scholarly journals Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

Author(s):  
Shreedevi Kori ◽  
Dayanand Biradar ◽  
Aruna Biradar ◽  
Rajasri Yaliwal ◽  
Subhashchandra R. Mudanur ◽  
...  

Background: Prolonged pregnancy is one that exceeds 42 0/7weeks. Management of prolonged pregnancy is very challenging in modern obstetrics.Methods: It is prospective observational study in department of Obstetrics and Gynecology, Shri B.M Patil medical college and Research center, deemed to be University, Vijayapur, North karnataka. Study period was from January 2018 to January 2019.Results: Total of 186 pregnant women were included in the study. Results in terms of age, gravidity, gestational age, time of induction, mode of delivery, neonatal outcome and maternal complications.Conclusion: Pregnancies beyond 40 weeks require early detection, effective fetal monitoring and proper planning of labour. In pregnancies beyond 40 weeks, decision of induction should be taken cautiously as early induction leads to failure of induction and increased rates of lower (uterine) segment Caesarean section (LSCS), while delayed induction leads to increased fetal complications.

Author(s):  
Mamta Mahajan ◽  
Amit Gupta ◽  
Anju Vij ◽  
Aanchal Gupta Sharma

Background: India is considered the world capital of diabetes, proper care and management of the same is the demand of society. The present study is carried out to identify the disease burden of GDM/ overt DM among antenatal cases. The main objective was to study the maternal and fetal outcome of diabetes complicating pregnancy.Methods: The present study was conducted at Dr. Rajendra Prasad Government Medical College at Tanda, District KangraHP from October 2015 to September 2016. All antenatal cases were screened for diabetes by OGTT 75 gm, 2-hour blood glucose level as per DIPSI guidelines and labelled as GDM/ overt DM. Those who fulfilled selection criteria were enrolled in the study. A total of 6452 cases who attended antenatal clinic during the study duration and were screened were selected for the study. 116 cases were found to have GDM / overt DM. Seventy-nine had GDM with OGTT>140 mg/dl (DIPSI guidelines) and 37 had overt DM with 2 hours PP >200 mg/dl (WHO criteria). Total 100 cases comprised of study group were followed till delivery to study maternal and fetal outcome.Results: The prevalence of diabetes in pregnancy was found to be low 1.79%. GDM was found to be more prevalent than overt diabetes in pregnant women (66% versus 34%). Among the antenatal maternal complications observed missed abortion (11.8% versus 1.55; p=0.026), polyhydraminos (26.4% versus 10.6%; p=0.04) and preterm labour (17.6% versus 4.5%; p=0.003) were significantly more common in overt diabetics than GDM cases. IUFD (8.8% versus 0; p=0.014) was also significantly more common in overt diabetics than GDM case. RDS was found significantly higher in neonates of overt diabetics as compared to GDM mothers (14.7 % versus 1.5%; p=0.009).Conclusions: Early detection and good glycemia control by MNT and insulin, regular antenatal check-ups, patient counselling and compliance, intrapartum fetal monitoring and early neonatal care are keys to improved outcome. 


2020 ◽  
Vol 11 (4) ◽  
pp. 5473-5480
Author(s):  
Poonam Kalburgi ◽  
Sanjaykumar Patil

Women after delivering her first baby by section have a choice about mode of delivery for her second baby. The study was planned to compare maternal and perinatal outcome between VBAC and repeat elective LSCS in patients with prior one LSCS and their complications. A prospective observational study was carried out in department of obstetrics and . Total 180 cases of previous LSCS who were eligible for vaginal delivery were recruited 90 in each group as per consent given by them. Group 1: Vaginal Birth after section Group 2: elective repeat section. It was observed that majority of the patients group 1(51.1%) and group 2 (47.8%) were in age group of 25 to 30 years. More than 25kg/m2 BMI was found in 18(20%) cases of VBAC group and 30(33.3%) cases of LSCS group pregnancy interval was significantly lower in LSCS group compared to VBAC group. Mean birth weight was 2.832 kg to 2.917kg in both group. with improved maternal care, close fetal monitoring and institutional delivery for a previous one section, VBAC is considered safer than repeat elective section in carefully selected patient.


