scholarly journals Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity

2017 ◽  
Vol 07 (01) ◽  
pp. e59-e63 ◽  
Author(s):  
Maureen Downing ◽  
Suela Sulo ◽  
Barbara Parilla
Keyword(s):  
Intrauterine Growth Restriction ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Prenatal Management ◽  
Baseline Characteristics

Objective To compare perinatal and neonatal outcomes of dichorionic (DC) and monochorionic (MC) with trichorionic (TC) triplet gestations. Methods A retrospective cohort study of DC + MC versus TC triplet gestations delivered at a tertiary care hospital from 2009 to 2015. The results include 42 sets of triplets (TC, n = 26; DC + MC, n = 16). Maternal demographics and pregnancy data were compared. Neonatal outcomes were assessed using composite morbidity and mortality. Results Maternal baseline characteristics including age, mode of conception, race, parity, body mass index, and previous preterm delivery were statistically comparable. Comparison of prenatal management and complications yielded no significant differences in terms of presence of shortened cervix, cerclage placement, use of tocolytics, intrauterine growth restriction, premature rupture of membranes, pregnancy-induced hypertension, or gestational diabetes. However, evaluation of composite morbidity and mortality (RDS, IVH, NEC, IUGR, and death) illustrated that all infants born from DC + MC triplet gestations suffered some morbidity or mortality compared with TC pregnancies (p < 0.01). Conclusion DC + MC triplet gestations are at an increased risk of neonatal morbidity and mortality compared with TC triplet gestations.

Risk Factors for Intrauterine Growth Restriction: 9 Years Analysis in Tertiary Care Hospital

2019 ◽  
Vol 2 (1) ◽  
pp. 77-82
Author(s):  
Abha Shrestha ◽  
N Pradhan ◽  
B Kayastha
Keyword(s):  
Risk Factors ◽  
Intrauterine Growth Restriction ◽  
Tertiary Care ◽  
Adult Life ◽  
Growth Restriction ◽  
Optimal Time ◽  
Care Hospital ◽  
Singleton Pregnancy ◽  
Maternal Risk ◽  
Intrauterine Growth

Background: Intrauterine growth restricted (IUGR) fetuses are at higher risk of developing neonatal complications and also known to develop metabolic syndrome in adult life. So, an early antenatal detection, choosing the optimal time and method of delivery and intervention when required could minimize the risk significantly. Objective: To find out the prenatal outcome and the maternal and placental risk factors. Methods: A prospective study was conducted from January 2010 to January 2019, at a Teaching Hospital. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 23.0 software. Results: Maternal risk factors like low pregnancy body mass index, preeclampsia, anaemia, hypothyroidism and placental factors like retro placental hemorrhage were mainly responsible for intrauterine growth restriction. Conclusions: The early identification of risk factors and management of the same antenatal is an important issue to prevent adverse prenatal outcomes associated with IUGR.

scholarly journals Microbiological Profile of Neonatal Septicemia by Automated Blood Culture System (BacT/ALERT) at a Tertiary Care Hospital in Jamnagar, Gujarat, India

2021 ◽  
pp. 17-22
Author(s):  
J. Ghedia Bindiya ◽  
Manish R. Shah
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Signs And Symptoms ◽  
Morbidity And Mortality ◽  
Automated System ◽  
Care Hospital ◽  
Coagulase Negative Staphylococci ◽  
Neonatal Septicemia ◽  
Gram Negative Organisms

Background: This study was carried out to do rapid diagnosis of neonatal septicemia to prevent septicemia related complications and neonatal morbidity and mortality. Materials and Methods: This study was carried out in a tertiary care hospital from a period of March 2014 to August 2015. This is a non-randomized, prospective study in which one hundred and nine cases of suspected neonatal septicemia on the basis of antenatal high risk factors and signs and symptoms of sepsis were studied. Blood samples were collected from neonates in whom septicemia was suspected usually before antibacterial agents were given and both positive and negative samples were detected by automated system BacT/ALERT. Results: Out of 109 samples tested, 69 samples were positive and 40 samples were negative. The incidence of neonatal septicemia due to Gram positive organisms (62.85%) was found to be high. Among them Coagulase negative staphylococci (CONS) (27) (38.57%) was most common organism followed by Staphylococcus aureus (11) (15.71%), Enterococcus spp. (7.14%) and Streptococcus spp. (1.43%). Rate of Gram negative organisms was quite low (32.85%). Out of them Acinetobacter spp. (17.14%) was most common followed by Klebsiella spp. (7.14%), E.coli (5.71%) and Pseudomonas spp. (2.86%). Conclusion: Early detection of infection in neonates and proper antibiotics for the treatment leads to reduced morbidity and mortality.

