Uterine Leiomyoma and Pregnancy Outcome: An Experience at Tertiary Care Setup

Objective: To determine the impact of leiomyoma in pregnant women a tertiary care set up in Hyderabad. Methods: This prospective observational study conducted at OPD of Gynecology unit-III, Liaquat University of Medical and Health Science Hyderabad, from June 2018 to December 2018. A total of 18,402 pregnant women of age 20-45 years were attended, out of which 195 had leiomyoma and they were asked to take part in study. Data regarding demographic characteristics including complications during pregnancy, and indications of caesarean section was collected via study proforma. Results: Total 186 out of 195 females were studied, their mean age was 31.23+3.12 years, average gestational age was 33.12+3.15 weeks and average size of Leiomyoma was 3.12+2.15cm. The most common complications were PPH among 28.49% of cases, blood transfusion was required in 39.25% of the cases, miscarriage occurred in 6.45% of the cases, cord prolapse was seen in 24.3% cases, placental abruption in 5.91% cases, placenta previa in 11.32% cases and retained placenta was observed among 1.61% of the cases. Preterm labour occurred in 5.38% of the cases and IUGR was seen in 10.22% of the cases. Out of all cases, 10 females underwent preterm delivery, while 12 underwent fetus delivery before 24 weeks (miscarriage). Among all term pregnancies, 78.66% underwent C-Section due to failure in progress, cord prolapsed, fibroid in lower segment, breech presentation and low-lying placenta. Conclusion: Fibroid complicates pregnancy itself and also the outcome. Rural area dwelling women are at more risk, which include increase in caesarean section and a multifold increased risk of PPH and associated hysterectomy in these cases. Keywords: Leiomyoma, Uterine Fibroids, Pregnancy, complications.

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Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

Medicine Today ◽

10.3329/medtoday.v31i1.40317 ◽

2019 ◽

Vol 31 (1) ◽

pp. 23-26

Author(s):

Mahe Jabeen ◽

Sabiha Shimul ◽

Ummay Salma ◽

Jebunnesa

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Maternal Morbidity ◽

Neonatal Outcome ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Cost Of Care ◽

Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

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A 3 year retrospective study of pregnancies complicated with placenta previa in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210003 ◽

2021 ◽

Author(s):

Vatsala Kamath ◽

Aparna C. Aravind ◽

Nishita Shettian

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Pregnant Women ◽

Neonatal Intensive Care ◽

Placenta Previa ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Multiple Pregnancy ◽

Age Group ◽

Tertiary Care Centre

Background: Placenta previa describes when a placenta is implanted partially or completely over the internal OS. About one third of the ante partum haemorrhage belongs to placenta previa. The incidence is increased beyond the age of 35 years, with high birth order pregnancies, prior caesarean deliveries and in multiple pregnancy. The aim of the study was to determine maternal and fetal outcome in pregnancies complicated with placenta previa.Methods: A 3 year retrospective study done in OBG department of A. J. Institute of Medical Sciences, Mangalore from January 2017- January 2020. All pregnant women who are diagnosed with placenta previa during regular antenatal care (ANC) follow up, at or after admission and during caesarean delivery are included in the study. Data were collected from the hospital records.Results: During the study period, there were 34 pregnant women with placenta previa. Maximum were in the age group of 31-35 years of age and 8.82 percentage were in the age group more than 35 years. Out of the study subjects,76.5 percentage were multigravidas and 50 percentage were giving history of prior one caesarean section. 29.4 percentage of study subjects had true placenta previa and 85.2 percentage underwent elective caesarean section. There were significantly higher number of babies required neonatal intensive care unit (NICU) admissions.Conclusions: An increase in the incidence of women with advanced maternal age, multiparity, prior caesarean deliveries contributes to a rise in the number of pregnancies complicated with placenta previa.

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A study on pattern of placentation in post caesarean pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202711 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2797

Author(s):

Deepthi P. S. ◽

Neena Devasia

Keyword(s):

Caesarean Section ◽

Caesarean Delivery ◽

Comparison Group ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Previous Caesarean Section ◽

Normal Delivery ◽

Adherent Placenta ◽

Increased Risk

Background: It appears that the rate of caesarean delivery has been increasing over the past two decades. Various western studies have shown that with previous caesarean section, increased risk of placenta previa, adherent placenta, and greater incidence of antepartum haemorrhage. Nonetheless, the extent to which previous caesarean delivery predisposes women to the development of placenta previa is unclear from earlier studies. Also, there are not many Indian studies regarding the association of placenta previa and previous caesarean section. This study aims to find the association between prior caesarean delivery and subsequent development of placenta previa and adherent placenta.Methods: A descriptive study was conducted on 600 antenatal women with post cesarean pregnancy in a tertiary care centre. Similar number of women with previous normal delivery was included in comparison group and placental location was studied. Those patients with previous caesarean were further divided into those with placenta previa and without previa to study the determinants of previa in those with previous caesarean section.Results: Placenta previa was found in 2.8% of the study group compared to 1.2% of comparison group. Adherent placenta was found only in post caesarean group. In the post caesarean group, the incidence of anterior previa was 41.2% compared to posterior previa (29.3%). In those with post cesarean pregnancy, determinants of placenta previa found were multiparity (35.3%), previous history of abortions (35%), multiple previous caesarean sections (29.4%), interpregnancy interval <2 years (35.29%).Conclusions: In post cesarean pregnancy, the risk of placenta previa is 2 times compared to those with a previous normal delivery. Anterior previa occurred with sufficient frequency in post-caesarean pregnancy to warrant ultrasonic placentography prior to surgical entry into lower segment. When the combination of previous caesarean and placenta previa occurs the risk of adherent placenta is 17.6%.

