scholarly journals Retrospective study on the effect of Body Mass Index (BMI) on maternal and neonatal outcome

Author(s):  
Pooja M. Shah ◽  
Anagha K. Chhatrapati ◽  
Pooja K. Bandekar

Background: Obesity has become health problem worldwide. Prevalence of obesity has increased globally with more incidence observed in female than male. Objective of present study was assessment of maternal outcome in term of associated medical disorder and mode of delivery and assessment of neonatal outcome.Methods: The retrospective study performed at Nowrosjee Wadia Maternity Hospital, a tertiary care centre between 1st January 2017 to 30th November 2017. Total 64 patients were enrolled. Maternal and neonatal outcomes were studied in all nulligravida women with high BMI using logistic regression adjusted for confounding variable.Results: Women with high BMI were at increased risk of hypertensive disorder of pregnancy (40.65%), diabetes (7.81%), induction of labour (62.5%), instrumental delivery (14.06%), operative intervention (42.18%), prolonged hospital stay and NICU admission (26.56%).Conclusions: This study observes increase risk of adverse outcome in pregnant women with high BMI.

2021 ◽  
pp. 31-34
Author(s):  
Deepali Jain ◽  
Uma Jain ◽  
Japhia David

Introduction:- IUFD occurrence without warning in a previously normal pregnancy is really a challenge to obstetrician and distressing situation for parents. It becomes crucial to identify specic probable cause of fetal death, to prevent the re-occurance and get the corrective measures. Prenatal mortality is still of one of the top most health indicators in measuring the quality and impact of health services in developing countries Still birth is a useful index to measure the values of antenatal and intranatal care. To decrease the fetal mortality rate, evaluation, documentation and audit of the etiology and the associated risk factors for stillbirth is required. Material and method :- The present study aims at studying the various causes related to IUFD. Prospective observational study conducted on 112 patients at Department of Obstetrics and Gynaecology, Kamla Raja Hospital, G.R. Medical College and J.A. Group of Hospitals, Gwalior (M.P.) for 18 months. All those cases who were diagnosed as intrauterine dead fetus at the time of admission with gestational age >24 weeks pregnancy were included in the study. All those investigation available at the centre of mother and father were noted and details were taken. Epidemiological evaluation of causes of fetal death was done. Record of the method of induction and mode of delivery taken. RESULTS :-Total 112 cases found during the study period were included . We found maximum cases unbooked - 71.43%, which were mainly emergency admissions. Majority of the IUFD cases- 77.67% were found to lie in the age group of 20-30 yrs, most of them were primigravida 62.5%., maximum cases of IUFD were of the gestational age 31-35 weeks- 47.32%. Hypertensive disorder of pregnancy- 23.3 % cases were found to be the major associated cause followed by Antepartum Haemorrhage 11.5%, Severe anaemia 15.1%, diabetes- 14.2% jaundice - 9.8%. congenital anomaly- 9.8%. Oligohydromnios- 8.9% and IUGR were also found to be associated with IUFD, forming an indirect reason. 39.29% cases were unexplained. 86.6% cases delivered vaginally. 10.7% cases had to undergo LSCS and only 2.68% cases underwent laparotomy for rupture uterus. 11.61% cases were of macerated IUFD baby indicating long term neglected IUFD. 39.78% and 38.39% IUFD were of 2.0-2.5 kg and 1.5-2.0 kg. This show strong corelation with LBW and IUGR. CONCLUSION:- Unexplained cases, hypertensive disorder, anemia and diabetes were the major causes for IUFD. In spite of advances in diagnostic and therapeutic modalities a major cause of fetal death remain unexplained because of poverty, illiteracy, unawareness and inaccessibility of a health centre. Undoubtedly, continued surveillance of stillbirth rates is wanted for both high- and low-risk pregnancies at a state and national level.


