Incidence and perinatal outcome of multiple pregnancy in a tertiary care centre in Central India

Background: The incidence of multiple pregnancy is increasing all over the world because of assisted reproductive technology or spontaneously as a result of numerous risk factors. The objective of this study was to study the perinatal outcome of multiple pregnancy in a tertiary care centre in central IndiaMethods: It is a prospective study total 2289 pregnant woman were enrolled. Out of which 72 pregnant women were either a twin or triplet. 2217 pregnant women were singleton and had acted as controls. Perinatal outcomes including perinatal morbidity and mortality in relation to history regarding any complication in the present pregnancy were noted and analyzed.Results: In case of multiple pregnancy 90.2% were conceived between 20-30 years of age and 9.8% more than 30 years.13.9% cases of multiple pregnancy were less than 34 weeks at the time of delivery. The IUGR in multifetal pregnant patient was significantly higher. Oligohydromnios was seen in 3 out of 72 multifetal gestation which accounted for 4.1%. The proportion of singleton and multiple pregnant females who had anemia during pregnancy was 92.33% and 91.67%. Most common indication of LSCS in multifetal gestation is abnormal presentation during labour accounting for 41.7% of LSCS. The most common indication for NICU admission in case of multifetal pregnancy was 80.8%.Conclusions: Majority of the twin pregnancy is high risk one, and as such all twin preganancies should have mandatory hospital delivery. Early diagnosis, antenatal, intra-natal and post-partum cares are necessary to improve the outcome

Ruptured Primary Ovarian Ectopic Pregnancy: A rare case report

Primary ovarian pregnancy occurs quite rarely and that too usually in young highly fertile multiparous women. Risk factors include previous pelvic inflammatory disease, IUD use, endometriosis, and assisted reproductive technologies. Its presentation often is difficult to distinguish from that of tubal ectopic pregnancy. We report a case where a young Second gravida with previous LSCS presented with two months amenorrhea along with abdominal pain presented to us and was diagnosed as ectopic pregnancy and was confirmed intra-operatively and histopathologically as primary ovarian pregnancy, managed successfully with laparotomy followed by partial ovariectomy.

A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

Background: Post-Partum Hemorrhage (PPH) is the commonest cause of maternal death worldwide. Studies suggest that the use of Misoprostol may be beneficial in clinical settings where oxytocin is unavailable. However studies are limited that show its use in prevention of PPH in high risk pregnancy involving elective caesarean section. Therefore our aim of study is to compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the prevention of postpartum hemorrhage in cesarean sections.Methods: In a double-blind randomized controlled trial, 200 pregnant women who had cesarean sections were assigned into two groups: to receive either oxytocin intramuscularly or misoprostol rectally after spinal anesthesia.Results: There was no significant difference between the two groups about change in postpartum hemoglobin, need for blood transfusion and incidence of PPH. We also did not observe any significant difference in any side effects.  Conclusions: Misoprostol may be considered as an alternative for oxytocin in low resource clinical settings.

Assessment of pregnancy outcome with low molecular weight heparin therapy: a retrospective, single centre observational study

Background: The objective of this study was to determine the outcomes of Low Molecular Weight Heparin Therapy (LMWH) given for various indications during pregnancy.Methods: In this context, a detailed retrospective analysis of all the patients who received LMWH for various indications over a period of two years from October 2015 to November 2017 at a single center, Sri Aurobindo Medical College and PG institute in Indore was performed.Results: Total 100 patients were studied, included over the period of 2 years for various indications for which Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement and atrial fibrillation (54.0%), chronic deep vein thrombosis (DVT) (13.0%), thrombophilias (9.0%), recurrent pregnancy loses (21.0%) and prophylaxis for deep vein thrombosis (3.0%) in overall patients. Abortion was seen in 8.0 % patients; fetal growth restriction in 13% patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, postpartum hemorrhage patients and Stillbirth occurred in 4.0 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.Conclusions: Low Molecular Weight Heparin Therapy (LMWH) used amongst pregnant women with various indications for anticoagulation therapy was associated with successful pregnancy outcome in the vast majority of cases. Further multicenter prospective studies and international registries of pregnant women on LMWH are necessary to broaden our knowledge in optimizing the care of women who require anticoagulation during pregnancy

Prevalence of thyroid dysfunction and impact on maternal and fetal outcome in Central Indian pregnant women

Introduction: Thyroid dysfunctions have become common endocrine problems in pregnant women. It is now well established that not only overt, but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are very few data from India about the prevalence of thyroid dysfunction in pregnancy. In this study, we determined the prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome in Central Indian Indore Pregnant Women.Methods: Total 300 pregnant women between the 13 and 26 weeks of gestation were recruited for this study who is residing in Indore. In all patients routine obstetrical investigations, TSH tests were done. Anti-TPO antibody tests and Free T4 were done in patients with deranged TSH. The obstetrical and perinatal outcomes were recorded. Almost all the patients were followed up to delivery.Results: The prevalence of hypothyroidism and hyperthyroidism was 13 and 4%, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (22.2 versus 11.6%) and placental abruption (22.2 versus 2.0%). Subclinical hypothyroidism was associated with preeclampsia (30.0 versus 11.6%) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (22.2 versus 6.6%), preterm birth (44.4 versus 30.0%), low birth weight (66.6 versus 30.0%), intrauterine growth retardation (33.3 versus 10.0%), and fetal death (22.2 versus 0%) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (2.0 versus 6.6%), preterm delivery (5.2 versus 30.0%), low birth weight (11.2 versus 30.0%), and intrauterine growth retardation (4.4 versus 10 %) as compared to the euthyroid women.Conclusions: The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome

Novel surgical approach: compare the efficacy of vaginal hysterectomy with abdominal hysterectomy in non-descent uterus

Background: The aim of the study was to compare the efficacy of vaginal hysterectomy with that of abdominal hysterectomy in non-descent uterus for safety and feasibility of advancing gynaecological practice.Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College and Postgraduate Institute, Indore (M.P.) from October 2013 to April 2015. A total of 170 cases were enrolled in this study. Subjects were equally divided into two groups of equal size and assigned to a specified group i.e. study and control group. Each group consists of 85 cases.Results: The two techniques of intervention measured a highly significant mean difference for parameters such as ambulation (1.75), need of analgesic doses post-operative (2.80), resumption of bowel/bladder activity (8.62) and hospital stay (4.44) were less in study group when compared to control group where in ambulation (2.25), need of analgesic doses post-operative (5.11), resumption of bowel/bladder activity (18.75) and hospital stay (6.96). It was also observed that vaginal discharge (4.7%), UTI (4.7%) and re-hospitalization (2.4%) were less in study group when compared to control group which showed vaginal discharge (4%), UTI (0%) and re-hospitalization (5%). Vaginal hysterectomy in women with non-descent and moderately enlarged uteri is safe. A combination of debulking techniques is often needed and the surgeon needs to be familiar with them. With experience larger uterus can be removed. Thus this scar less approach should be chosen as a preferred method for hysterectomy.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Study on prevalence of hepatitis B in pregnant women and its effect on maternal and fetal outcome at tertiary care centre

Background: Hepatitis-B is caused by double stranded DNA virus. Prevalence of hepatitis B in pregnant woman worldwide is 2.5 to 1.5% whereas in India it is 2 to 7.7%.Methods: This is a retrospective study conducted at SAMC and PGI, Indore between January 2016 to December 2016. Hepatitis- B prevalence and outcome was assessed by doing routine screening of hepatitis B antigen in our indoor patients and finding out their maternal and fetal outcome.Results: Total 3567 deliveries were conducted during study period, out of them 39 were diagnosed as HbsAg positive pregnant patient; so, prevalence was found to be 1.09%. out of these, 84.6% were booked cases, mode of delivery was vaginal in 66.67% cases, preterm Delivery was in 10.26% of cases, meconium stained liquor was found in 5.13% cases, maternal mortality was nil, perinatal mortality was found in 2.56% cases and 5.13% cases were admitted in NICU.Conclusions: Screening of all pregnant women for HbsAg irrespective of risk factors will definitely help to know the correct prevalence and reduce the transmission of hepatitis B infection. Hepatitis B is a major public health problem in India and will continue to be until appropriate nationwide vaccination programs and other control measures are established

Incidence and perinatal outcome of multiple pregnancy in a tertiary care centre in Central India

Background: The incidence of multiple pregnancy is increasing all over the world because of assisted reproductive technology or spontaneously as a result of numerous risk factors. The objective of this study was to study the perinatal outcome of multiple pregnancy in a tertiary care centre in central IndiaMethods: It is a prospective study total 2289 pregnant woman were enrolled. Out of which 72 pregnant women were either a twin or triplet. 2217 pregnant women were singleton and had acted as controls. Perinatal outcomes including perinatal morbidity and mortality in relation to history regarding any complication in the present pregnancy were noted and analyzed.Results: In case of multiple pregnancy 90.2% were conceived between 20-30 years of age and 9.8% more than 30 years.13.9% cases of multiple pregnancy were less than 34 weeks at the time of delivery. The IUGR in multifetal pregnant patient was significantly higher. Oligohydromnios was seen in 3 out of 72 multifetal gestation which accounted for 4.1%. The proportion of singleton and multiple pregnant females who had anemia during pregnancy was 92.33% and 91.67%. Most common indication of LSCS in multifetal gestation is abnormal presentation during labour accounting for 41.7% of LSCS. The most common indication for NICU admission in case of multifetal pregnancy was 80.8%.Conclusions: Majority of the twin pregnancy is high risk one, and as such all twin preganancies should have mandatory hospital delivery. Early diagnosis, antenatal, intra-natal and post-partum cares are necessary to improve the outcome

Assessment of pregnancy outcome with low molecular weight heparin therapy: a retrospective, single centre observational study

Background: The objective of this study was to determine the outcomes of Low Molecular Weight Heparin Therapy (LMWH) given for various indications during pregnancy.Methods: In this context, a detailed retrospective analysis of all the patients who received LMWH for various indications over a period of two years from October 2015 to November 2017 at a single center, Sri Aurobindo Medical College and PG institute in Indore was performed.Results: Total 100 patients were studied, included over the period of 2 years for various indications for which Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement and atrial fibrillation (54.0%), chronic deep vein thrombosis (DVT) (13.0%), thrombophilias (9.0%), recurrent pregnancy loses (21.0%) and prophylaxis for deep vein thrombosis (3.0%) in overall patients. Abortion was seen in 8.0 % patients; fetal growth restriction in 13% patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, postpartum hemorrhage patients and Stillbirth occurred in 4.0 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.Conclusions: Low Molecular Weight Heparin Therapy (LMWH) used amongst pregnant women with various indications for anticoagulation therapy was associated with successful pregnancy outcome in the vast majority of cases. Further multicenter prospective studies and international registries of pregnant women on LMWH are necessary to broaden our knowledge in optimizing the care of women who require anticoagulation during pregnancy