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.

Risk Factors for Adverse Maternal Outcomes following Expectantly Managed Preterm Prelabor Rupture of Membranes

Objective We sought to characterize the incidence and risk factors associated with developing maternal morbidity following preterm prelabor rupture of membranes. Study Design Retrospective case–control study of patients with preterm prelabor rupture of membranes at a single institution from 2013 to 2019 admitted at ≥23 weeks gestational age. The primary outcome was a composite of maternal morbidity which included: death, sepsis, intensive care unit (ICU) admission, acute kidney injury, postpartum dilation and curettage, postpartum hysterectomy, venous thromboembolism, postpartum hemorrhage, postpartum wound complication, postpartum endometritis, pelvic abscess, postpartum pneumonia, readmission, and/or need for blood transfusion were compared with patients without above morbidities. Severe morbidity was defined as: death, ICU admission, venous thromboembolism, acute kidney injury, postpartum hysterectomy, sepsis, and/or transfusion >2 units. Demographics, antenatal, and delivery characteristics were compared between patients with and without maternal morbidity. Bivariate statistics and regression models were used to compare outcomes and calculate adjusted odd ratios. Results Of 361 included patients, 64 patients (17.7%) experienced maternal morbidity and nine (2.5%) had severe morbidity. Patients who experienced maternal morbidity were significantly (p < 0.05) more likely to be older, have private insurance, have BMI ≥40, have chorioamnionitis at delivery, and undergo cesarean or operative vaginal delivery when compared with patients who did not experience morbidity. After controlling for confounders, cesarean delivery (aOR 2.38, 95% CI[1.30,4.39]), body mass index ≥40 at admission (aOR 2.54, 95% CI[1.12,5.79]), private insurance (aOR 3.08, 95% CI[1.54,6.16]), and tobacco use (aOR 3.43, 95% CI[1.58,7.48]) were associated with increased odds of maternal morbidity. Conclusion In this cohort, maternal morbidity occurred in 17.7% of patients with preterm prelabor rupture of membranes. Private insurance, body mass index ≥40, tobacco use, and cesarean delivery were associated with higher odds of morbidity. These data can be used in counseling and to advocate for smoking cessation. Key Points

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.

Indications and outcomes of emergency obstetric hysterectomy; a 5-year review at the Bafoussam Regional Hospital, Cameroon

Background Emergency Obstetric Hysterectomy (EOH) is removal of the uterus due to life threatening conditions within the puerperium. This life saving intervention is associated with life threatening complications. In our setting, little is known on EOH. Objectives To determine the prevalence, indications and outcomes of emergency obstetric hysterectomy while comparing both postpartum hysterectomy and caesarean hysterectomy. Methods A 5-year hospital-based retrospective cohort study involving medical records of patients who underwent emergency obstetric hysterectomies between 1st January 2015 and 31st December 2019, was carried out at the Bafoussam Regional Hospital (BRH) from 1st February 2020 to 30th April 2020. Cases were classified as caesarean hysterectomy (CH) or postpartum hysterectomy (PH). Epidemiological data, indications, and complications of EOH were collected and analyzed in EPI-INFO 7.2.2.1. The chi-squared test was used to compare the two groups, and bivariate analysis was used to identify indicators of adverse outcomes of EOH. Statistical significance was set at p < 0.05. Results There were 30 cases of emergency obstetric hysterectomy (24 caesarean hysterectomies and 6 postpartum hysterectomies), giving a prevalence rate of 3.75 per 1000 deliveries. The most common indication for CH, was intractable postpartum haemorrhage and uterine rupture (33.33% each), while abnormal placentation (50%) was commonly indicated for PH. Anaemia (both groups) (p = 0.013) and sepsis (PH group only, 33.33%) (p = 0.03) were the most statistically significant complications of EOH respectively. Absence of blood transfusion prior to surgery (p = 0.013) and prolonged surgery lasting 2 or more hours (p = 0.04), were significantly associated with a negative clinical outcome. Conclusion The prevalence of EOH is high. There were no differences in the sociodemographic profile, risk factors and indications of both groups. PH group was more likely to develop sepsis as complication. Lack of blood transfusion prior to surgery and prolonged surgeries were significantly associated to complication. Meticulous care and timely recognition of negative prognostic factors of delivery as well as those of EOH will help improve maternal outcomes of pregnancy.

Surgical Treatment of Early Postpartum Hemorrhage Caused by Lower Uterine Segment Atony

Purpose: Lower uterine segment atony is recently being recognized as one of the major reasons for early postpartum hemorrhage.Methods: We present our experience in surgical treatment of lower uterine segment atony patients that were delivered in our tertiary perinatal center during the 10 years period (2010-2019).Results: This particular study enrolled total number of 29 543 deliveries with 215 cases of early PPH (0,72%). LUSA was diagnosed in 44 cases or in 29,93% in all uterine atony cases. Exploration of the lower uterine segment accompanied by evacuation of the coagula was conducted in 5 cases (11,36%), haemostatic ligation procedures according to authors: Losickaja in 2 cases, Hebisch-Huch in 9 cases, Habek in 5 cases, Hebisch-Huch+Losickaja in 9 cases. Evacuation procedures were combined with ligation techniques in 7 cases, evacuation methods with ligation techniques and balloon tamponade in 2 cases, exploration combined with gauze tamponade in 1 case and ligation procedures with balloon tamponade in 3 cases. According to our results, haemostatic ligation procedures alone or combined with tamponade, have shown to be highly effective in 88,63%. Conclusion: Transvaginal approach for surgical treatment of lower uterine segment atony is accessible, feasible, successful and life saving. It can be easily performed in inpatient and outpatient care settings followed by administration of uterotonics, uterostiptics and tranexamic acid and fluid replacement. All of the above mentioned methods are of great importance in the prevention and treatment of obstetric hemorrhagic shock, development of coagulopathy, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.