2021 ◽  
Vol 10 (31) ◽  
pp. 2481-2484
Author(s):  
Swetha Gulabi Gaddam ◽  
Vijithra Thangamani

BACKGROUND Antepartum haemorrhage of unknown origin (APHUO) being a diagnosis of exclusion, is a rare condition which poses dilemma in the management of pregnancy in terms of timing and mode of delivery. The purpose of this study was to evaluate antenatal factors associated with APHUO, clinical presentation and analyse its impact on pregnancy and its outcome. METHODS This is a retrospective study conducted over a period of two years in a tertiary care hospital. Pregnancy outcomes were compared between 41 cases who had APHUO versus 39 controls who never had history of bleeding in their antepartum period. Bleeding pattern, incidence of preterm labour, intra partum and postpartum complications, mode of delivery, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score of the baby and neo-natal intensive care unit (NICU) admission were analysed. RESULTS Patients with APHUO had subclinical abruption and increased risk of preterm delivery. Intrapartum and postpartum complications were similar among both the groups. The average birth weight was much lesser in the study group, but the cause was attributed to prematurity. These findings were consistent with the previous studies. CONCLUSIONS APHUO is associated with subclinical abruption and increased risk of preterm labour. Hence the patient should be counselled for delivery at a tertiary care center with adequate neonatal care. Greater incidence of NICU admission and low birth weight were attributed to prematurity among the study group. Induction of labour at term in this group is of questionable value unless there is an associated obstetric indication. KEY WORDS APHUO, Preterm Labour, Sub Clinical Abruption, Low Birth Weight


Author(s):  
Pratibha Garg ◽  
Urmila Tripathi

Background: Pregnancy poses unique consideration for critical care and it is imperative that obstetrician and other members of health care team have a working knowledge of these factors because these are women are usually young and in good health, their prognosis should be better than that of many other patients admitted to an intensive care.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Gaja Raja Medical College and associate Kamla raja Hospital, Gwalior in the ICU from Oct. 14 to Oct. 15.Results: 678 obstetric women were admitted into the ICU of Kamla Raja Hospital, over a period of 1 year study period. Maximum number of patients belong to age group 21-25 years (54.8%), 398 (58.7%) patients were uneducated, 343 (50.59%) came directly to Kamla Raja Hospital. 362 (53.39%) belongs to urban area. The mean length of stay in ICU was 3 days. Maximum number of patients were postpartum 580 (85.55%). According to mode of delivery maximum number of patients 348 (51.33%) underwent LSCS. Most common obstetric indication for admission in ICU was hypertensive disorder of pregnancy 472 (69.61%). Most common medical indication was severe anaemia 128 (18.87%). Various type intervention like pulse oxymetry, O2 inhalation, BT, nebulisation and ventilation were done in ICU according to patients need. 43 maternal death happened during the study period with most common cause was cardiorespiratory arrest 9 (1.32%) and pulmonary edema 8 (1.17%).Conclusions: Establishment of a dedicated obstetric ICU at tertiary care centre with knowledge familiarity, experience and expertise of an obstetrician and a special team would be best place to monitor and treat the critically ill obstetric patients which will reduce the maternal morbidity and mortality.


Author(s):  
Devika J. Kamat ◽  
Guruprasad Pednecar

Background: Eclampsia is one of the major causes of maternal and perinatal mortality in India. Here authors present a prospective study which was conducted in a tertiary health centre to study the cases of eclampsia, the mode of presentation and the maternal and perinatal outcomes.Methods: A total 95 women were diagnosed as eclampsia during the period of 2 years. Various parameters and their effects on maternal and perinatal morbidity and mortality were studied. Maternal outcomes were assessed based on parameters like antenatal care received, mode of delivery, complications associated with eclampsia. Perinatal outcomes were noted depending upon the period of gestation, NICU admission, stillbirths and neonatal deaths.Results: Authors found the incidence of eclampsia to be 0.9%. 52.7% women had irregular antenatal follow up at any nearby health centre. A total 76.8% women had antepartum eclampsia. 56.8% delivered by caesarean section while 7.4% required operative vaginal delivery. 61.1% women delivered within 10 hours of onset of convulsion. Authors had 02 deaths in the study group, one due to ARDS with DIC and the other attributed to pulmonary oedema. There were 51.6% preterm deliveries. 21 neonates required NICU admission with 5 neonatal deaths and 11 stillbirths.Conclusions: Due to inadequate antenatal care, most of the cases of pre-eclampsia go unnoticed increasing the referrals to tertiary care centre for intensive care. Thus, it is necessary to emphasise on timely interventions and availability of blood bank, ICU and NICU facilities at the closest referral centre for better maternal and perinatal outcome.