Author(s):  
Bharti Maheshwari ◽  
Preeti Sharma ◽  
Kamini Pawar ◽  
Kirti Goswami

Background: COVID-19 has spread globally at an accelerated rate with rapid increases in cases and mortality. Viral pneumonia is one of the leading causes of pregnancy deaths worldwide. Physiological changes during pregnancy, such as reduced functional residual volumes, diaphragm elevation, and oedema of respiratory tract mucosa, as well as changes in cell immunity can lead to increased susceptibility to viral infections and can have worsened outcomes.Methods: The study was conducted after clearance from Board of Studies and Ethical committee in the Department of obstetrics and gynaecology, Muzaffarnagar medical college, Muzaffarnagar. It was a retrospective study. Out of total 1500 covid positive patients admitted in 3 months, 33 pregnant women were included which were covid positive.Results: The study population consisted of 16 (48.5%) women from 20-25 years, 12 (36.4%) women from 26-30 years and 5 (15.2%) women from above 30 years. There was history of exposure among all (100.0%) pregnant women with only 2 (6.1%) having symptoms of COVID-19.Out of 33, 8 patients were severelyanemic, 4 had preeclampsia, 2 cases had previous 2 LSCS, 5 previous 1 LSCS, 1 leaking pervaginum, 3 cases had fetal distress at admission. As per gestational age, 9 (27.3%) women had pre-term delivery, 21 (63.6%) had normal term delivery and 3 (9.1%) had post-term delivery. 13 women were primigravida and 20 were multigravida. The mode of delivery was LSCS among 24 (73%) and normal delivery among 1 (3.0%) women.Conclusions: In our study, there were no maternal and fetal complications among pregnant women with COVID-19.


Author(s):  
Santosh Kumar Dora ◽  
Lalmohan Nayak ◽  
Benudhar Pande ◽  
Atal Bihari Dandapat

Background: Eclampsia continues to be a measure health issue in developing country. In order to get a comprehensive data on eclamptic patients we conduct a prospective observational study to address the maternal and fetal complication during pregnancy.Methods: It is a prospective observational study conducted in a tertiary care medical college between the periods September 2016 to February 2017. During the period all patients with eclampsia admitted to the labour room were taken. Any patients with known epilepsy were excluded from the study.Results: During the period 3780 women were admitted to the labour room, out of which 56 women had eclampsia with an incidence of 1.48%. Out this antenatal eclampsia was most common with an incidence of 91.08% followed by intra partum 4 (7.14%) and postpartum eclampsia 1 (1.78%). Majority of patients 54 (96.43%) were unbooked or inadequately supervised. Most of the patient had normalization of blood pressure after oral nifedipine 46 (82.14%), only 10 (17.86%) patient required additional injection labetalol for control of blood pressure. The maternal complications were placental abruption 8 (14.28%), HELLP 6 (10.71%), pulmonary edema 1 (1.78%), acute renal failure 1 (1.78%), DIC 1 (1.78%) and maternal death 2 (3.57%). Out of fifty six babies delivered 42 (75%) had live birth and 14 (25%) had still birth. A total of 17 (40.42%) had IUGR, 17 (40.47%) require SNCU admission post-delivery.Conclusions:Eclampsia still remains the major cause of maternal and fetal morbidity. In low resource countries improvement in health care facility, adequate antenatal supervision, and timely referral will reduce the maternal and fetal complication. 


2019 ◽  
Vol 6 (2) ◽  
pp. 491 ◽  
Author(s):  
Shilpasri Y. M. ◽  
Madhurya B.

Background: Meconium stained amniotic fluid has been considered a sign of fetal distress and associated with poor fetal outcome, but others considered meconium passage by fetus is physiological phenomena and produce environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study and aim was to find out incidence and effect of meconium in terms of morbidity and mortality.Methods: Two hundred babies born with meconium stained amniotic fluid considering the inclusion and exclusion criteria from December 2012 to June 2013 in the Department of Paediatrics, Cheluvamba hospital attached to Mysore Medical College and Research Institute, Mysore. Fetal monitoring, mode of delivery, Apgar score, birth weight, resuscitation of baby are noted. All babies followed-up up to 1st week of neonatal life.Results: In present study 200 babies born through meconium stained amniotic fluid was randomly selected-thin 37% and thick 63%. Major complications like birth asphyxia, meconium aspiration syndrome, early neonatal death seen in 5.5% (11 cases), morbidity in 37%, 12.5% in thin and 24.5% in thick MSAF. Causes of death were meconium aspiration syndrome in 3 cases, sepsis in 1 case, pneumonia in 1 case and birth asphyxia in 6 cases.Conclusions: Immediate airway management, need for suction and intubation should be guided by state of newborn rather than presence of meconium. Timely diagnosis and management of meconium stained amniotic fluid may improve fetal outcome. From present study authors conclude that MSAF adversely affect fetal outcome mostly by thick meconium.


