Women with Severe Anemia in Labor: Fetomaternal Outcomes

Background: Anaemia in pregnancy is the leading medical disorder in developing countries like India. Women with severe anemia in labor is a challenging situation for the obstetrician with increased maternal and perinatal morbidity and mortality. It has multifactorial etiology, Main cause of anemia in obstetrics is iron deficiency. There are specific risks for the mother like preterm labour pain, IUGR baby, preeclampsia, antepartum haemorrhage, sepsis etc and the fetus such as prematurity, lowbirth weight, birth asphyxia etc. Aim and Objectives: To determine the socio-demographic variables and also the maternal and perinatal outcomes of pregnant women admitted to labour room with severe anemia (Hb <7gm%) late in pregnancy. Results: It was seen that out of 50 severely anemic women, 82% had Hb between 4-7 gm% and 18% had Hb < 4gm%. Severe anemia is seen in 82% unbooked patients and only in 18% booked patients. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, mortality in anemic group as compared to non anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admission, low birth weight among the anemic group as compared to non anemic group. Conclusions: Severely anemic women reporting in labor had significantly high maternal and perinatal morbidity and mortality. Even a minor blood loss is much devastating for such patients. Extrapolating our observations, it can be said that a close vigilance, anticipation of complications and appropriate care and interventions during labor and puerperium will help in improving outcomes in these severely anemic women. Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy. Key words: Anaemia, Iron deficiency, Intrauterine growth retardation, prematurity, maternal outcome, neonatal outcome.

Download Full-text

Clinical significance of ultrasonic placental grading during third trimester in hypertensive disorders in pregnancy and its correlation with fetal outcome in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213443 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3325

Author(s):

Aruna Naik ◽

Susheela Khoiwal ◽

Nisha Sharma ◽

Priya Aarthy

Keyword(s):

Pregnant Women ◽

Birth Asphyxia ◽

Morbidity And Mortality ◽

Study Group ◽

Perinatal Morbidity ◽

Foetal Distress ◽

Third Trimester ◽

Foetal Outcome ◽

Grade Iii ◽

In Pregnancy

Background: Hypertension is one of the common complications in pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. The aim of the present study was to study placental grading by grading by ultrasonography in pregnancy complicated with hypertension and normotensive gravidas. To compare the foetal outcome regarding placental grading and its correlation pattern of placental grade distribution, type of delivery, foetal distress, birth asphyxia, foetal maturity, perinatal morbidity and mortality.Methods: The present study was conducted for a period of 12 months, which included 200 patients who attended OPD at PDRMC, Udaipur. Inclusion criteria was hypertensive pregnant women with BP >140/90 mmHg. Exclusion criteria was Pregnancy associated with other medical disorders, twin gestation, renal and cardiovascular disease and diabetes mellitus.Results: 100 pregnant women with preeclampsia as study group. The most common age group in study group is 22-23 Years. The grade III placenta was found early third trimester in study group. Caesarean delivery was more common mode of delivery in grade III placenta. In foetal outcome small for gestational age was more among the grade III placenta. Foetal distress, birth asphyxia, perinatal mortality, morbidity more among the grade III placenta among the study group.Conclusions: Foetal complications were significantly more in study group compared to control group. Ultrasound placental grade III was statistically significant in correlating with foetal complications like foetal distress, birth asphyxia, perinatal morbidity and mortality.

Download Full-text

Maternal and perinatal outcomes of hyperthyroidsm in pregnancy at Dr. Cipto Mangunkusumo Hospital, Jakarta, period of January 2015 - December 2016

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v29i12021.36-40 ◽

2021 ◽

Vol 29 (1) ◽

pp. 36

Author(s):

Fita Maulina ◽

M Adya F F Dilmy ◽

Ali Sungkar

Keyword(s):

Pregnant Women ◽

Preterm Delivery ◽

Intrauterine Growth Restriction ◽

Fetal Death ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Intrauterine Fetal Death ◽

Adequate Treatment ◽

Intrauterine Growth ◽

In Pregnancy

Objectives: To report maternal and perinatal outcomes of hyperthyroidsm in pregnancy.Case Report: There were 3622 cases of delivering pregnant women during the period of the study. From this number, the prevalence of pregnant women with hyperthyroid was 0.2 %. We reported 9 cases of hyperthyroid in pregnancy. The number of pregnancy complication and outcome on pregnant women with hyperthyroidism were preterm labor (44%) and preeclampsia (22%), both were found in group of mother who did taking antihyperthyroid therapy. In those who did not take antihyperthyroid therapy 11% had spontaneous abortion and 11% had preterm delivery. Fetal complications were intrauterine growth restriction (11%) and intrauterine fetal death (23%), both of these complication were on the group who did not take antihyperthyroid. On the contrary, 44% babies were born with normal birthweight in group who took antihyperthyroid.Conclusion: There were differences noted between the group that took adequate treatment and the group that did not take antihyperthyroid. The incidence of intrauterine growth restriction and intrauterine fetal death were high in group that did not took antihyperthyroid therapy but the incidence of preterm delivery as the maternal complication was high in group that did take the antihyperthyroid therapy.

