scholarly journals Feto-maternal outcome of pregnancies diagnosed as hypothyroidism after 28 weeks of gestation, at a tertiary hospital

2021 ◽  
Vol 10 (11) ◽  
pp. 4136
Author(s):  
Asha Garg ◽  
Sham Sunder Goyal ◽  
Mini Bedi ◽  
Muskan .
Keyword(s):  
Post Partum ◽  
Neonatal Resuscitation ◽  
Tertiary Hospital ◽  
Maternal Outcome ◽  
Adverse Outcomes ◽  
Labour Induction ◽  
Overt Hypothyroidism ◽  
Maternal Complications ◽  
Increased Risk ◽  
Nicu Admission

Background: The most frequent thyroid alteration observed in pregnancy is hypothyroidism with subclinical hypothyroidism being more common than overt hypothyroidism. Women with thyroid dysfunction both overt and subclinical are at increased risk of pregnancy-related complications. In present study we assessed feto-maternal outcome of pregnancies in whom hypothyroidism was diagnosed after 28 weeks of gestation.Methods: This study was conducted in the department of obstetrics and gynaecology, Adesh institute of medical sciences and research Medical College, Bathinda. The present study was of prospective, observational design, conducted in pregnant women with more than 28 weeks pregnancy, first time diagnosed as hypothyroid (TSH>3.0 mIU/l).Results: In present study total 37 patients completed study protocol, 6 patients were delivered at other hospital. Most patients were less than 20 years (32%), nulliparous (68%). 19% patients delivered preterm either due to spontaneous labour or labour induction for obstetric reason. 62% patients delivered vaginally, 35% underwent LSCS. In present study maternal complications such as preterm labour (24%), hypertensive disorders of pregnancy (22%), oligohydramnios (16%), overt/gestational diabetes mellitus (8%) and post-partum haemorrhage (5%) were noted. 2.5-3.4 kg birth weight was most common group (65%). Total 16 % babies required neonatal resuscitation. Babies requiring neonatal resuscitation were admitted in NICU for observation and for any further management. Neonatal jaundice was noted in 30% babies. Total 22% babies needed NICU admission. We noted early neonatal death in one baby. No maternal mortality was noted.Conclusions: Treatment of maternal hypothyroidism is essential, because adverse outcomes for both mother and baby are greatly reduced, if not eliminated, when patients are treated.

scholarly journals A study evaluating third trimester haemoglobin level as a predictor of feto-maternal outcome in pregnancy induced hypertension cases

2018 ◽  
Vol 7 (11) ◽  
pp. 4439
Author(s):  
Sasmita Das ◽  
Tapan Pattanaik ◽  
Manisha Sahu
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Haemoglobin Level ◽  
Maternal Outcome ◽  
Adverse Outcomes ◽  
Chronic Hypertension ◽  
Third Trimester ◽  
Maternal Complications ◽  
Significant Difference ◽  
Nicu Admission

Background: The aim of this study is to assess whether third trimester haemoglobin level can be used as a predictor of feto-maternal adverse outcomes in pregnancies complicated with PIH.Methods: This is an observational study in the Obstetrics and Gynaecology Department of IMS and SUM hospital, SOA university from July 2015 to December 2017. Institutional ethical committee permission obtained. All singleton pregnancies delivered during this period with PIH were included in the study. PIH and eclampsia was diagnosed as per ISSHP criteria. All chronic hypertension cases excluded. All were evaluated with haemoglobin level. They were divided into 3 groups depending upon haemoglobin level; low (<11gm%), normal (11-13gm%) and high haemoglobin group (> 13gm%) considering the WHO standard. Maternal complications observed were incidence of eclampsia, abruptio placentae, HELLP syndrome, PPH, neurological complications, ICU admissions and death. Fetal outcomes studied were NICU admission, stillbirth, incidence of prematurity and low birth weight. All these parameters were compared among 3 groups. Statistical analysis was done with SPSS 20 software using Yate’s corrected chi square test.Results: Incidence of eclampsia was significantly greater with both high (p<0.001) and low (p=0.0085) haemoglobin level than normal haemoglobin level. Maternal complications and adverse perinatal outcomes (stillbirth, low birth weight, prematurity, NICU admission) are significantly greater with high haemoglobin level than cases with normal haemoglobin level. There is no significant difference in maternal and perinatal complications between low and normal haemoglobin group.Conclusions: High haemoglobin level >13gm% in third trimester is associated with worst feto-maternal outcome whereas normal haemoglobin level (11-13gm%) is associated with least feto-maternal complications.

