Prevalence of thyroid dysfunction in pregnant women and the need for universal screening: an observational study in Northern Andhra Pradesh population

Background: The maternal thyroid dysfunction is associated with adverse outcomes such as miscarriage, preterm delivery, preeclampsia, postpartum haemorrhage in mother whereas increased risk of impaired neurological development in foetus. The present study was designed with an aim to determine the prevalence of thyroid dysfunction and the need for universal screening in pregnant women.Methods: Three hundred and eighty pregnant women between 8-36 weeks of gestation with age group 20-32 years were recruited. Serum free T3, free T4 and TSH levels were assayed by chemiluminescence method. The pregnant women were classified into euthyroid, subclinical hypothyroid (SH), overt hypothyroid (OH) and overt hyperthyroid groups based on the results obtained in the study.Results: In the present study, the mean ± SD age (in years) and BMI of all pregnant women was 23.9±3.9 and 22.9±1.6 respectively. The maternal age was high in OH and overt hyperthyroid and was statistically significant (p<0.05). Similarly, women with high BMI were prone to OH than normal BMI (p<0.05). The prevalence of thyroid dysfunction was found to be 18.7%. The prevalence of hypothyroidism was 17.4% in which the SH was 13.4% and overt hypothyroidism 3.9%, but overt hyperthyroidism was 1.3%. TSH levels increased with the advancement of gestational age from 2.72±1.85 in first trimester to 3.4±2.05 µIU/mL in third trimester, and the difference was statistically significant (p<0.05). Finally, it was also noticed that the prevalence of raised TSH in high-risk pregnant women was high compared to low-risk women (35.6% vs 5.1%) relative risk (RR) 7.64, 95% confidence interval (CI) 4.62-12.65, (p<0.0001). However, 14 out of 51 (27.5%) with SH were in low-risk group.Conclusions: The present study states that the prevalence of thyroid dysfunction was 18.7% and also emphasizes the importance of screening all pregnant women for thyroid dysfunction rather than targeted high-risk pregnant women to prevent both maternal and fetal morbidity

Audit of caesarean deliveries in a tertiary care hospital of northern Andhra Pradesh using modified Robson criteria

Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate.Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016).Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively.Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate