Feto-Maternal Outcome in Patients with Jaundice During Pregnancy

2021 ◽  
Vol 15 (10) ◽  
pp. 3452-3454
Author(s):  
Gulfareen Haider ◽  
Momna Khan ◽  
Fozia Shaikh ◽  
Asma Jabeen
Keyword(s):  
Renal Impairment ◽  
Viral Hepatitis ◽  
Hepatic Coma ◽  
Fetal Distress ◽  
Maternal Outcome ◽  
University Hospital ◽  
Maternal Complications ◽  
Singleton Pregnancy ◽  
Vaginal Deliveries ◽  
Abruptio Placenta

Objective: To find out causes and feto-maternal outcome among patients presented with jaundice during pregnancy. Material and methods: This study was conducted at Isra university Hospital over period of one year from January 2018 to December 2019 in OBS and gynecology department. A total of 50 females having singleton pregnancy and having jaundice were included in the study after taking verbal informed consent. All the patients underwent normal vaginal deliveries and cesarean section as per indications and Hospital protocol. All the information regarding demographic characteristics including maternal and fetal outcome in terms of complications and mortality was collected via self-made study proforma and data was analyzed by SPSS version 20. Results: Total 50 patients were included in this study and 50% belonged to the age group of more than 30 years. 50% were un-booked, multigravida were 80% and 60% women poor socioeconomically. Most of the females had jaundice occurrence during the third trimester. Most patients 40% had jaundice due to viral hepatitis. Major maternal complications were the coagulation failure and renal impairment among 40% and 20% of the cases respectively, followed by septicemia, hepatic coma, hepatic coma, ICU admission, Abruptio placenta, PPH and maternal mortality were found with the percentage of 12.0%, 10.0%, 20.0%, 28.0%, 30.0% and 4.0% respectively. As per neonatal complications, fetal distress was 20.0%, still births were 10.0% and IUD were 10.0%. Conclusion: As per study conclusion the most common cause of jaundice was viral hepatitis. Coagulation failure, renal impairment, abruptio placenta and PPH were observed to be the commonest maternal complications, while fetal distress, IUD and still birth were the frequent fetal complication among patients presenting with jaundice during pregnancy. Keywords: Jaundice, feto-maternal outcome, viral hepatitis

scholarly journals Forceps deliveries and fetomaternal outcome in modern obstetrics

2019 ◽  
Vol 8 (12) ◽  
pp. 4862
Author(s):  
Sarda Devi Okram ◽  
Kalpana Betha ◽  
Jothsna Bodhanapati ◽  
Koorapati Tejasri
Keyword(s):  
Neonatal Outcome ◽  
Demographic Data ◽  
Fetal Distress ◽  
Reproductive Age ◽  
Age Group ◽  
Forceps Delivery ◽  
Maternal Complications ◽  
Common Indication ◽  
Vaginal Deliveries ◽  
Tertiary Teaching

Background: In modern obstetrics practice has witnessed an increase in the caesarean section rates everywhere. The incidence of instrumental deliveries varies between 10-12% in UK. The incidence of instrumental deliveries varies between 2.7-5% in India. There is an urgent need to reintroduce instrumental need in the modern obstetrics. Instrumental delivery is one of the basic functions of emergency care according to WHO. This study was done to know the prevalence, indications and fetal outcomes of forceps deliveries.Methods: A retrospective study was conducted at a tertiary teaching hospital, India from January 2014 to December 2018. All cephalic singleton pregnant mothers who underwent forceps delivery after 28 weeks were included. All the forceps delivery done in twins and breech vaginal delivery were excluded. Demographic data, Indication of forceps delivery, maternal complications of forceps delivery like episiotomy extension, cervical tear, vaginal wall tear, PPH and neonatal outcome like low birth weight, NICU admissions, stillbirth, APGAR score at 1 and 5 minutes were recorded. Equal number of mothers of reproductive age group 20-45 ages who underwent normal non breech vaginal deliveries were randomly selected as control.Results: The prevalence of forceps delivery was 5.25%. The most common indication was fetal distress (55%). Most of the mothers were primigravidas in age group 20-30 years (p<0.001). Regarding the neonatal outcome, 72% of the babies were having weight >2.5 kgs.  APGAR <7 at 1 and 5 min was not significant.Conclusions: As fetal distress is the most common indication, every obstetrician should learn the skill of forceps delivery and it should not be a dying art.

