Analysis of risk factors of stillbirth: a hospital based study in a tertiary care centre

Background: Stillbirth is an indicator of maternal health and maternal health care services. Developing countries have high stillbirth rate. Documentation and evaluation of the risk factors for stillbirth is required for management of the risk factors and to devise plan in maternal health sector.Methods: It was a hospital based retrospective study carried out in a tertiary care hospital. Inclusion criteria were a case of fetal death with gestational age ≥20 weeks or fetal weight ≥ 500gm.Results: Total birth during the study period was 5132 and stillbirth 282. Stillbirth rate was 5.4% (54/1000). Majority of patients were primigravida (52.59%). Risk factors were detected in 164 (60.74%). Incidence of some of the risk factors were hypertensive disorder of pregnancy 46 (17.03%), antepartum haemorrhage 33 (12.22%), IUGR 11 (4.07%), Malpresentation 15 (5.55%) and fetal anomalies 4 (1.48%). Stillbirth without risk factors was 106 (39.25%).Conclusion: Majority of the risk factors found in the present study were preventable. Stillbirth rate can be reduced by proper management of these risk factors during antenatal care and intrapartum care

Maternal and perinatal outcome in eclampsia at a tertiary care center

Background: Preeclampsia is the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient. The objective of this study was to study the prevalance of eclampsia at PGIMS, Rohtak. To study the clinical profile, maternal and perinatal outcome in eclamptic patients.Methods: This is a retrospective study and case records of all eclampsia cases were analysed from the study period of January 2018 to December 2018.Results: There were 113 cases of eclampsia out of 11,661 deliveries and prevalence of eclampsia was calculated to be 0.96%. Majority of the patients were not registered 95.57%. 58% of patients were Primigravidas. 56% of the patient in the age group of 21-25 years. Antepartum, intrapartum and postpartum eclampsia were 71%, 1.7% and 27% respectively. Caesarean section was the preferred mode of delivery and was performed in 57% cases. ICU admission was required in 25% and remaining cases were managed in general/eclampsia ward. All patients received MgSO4 by Zuspan regimen. 12% patient developed HELLP syndrome and pulmonary oedema developed in 6% patient. There were a total of 3.5% maternal deaths during the study period. Total percentage of perinatal deaths due to eclampsia was 23%.Conclusions: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality. This is due to lack of proper antenatal care, low socioeconomic condition and lack of education. Regular antenatal checkup, early recognition and proper management are vital to tackle this challenge. MgSo4 is the anticonvulsant of choice and Zuspan regimen of MgSO4 is effective in the management of eclampsia

Maternal and perinatal outcome of eclampsia in a tertiary care centre

Background: Eclampsia is associated with devastating maternal and fetal complications. The main objective was to study the perinatal and maternal outcome and the causative factors for the mortality and morbidity in eclampsia patients admitted to this hospital and to explore the factors contributing to the alarming situation.Methods: 218 eclampsia cases admitted to the labour room in Department of Obstetrics & Gynaecology, SCB Medical College Cuttack, Odisha, India from Jan 2013 to Sept 2014 enrolled for the study.Results: In this study 218 eclampsia cases were studied. The incidence of eclampsia in S.C.B.MCH during study period was 1.39%. Most of the patients were primigravida accounting 83.48% out of which 74.31% were antepartum, 14.22% were intrapartum and 11.47% were postpartum. 44.04% of cases had no ANC and 40.36 irregular ANC. Occurrence of onset of eclampsia at <34 weeks GA 27.53%, 35-37 weeks 43.12 % and >38 weeks 29.35%. Most of patients were from rural area (97.50%) and having low socioeconomic status (83.94%) and illiterate. Out of 218 cases 46.33% patients had vaginal delivery, 3.21% patients had vaginal delivery with instrumentation.Conclusions: There is a need of proper antenatal care to prevent eclampsia and the need for intensive monitoring of women with eclampsia throughout hospitalization to improve both the maternal and perinatal outcome

A study on maternal and perinatal out comes in cases of eclampsia admitting to government medical college and general hospital, Anantapuramu, Andhra Pradesh, India