Author(s):  
Anju Padmasekar ◽  
Shyamala Jothy

Background: Massive obstetric haemorrhage is defined as blood loss of >1500 ml, or a decrease in haemoglobin>4 gm/dl or acute transfusion requirement of >4 units of blood when need for further transfusion is foreseeable. The purpose of this study is to analyse the demographic, medical and obstetric risk factors for massive obstetric haemorrhage and it’s materno fetal outcomes.Methods: Criteria for patient selection was all patients who had an acute obstetric haemorrhage necessitating a transfusion of >4 units of blood at a stretch when there was a need for more. This is a retrospective study conducted for a period of one year January to December 2015. Data regarding all cases under study during this period was obtained from Medical Records Department with prior permission. This study was conducted in the Department of Obstetrics and Gynecology, Government Raja Mirasudhar Teaching Hospital, Thanjavur Medical College, Tamil Nadu. Maternal outcomes like mode of delivery, rate of hysterectomy, postpartum complications, maternal mortality and fetal outcomes like intra uterine death, still birth and preterm birth were analysed.Results: The rate of massive obstetric haemorrhage in our hospital during the study period was 5.7/1000 births. Massive obstetric haemorrhage contributed to 25% of all maternal deaths in 2015. Atonic PPH was the commonest cause. Multiparity and previous caesarean section were identified to be significant risk factors.Conclusions: We found an increased association of massive obstetric haemorrhage with multiparity, caesarean sections and pre-eclampsia. Atonic PPH was the commonest cause. Massive obstetric haemorrhage had contributed significantly to adverse maternal and perinatal outcomes.


2019 ◽  
Vol 15 (2) ◽  
pp. 154-160
Author(s):  
Naina Kumar ◽  
Amit K. Singh

Objective: To assess the relationship between maternal serum uric acid and severity of Hypertensive disorders of pregnancy in a rural tertiary care centre. Materials and Methods: Present study was conducted in Obstetrics and Gynaecology department of rural tertiary care centre of Northern India over seven months (October 2016-May 2017) on 110 women admitted with a Hypertensive disorder of pregnancy (Gestational hypertension, Preeclampsia, Eclampsia) at ≥;34 weeks gestation. Maternal serum uric acid levels were compared in three groups in relation to disease severity, mode of delivery, maternal outcome. Results: Of total 110 women with a Hypertensive disorder of pregnancy; 35 (31.81%) had Gestational Hypertension, 49 (44.54%) preeclampsia and 26 (23.63%) had eclampsia. Mean±SD values for serum uric acid were 5.47±1.93 mg/dl in women with Gestational Hypertension; 6.72±2.15 mg/dl in Pre-eclampsia and 8.71±2.97 mg/dl in the eclamptic group. Of 110 women 34(97.14%) with gestational hypertension, 27(55.10%) with pre-eclampsia and one (3.85%) with eclampsia remained stable in post-partum period, 17 (34.69%) women with severe pre-eclampsia and 15 (57.69%) with eclampsia required intensive care in postpartum period and one (2.86%) women with gestational hypertension, five (10.20%) with pre-eclmapsia and ten (38.46%) with eclampsia required ventilator support and high dependency unit care. Of these 16 women with the severe disease, ten succumbed to death. Also, in women with serum uric acid,>6mg/dl, most common mode of delivery was a lower segment cesarean section (50.90%). Conclusion: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome.


2018 ◽  
Vol 13 (1) ◽  
pp. 26-29
Author(s):  
Anjali Subedi ◽  
Junu Shrestha ◽  
Aashika Shrestha ◽  
Sangeeta Gurung