scholarly journals Induction of labour and its feto-maternal outcome

2019 ◽  
Vol 8 (7) ◽  
pp. 2748
Author(s):  
Mridu Sinha ◽  
Shashi Bala Arya ◽  
Shashi Saxena ◽  
Nitant Sood
Keyword(s):  
Vaginal Delivery ◽  
Statistical Tests ◽  
Post Partum ◽  
Tertiary Care ◽  
Relative Effect ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Time Period ◽  
Increased Risk ◽  
One Year

Background: Induction of labour is an iatrogenic deliberate attempt to terminate the pregnancy in order to achieve vaginal delivery in cases of valid indication. It should be carefully supervised as it is a challenge to the clinician, mother and the fetus. Aim of this study was to find out common indications for IOL in a tertiary care teaching centre and its feto-maternal outcome.Methods: An institutional based retrospective observational study was conducted to describe the prevalence of labour induction and factors associated with its outcome, during the time-period of one year from January 2018 to December 2018, at SRMS IMS, Bareilly. Logistic regression analysis was employed to assess the relative effect of determinants and statistical tests were used to see the associations.Results: Most of the patients were primigravidas of younger age-group. Idiopathic oligohydramnios and postdatism were the commonest indications for induction of labour and Misoprost was the commonest drug used for it. Though majority had vaginal delivery, as the method was changed to combined method it was significantly associated with increased likelihood of LSCS. Similarly there was increased association with maternal cervico-vaginal tear / lacerations as the method was changed to combined type. However there were no association between post-partum hemorrhage, meconium stained liquor or fetal distress.Conclusions: Common indications for induction of labour were oligohydramnios and postdatism. Misoprost can be safely used for induction of labour without any increased risk for LSCS or any fetal / neonatal risks.

scholarly journals A Retrospective Review of 25 cases of Lethal Fetal Anomalies

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dalia FA ◽  
Hamizah I ◽  
Zalina N ◽  
Yong SL ◽  
Mokhtar A
Keyword(s):  
Gestational Age ◽  
Retrospective Review ◽  
Post Partum ◽  
Case Series ◽  
Tertiary Hospital ◽  
Prenatal Ultrasound ◽  
Age At Diagnosis ◽  
Maternal Complications ◽  
Breech Delivery ◽  
Failed Induction

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25 women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9 years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%) women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight (32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus. Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various maternal morbidities, in this case series , which could have been prevented if they were diagnosed and terminated at early trimester. A new direction is needed in our local practice.

scholarly journals Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

Biomedicines ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 32 ◽  
Author(s):  
Kelly Tisovic ◽  
Lilyana Amezcua
Keyword(s):  
Multiple Sclerosis ◽  
Post Partum ◽  
Fetal Exposure ◽  
Childbearing Age ◽  
Maternal Complications ◽  
Increased Risk ◽  
Effective Contraception ◽  
Disease Modifying ◽  
Contemporary Management ◽  
In Pregnancy

Multiple sclerosis (MS) primarily affects women in childbearing age and is associated with an increased risk of adverse post-partum outcomes. Relapses and now fetal exposure to disease modifying treatments in the early phase of pregnancy and thereafter are of concern. Safe and effective contraception is required for women who wish to delay or avoid pregnancy while on disease-modifying treatments. Counseling and planning is essential to assess the risk of both fetal and maternal complications, particularly now in the era of highly efficient and riskier therapies. The purpose of this review is to provide a practical framework using the available data surrounding pregnancy in MS with the goal of optimizing outcomes during this phase in MS.