Indications and Outcomes of Emergency Obstetric Hysterectomy; a 5-Year Review at the Bafoussam Regional Hospital, Cameroon

Background: Emergency Obstetric Hysterectomy (EOH) is removal of the uterus due to life threatening conditions within the puerperium. This life saving intervention is associated with life threatening complications. In our setting, little is known on EOH. Objectives: To determine the prevalence, indications and outcomes of emergency obstetric hysterectomy while comparing both postpartum hysterectomy and caesarean hysterectomy. Methods: A 5-year hospital-based retrospective cohort study of medical records of patients who underwent emergency obstetric hysterectomies was carried out at the Bafoussam Regional Hospital (BRH) from 1 st January 2015 to 31 st December 2019. Cases were classified as caesarean hysterectomy (CH) or postpartum hysterectomy (PH). Epidemiological data, indications, and complications of EOH were collected and analyzed in EPI-INFO 7.2.2.1. The chi-squared test was used to compare the two groups, and bivariate analysis was used to identify indicators of adverse outcomes of EOH. Statistical significance was set at p < 0.05 Results: There were 30 cases of emergency obstetric hysterectomy (24 caesarean hysterectomies and 6 postpartum hysterectomies), giving a prevalence rate of 3.75 per 1000 deliveries. The most common indication for CH, was intractable postpartum haemorrhage and uterine rupture (33.33% each), while abnormal placentation (50%) was commonly indicated for PH. Anaemia (both groups) (p=0.013) and sepsis (PH group only, 33.33%) (p=0.03) were the most statistically significant complications of EOH respectively. Absence of blood transfusion prior to surgery (p=0.013) and prolonged surgery lasting 2 or more hours (p=0.04), were significantly associated with a negative clinical outcome. Conclusion: The prevalence of EOH is high. There were no differences in the sociodemographic profile, risk factors and indications of both groups. PH group was more likely to develop sepsis as complication. Lack of blood transfusion prior to surgery and prolonged surgeries were significantly associated to complication. Meticulous care and timely recognition of negative prognostic factors of delivery as well as those of EOH will help improve maternal outcomes of pregnancy.

Management of pregnancy in case of multiple and giant uterine fibroids

Uterine fibroids are common among women of reproductive age. During the pregnancy, the potential complications of fibroids, although rare, are of frequent clinical concern. Available studies describing management and obstetrical outcomes in pregnant women with giant fibroids are limited. We present the case of a 39-year-old pregnant woman with multiple and large uterine fibroids. During the pregnancy, there was adequate fetal development, without major maternal complications. Given the characteristics of the fibroids and breech position of the fetus, an elective caesarean section was decided, and postpartum hysterectomy planned. This challenging obstetrical case required a multidisciplinary approach.We considered crucial discussing five main issues: preconceptional counselling, tailored pregnancy surveillance, decision of time and route of delivery, decision to perform a peripartum hysterectomy and management of decreasing blood loss perioperatively. Given the limitation of the published reports, we believe that sharing our experience, along with a literature review, is beneficial for other clinicians.

The outcomes of triplet pregnancies

Introduction. Extensive use of assisted reproduction has resulted in an increased incidence of triplet pregnancies, which are associated with higher risk of complications in mothers and newborns. Material and Methods. A retrospective study reviewed a total of 85 triplet pregnancies delivered at the Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, from January 1, 2010 to December 31, 2017. Results. The average maternal age was 32 years and the average body mass index was 30.56 kg/m2. The average gestational age at birth was 32 weeks. One patient (1.18%) had vaginal delivery, while 84 (98.82%) pregnancies were completed by cesarean section. The average blood loss was 1294 ml and there was one postpartum hysterectomy. The most common maternal pregnancy-induced complications were sideropenic anemia (70.58%), hypertensive syndrome (40%) and obstetric cholestasis (35.29%). Preterm premature rupture of membranes was observed in 17 (20%) patients. Prophylactic cerclage was performed in 57 patients (67.05%) and 12 patients (14.11%) received tocolytic therapy. The average birth weight of the first newborn was 1838 g, 1755 g of the second, and 1695 g of the third. Body weight ? 1500 g was observed in 61 newborns (24.01%). The mean Apgar score in the first minute was 7, while in the fifth minute it was 8. Respiratory distress syndrome was found in 64 newborns (25.19%). Conclusion. Monitoring and treatment of triplet pregnancies remains a complex task for obstetricians due to the increased incidence of prematurity and perinatal morbidity.