Clinical study of various risk factors associated with intrauterine fetal death

Background: The death of a fetus is one of the unhappy events in the field of obstetrics. It is really distressing when it occurs without warning in a pregnancy that has previously entirely normal. It is thus vital to identify specific probable causes of fetal death to determine the risk of recurrence, prevention or corrective action.Methods: A prospective observational study was conducted in ESIC MC and PGIMSR, Rajajinagar, Bangalore, Karnataka, India. All cases of intrauterine fetal death confirmed either with ultrasound or on clinical examination by absence of fetal heart rate and fetal movements were studied. The age, parity, literacy, socio-economic status was recorded. Detailed history, clinical examination, associated conditions. Mode of delivery and details of the fetus and their placentas were noted. They were followed for 3 days for complications.Results: Mean maternal age was 26.03yrs, 98.5% of the women were booked cases, 82% belonged to lower middle class.16.39% of the women had hypertensive disorder of pregnancy, 4.91% had gestational diabetes, 9.8% had abruption placentae, 9.8% had oligohydramnios and 1.63% had polyhydramnios 4.9% were Rh isoimmunisation, 1.9% had twin pregnancy, 3.27% had PROM, 6.6% had cord accidents, 21% had anomalous fetus, 3.27% foetuses had non immune hydrops, 19.67% of IUDs were unexplained.Conclusions: Unexplained causes, PIH and abruptio placentae were major causes of IUFD. Significant proportion of IUFD due to PIH and abruption placenta is preventable by regular antenatal care and timely intervention. Despite advances in diagnostic and therapeutic modalities large number of fetal deaths remain unexplained. Poverty, illiteracy, unawareness and inaccessibility may be some of the reasons for unexplained IUFD

Diagnostic laparoscopy in the evaluation of female factor infertility

Background: Infertility is a global problem, with more than 70 million couples suffering every year. In India 10-15% of populations are suffering from infertility. All these people need accurate diagnosis and treatment. Among the many investigations available to evaluate the female partner of the infertile couples, laparoscopy is relatively recent and considered gold standard for pelvis evaluation. The objective of the study was to study the different causes of female factor infertility with diagnostic laparoscopy.Methods: This is a prospective study done on 50 infertile females who attended infertility clinic of department of OBG, ESIC MC and PGIMSR, Rajajinagar, Bengaluru from September 2013 to 2015. Both primary and secondary infertility females were included in this study. These patients underwent diagnostic laparoscopy in premenstrual phase (7, 8, 9th day of menstrual cycle) after conducting thorough clinical and biochemical examinations.Results: In the present study total 50 infertility cases were included. 41 cases had primary infertility and 9 cases had secondary infertility. Mean age was 29.88 years and mean duration of infertility was 5.9 years. Abnormal laparoscopic findings were detected in 41 (82%) cases. Tubal factor was seen in 14 (28%) cases, 11 (22%) cases had endometriosis, 10 (20%) cases had ovarian factor, 4 (8%) cases had pelvic adhesions and 2(4%) had fibroid uterus.Conclusions: Tubal factor is the commonest cause for infertility followed by endometriosis and ovarian factor. Diagnostic laparoscopy is the gold standard procedure to assess tubal status. Laparoscopy has a better role than ultrasonography in diagnosing endometriosis and pelvic adhesions

Maternal haemoglobin and perinatal outcome

Background: Maternal anaemia is common medical disorder in developing countries. WHO defines anaemia as haemoglobin concentration of ≤11 g/dl. However, in developing countries like India, the lower limit is accepted as 10 g/dl.Results: Of 218 women, 69 had anaemia. The prevalence of anaemia was 31.65%; of which 84% had mild anaemia, 14.6% had moderate and only 1.4% had severe anaemia. Mean Hb levels were 12.04% among non-anaemic mothers and mean birth weight was 2.89 Kg whereas 9.14%, 2.18 kg in anaemic mothers respectively. In our study, 21% in anaemic group has birth weight <2.5 kg and only 0.06% in non-anaemic mothers (p<0.0012) 3.6 times higher. The risk of IUGR was 3.77 times higher, low APGAR score at 1 min was 3.8 times higher (p<0.0001), meconium stained liquor was 2.3 times higher and NICU admissions 2.96 times higher in anaemic mothers than non-anaemic mothers.Conclusions: Anaemia in pregnancy is one of the causes of poor perinatal outcome. Maternal anaemia is associated with the high risk of low birth weight, IUGR babies, low APGAR scores and NICU admissions and overall increase in perinatal morbidity. Hence proper antenatal care and counseling can reduce occurrence of anaemia in pregnancy.