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.

African traditional abdominal massage in pregnancy resulting in antepartum uterine rupture, abruptio placenta and foetal demise – a case report

The practice of abdominal massage dates to years ago and associated with foetal and maternal morbidity and mortality when undertaken by untrained traditional birth attendants in our setting. We present a 30-year old G3P2+0 with uterine rupture and intra-uterine foetal death following abdominal massage. She was resuscitated and had emergency exploratory laparotomy and repair of uterine rupture.

Chronic ectopic pregnancy complicated by septicemic shock and disseminated intravascular coagulation

Disseminated intravascular coagulation is a life threatening complication of ectopic pregnancy. It results from washing out of all important procoagulants. This is basically a state of increased propensity for clot formation triggered by a variety of stimuli related to such diverse disorders as sepsis ,endothelial cell damage (heat stroke and shock), obstetrical complication (abruptio placenta, amniotic fluid embolism, severe preeclampsia and retained intrauterine dead foetus). A case of disseminated intravascular coagulation with septicemic shock following laprotomy for ectopic pregnancy is reported. She was treated by vasopressors, broad spectrum antibiotic and aggressive blood and blood component therapy.

Feto-Maternal Outcome in Patients with Jaundice During Pregnancy

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

Prophylactic antibiotics in patients with artificial rupture of membranes during labor: (Randomized controlled clinical trial)

Background Amniotomy, also known as artificial rupture of membranes (AROMs) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. Amniotomy during labor induction is associated with a faster time to delivery, most notably in nulliparous women, without an increase in cesarean delivery or maternal and neonatal morbidity. Shortening time to delivery is associated with decreased hospital costs and increased patient satisfaction, and therefore, early amniotomy, given the safety profile, should be considered when a faster delivery is of importance to patients and providers. Objective To determine the efficacy of prophylactic antibiotics in patient during labor on reducing maternal and neonatal morbidities. Methods This prospective randomized study was performed from January 2020 to July 2020, at maternity hospital of Ain Shams University. Informed consent was obtained from all participants. Candidates for this study included all patients with singleton gestations between 37 weeks and 41 weeks of gestation underwent artificial rupture of the membranes during active phase of labor. Gestational age was confirmed by a reliable last menstrual period, early sonogram. Amniotomy was confirmed by visualization of pooling fluid in the posterior vaginal fornix through the cervix after artificial rupture of membrane by sterile hook. Results There were no statistical significance differences between two groups regarding demographic characteristics, endometritis, cord-prolapse and abruptio placenta. Maternal septicemia was absent in both groups. Chorio-amnionitis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage were significantly less frequent in prophylaxis group. Conclusion Using of prophylactic antibiotics with amniotomy in pregnant women during labor reduced maternal and neonatal morbidities as chorio-amnionitis, endometritis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage. On the other side it had no proved protective effect against maternal septicemia, cord-prolapse and abruptio placenta.

Maternal and fetal outcome in abruptio placentae at a tertiary care centre: a retrospective analysis

Background: Placental abruption is a major obstetric complication leading to increased risk of maternal and neonatal morbidity and mortality globally. Placental abruption is traditionally defined as premature separation of a normally implanted placenta after 20 weeks of gestation and before delivery of the fetus. Early recognition of the risk factors, timely diagnosis and early intervention can significantly reduce maternal and fetal morbidity and mortality. This study was aimed to identify the associated risk factors with abruptio placenta and to analyse the maternal and perinatal outcome in abruptio placenta.Methods: This was a retrospective observational study, from Jan 2016 to Dec 2019 at M.S. Ramaiah medical college and hospitals, Bangalore.Results: In our study, the incidence of abruptio placenta was 0.95%. Majority of our patients were between 20-24 years (41.5%). Primigravidae accounted for 46.15% of the cases. The unbooked cases were 92%. The commonest risk factor was hypertension complicating pregnancy which accounted for 26% .The live births were 64%. Postpartum haemorrhage was one of the major complications in our study. There was no maternal mortality, probably due to early intervention and availability of blood and blood products.Conclusions: Timely diagnosis and appropriate intervention preferably in tertiary care centre will significantly reduce mortality and morbidity in both mother and fetus.

