MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% delivered vaginally. 23.53% patients had postpartum haemorrhage whereas only 2.98% had undergone Postpartum Hysterectomy. The most common fetal complication in Abruptio Placenta was prematurity (35.71%). 5.89% patients of Abruptio Placentas died during Peripartum period. Perinatal mortality was high 48.58%. Conclusions: Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcomes.

Comparative study of oxytocin bolus and oxytocin infusion during caesarean section

Background: The incidence of postpartum haemorrhage varies from 2-11%. Postpartum haemorrhage complicates approximately 4% of deliveries in most large obstetric services. Postpartum haemorrhage is the third major cause of maternal mortality next to pregnancy induce hypertension (pre-eclampsia) and infection. Prevention, early recognition and prompt appropriate intervention are keys to minimizing its impact. Conventionally loss of more than 500 ml of blood following vaginal delivery and 1000 ml of blood following caesarean section is defined as postpartum haemorrhage. In this study we compared the efficacy of intravenous oxytocin bolus (2 IU) dose followed by infusion (160 mIU/minute) and only i.v. oxytocin infusion following delivery of fetus in elective and emergency LSCS with regard to uterine tone.Methods: This study was a prospective observational study. 200 low risk patients scheduled to undergo elective and emergency caesarean section under spinal anaesthesia in Department of obstetrics and gynecology, SSMC, Tumkur. Group A included i.v. bolus + i.v. injection, group B: i.v. infusion.Results: There was significant drop in haemoglobin and PCV in both group A and group B. But it was comparable among two groups. At 15th minute MBP was 77.2 mm of Hg and 80.04 mm of Hg in Group B. In group A better uterine tone was achieved earlier compared to group B at 2, 5, 10, 20 minutes.Conclusions: It was concluded from this study that oxytocin i.v. bolus with infusion causes earlier attainment of better uterine tone when compared with only infusion.

Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

<p>Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB. Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge. Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.</p>

Management of Prelabour Rupture of Membranes at Term, at Northland District Health Board.

<p>Background Prelabour rupture of membranes at term (PROM) is a subject of interest to women and maternity care providers alike. Management of PROM varies internationally, and regionally within New Zealand, despite the presence of interprofessional consensus statements. Northland District Health Board (NDHB) policy differs from most maternity care facilities by enabling expectant management of labour for women at low risk of transmission of Group β Streptococcus to their baby to extend to 96 hours from time of rupture of membranes. This study aimed to explore whether the NDHB policy was applied in practice and safely served the needs of women and babies in this DHB. Methods A retrospective quantitative clinical notes review was conducted of files in a one-year sample. The clinical notes of 123 women who had duration from ROM to birth at term of 18 hours or more were reviewed. Statistical comparisons using percentages, means and odds-ratios were made to a one-year sample of all other births at term at NDHB facilities, and with birth data from the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). Findings Variables including demographic data, antenatal and intrapartum care given, time factors and outcomes themselves were reviewed. Few variables impacted outcomes within the PROM sample, though use of intravenous oxytocin was associated with increased epidural use and increased incidence of instrumental birth. Wāhine Māori had an increased incidence of vaginal births but some variables and outcomes highlighted inequities, including reduced antenatal screening, a higher incidence of maternal smoking, severe postpartum haemorrhage, and admission to Special Care Baby Units. Duration splits at 48 and 96 hours were applied to identify whether time increased risks for women or babies, but duration did not appear to be a factor which increased risk. The phenomenon of PROM itself increased risk for women and babies, increasing rates of labour induction, augmentation, epidural use, operative births, postpartum haemorrhage, admission to Special Care Baby Units and decreased exclusive breastfeeding at discharge. Conclusions The NDHB PROM policy appeared to be applied consistently and did not appear to increase risk for women and babies. Risks were increased for all women with PROM, with some inequitable outcomes for wahine Māori and pēpi. This research provides a comparison which is informative for clinical practice, education, and future research, and supports women’s involvement in decision-making.</p>

Relationship between Anaemia during Pregnancy and Postpartum Haemorrhage: A Case from Saudi Arabia

Background: Anemia during pregnancy is an important cause of morbidity and mortality among postpartum women. The main reason for the condition is dietary Iron deficiency and the most common type of anemia found in women during pregnancy is iron deficiency anemia. Among many complications, postpartum hemorrhage is a problem linked with anemia during pregnancy. In Saudi Arabia, pregnancy and postpartum haemorrhage (PPH) is not common but still, cases are reported. The present study aimed to determine its prevalence in population and to see its relationship with anemia during pregnancy. Methods: It was an analytical cross-sectional study in which the data was collected from women using properly designed questionnaires. The study population was women who got pregnant and delivered in main hospitals of the kingdom of Saudi Arabia. The data of respondents for demographical and clinical variables were collected and analyzed using SPSS using appropriate statistical tests. Results: 600 participants responded to the questionnaire. The mean age was 26.32 years. The prevalence of PPH among studied population was 11.9%. Anemia during pregnancy was found to be positively associated with PPH with the p value of 0.0039. Smoking history was also correlated with PPH. There was no strong association between age and increase risk of PPH. Conclusion: This study concluded that PPH is not common in Saudi Arabia. There is a moderate association of anemia during pregnancy and PPH. Smoking is also a positive predictor for PPH. There are some limitations in the study so there is a need of large-scale study to confirm the findings in the population.

Impact of Dengue Fever on Pregnancy and Its Outcome

BACKGROUND Dengue fever is a vector-borne disease common in the tropics. It is known to have an adverse effect on pregnant women with unfavourable foetal outcomes. However, only a few studies are addressing this problem. Many of the studies had confounding factors such as the simultaneous occurrence of other vector-borne diseases and maternal health conditions. Therefore, the actual impact of dengue fever on pregnancy and pregnancy outcome is not clear. We wanted to study maternal and foetal outcomes in dengue positive pregnant females. METHODS This is a retrospective study done over 6 months in a tertiary care institute. Data regarding demography, obstetric history, biochemical parameters / blood investigation and pregnancy outcomes were collected and analysed. RESULTS Most of the dengue positive women presented with fever and thrombocytopenia in 44 % of cases. Obstetric complications such as preterm labour, abruption and postpartum haemorrhage (PPH) were common. Caesarean section rate was increased and the most common indication was foetal distress. The need for new-born intensive care unit (NICU) admission for new-born and foetal death was also increased. No evidence of congenital anomaly was found in the study. CONCLUSIONS Antenatal complications like preeclampsia, oligohydramnios; intrapartum complications like abruption, DIC, foetal distress and immediate postpartum complications like postpartum haemorrhage, need for blood, platelet transfusion were common in women with a history of dengue fever especially more in the low platelet group. The maternal and foetal outcomes were compromised and both required intensive care. A high index of clinical suspicion is essential in pregnant women presenting with fever and thrombocytopenia. Early diagnosis and management are essential. KEY WORDS Dengue Fever, Dengue in Pregnancy, Complications of Dengue Fever in Pregnancy