Background: Eclampsia is a life threatening emergency that continues to be a major risk factor dictating the outcome of pregnancy and is still the leading etiological factor of maternal mortality worldwide. The aim was to study the incidence of eclampsia at Government General Hospital, Anantapuramu, Andhra Pradesh, India, to evaluate the clinical course and complications and to study the maternal and perinatal outcome in eclamptic patients.Methods: Current study is a retrospective study carried out based on the data acquired from the case records of all eclampsia patients who admitted in the department of obstetrics and gynecology, government general hospital, Anantapuramu, Andhra Pradesh, India from February 2015 to February 2016. Data was recorded in a pretested proforma and was analyzed using appropriate statistical methods.Results: Out of a total of 8595 deliveries conducted during the study period, 50 cases of eclampsia were recorded making the incidence of eclampsia to be 0.58% in the hospital. There were no maternal deaths occurred during the study period. Total numbers of perinatal deaths due to eclampsia were 14, hence the perinatal mortality rate for eclampsia was 280/1000. Majority of the patients were unbooked (90%). 78% of patients were primigravidas and 80% of patients were less than 25 years of age. Antepartum eclampsia was seen in 72% of the cases, intrapartum eclampsia in 4% patients and postpartum eclampsia was found in 24% of the patients. Vaginal delivery was a common mode of delivery conducted in 56% of patients while 44% of the patients required caesarean section.Conclusions: Eclampsia continues to be an important etiological factor for maternal/perinatal morbidity and mortality. The contributory factors for this being lack of proper antenatal care, low socio economic status and lack of education. There is an urgent need for proper antenatal care, proper medication (magnesium sulfate), intensive monitoring of women with eclampsia and timely hospitalization to improve both the maternal and perinatal outcome. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome

Study of clinical-etiological profile, outcome and maternal risk-factors of birth asphyxia: a hospital based observational study

Background: Birth asphyxia is an important cause of neonatal morbidity and mortality. According to world health organization (WHO) out of the 130 million babies born every year, about 4 million die in the first 4 weeks of life the neonatal period. This study is aimed to assess the incidence, risk factors, complications and maternal variables associated with birth asphyxia.Methods: This is a prospective observational study conducted at pediatric newborn stabilization unit (NBSU) district hospital, Bageshwar (Uttarakhand) over a period of 12 months from January 2021 to December 2021. Total 110 newborns with no spontaneous breathing or APGAR score <7 at 5-minute requiring basic/advanced neonatal resuscitation as per NRP AHA protocol were enrolled in this study. Detailed mother’s antenatal history, risk factors along with clinical course of neonate was documented as per NICU protocol till the hospital stay in pre-designed pro-forma.Results: Total 110 newborns were admitted with incidence of 6.2% and mean birth weight of 2760±575 gm. Male gender (71%), Term delivery (82.7%), majority 85.4% neonates were revived by basic, 27.2% developed HIE grade 1. Outcome wise majority 71% (78) were discharged, 22.7% (25). Among maternal variables, majority 82.7% (91) were booked pregnancy with mean maternal age 25.69-year, multigravida 54% (59), anemia 54.5% (60) and meconium-stained amniotic fluid (MSAF) constitutes most common risk factor.Conclusions: Birth asphyxia is an important contributor of perinatal morbidity and mortality. Focus on early identification and timely management along with proper antenatal care and identification of high-risk pregnancy is crucial.

Meta-Analysis of Selected Maternal and Fetal Factors for Perinatal Mortality

BACKGROUND: In several developing countries, achieving Millennium Development Goal 4 is still off track. Multiple maternal and fetal risk factors were inconsistently attributed to the high perinatal mortality in developing countries. However, there was no meta-analysis that assessed the pooled effect of these factors on perinatal mortality. The purpose of this meta-analysis was to identify maternal and fetal factors predicting perinatal mortality. METHODS: In this meta-analysis, we included 23 studies that assessed perinatal mortality in relation to antenatal care, parity, mode of delivery, gestational age, birth weight and sex of the fetus. A computer based search of articles was conducted mainly in the databases of PUBMED, MEDLINE, HINARI, AJOL, Google Scholar and Cochrane Library. The overall odds ratios (OR) were determined by the random-effect model. Heterogeneity testing and sensitivity analysis were also conducted. RESULTS: The pooled analysis showed a strong association of perinatal mortality with lack of antenatal care (OR=3.2), prematurity (OR=7.9), low birth weight (OR=9.6), and marginal association with primigravidity (OR=1.5) and male sex (OR=1.2). The regression analysis also showed down-going trend lines of stillbirth and neonatal mortality rates in relation to the proportion of antenatal care. The meta-analysis showed that there was no association between mode of delivery and perinatal mortality. CONCLUSION: The present meta-analysis indicated a significant reduction in perinatal mortality among women who attended antenatal care, gave birth to term and normal birth weight baby. However, the association of perinatal mortality with parity, mode of delivery and fetal sex needs further investigation. KEYWORDS: antenatal care, developing countries, meta-analysis, perinatal mortality, skilled person attended deliver

Intraoperative findings in primary caesarean section for non-reassuring fetal status and its correlation with cardiotocography