Download Full-text

The use of intravenous iron in pregnancy: for whom and when? A survey of Australian and New Zealand obstetricians

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03363-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sarah Smith-Wade ◽

Giselle Kidson-Gerber ◽

Antonia Shand ◽

Luke Grzeskowiak ◽

Amanda Henry

Keyword(s):

New Zealand ◽

Iron Deficiency ◽

Online Survey ◽

Controlled Trial ◽

Perinatal Outcomes ◽

Intravenous Iron ◽

Line Treatment ◽

Second Line ◽

First Line ◽

In Pregnancy

Abstract Background Iron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes. National prescribing data suggests the use of intravenous iron in pregnancy is increasingly common. This study aimed to: 1) Establish the current patterns of intravenous iron use by Fellows of the Royal Australian and New Zealand College of Obstetricians (FRANZCOG) when treating iron deficiency and IDAP including immediately postpartum and; 2) Assess FRANZCOG opinions regarding potential trial of intravenous iron for first-line treatment of IDAP. Methods An online survey of RANZCOG Fellows practicing obstetrics was distributed in September 2018. Results were analysed descriptively and responses compared by clinician demographics using Chi-squared testing. Results Of 484 respondents (21% of FRANZCOG), 457 were currently practicing obstetrics. Most prescribed intravenous iron in pregnancy (96%) and/or postpartum (85%). Most intravenous iron was prescribed for IDAP (98%) rather than iron deficiency without anaemia (53%), and for IDAP most commonly second-line to failed oral iron supplementation and first-line in special circumstances (59%). Intravenous iron prescribing was associated with shorter time since FRANZCOG completion (p = 0.01), public hospital practice (p = 0.008) and higher hospital birth numbers (p = 0.01). Most respondents (90%) would consider a randomised controlled trial of first-line intravenous iron for IDAP, although views on appropriate thresholds differed. Conclusions Almost all respondents prescribed intravenous iron for IDAP, and while mostly used for second-line treatment over half sometimes used it first-line. With accelerating intravenous iron use, further research is required into its optimal use in pregnancy, recognizing important clinical outcomes and cost effectiveness.

Download Full-text

Hypertension in pregnancy: Pathophysiology and treatment

SAGE Open Medicine ◽

10.1177/2050312119843700 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984370 ◽

Cited By ~ 12

Author(s):

Stephanie Braunthal ◽

Andrei Brateanu

Keyword(s):

Gestational Hypertension ◽

Severe Hypertension ◽

Organ Damage ◽

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

In Pregnancy ◽

The Ideal

Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.

Download Full-text

Study of sociodemographic profile, maternal, fetal outcome in preeclamptic and eclamptic women: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196025 ◽

2019 ◽

Vol 9 (1) ◽

pp. 230

Author(s):

Vedavathi . ◽

Rajeev Sood

Keyword(s):

Blood Pressure ◽

Prospective Study ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Intrauterine Death ◽

Perinatal Morbidity

Background: Preeclampsia is pregnancy specific disease, lead to maternal, perinatal morbidity and mortality. This study is conducted to identify the socio demographic profile of subjects suffering from preeclampsia and its effect on maternal and fetal health.Methods: This prospective study was conducted at department of obstetrics and gynecology, Kamla Nehru State Hospital, Shimla, in this, 100 preeclamptic women were included. Preeclampsia was diagnosed with blood pressure of ≥140/90 mmHg noted for the first-time during pregnancy, after 20 wks of gestation and proteinuria. Demographic details were collected. Investigations i.e. hemogram, liver and renal function tests, coagulation profile and fundoscopy were done. Maternal and perinatal outcomes were recorded.Results: In this study, majority of the subjects were primigravida 65. In this, 11 subjects had systolic blood pressure of 140-159 mmHg and 89 subjects had systolic blood pressure of > 160 mmHg. 25 subjects had diastolic blood pressure of 90-109 mmHg and 75 subjects had diastolic blood pressure of > 110 mmHg. In this, 82 subjects had warning symptoms, mainly headache 49. 14 subjects showed hypertensive changes in fundus. Unfavorable Bishop Score, observed in 86 subjects and 78 subjects were induced after controlling blood pressure. Majority of subjects had vaginal delivery 73. Majority of the subjects had deranged liver function 61. Maternal morbidity was reported in 54 subjects. Intrauterine death reported in 14 subjects. Birth weight was < 2.5 kg was observed in 70 babies. Out of 74 live births, 53 neonates required admission in NICU and 16 neonates died in NICU.Conclusions: It may be concluded that, maternal and neonatal morbidity and mortality can be reduced by early identification of risk factors and timely intervention is the hall mark in preventing the maternal and perinatal morbidity and mortality.

Download Full-text

Maternal and Perinatal Morbidity and Mortality Associated With Anemia in Pregnancy

Obstetrics and Gynecology ◽

10.1097/aog.0000000000003735 ◽

2020 ◽

Vol 135 (3) ◽

pp. 730

Author(s):

Catherine Deneux-Tharaux ◽

Marie-Pierre Bonnet

Keyword(s):

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Anemia In Pregnancy ◽

In Pregnancy

Download Full-text

Cocaine use in pregnancy: Perinatal morbidity and mortality☆

Neurotoxicology and Teratology ◽

10.1016/0892-0362(87)90017-1 ◽

1987 ◽

Vol 9 (4) ◽

pp. 291-293 ◽

Cited By ~ 198

Author(s):

I CHASNOFF ◽

K BURNS ◽

W BURNS

Keyword(s):

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Cocaine Use ◽

In Pregnancy

Download Full-text

Hypertensive disorders in pregnancy at the federal medical centre, Yenagoa, South-South Nigeria: a 5 year review

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213914 ◽

2021 ◽

Vol 9 (10) ◽

pp. 2923

Author(s):

Peter Chibuzor Oriji ◽

Dennis Oju Allagoa ◽

Akaninyene Eseme Ubom ◽

Amos Kattey Kattey ◽

Datonye Christopher Briggs ◽

...

Keyword(s):

Perinatal Outcomes ◽

Case Fatality ◽

Medical Centre ◽

Morbidity And Mortality ◽

Chronic Hypertension ◽

Maternal Deaths ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

Gestational Age At Delivery ◽

In Pregnancy

Background: Hypertensive disorders complicate 5.2%-8.2% of pregnancies, and contribute significantly to perinatal and maternal morbidity and mortality worldwide. To determine the incidence, clinical characteristics, maternal and perinatal outcomes of hypertensive disorders in pregnancy at the Federal medical centre, Yenagoa, Bayelsa State, South-South Nigeria.Methods: This retrospective study was conducted between 1 January, 2016 and 31 December, 2020. Relevant data was retrieved, entered into a pre-designed proforma, and analysed using IBM SPSS version 25.0.Results: Out of the 4,571 obstetric patients that were managed in our Centre in the period under review, 335 of them had HDP, giving an incidence rate of 7.32%.The most common HDP were pre-eclampsia (189, 56.4%) and eclampsia (82, 24.5%), while the least common was chronic hypertension (3, 0.9%). A little more than one-half (171, 51.0%) of the women delivered preterm, with a mean gestational age at delivery of 35.5 weeks. The most common route of delivery was emergency Caesarean section (205, 61.2%). There were three maternal deaths, giving a case fatality rate of 0.9%. Two of the maternal deaths were due to eclampsia, and one, from pre-eclampsia.Conclusions: Women should be adequately counseled to embrace preconception care, and early and regular antenatal care visits, with proper monitoring of blood pressure and urine protein. Prompt diagnosis and management are key in preventing the maternal and perinatal morbidity and mortality that are associated with these disorders.

Download Full-text

Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1005 ◽

2009 ◽

Vol 1 (3) ◽

pp. 25-28 ◽

Cited By ~ 7

Author(s):

Anshu LNU ◽

Deepika LNU

Keyword(s):

Pulmonary Embolism ◽

Antenatal Care ◽

Pulmonary Edema ◽

Perinatal Outcome ◽

Tertiary Care ◽

Birth Asphyxia ◽

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Perinatal Complications ◽

Function Tests

ABSTRACT Background Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Present study was planned to find the maternal and perinatal outcome in patients of severe pre-eclampsia and eclampsia. Methodology It is a prospective study, carried out on 100 pregnant women admitted with severe pre-eclampsia and eclampsia at a tertiary care referral unit. Detailed history and examination was carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, fundus and 24 hours urine for protein were done. Obstetric management was done as per existing protocol in the department, magnesium sulphate was the drug of choice for controlling convulsions, and blood pressure was controlled either by oral nefidipene or methyl dopa. Maternal and perinatal complications were noted down. Results The majority of the patients was unbooked (82%), belonged to lower socioeconomic status (84%) and had rural background (84%). Headache was the most common antecedent symptom (44%) followed by epigastric pain (20%), oliguria (9%), blurring of vision (8%) and ascitis (5%). There was high incidence of maternal complications like PPH (31%), abruption placentae (11%), renal dysfunction (8%), pulmonary edema (8%), pulmonary embolism (4%), HELLP syndrome (2%) and DIC (2%). Maternal mortality was 8% and the causes were pulmonary embolism in four women, DIC in two, HELLP and pulmonary edema in one each. Perinatal complications were also high 71.43% were low birth weight, 66% had preterm delivery, 52.4% babies had birth asphyxia and 28.57% were still born. Maternal and perinatal outcome was much poorer in eclampsia as compared to severe pre-eclampsia. Conclusion There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care. Good antenatal care could have been prevented severe pre-eclampsia and eclampsia to some extent. Thus it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.

Download Full-text