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LOWER SEGMENT CESAREAN SECTION (LSCS);

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.06.1737 ◽

2013 ◽

Vol 20 (06) ◽

pp. 916-923

Author(s):

NAZIA MUSSARAT ◽

SAIMA QURASHI ◽

MAHNAZ ROOHI

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Placenta Previa ◽

Caesarean Section Rate ◽

Elective Caesarean Section ◽

Tertiary Care ◽

University Hospital ◽

Breech Delivery ◽

Lower Segment Cesarean Section ◽

Increased Risk

Introduction: Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one ofthe oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in thedeveloped countries. As primary caesarean deliveries contributed most to the overall caesarean section rate (CSR). So this is clear thatprimary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery.Objectives: To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperativecomplications of LSCS at tertiary care centre. Material And Methods: All caesarean sections performed at Obstetrics andGynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information wasobtained from operation theater and labor ward records. Results: During the study period 100 patients undergone caesarean section. Outof 100 patients, 58(58%) had emergency and 42(42%) had elective caesarean section. The leading maternal indications were previouscaesarean section 34 (34%), severe pre- eclampsia 6(6%),post date& failed induction of labor6 (6%), placenta previa 6(6%), and failureof progression of labor 5(5%), PROM3(3%), Pre-PROM3(3%)and cephalopelvic disproportion2 (2%).Major fetal indications include fetaldistress9 (9%), malpresentation 6(6%), cord prolapse 3(3%),IUGR 5(5%) and pregnancy complicated by multiple fetuses 7 (7%). Intraoperativesurgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Conclusions: Majority of cesarean sectionare done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to controlCS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection,selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral intime is the key factor in decreasing the cesarean section rate and complications.

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Caesarean Myomectomy among Patients Undergoing Lower Segment Caesarean Section in a Tertiary Care Center

Journal of Nepal Medical Association ◽

10.31729/jnma.6160 ◽

2021 ◽

Vol 59 (234) ◽

Author(s):

Sapana Amatya Vaidya ◽

Rijuta Jha

Keyword(s):

Postpartum Hemorrhage ◽

Placenta Previa ◽

Care Center ◽

Tertiary Care ◽

Uterine Fibroids ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Safe Procedure ◽

Prophylactic Measures ◽

Cesarean Myomectomy

Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. The most common indications were breech presentation and previous cesarean section. The most common site was anterior, except one which was posterior and the common type is intramural. Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.

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AB0747 MATERNAL AND FETAL OUTCOMES IN PREGNANT WOMEN WITH JUVENILE IDIOPATHIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3647 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1402.1-1402

Author(s):

R. Pinheiro Torres ◽

M. H. Fernandes Lourenco ◽

A. Neto ◽

F. Pimentel Dos Santos ◽

I. Silva ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Literature Review ◽

Pregnant Women ◽

Systematic Literature Review ◽

English Language ◽

Placenta Previa ◽

Bibliographic Databases ◽

Fetal Outcomes ◽

Term Birth ◽

Increased Risk

Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared

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Risk of Nursing Home Use Among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function

The Journals of Gerontology Series B ◽

10.1093/geronb/gbab045 ◽

2021 ◽

Author(s):

Maria T Brown ◽

Miriam Mutambudzi

Keyword(s):

Nursing Home ◽

Cognitive Function ◽

Latent Class ◽

Study Data ◽

Psychiatric Training ◽

Psychiatric History ◽

Term Care ◽

Increased Risk ◽

Course Variables ◽

The Impact

Abstract Objectives Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. Methods We used 8 waves (1998–2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998–2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. Results Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06–1.51, p < .01), net the effects of life course variables. Furthermore, “low-declining” (SHR 2.255, 95% CI 1.70–2.99, p < .001) and “medium-declining” (2.103, 95% CI 1.69–2.61, p < .001) trajectories predicted increased risk of nursing home use. Discussion Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.

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The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus

Lupus ◽

10.1177/09612033211004716 ◽

2021 ◽

pp. 096120332110047

Author(s):

Katarina Bremme ◽

Sonja Honkanen ◽

Iva Gunnarsson ◽

Roza Chaireti

Keyword(s):

Caesarean Section ◽

Lupus Nephritis ◽

Pregnant Women ◽

Lupus Erythematosus ◽

Premature Birth ◽

Renal Involvement ◽

Significant Risk ◽

Obstetric Outcomes ◽

Increased Risk ◽

Renal Lupus

Introduction Pregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN). Patients and methods The study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section. Results Women with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035). Conclusions Lupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.

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P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽

10.1017/cem.2017.272 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S102

Author(s):

S.W. Kirkland ◽

A. Soleimani ◽

B.H. Rowe ◽

A.S. Newton

Keyword(s):

Systematic Review ◽

Health Care ◽

Emergency Department ◽

Health Care Services ◽

Grey Literature ◽

Study Data ◽

Care Utilization ◽

Alternative Source ◽

Increased Risk ◽

The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

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MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

Paediatrics & Child Health ◽

10.1093/pch/pxy054.069 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e27

Author(s):

Sarah McKnight ◽

Bishal Gautam ◽

Michael Miller ◽

Bryan S Richardson ◽

Orlando da Silva

Keyword(s):

Caesarean Section ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Neonatal Outcomes ◽

Care Hospital ◽

Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

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