours apart is given for fetal lung maturity. One group will receive weekly intramuscular 17a hydroxyprogesteron (250 mg) injection while other group will receive daily micronized vaginal progesteron suppository (200mg). Subsequently compare the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour and analyse maternal and fetal factors.Subsequently compared the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour.This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean ± SD of birthweight in Group A and Group B was 2784.2 ± 490.7 gm and 2813.9 ± 363.3 gm respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth. Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.

A prospective study of prediction of preterm delivery by cervical assessment by transvaginal sonography

Preterm birth is a major cause of death and a significant cause of long-term loss of human potential amongst survivors all around the world. Complications of preterm birth are the single largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths a year, and the second most common cause of under-5 deaths after pneumonia. In this study, an attempt has been made to evaluate the usefulness of cervical assessment by TVS in prediction of risk of preterm delivery in low risk pregnant women, thereby earlier management option can be planned and patients specific treatment can be given at the earliest. The present study was carried out in tertiary care teaching hospital for 1 year from 1 Jan 2019 to 31 Dec 2019. Total of 100 study participants who underwent TVS assessments of cervix regularly followed up who underwent TVS assessment of cervix and were regularly follow up and delivered. The mean cervical length in all these women was 30±6.68 mm. It was observed that 51.72% of patients with short cervical length less than 25 mm had preterm labour compared to the patients with cervical length more than 25mm i.e. 4.22%. Cervical assessment by TVS is effective in predicting preterm labour.

Outcome of Preterm Labour in SSMC Mitford Hospital, Dhaka.

Introduction: : Preterm birth as a consequence of preterm labour is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability and two-thirds of all perinatal deaths. Moreover, preterm labour comprises a large number of low birth weight babies. Global incidence of preterm labour is 5-10% of all births. The aim of this study was to determine the clinical profile and to find out pregnancy outcomes of preterm labour. Materials & Methods: This cross-sectional study was conducted in Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2005 to December 2005. A total 103 gravid women who got admitted with established premature labour pain were included as study patients. Preterm labour associated with severe pre-eclampsia, eclampsia, antepartum haemorrhage and intrauterine fetal death were excluded. Data were collected in a pre-designed questionnaire and analyzed by SPSS software. Results: Incidence of preterm labour was found 6.3%. Among maternal morbidities, puerperal sepsis found to be highest (14.56%) followed by UTI (7.77%), PPH (6.80%), wound infection (5.83%) and retained placenta (3.88%). This study found perinatal mortality 32.0% and morbidity 49.5% of which RDS contributed highest (24.27%) followed by neonatal jaundice (11.65%), septicemia (8.73%), neonatal convulsion (2.91%) and umbilical sepsis (1.94%). Conclusion: Preterm labor followed by preterm birth significantly contributes to maternal morbidity and perinatal morbidity and mortality. Medicine Today 2021 Vol.33(2): 143-146

MATERNALAND PERINATAL OUTCOME IN HYPOTHYROIDISM IN PREGNANCY.

BACKGROUND: Pregnancy is a period that places great physiological stress on both the mother and the foetus .This study was conducted to analyse the fetomaternal outcome of pregnant women with hypothyroidism. The commonest thyroid disorder found in pregnancy is hypothyroidism and it adversely affects the maternal and foetal health in the form of infertility, early pregnancy loss, pre eclampsia , anaemia ,FGR, PROM, preterm labour, neonatal and maternal morbidity and mortality. Routine screening, early detection and conrmation of diagnosis and prompt treatment is required to ensure favourable maternal and foetal outcomes. METHODS: The present study was conducted in the department of obstetrics and gynaecology of Adhichunchanagiri Institute of Medical Sciences ,B.G Nagara , Mandya from November 2019 to October 2020.All pregnant females who are diagnosed as hypothyroidism , admitted to labour room were included in the study . RESULTS: In the present study the most common maternal complication is preeclampsia , postpartum haemorrhage and fetal complication is preterm labour. CONCLUSION: Maternal hypothyroidism is a disorder with great potential to adversely affect maternal and foetal outcomes .If the condition is diagnosed early and prompt initiation of treatment ,adequate follow up is done then the condition can be easy treated with very little detrimental effects to the mother and the foetus. This study concludes that sufcient education of the doctors and the patients about the universal screening, thyroid associated complications along with ease and advantages of prompt management is very much necessary.

Association Between Pre-Term Labour and Inter Pregnancy Interval

Objectives: To determine the frequency of preterm labour in association with interpregnancy interval among pregnant women visiting tertiary care Hospital. Subject and Methods: This prospective cross-sectional study was performed at Unit-I, Obstetrics and Gynaecology Department, Civil Hospital Karachi; from June to November 2020. A total of 190 women with singleton pregnancy confirmed by ultrasound were included. After taking detailed medical history regarding previous fetal death and C-section was recorded either patient goes into preterm labour or not and confirmed by history for short and prolong interpregnancy interval (IPI). Data was collected by pre-designed study proforma. Results: The average age of study subjects was 26.27±4.07 years. The frequency of preterm labour among the pregnant women was 51.05%. The rate of preterm was significantly higher in those women who had with short inter interpregnancy interval (p=0.0005). Conclusion: Our findings clearly show that a short interval in inter-pregnancy is a cause of premature birth. Preterm birth can also be indicated by the antenatal care visits, inter-pregnancy complications, and having a birth defect. Premature birth minimization can enhance overall newborn's health and can lead to considerable minimization of neonatal death in the future. Keywords: Preterm labor, prolong pregnancy interval, neonatal health