On the clinical importance of thyroid microsomal and thyroglobulin antibody determination

1987 ◽  
Vol 116 (1_Suppl) ◽  
pp. S325-S329 ◽  
Author(s):  
W. A. Scherbaum
Keyword(s):  
Autoimmune Thyroiditis ◽  
Type I Diabetes ◽  
Post Partum ◽  
Thyroid Autoimmunity ◽  
Elevated Serum ◽  
Clinical Importance ◽  
Overt Hypothyroidism ◽  
Type I ◽  
Increased Risk ◽  
Antibody Determination

Abstract. Among the various autoantibody tests applied in research and clinical practice, the determination of thyroid microsomal (TMAb) and thyroglobulin antibodies (TgAb) still retains its strong value in the screening for thyroid autoimmunity. The presence in the serum of TMAb is almost invariably associated with thyroid autoimmune disease or focal thyroiditis. The appearance of TMAb together with elevated serum-TSH in subclinical autoimmune thyroiditis strongly suggests progression to overt hypothyroidism. Pregnant women with positive TMAb and/or TgAb run an increased risk for post-partum painless thyroiditis with transient thyrotoxicosis and subsequent hypothyroidism. After delivery also a relapse of previously unrecognized Graves' thyrotoxicosis may occur. Thyroid antibody determination is not a valuable tool to discriminate autoimmune thyroiditis from thyroid malignancies. TMAb and TgAb determination helps to recognize individuals with thyroid autoimmunity among patients with non-thyroid autoimmune diseases such as Addison's disease and Type I diabetes mellitus.

Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kyosuke Kamijo ◽  
Daisuke Shigemi ◽  
Mikio Nakajima ◽  
Richard H Kaszynski ◽  
Satoshi Ohira
Keyword(s):  
Logistic Regression ◽  
Postpartum Hemorrhage ◽  
Neonatal Intensive Care ◽  
Multivariable Logistic Regression Analysis ◽  
Maternal Complications ◽  
Logistic Regression Models ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Assisted Delivery ◽  
Nicu Admission

Abstract Objectives To determine the association between the number of pulls during vacuum-assisted deliver and neonatal and maternal complications. Methods This was a single-center observational study using a cohort of pregnancies who underwent vacuum-assisted delivery from 2013 to 2020. We excluded pregnancies transitioning to cesarean section after a failed attempt at vacuum-assisted delivery. The number of pulls to deliver the neonate was categorized into 1, 2, 3, and ≥4 pulls. We used logistic regression models to investigate the association between the number of pulls and neonatal intensive care unit (NICU) admission and maternal composite outcome (severe perineal laceration, cervical laceration, transfusion, and postpartum hemorrhage ≥500 mL). Results We extracted 480 vacuum-assisted deliveries among 7,321 vaginal deliveries. The proportion of pregnancies receiving 1, 2, 3, or ≥4 pulls were 51.9, 28.3, 10.8, and 9.0%, respectively. The crude prevalence of NICU admission with 1, 2, 3, and ≥4 pulls were 10.8, 16.2, 15.4, and 27.9%, respectively. The prevalence of NICU admission, amount of postpartum hemorrhage, and postpartum hemorrhage ≥500 mL were significantly different between the four groups. Multivariable logistic regression analysis found the prevalence of NICU admission in the ≥4 pulls group was significantly higher compared with the 1 pull group (adjusted odds ratio, 3.3; 95% confidence interval, 1.4–7.8). In contrast, maternal complications were not significantly associated with the number of pulls. Conclusions Vacuum-assisted delivery with four or more pulls was significantly associated with an increased risk of NICU admission. However, the number of pulls was not associated with maternal complications.