Aims: To evaluate the maternal and perinatal outcome in adolescent pregnancy,Method: This was a cross-sectional study conducted in Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara from October 2017 to March 2018 for duration of 6 months.Results: There were total 82 cases of teenage pregnancy in the study duration with incidence of  6% among total deliveries. Majority of cases were of age 19 and were primigravida. Fifty five percent of the cases had normal vaginal delivery and cesarean section accounted for 39% of cases. The major indication for cesarean section was meconium stained liquor (52%) followed by oligohydraminos (15%) and cephalopelvic disproportion (11%). The maternal complication accounted for 59% of total cases. Among them, anaemia was highly prevalent comprising 11% of cases followed by PPROM (9.8%) and hypertensive disorders in pregnancy (8.5%). In perinatal outcome, the incidence of preterm birth was 15.9% and low birth weight was 13.4%. The rate of NICU admission was 2.4% and there was one case of still birth.Conclusion: The study showed that teenage pregnancy is at increased risk of adverse maternal and perinatal outcome. So if we lay an effort for reducing the incidence of teenage pregnancy, we can bring in positive changes in the indicators of maternal and perinatal morbidities.


Author(s):  
Shabnam Ara ◽  
Shazia Nisar ◽  
Umrazia Bashir

Background: Intrauterine fetal death (IUFD) is the tragic event contributing to high perinatal mortality in developing countries. So many risk factors have been seen associated with IUFD that can be prevented with better antenatal care and timely detection at the earliest so that the prevalence can be decreased. This study was done to identify the risk factors associated with IUFD.Methods: This is a retrospective study from done from March 2017 to March 2018 at skims maternity hospital. IUFD was defined as fetal death beyond 20 weeks of gestation. Records were analyzed and data was compiled.Results: In our study there were total of 2500 deliveries out of which 70 were IUFD. Incidence was 28 per 1000 live births. It was found more common in the age group of 20-29 year (65.71%)  %). Preeclampsia was the risk factor in 17.14% of cases , followed by abruption in 11.42% followed by placenta previa in 7.14% of cases. However, 20% of the cases had unidentified risk factor.Conclusions: Present study was an effort to compile common risk factors associated with IUFD at tertiary centre of Kashmir.


Author(s):  
Deeksha Rao M. ◽  
Vasantha Kumar S.

Background: Preterm birth (PTB) is one of the main causes of perinatal mortality and morbidity. It can also result in long term health consequences for both mother and the newborn. The objective was to assess maternal and fetal morbidity and mortality in PTBs.Methods: A retrospective study was done in the department of obstetrics and gynecology in a tertiary care hospital during January 2020 and June 2020. Ninety-three women with records of preterm births were analyzed for maternal and fetal outcomes. coGuide statistical software was used for data analysis.Results: 48.39% of the women were between 20 to 24 years of age. The majority (50.54%) were primigravida. The main causes for PTB among the study participants were medical disorders (39.78%), PPROM (29.03%), spontaneous labor without any underlying cause (18.28%). 51.61% had a vaginal delivery, 88.17% had a live birth. The majority of 52 (55.91%) neonates had birth weights between 1.51 to 2.5 kg. Fifty-nine neonates (63.44%) needed NICU admission. The reason for NICU admission in majority 25 (26.88%) was respiratory distress.Conclusions: Timely, early diagnosis and treatment of medical disorders among antenatal women can aid in reducing the occurrence of preterm births and their associated morbidity and mortality. Medical disorders and premature preterm rupture of membrane remain the main causes of preterm birth. 


Author(s):  
Shobha Sreedharan Pillai

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. In India, they account for the third most important cause of maternal mortality. The objectives of this study were to evaluate maternal and perinatal outcome and complications in cases with severe preeclampsia and eclampsia.Methods: A retrospective study was carried out on 110 women with severe preeclampsia and eclampsia in a tertiary care referral centre over a period of 15 months. Only those cases with initial B.P reading of ≥160/110 mm Hg or presenting with eclampsia were included in the study. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed.Results: 42% of the cases were in the age group of 26-30 years, nearly 61% were primigravidae and the majority (64) were referred from peripheral hospitals. Liver function tests were deranged in 19% of the patients and 17% had abnormal renal function. Nifedipine was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases.  Lower segment caesarean section was the mode of delivery in 64.5% of the cases. Commonest maternal complication was atonic PPH. There was no maternal mortality but there were 3 maternal near-miss cases due to DIC. 65% of the cases had a preterm delivery and 39% of the babies needed NICU admission. There were 10 neonatal deaths.Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia.  Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome. 


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