scholarly journals Outcome of Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

2019 ◽  
Vol 9 (3) ◽  
pp. 170-176
Author(s):  
Ashraful Islam ◽  
Easnem Khanum ◽  
Samiul Alom ◽  
Sumia Bari Sumi ◽  
Nasima Begum ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Severe Preeclampsia ◽  
Morbidity And Mortality ◽  
Anesthetic Technique ◽  
Close Monitoring ◽  
Care Hospital ◽  
Emergency Cesarean ◽  
Thiopental Sodium

Background: In Bangladesh eclampsia and severe preeclampsia or toxemia (PET) are the leading cause of perinatal morbidity and mortality. Its management is challenging for the obstetrician and anesthesiologist. Still now general anesthesia is commonly practiced for emergency LUCS in developing countries, but the outcome of spinal anesthesia is better than GA. Recently in developed countries like the UK and United States, spinal anesthesia is also accepted as a safer anesthetic technique. Objective: The objective of our study was to establish spinal anesthesia as a preferable method to reduce maternal and neonatal morbidity and mortality during emergency LUCS in severe PET and eclampsia patients. Materials and Methods: The study was done in the Department of Anesthesiology and ICU of Enam Medical College & Hospital, Savar, Dhaka during the period from January 2016 to December 2017. Total 62 cases of severe PET and eclampsia patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Thiopental sodium 50−100 mg was given to those who had convulsion during SAB. About 2−2.5 mL (10−12.5 mg) 0.5% bupivacaine heavy was used by 25−27 G spinocaine in L3−4 or L4−5 space. After the establishment of the desired block, LUCS was performed. Meticulous monitoring was done and all events were recorded and problems were effectively managed. Results: Our study shows higher maternal (96.6%) and neonatal (95.17%) success rate. Almost all patients were eclamptic (74.19%), primi (59.67%), term pregnancy (64.51%), aged between 21–30 years (43.54%) and rest of them had preeclampsia (25.80%), multigravida (40.32%), preterm (35.48%), aged <20 years (25.80%) and aged >30 years (30. 64%). Thiopental sodium was given in 9.65% cases for controlling convulsion during LUCS. Remarkable complications were hypotension (33.87%) with highly significant p value (0.000) and bradycardia (27.41%). Conclusion: With close monitoring of perioperative events, spinal anesthesia may be given as a safe alternative technique in severe preeclampsia and eclapmsia rather than GA or epidural even in cases of altered consciousness or restless in presence of an expert and skilled anesthesiologist and thereby perioperative maternal and neonatal morbidity and mortality will be reduced. J Enam Med Col 2019; 9(3): 170-176

scholarly journals Study of changes in non-stress test following antenatal corticosteroid therapy in preterm pregnancy

2019 ◽  
Vol 8 (11) ◽  
pp. 4435
Author(s):  
Renuka S. ◽  
Sathiya S. ◽  
Famida A. M. ◽  
Vijayalakshmi K. ◽  
Sailatha R.
Keyword(s):  
Tamil Nadu ◽  
Stress Test ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Antenatal Corticosteroid ◽  
Corticosteroid Administration

Background: Preterm birth is the largest unsolved problem in obstetrics and the single most significant cause of neonatal morbidity and mortality. Preterm labour constitutes 5-10% of pregnancies and is the leading cause of neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life, long term disability (cerebral palsy, blindness, deafness, chronic lung disease). The objectives of this study were to determine whether antenatal corticosteroid administration affects the non-stress test. To evaluate the effect of antenatal steroid on foetal movements. To assess the incidence of respiratory distress syndrome and neonatal mortality after antenatal corticosteroid administration.Methods: All antenatal cases between 28-32 weeks of gestation judged to be at risk for preterm delivery attending the outpatient department or admitted in a tertiary care hospital, Tamil Nadu during the study period of 3 years.Results: The present study was undertaken to evaluate the NST for a period of 3 days following antenatal corticosteroid administration and to study the immediate changes in the mother and the foetus. We found out that there was a statistically significant change (p <0.01) in non-stress test when compared with the pre-betamethasone assay.Conclusions: Corticosteroids can cause metabolic alterations in mother, short- and long-term effect in the foetus.

Pregnancy outcomes in women with tuberculosis: a 10-year experience from an Indian tertiary care hospital

2016 ◽  
Vol 47 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Seema Chopra ◽  
Sujata Siwatch ◽  
Neelam Aggarwal ◽  
Pooja Sikka ◽  
Vanita Suri
Keyword(s):  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Tertiary Care ◽  
Treatment Compliance ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Pulmonary Tb ◽  
Intrauterine Growth ◽  
Tertiary Centre ◽  
Extra Pulmonary

Our study sought to determine the characteristics of antenatal patients with tuberculosis (TB) and their pregnancy outcomes. Case records of 50 antenatal women with extra-pulmonary and pulmonary TB at a tertiary centre in India were compared to 150 antenatal women not suffering from TB, for adverse medical, obstetric and neonatal outcomes. The prevalence of TB was 1.16 per 1000 deliveries. Of these, 62% had extra-pulmonary TB. There were two maternal deaths. TB in pregnancy was associated with a five times higher risk of prematurity and three times higher risk of intrauterine growth restriction than the norm. Maternal prognosis depends on the complications of tuberculosis and treatment compliance.

scholarly journals SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes

2021 ◽  
Author(s):  
Haley A. Steffen ◽  
Samantha R. Swartz ◽  
J. Brooks Jackson ◽  
Kimberly A. Kenne ◽  
Patrick P. Ten Eyck ◽  
...  
Keyword(s):  
Private Insurance ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Antibody Testing ◽  
University Of Iowa ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
Cesarean Delivery Rate

Objective This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. Study Design This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. Results In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26–33 years) and body mass index was 31.75 kg/m2 (IQR 27.7–37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. Conclusion In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. Key Points

scholarly journals A retrospective interventional study for evaluation of efficacy and safety of sildenafil citrate in improving intrauterine growth restriction and oligohydramnios using ultrasound Doppler velocimetry

2019 ◽  
Vol 8 (12) ◽  
pp. 2736
Author(s):  
Kedar N. Ganla ◽  
Rana A. Choudhary ◽  
Kavita N. Desai ◽  
Santoshi B. Kadam ◽  
Krutika Arunachalam
Keyword(s):  
Birth Weight ◽  
Intrauterine Growth Restriction ◽  
Uterine Artery ◽  
Neonatal Morbidity ◽  
Growth Restriction ◽  
Morbidity And Mortality ◽  
Sildenafil Citrate ◽  
Common Finding ◽  
Interventional Study ◽  
Intrauterine Growth

Background: Intrauterine growth restriction (IUGR) is one of the major reasons for neonatal morbidity and mortality. Oligohydramnios is a common finding in IUGR. In majority of these cases diminished utero-placental blood flow is observed. However, in spite of this understanding and identification of high-risk patients, the management options are limited. Sildenafil citrate, a phosphodiesterase type-5 inhibitor improves utero-placental perfusion.Methods: We present a retrospective interventional study involving 50 adult pregnant women diagnosed with early-onset IUGR (n=38) and oligohydramnios (n=12). Vaginal sildenafil citrate 25 mg t.i.d. was started from the day of diagnosis till delivery. Primary efficacy endpoints included changes in Doppler parameters i.e., amniotic fluid index (AFI), uterine artery (UA)- pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (S/D ratio). Secondary endpoints included live birth, birth weight, Apgar score at birth, neonatal survival to hospital discharge and adverse maternal side effects.Results: There was a statistically significant improvement in UA-PI, RI and S/D ratios (p<0.0001) in all cases. In oligohydramnios cases, treatment showed a statistical significant increase in AFI score (2.86±1.33 cm). The mean birth weight on delivery was 2200 gm with good Apgar scores. No major adverse effects were reported by women using sildenafil citrate vaginally.Conclusions: Sildenafil citrate, by increasing utero-placental perfusion, improves uterine artery Doppler patterns, AFI, fetal weight and overall better neonatal survival rates by reducing neonatal morbidity and mortality. Sildenafil citrate may hold a promising treatment strategy for management of IUGR and oligohydramnios.