Author(s):  
Rashmi Kumar Karning ◽  
Bhanu B. T. ◽  
. Sarojini

Background: Breech presentation is the commonest malpresentation with the incidence of 3-4% at term. This study was done with the objective of studying the mode of delivery in breech presentation and to compare the maternal and fetal outcome in patients delivered vaginally to those delivered by cesarean section.Methods: This prospective observational study was conducted in Vanivilas Hospital, affiliated to Bangalore Medical College and Research Institute, from June 2014 to May 2015. The study group included 509 patients with breech presentation who were studied with respect to their gestational age, birth weight, type of breech, mode of delivery, maternal and perinatal outcome.Results: The incidence of breech presentation was 2.92% (509) among 17454 total deliveries with the incidence of 3.17% in primi and 2.73% in multies. 193 (38%) patients had vaginal breech delivery and 316 (62%) delivered by LSCS. Apgar score of less than 7 at 1 minute was seen with 21.42% of vaginally delivered fetuses and 9.09% of fetuses delivered by cesarean section. The perinatal mortality was 1.6% (8 cases) in vaginal group 0.8% (4 cases) in LSCS group. The short term maternal complications in LSCS group was 7.62% and in vaginal delivery group was 3.09%.Conclusions: The short term maternal morbidity is higher in patients with cesarean section compared to those with vaginal breech delivery. Perinatal outcome is better in babies delivered by cesarean section. Still vaginal breech delivery can be an option for breech babies with proper selection and when conducted by a skilled obstetrician.


2018 ◽  
Vol 27 (1) ◽  
pp. 47-50
Author(s):  
Fahmida Naz Mustafa ◽  
Nahid Yasmin ◽  
Nasreen Afreen ◽  
Kamrun Sattar ◽  
Aftabun Nahar ◽  
...  

Background: People always complain that previously almost all women used to have vaginal delivery, but they do not mention the fetal outcome, eg, the number of affected fetus and also intrauterine death or stillborn. The objective of our study was to see the fetal outcome among antenatally unbooked women with gestational age beyond EDD who came to hospital with labor pain and also to see the mode of delivery in these pregnancies. Method: It was an observational prospective study conducted in Daudkandi Upazilla Health Complex, Kumilla, from March , 2012 to May, 2012. Sampling procedure was consecutive sampling. A total number of 52 postdated pregnant women were enrolled in our study who came to hospital with labor pain. Result: The percentage of vaginal delivery in postdated pregnancy was 80.77% and the percentage of cesarean delivery was 19.23% . Fetal outcome was good in 76.92%, baby was asphyxiated in 19.23% , baby was stillborn in 3.85% women. Conclusion: Though vaginal delivery rate is high in women with antenatally unbooked postdated pregnancy with spontaneous onset of labour pain , but the fetal outcome is not good. The women who are crossing EDD must undergo careful fetal monitoring to have more vaginal delivery with good fetal outcome. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 47-50


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049944
Author(s):  
Sarah K Schäfer ◽  
Robert Fleischmann ◽  
Bettina von Sarnowski ◽  
Dominic Bläsing ◽  
Agnes Flöel ◽  
...  

IntroductionStroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.Methods and analysisThe study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.Ethics and disseminationThe study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.Trial registration numberNCT04704635.


2020 ◽  
pp. 60-62
Author(s):  
Narendra Nath Hait ◽  
Brahmarshi Das ◽  
Ratan Chandra Mandal ◽  
Haricharan Roy ◽  
Debarshi Jana

Background: Threatened abortion is till most common cause of early trimester bleeding PV and can be diagnosed and managed by early USG diagnosis. Materials and methods: This was a prospective observational study. Place of the study was Department of Obstetrics and Gynaecology and Department of Radiodiagnosis, Midnapore Medical College and Hospital from January 2019 to June 2020. Eighteen months. Result: When the clinical method to diagnose threatened miscarriage was compared to the sonographic method, it was evident that sonographic method was reliable than the clinical method and the difference was statistically significant. Conclusion: In case of missed miscarriage and complete miscarriage, although the percentage of discrepancy was 100%, on further statistical analysis, the discrepancy was not statistically significant. And the cause behind this was probably inadequate sampling.


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