scholarly journals Caesarean Section During Second Stage of Labor in a Tertiary Centre

2017 ◽  
Vol 15 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Padma Gurung ◽  
Sameer Malla ◽  
Sushma Lama ◽  
Anagha Malla ◽  
Alka Singh
Keyword(s):  
Caesarean Section ◽  
Post Partum ◽  
Caesarean Section Rate ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Perinatal Complications ◽  
Maternal Complications ◽  
Postoperative Fever ◽  
Second Stage Of Labor ◽  
Second Stage

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. Within this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlight the feto-maternal outcome of caesarean section in second stage of labour.Methods: This was a retrospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between April 1, 2013 and March 30, 2017 at Patan Academy of Health Sciences. The main outcome measures were second stage caesarean section, indications and its maternal and fetal morbidity.Results: During the study period, there were 40,860 deliveries. A total of 18,011 (44%) babies were born by caesarean section, 10484 emergency and 7527 elective. Out of the emergency caesarean section, 200 (1.9 %) were performed in second stage of labor. In this study, the most common indication was cephalopelvic disproportion. (92.4%) were delivered without a trial of instrumental delivery. In terms of maternal complications, atonic post partum haemorrhage uterine incision extension 18 (12.5%), postoperative fever 27(18.8%), wound infection 7 (4.8%) were observed. In perinatal complications, meconium stained amniotic fluid 49(34.2%), neonatal hyperbilirubinemia 14(9.7%) and increased nursery admission 2(15.3%) and 2(1.3%) perinatal mortality were seen.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and neonatal morbidity.

scholarly journals Prevalence of thyroid dysfunction in pregnant women and the need for universal screening: an observational study in Northern Andhra Pradesh population

2017 ◽  
Vol 6 (6) ◽  
pp. 2536
Author(s):  
Krishnamma B. ◽  
Prabhavathi V. ◽  
Prasad D. K. V.
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Overt Hypothyroidism ◽  
Free T4 ◽  
Increased Risk ◽  
Tsh Levels

Background: The maternal thyroid dysfunction is associated with adverse outcomes such as miscarriage, preterm delivery, preeclampsia, postpartum haemorrhage in mother whereas increased risk of impaired neurological development in foetus. The present study was designed with an aim to determine the prevalence of thyroid dysfunction and the need for universal screening in pregnant women.Methods: Three hundred and eighty pregnant women between 8-36 weeks of gestation with age group 20-32 years were recruited. Serum free T3, free T4 and TSH levels were assayed by chemiluminescence method. The pregnant women were classified into euthyroid, subclinical hypothyroid (SH), overt hypothyroid (OH) and overt hyperthyroid groups based on the results obtained in the study.Results: In the present study, the mean ± SD age (in years) and BMI of all pregnant women was 23.9±3.9 and 22.9±1.6 respectively. The maternal age was high in OH and overt hyperthyroid and was statistically significant (p<0.05). Similarly, women with high BMI were prone to OH than normal BMI (p<0.05). The prevalence of thyroid dysfunction was found to be 18.7%. The prevalence of hypothyroidism was 17.4% in which the SH was 13.4% and overt hypothyroidism 3.9%, but overt hyperthyroidism was 1.3%. TSH levels increased with the advancement of gestational age from 2.72±1.85 in first trimester to 3.4±2.05 µIU/mL in third trimester, and the difference was statistically significant (p<0.05). Finally, it was also noticed that the prevalence of raised TSH in high-risk pregnant women was high compared to low-risk women (35.6% vs 5.1%) relative risk (RR) 7.64, 95% confidence interval (CI) 4.62-12.65, (p<0.0001). However, 14 out of 51 (27.5%) with SH were in low-risk group.Conclusions: The present study states that the prevalence of thyroid dysfunction was 18.7% and also emphasizes the importance of screening all pregnant women for thyroid dysfunction rather than targeted high-risk pregnant women to prevent both maternal and fetal morbidity.