scholarly journals Cerebroplacental ratio for prediction of adverse intrapartum and neonatal outcomes in a term uncomplicated pregnancy

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Mariam Lotfy Mohamed ◽  
Salwa Adel Mohamed ◽  
Amal Mohamed Elshahat
Keyword(s):  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Uncomplicated Pregnancy ◽  
Cerebroplacental Ratio ◽  
Flow Disturbances ◽  
Increased Risk ◽  
Nicu Admission ◽  
Fetal Compromise

Abstract Background Fetal hypoxia is one of the major causes of high perinatal morbidity and mortality rates. Doppler ultrasound tests such as cerebroplacental ratio (CPR) evaluation are commonly used to assess blood flow disturbances in placento-umbilical and feto-cerebral circulations. A low cerebroplacental ratio has been shown to be associated with an increased risk of stillbirth regardless of the gestation or fetal weight. We conducted this study to assess the fetal cerebroplacental ratio in prediction of adverse intrapartum and neonatal outcomes in a term, uncomplicated pregnancy to reduce fetal and neonatal morbidity and mortality. Results It was found that neonates with CPR ≤1.1 had significantly higher frequencies of cesarean delivery (CS) for intrapartum fetal compromise compared to those with CPR >1.1 (p=0.043). Neonates with CPR ≤1.1 had significantly lower Apgar score at 1 min and 5 min than those with CPR >1.1 (p=0.004) and (p=0.003), respectively. Neonates with CPR ≤1.1 had significantly higher rates of NICU admission than those with CPR <1.1 (p=0.004). Conclusion The cerebroplacental ratio shows the highest sensitivity in the prediction of fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at term. The cerebroplacental ratio index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

scholarly journals Feto-maternal outcome in patients with couvelaire uterus: a 3 year study in a tertiary care hospital in rural Karnataka, India

2018 ◽  
Vol 7 (2) ◽  
pp. 503
Author(s):  
Sunanda N. ◽  
Sruthi T. ◽  
Sheela S. R.
Keyword(s):  
Blood Transfusion ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Severe Form ◽  
Care Hospital ◽  
Maternal Complications ◽  
Increased Risk ◽  
Abruptio Placenta ◽  
Prolonged Hospital

Background: Couvelaire uterus also known as uteroplacental apoplexy is a life threatening condition where abruptio placenta causes bleeding that penetrates into the uterine myometrium. It can only be diagnosed on direct visualization. Therefore, its occurrence is perhaps under reported and underestimated in the literature. The objective of this study was to determine the risk factors for couvelaire uterus and feto-maternal outcomes associated with couvelaire uterus in comparison with patients who presented with abruption without couvelaire uterus in a tertiary care hospital in rural Karnataka.Methods: All women who had abruptio placenta who were delivered by cesarean section were included in the study. Cases were women with couvelaire uterus and controls were women without couvelaire uterus observed intraoperatively during cesarean section.Results: Patients without couvelaire uterus had significantly more vaginal bleeding (22.2% vs 75%). However, patients with couvelaire uterus had a higher incidence of PPH (66.7% vs 28.6%), need for blood transfusion (5.9±3.2 pints vs 1.6±1.8 pints), DIC (22.2% vs 14.3%), maternal mortality (5.6% vs 0) and adverse neonatal outcome.Conclusions: We conclude that patients with couvelaire uterus had an increased risk of maternal complications such as postpartum hemorrhage and disseminated intravascular coagulation which resulted in increased need for blood transfusion, prolonged hospital stay and maternal morbidity and mortality. Present study further highlights that adverse neonatal outcomes such as low birth weight, low Apgar score and neonatal death were more frequently associated with couvelaire uterus. Thus, the presence of couvelaire uterus may be considered as a severe form of abruption and such patients should be anticipated for higher incidence and risk for maternal and neonatal morbidity.

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