scholarly journals Fertility and Pregnancy Outcomes in Females with Dyskeratosis Congenita

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1598-1598 ◽  
Author(s):  
Neelam Giri ◽  
Blanche P. Alter ◽  
Sharon A Savage ◽  
Pamela Stratton
Keyword(s):  
High Risk ◽  
Pregnancy Outcomes ◽  
Placenta Previa ◽  
Fetal Distress ◽  
Dyskeratosis Congenita ◽  
Maternal Complications ◽  
Maternal Fetal Medicine ◽  
Diamond Blackfan Anemia ◽  
Vaginal Deliveries ◽  
Fetal Complications

Abstract Background:Reduced fertility and increased fetal and maternal complications during pregnancy have been reported in patients with Fanconi anemia, Diamond-Blackfan anemia and Shwachman-Diamond syndrome. Such high-risk pregnancies benefit from coordinated care by hematologists and maternal-fetal medicine specialists with expertise in inherited bone marrow failure syndromes (IBMFS). There are no data on fertility and pregnancy outcomes in women with dyskeratosis congenita (DC). Objectives: To determine pubertal development, fertility, and pregnancy outcomes in women with DC. Methods: Prospective evaluation and medical record review was performed of women with DC ≥10 years of age enrolled in the NCI IBMFS cohort study. We examined ages at menarche and menopause, details regarding fertility and pregnancy, hematologic and non-hematologic complications of pregnancy, and maternal and fetal outcomes. Results: We evaluated 27 women with DC (median age 31 years, range 10-63), who all attained menarche (median age 12 years, range 9-17). The median age at natural menopause was 51 years, range 50-52. Seventeen women had 46 pregnancies (median 2 pregnancies per person, range 1-6); 1 was unable to conceive, 3 were using contraceptives and 6 were not yet sexually active. Thirty-two of 46 pregnancies (70%) in 17 women who carried to 27-42 weeks gestation (median 39 weeks) resulted in 34 live births (2 sets of twins). Thirty pregnancies (65%) in 11 women were associated with a variety of complications: 13 ended in miscarriages; 1 was an elective abortion. Maternal complications were preeclampsia (n=3), placenta previa with abruption (n=2 pregnancies in the same patient) and cesarean section for failure to progress (n=5; 4 were in 1 patient). Fetal complications were 5 preterm births (3 associated with preeclampsia) and 2 others had fetal distress. Six women had cytopenia during 8 pregnancies: in 2, mild cytopenia worsened during pregnancy but did not need treatment. One progressed to severe aplastic anemia (SAA) and 1 with SAA was transfusion-dependent throughout. Two patients had normal counts at the start of pregnancy, but developed cytopenia with preeclampsia or abruption with placenta previa, respectively. Three others with normal blood counts had macrocytosis. One was post-transplant. Four had only non-hematologic manifestations of DC. And, 3 women, with no DC-associated clinical features, were identified after diagnosis of an affected offspring. Fourteen of 32 pregnancies were cesarean deliveries performed in 8 patients for maternal complications (n=7), fetal distress (n=2) or failure to progress (n=5). Three of the 18 vaginal deliveries were in 2 mothers with mild cytopenia, and 1 preterm birth in a patient with SAA. Only 14/46 pregnancies (30%) in 6 women were uncomplicated, term vaginal deliveries; of these, 2 occurred in 1 post-hematopoietic stem cell transplant recipient, conceived by in vitro fertilization. There were 8 patients with TERC mutations, 3 TERT, 2 TINF2, 2 RTEL1and 2 were gene unknown. Fetal loss or maternal complication did not differ significantly in relation to mutated genes in mothers. Conclusions: This is the first study of fertility and pregnancy outcomes in patients with DC. We show that females with DC attain menarche and menopause at normal ages and have normal fertility. However, women with DC appear to have high rates of maternal and fetal complications resulting in miscarriage, preeclampsia, and worsening cytopenias. These complications may lead to increased likelihood of cesarean section and/or preterm delivery. Thus, similar to Fanconi anemia and Diamond-Blackfan anemia, pregnant women with DC are at high-risk for complications and should be managed by a hematologic and high risk maternal-fetal medicine team. Disclosures No relevant conflicts of interest to declare.

PRIMIGRAVIDAS;

2017 ◽  
Vol 24 (02) ◽  
pp. 258-262
Author(s):  
Sarwat Memon ◽  
Sumaira Rauf
Keyword(s):  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
University Hospital ◽  
Maternal Complications ◽  
Spontaneous Vaginal Delivery ◽  
Birth Attendants ◽  
Products Of Conception ◽  
Vaginal Deliveries ◽  
Study Setting

Objectives: To determine frequency of different mode of deliveries andassociated maternal complications in primigravidas in tertiary care setup. Study Design: Caseseries study. Setting: Department of Obstetrics and Gynaecology (Liaquat University Hospital)Hyderabad, Sindh, Pakistan. Period: 6 months from Jan 2009 till June 2009. Methodology: Allthe primigravidas underwent delivery by any means i-e emergency\elective caesarean sectionor spontaneous vaginal delivery\instrumental vaginal delivery and developed postpartumcomplications up till 7 days after delivery were included. Data was analyzed on pre- designedprofoma and was analyzed through software program SPSS version 10. Results: In this studymost frequent mode of delivery were found to be spontaneous vaginal delivery 46(36.8%)and emergency caesarean section 29(23.2%) while forceps 8.8%, vacuum 20% and electivecaesarean section 1.2%. Complications associated with mode of deliveries included postpartumhemorrhage were reported to be 51.2%, abdominal wound infection 11.2%, perineal woundinfection 17.6%, retained products of conception 28% and puerperal sepsis 16.8%. Conclusion:Deliveries in our setup are mostly conducted by dais (birth attendants) without any asepticmeasures and without assessing the abnormalities that will leads to emergency caesareansection or instrumental vaginal deliveries and in the consequence of these entire patientsdevelop postpartum complications.

scholarly journals Outcome of induction of labour with dinoprostone at a teaching hospital in Nepal

2017 ◽  
Vol 6 (4) ◽  
pp. 1170
Author(s):  
Punita Yadav ◽  
Veena R. Shrivastava
Keyword(s):  
Gestational Age ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Induction Of Labour ◽  
Maternal Complications ◽  
Singleton Pregnancy ◽  
Care Visit ◽  
Common Causes ◽  
Vertex Presentation ◽  
In Pregnancy

Background: Induction of labour has now become a common practice; this study was conducted to find the outcome of induction of labour in pregnant women in relation to: induction delivery interval, mode of delivery, maternal complications and fetal outcome.Methods: It was a hospital based prospective study conducted from April 2012 to March 2013. Singleton pregnancy of gestational age ≥37 weeks, with vertex presentation and Bishops Score <6 were the cases included for induction. Dinoprostone (0.5mg) intracervically was used for induction. The different outcome parameters were analyzed.Results: Of 100 cases enrolled, majority 93% were below 30 years, mean gestational age of induction was 40.7± 0.7weeks and 58% were primi gravida. Ante natal care visit of ≥3 was present only in 66%. At induction 55% had bishop score of (0-3) and rest had score of (4-5). Postdated pregnancy (67%) followed by hypertension (13%) were the two most common causes for induction. 58% required second dose of dinoprostone, and the induction delivery interval was 24.3±9.6 hrs. 63% of the induced labour progress for vaginal delivery. Fetal distress (56.4%) was the commonest indication for caesarean section (CS). 6% of the cases had postpartum hemorrhage. 13% of the delivered neonate required NICU care, of which 53.8% was moderately asphyxiated. There was no maternal or neonatal death.Conclusions: In pregnancy undergoing induction of labour, CS is not uncommon, and there are few chances of maternal and neonatal morbidities. Therefore, obstetrician should be vigilant to avoid any untoward events.

scholarly journals Comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor

2021 ◽  
Vol 10 (11) ◽  
pp. 4249
Author(s):  
Salma Kousar Beigh ◽  
Samar Mukhtar ◽  
Nighat Firdous ◽  
Fariha Amaan
Keyword(s):  
Caesarean Section ◽  
Post Partum ◽  
Caesarean Section Rate ◽  
Fetal Distress ◽  
Induction Of Labor ◽  
Maternal Complications ◽  
Medical College ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Elective Induction

Background: Elective induction of labor is defined as an initiation of labor, either by mechanical or pharmacological means at a time earlier than nature regardless of a medical or obstetric indication. Objectives were to estimate the proportion of caesarean sections and vaginal deliveries and magnitude of maternal complications following elective induction and spontaneous labor.Methods: The study entitled “comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor in LD Hospital, Kashmir” was a hospital based observational study, conducted in the Postgraduate Department of Obstetrics and Gynaecology, LallaDed Hospital of Government Medical College, Srinagar over a period of one and a half years.Results: Women in induced labor group had slightly increased risk of caesarean section than those in spontaneous group. Fetal distress was the most common indication for caesarean section in both the groups. There was no difference in both groups regarding maternal complications such as perineal lacerations; postpartum hemorrhage (PPH); need for blood transfusions and post partum hospital stay.Conclusions: Though induction of labor is associated with a slight increased risk of caesarean delivery, it is not related to other maternal complications. Therefore inductions are safe in hands of safe obstetricians.

scholarly journals FETO-MATERNAL OUTCOME

2018 ◽  
Vol 21 (01) ◽  
pp. 173-178
Author(s):  
Nailla Yousuf Memon ◽  
Uzma Sirajuddin ◽  
Firdous Mumtaz
Keyword(s):  
Gestational Age ◽  
Apgar Score ◽  
Mode Of Delivery ◽  
Well Being ◽  
Maternal Outcome ◽  
University Hospital ◽  
Clinical Test ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Significant Difference

Background: Trial of labour is a clinical test to assess the adequacy of pelvis andability of fetus and mother to withstand labour. If progressive changes in dilation and station donot occur, a cesarean delivery is performed. Objective: Feto-maternal outcome after trial oflabour in women with gestational age b/w 37 to 42 weeks. Study Design: Cross sectional study.Setting: Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. Duration ofStudy: One year from 01-02-2009 to 31-01-2010. Subjects and Methods: 100 pregnant women,with gestational age between 37-42 weeks, who underwent trial of labour at labour ward,Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included inthe study. Detailed history and examination including abdominal and pelvic examination as wellas Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation andCTG. Partogram was maintained to observe the progress of labour. Those who progressed withtrial either delivered normally or with the help of instruments and those who did not progress weredelivered by C-section. After delivery, mothers were watched for any postpartum complicationand condition of neonates was assessed by APGAR score. Results: Out of 100 women includedin this study 58% delivered vaginally, 31 % delivered by cesarean section and 11 % hadinstrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% hadspontaneous labour. 77.0% babies had apgar score > 5(7.1±0.72), 16% < 5(3.68±2.18) and 6%were still birth. 81% mothers had no complication during or after delivery, whereas 19 developedcomplications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterinerupture and one retained placenta. There was no statistically significant difference (P=0.42)when mode of delivery was compared with the trial of labour. However augmentation of labourwas associated with increased rate of maternal complications when maternal outcome wascompared with the type of labour (P=0.03). Conclusions: Trial of labour in carefully selectedwomen with high probability to deliver their babies vaginally decreases the rate of LSCS, therebyreducing the maternal morbidity and mortality associated with it. However augmentation oflabour is associated with increased rate of maternal complications as compared to spontaneousor induced labour.

scholarly journals Perinatal outcome in terminal oligohydramnios

2017 ◽  
Vol 8 (6) ◽  
pp. 35-39
Author(s):  
Rajeshree Tukaram Patil ◽  
Renuka Vivekanand Patil
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Mortality ◽  
Perinatal Outcome ◽  
Fetal Distress ◽  
Medical Sciences ◽  
Amniotic Fluid Index ◽  
Singleton Pregnancy ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Meconium Staining

Background of the Study: Amniotic fluid or liquor, the fluid around the developing fetus serves various functions. A balance of formation and reabsorption of this fluid has to be maintained. The amniotic fluid volume (AFV) undergoes changes during pregnancy. Oligohydramnios is a condition in which the AFV decreases and is associated with conditions like renal agenesis, placental dysfunction, congenital anomalies, anemia, PIH, hypoxia. Its effects depend on the duration of pregnancy. But when AFV decreases terminally, the chances of having a normal baby are more.Aims and Objective: This study was aimed to find the perinatal outcome in terms of LSCS and instrumental deliveries, needs for induction, neonatal mortality, low apgars, meconium staining, NICU admissions in women with oligohydramnios occurring after 34 weeks of pregnancy.Materials and Methods: A prospective observational study included women with singleton pregnancy admitted with intact membranes after 34 weeks. AFV was calculated by USG.Results: Less number of women had AF Index less than 5 cm but as AFV decreases risk of LSCS increases and spontaneous onset of labor ends mostly with vaginal deliveries. Amniotic fluid Index less than 5 cm increases the risk of low Apgar, septicaemia and neonatal mortality. Although Apgar was low at 1 min, it improved at 5 min suggesting a good adaption outside utero.Conclusion: Low AF Index (as determined by USG)in last trimester was associated with increased risk of adverse perinatal outcome like operative delivery, fetal distress, NICU, low apgar, septicemia, neonatal mortality. Here, Doppler can relieve obstetrician stress in decision making and amnioinfusion in selected cases can reduce operative morbidity. Parameters like risk of septicemia and effects in extremes of maternal age need to be evaluated further in a larger number of cases.Asian Journal of Medical Sciences Vol.8(6) 2017 35-39

scholarly journals VACUUM EXTRACTION AND FORCEPS DELIVERIES;

2012 ◽  
Vol 19 (05) ◽  
pp. 652-656
Author(s):  
Shabnam NAZ ◽  
IRUM MEMON ◽  
SHOAIBUNISA SOOMRO ◽  
Rehana Parveen
Keyword(s):  
Gestational Age ◽  
P Value ◽  
Vacuum Extraction ◽  
Forceps Delivery ◽  
Maternal Complications ◽  
Singleton Pregnancy ◽  
Fourth Degree ◽  
Neonatal Complications ◽  
Skill Laboratory ◽  
Vaginal Deliveries

Objective: To compare the maternal and neonatal morbidity between vacuum extraction versus forceps vaginal delivery. Studydesign: Quasi-experimental study. Period: January 2009 to December 2010. Setting: Department of Obstetrics and Gynecology CMC,SMBBMU Larkana. Methodology: All patients delivered by forceps or vacuum with singleton pregnancy were included, the patient withmultiple gestation, breech presentation and gestational age less than 34 weeks were excluded. Data collected in pre-set Proforma include typeof instrument used, indication of instrumental delivery, maternal and neonatal complications of procedure. Data was analyzed; frequency andpercentage will be calculated for maternal age, gestational age, and degree of perineal and cervical tears. .chi-square test was applied tocompare the degree of neonatal and maternal complications. P-value less than 0.05 taken as significant. Results: Total 9, 5600 deliveries wereconducted, among them assisted vaginal deliveries were169 making the frequency of 2.66%, among which 96 have forceps and 64 wereventouse vaginal deliveries. Majority of women were primigravida. In infants of less than 37 weeks of gestation the use of forceps wassignificantly more common, delay in second stage of labor was the most common indication for vacuum extraction while fetal distress was morecommon reason for forceps delivery. Severe birth canal injuries (third and fourth degree perineal tears) and procedure related blood loss ofmore than 500 ml was significantly more common in forceps delivery group. Cephalhaematoma, neonatal jaundice and severe caputsuccedanum at discharge were more seen in vacuum deliveries, but facial injuries were more common after forceps delivery. Intracranialhemorrhage was identified in two infants born by vacuum extraction and none in forceps group. Two infants delivered by vacuum extractionexpired, one due to respiratory distress and other due to intracranial hemorrhage, and one of the infants delivered by forceps expired due tomeconium aspiration syndrome (MAS). Conclusions: Each instrument has its own merits and demerits .Maternal and neonatal outcomedepends on indications of instruments, patient selection and skill of operator. We conclude that forceps delivery is more associated withmaternal genital tract trauma and vacuum delivery is associated with more neonatal complications. So it is the choice of obstetrician to selectthe proper instruments . We also suggest that obstetricians learn these skills not on patients but in a skill laboratory using models.

scholarly journals SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID)

2021 ◽  
Vol 10 (8) ◽  
pp. 1571
Author(s):  
Antoine-Marie Molina Barragan ◽  
Emmanuel Pardo ◽  
Pierre Galichon ◽  
Nicolas Hantala ◽  
Anne-Charlotte Gianinazzi ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Renal Injury ◽  
Kidney Injury ◽  
Critical Factor ◽  
University Hospital ◽  
Co2 Partial Pressure ◽  
Icu Admission ◽  
Icu Stay ◽  
Arterial Blood ◽  
Mixed Pattern

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1–19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.

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