scholarly journals Feto-maternal outcome of oligohydramnios in tertiary care hospital

2021 ◽  
Vol 10 (11) ◽  
pp. 4101
Author(s):  
Shetal Prajapati ◽  
Sakina Johar
Keyword(s):  
Cesarean Section ◽  
Neonatal Death ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Maternal Outcome ◽  
Care Hospital ◽  
Maternal Complications ◽  
Risk Pregnancy ◽  
Fetal Surveillance ◽  
Nicu Admission

Background: The importance of amniotic fluid volume as an indicator of fetal wellbeing has made its assessment an important part of antenatal fetal surveillance. Oligohydramnios complicates 0.5% to 8% of pregnancies and the prognosis for pregnancies complicated by oligohydramnios is dependent on the gestational age and the underlying aetiology. This study aims to determine the feto-maternal outcome of oligohydramnios in a tertiary care hospital.Methods: In this study, we included 100 patients of oligohydramnios, with AFI ≤5 cm with a singleton pregnancy with intact membranes. The maternal outcome was accessed by mode of delivery and maternal complications and the neonatal outcome was studied by birth weight, APGAR score, NICU admission and perinatal mortality.Results: PIH was the most common risk factor in 38% of cases followed by IUGR in 29%, doppler changes in 24%. The reduced diastolic flow was the most common abnormal doppler finding in the 23% abnormal doppler cases, from which 39% underwent cesarean section, 9% required NICU admission and 61% had neonatal death. 53% delivered by cesarean section of which 13% had neonatal death. NICU admission is required in 64% of cases.Conclusions: We conclude that oligohydramnios is a high-risk pregnancy and proper antepartum care, intensive fetal surveillance and intrapartum care are required in a patient with oligohydramnios. Every case of oligohydramnios needs careful antenatal evaluation, parental counselling, individualization, decisions regarding time and mode of delivery. Continuous intrapartum fetal monitoring and good neonatal care are necessary for a better perinatal outcome.

scholarly journals Feto-maternal outcome in grand multipara

2017 ◽  
Vol 6 (7) ◽  
pp. 2846 ◽  
Author(s):  
Rajib Roy ◽  
Manisha Vernekar
Keyword(s):  
Caesarean Section ◽  
Antenatal Care ◽  
Post Partum ◽  
Caesarean Section Rate ◽  
Birth Asphyxia ◽  
Maternal Outcome ◽  
Hypertensive Disorder ◽  
Maternal Complications ◽  
Grand Multiparity ◽  
Set Up

Background: Grand multiparity has been considered as obstetric hazards both to the mother and foetus and thus, viewed with great caution. In present set up grand multiparity is associated with increased likelihood of feto-maternal complications.Methods: The study was conducted to determine the feto-maternal outcome in grand multipara pregnancy.Results: In present study, the prevalence of grand multipara was 0.72% out of 15196 deliveries in the period from September 2010 to august 2012. 79.1% of the grand multipara women belonged to the age group of 31-40 years. A majority of the women were in Para 5. Most of the women had no antenatal care attendance. The highest prevalence of grand multipara women was seen among Muslim community (1.65%). A majority (59.1%) of the women were anemic. Caesarean section rate was 30.0% in our study. Post-partum hemorrhage was the most common complication encountered. 7.0% were macrosomic babies, whereas 8.7% were LBW babies. There were 10 perinatal deaths, birth asphyxia being the most important cause for the perinatal mortality. There were no maternal deaths.Conclusions: Our study demonstrates that, there is increase in antenatal and intra-partum maternal complications like anaemia, hypertensive disorder, preterm labour, increase in the rate of caesarean section, PPH etc., leading to severe maternal morbidity. So, the study concludes that in grand multipara pregnancy, both the woman and the fetus are at a greater risk during pregnancy and labour. This risk can be effectively reduced with good antenatal care and delivery by trained personnel.

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