Identifying the risk factors of antepartum haemorrhage and to evaluate the feto maternal outcome in antepartum haemorrhage cases

Background: Antepartum haemorrhage is an obstetric emergency contributing to a significant percentage of perinatal and maternal morbidity and mortality. Approximately 30% of maternal deaths are caused by ante-partum haemorrhage. In spite of a lot of improvement in antenatal care and intrapartum surveillance, antepar-tum haemorrhage has not reduced. Present study was conducted to assess the causes of APH and to compare the fetomaternal outcome among placenta previa and abruptio placenta group.Methods: The study was conducted in BRD medical college Gorakhpur, over a period of 1 year (October 2019 to September 2020) in which 100 cases of APH were taken and classified into placenta previa and abruptio placenta group and their fetomaternal outcome were compared.Results: In our study, out of 100 cases of APH 69% cases were of placenta previa followed by abruptio placen-ta in 29% cases and rest 2% cases were unclassified APH. Multigravida is the major risk factor in both placenta previa and abruptio placenta group. Second major risk factor in placenta previa group was h/o LSCS and in abruptio placenta group was HDP. Stillbirth was significantly seen in abruptio placenta group whereas Low birth weight babies (1.5-2.5 kg) were more in placenta previa group. Though the maternal outcome is poor in placenta previa group but the fetal outcome is worse in abruptio placenta group.Conclusions: APH neither can be reliably predicted nor can be prevented but only a comprehensive focused experienced team work can reduce maternal and perinatal morbidity and mortality.

Giant chorioangioma with severe polyhydramnios presenting with abruptio placenta: a case report

Chorioangioma is the most common non trophoblastic tumor of the placenta which can result in pregnancy complications with attendant maternal and fetal mortality and morbidity.Although majority of them are asymptomatic, clinical course depends mainly on the size of the neoplasm.We present a case of large symptomatic placental chorioangioma managed successfully at Shri B M Patil Medical College,Vijayapura.The patient presented with acute features of abruptio placenta secondary to sudden decompression of uterus with polyhydramnios associated with large placental capillary chorioangioma of 10 cm size.Immediate intervention with Emergency LSCS helped rescue the baby of Intauterine demise and possible hemorrhagic morbidity in the mother.Further gross and histological examination confirmed the diagnosis.

RISK FACTORS AND PREGNANCY OUTCOME OF ABRUPTIO PLACENTA: A RETROSPECTIVE STUDY

Background: Abruptio placenta is the most common cause of antepartum haemorrhage which is defined as separation of normally situated placenta after 20 weeks of gestation and before birth of fetus. Obstetrical haemorrhage accounts for almost half of all postpartum deaths in developing countries. Aim of study was to determine maternal and fetal outcome in pregnancy complicated by abruption. Methods: This was a retrospective study conducted at Gopinath maternity home, Sir T. Hospital, Bhavnagar. From MAY 2020 –APRIL 2021.all pregnant women came to labour room with diagnosis of abruptio placenta were included. Results: Total patients of abruption Identified Are 33 out of 2683 deliveries giving incidence of 1.1% In this study. Most of them are found at 26-35 years of age with 33-36 weeks of gestation. It is associated with multiparity in 57.5%. Vaginal bleeding is the most common presenting complain followed by absent fetal movement. 72.7% cases had association with preeclampsia. There is higher LSCS rates (61%) as compared to vaginal deliveries (39%). Most common complication found is DIC (30.3%) and next common is ARF (24.2%). case fatality rate of 6.06%. In our study 60.6% still birth and 39.3% live birth. Many of them required NICU admission. Conclusion: Abruption is continued to be responsible cause of maternal and foetal adverse outcome. early detection and proper management prevents morbidity associated with it. Combined care is required for it. Keywords: Abruptio placenta, risk factors, feto-maternal outcome.

Study of antepartum hemorrhage and its maternal and perinatal outcome at a tertiary care hospital

Background: Antepartum haemorrhages are defined as bleeding from or into the genital tract after the period of viability untill delivery of the fetus. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Objective of this study is to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care hospital.Methods: A retrospective observational study was carried out in the department of obstetrics and gynecology, Smt. Kashibai Navale medical college and general hospital, Pune. Patient information was obtained from the delivery records of 2018, 2019 and 2020. Patients presenting after the gestational age of 28 weeks with antepartum haemorrhage were included in the study.Results: Out of 100 cases of APH, abruptio placenta contributes to 60%, placenta previa to 37% and 3 cases were due to unknown cause. Overall maternal mortality was 3% and perinatal mortality was 23% in abruptio placentas compared to 13% in cases with placenta previa. Main cause of perinatal mortality was prematurity69%.Conclusions: Antepartum haemorrhage is one of the leading cause of perinatal mortality and morbidity. These cases should be deliverd at a centre with transfusion facility, NICU facility and by the obstetrician skilled in controlling intraoperative haemorrhage by stepwise devascularising sutures. Timely decision of uterine tamponade can also save few ceaserean hysterectomies.