Background: Cardiotocography plays an important role in diagnosing nonreassuring fetal status during labour, which is a leading cause for caesarean section among primigravida. These abnormal cardiotocographic traces may or may not translate into intraoperative findings of meconium stained liquor or low APGAR at birth. Hence a study is warranted to understand their correlation, thereby demonstrating the utility of cardiotocography in diagnosing nonreassuring fetal status. The objective of the study was to assess the correlation of intraoperative findings and neonatal outcome in primigravida undergoing emergency caesarean section for nonreassuring fetal status with cardiotocography.Methods: A retrospective analysis of 104 case records of primigravida undergoing emergency caesarean section for fetal distress at Department of Obstetrics and Gynecology, Apollo Institute of Medical Sciences and Research, Hyderabad, was done. Their CTG traces were correlated with their intraoperative findings such as meconium stained liquor; nuchal cord and APGAR score at birth.Results: Out of these 104 primigravida who underwent emergency caesarean section for nonreassuring fetal status, 63.4% had CTG with decelerations-Non reactive, 28% had a CTG trace with persistent decreased variability while 7.6% had a reactive CTG with meconium stained liquor. Among patients with CTG trace showing decelerations 54.5% had meconium stained liquor, 28.7% had cord around the neck and 43.9% had low APGAR scores at birth. Among the group of patients with decreased variability 63.4% had meconium stained liquor, 30% had cord around the neck and 30% had low APGAR scores at birth. There were 8 patients who had reactive CTG with meconium stained liquor, among them only 3 had low APGAR scores.Conclusions: Cardiotocography positively correlates with meconium stained liquor and APGAR scores at birth, but not with the presence of nuchal cord. Hence, judicious interpretation of CTG and introduction of another noninvasive, cost effective and acceptable test to detect non reassuring fetal status is warranted to prevent unnecessary caesarean sections

Meditation and Yoga in pregnancy: maternal and fetal impact

Background: Yoga is a practice which amalgamates the emotional, mental, physical and spiritual aspects of the human body through physical postures(asanas), breathing exercises (pranayama), concentration and meditation (dharana and dhyana). Evaluation of databases suggests a positive role of yoga in pregnancies associated with depression, anxiety and lumbosacral pain and also in reducing antepartum complications and pain score during labor. These beneficial effects of yoga are suggested but more systematic researches are required to validate it. With the background of above researches, we undertook the study to evaluate the effect of prenatal yoga and meditation on maternal and fetal outcomes. Aim of the study was to determine the effect of antenatal meditation and yoga on obstetric and fetal outcome. Methods: This was a prospective randomized trial conducted in the antenatal OPD of the institute. Sixty primigravida women with low risk pregnancy between 18 to 26 weeks gestation were included in the trial.They were randomly divided into two equal groups;  interventional group underwent meditation and yoga sessions of 30 minutes twice in a week till delivery. Obstetric outcomes including gestational age, antepartum and intrapartum complications, cord blood cortisol levels at delivery and neonatal outcomes were recorded. Results: Thirteen women went post-dated as compared to 3 in the interventional group which was statistically significant (p=0.0003). APGAR scores of neonates in the interventional group showed a highly significant improvement with p=0.0013 as compared to the control group. Cord blood cortisol levels were higher than 10 ng/ml in 16 women in the control group compared to 7 in the group who performed yoga and meditation with p=0.01. NICU admissions were significantly more (p=0.002) in the control group. Conclusions: Meditation and yoga during pregnancy improves maternal and neonatal outcomes

Analysis of incidence of caesarean sections in primigravida

Background: Current study was conducted to determine the incidence of caesarean sections in primigravida.Methods: A total number of 1698 primigravidas were admitted in the department of DNB district hospital Ballari, out of which 501 primigravidas who underwent caesarean section were included in the study.Results: Caesarean section rate in primigravida was observed to be 29.5%, 55% of women were from rural areas and 45% from urban areas, 69.9% women belonged to lower class 31.1% belonged to upper middle class, 25% were illiterate while 75% were literate.Conclusions: Meta-analysis suggests that the occurrence of pregnancy complications differ according to fetal sex with a higher cardiovascular and metabolic load for the mother in the presence of a male fetus.

Therapeutic Management of Pre-Eclampsia and Eclampsia in Nigeria

Pre-eclampsia/eclampsia is the fourth most common cause of maternal mortality worldwide, affecting a disproportionate number of women in developing countries. Nigeria has a maternal mortality ratio (MMR) of 840/100,000 live births and an estimated 10,000 women die from pre-eclampsia/eclampsia annually. Magnesium Sulfate (MgSO4) is proven to reduce the likelihood that pre-eclampsia will progress to eclampsia by 58%, halt ecliptic seizures, and it is likely to reduce risk for maternal mortality related to this disease. A review of the research of pre-eclampsia/eclampsia conducted in Nigeria reflects the gross underuse of MgSO4 as a life-saving therapeutic. Changes in current health policy are needed to improve antenatal care (ANC) services, provider education, and provision of essential medicines to improve maternal-fetal outcomes in Nigeria.Master of Public Healt