Risk factor and perinatal outcome of preterm delivery in a tertiary care centre in rural Haryana

Background: Aim of the study was to identify risk factors and to assess neonatal mortality and morbidity associated with preterm delivery in patient attending a tertiary care centre in rural Haryana.Methods: This retrospective cohort study was conducted in Shree Guru Gobind Singh Tricentenary Medical College, over a period of one year (January to December). All pre-term deliveries were included in the study. They were followed up from admission till delivery and till discharge from hospital. Various, parameters like maternal age, associated medical disorder, obstetric complications, gestational age, neonatal mortality, need of neonatal intensive care and condition of baby at discharge were analyzed.Results: In the present study, incidence of preterm deliveries was 16.1%. The most common risk factor found to be history of previous abortion (23.6%), preterm premature rupture of membrane (17.1%), Intra-uterine growth restriction (IUGR) with oligohydramnios (10.5%), hypertensive disorder during pregnancy (5.9%), and antepartum hemorrhage (4.6%). But majority of the patient (56.5%) no cause could be identify. Out of total 160 preterm births 3 were still born and 157 live preterm births, and out of which total Neonatal intensive care (NICU) admission were 60. Mortality rate was 100% in neonate weighing less than 1000 gm and 18% in babies weighing less than 2000 gm.Conclusions: The commonest risk factor for preterm delivery is previous history of abortion and adverse perinatal outcome is inversely proportionate to the period of gestation at the time of delivery. All efforts should be made to prolong the pregnancy beyond 34 weeks by identifying and actively managing the risk factors for better neonatal outcome

Twin foetus papyraceous in triplet pregnancy

The occurrence of twin papyraceous foetuses in triplet pregnancy is rare. A papyraceous foetus is found almost exclusively in multiple pregnancy. Papyraceous foetus is most frequent in foetuses dying between the third and sixth months of development. No convincing information has been obtained about the cause of early death of one or more foetuses and continued development of one or more others. There are rarely any symptoms or signs that suggest occurrence of foetus papyraceous, and a definite diagnosis can be made only at the time of delivery. Even then it may be missed by careless examination. We report here a case of a 25 year female with triplet pregnancy who delivered a healthy baby at term with two foetus papyracei

Awareness and acceptance of contraception in post-partum women in a tertiary care hospital of Delhi

Background: India is second most populous country of the world and in next few decades it will cross china if it will keep on increase by this exponential growth. This calls for steps to stabilize India’s population. India was the first country in the world to launch the Family Planning Programme in 1951. Despite this fact, India still lags behind in practicing contraception and limiting their family size.  Methods: A prospective cross-sectional interview based study was conducted on a sample of 492 post partum women who underwent their deliveries in this hospital in six months duration in the department of Obstetrics and Gynecology, Safdarjung Hospital, New Delhi. The women were counseled regarding post-partum contraception after assessment of their knowledge and practices. The interview included socio demographic profile of the participants, their awareness for contraceptive methods and reasons for its acceptance/refusal.Results: Out of 492 post-partum women, 56.9 % accepted one of the contraceptive methods during their hospital stay only. The most common contraceptive method chosen was intrauterine device (45.0%). The main reason for non-acceptance of contraception was expectation of a male child.  Conclusions: Providing effective, high quality antenatal and post-partum contraceptive counseling can reduce unintended pregnancies, decrease maternal and fetal morbidity and mortality and prevent unsafe abortions. In order to improve the situation, health authorities should be encouraged to provide counseling on postpartum contraceptive methods during antenatal and immediate postpartum period

Vaginal delivery for breech presentation should be an option: experience in a tertiary care hospital

Background: The purpose of this prospective study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation.Methods: 290 women with singleton breech presentation at term in labor were counseled about the risks and benefits of both the modes of delivery. Neonatal and maternal outcome were recorded and statistically analyzed.Results: APGAR at 5 min and NICU admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births.Conclusions: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre

Successful outcome of pregnancy in uncorrected tetralogy of fallot

Tetralogy Of Fallot (TOF) is the most common cyanotic congenital heart disease. Most commonly, it is detected in the first year of life and it is rare for patients with the disease to reach adulthood without corrective surgery. Pregnancy in patients with uncorrected TOF is rare and is associated with high morbidity and mortality rates. This is due to increased maternal hypoxemia and cyanosis because of fall in systemic vascular resistance and rise in cardiac output which exacerbates the right to left shunt. Its management poses a challenge to the clinician because of the rarity of its occurrence and the paucity of literature. 22 year old woman, G3A2 with uncorrected TOF presented at 36 weeks gestation to the emergency room with breathlessness on routine daily activities (NYHA III) and severe fetal growth restriction. The patient had higher hemoglobin and hematocrit levels and lower platelet count. Oxygen saturation was low. Pregnancy was terminated by caesarean section under spinal anesthesia. Post caesarean patient had a febrile course and falling oxygen saturation (nadir 45.4%) which was intensively managed in consultation with cardiologist and physicians. She was discharged along with her baby in satisfactory condition on post-operative day twelve. Uncorrected TOF in pregnancy poses a therapeutic dilemma to the obstetrician, cardiologist and anesthetist.  Intensive multidisciplinary management is essential to optimize the fetomaternal prognosis. With adequate care, good outcome can be achieved

Determination of the prevalence and pattern of menstrual disorders in college going adolescent girls in rural Haryana

Background: Adolescence is the transitional period from puberty to adulthood, causing rapid physical, cognitive, social and emotional changes. Any deviation of normal menstrual pattern is one of the reasons of severe stress and academic losses on many. The aim of the study was to determine prevalence and pattern of menstrual disorders in college going adolescent girls.Methods: A descriptive cross-sectional study was conducted in a medical college of Gurugram district of Haryana, North India. A semi-structured, pretested questionnaire was used to ask about the characteristics of girl’s menstruation: age of menarche; regularity/irregularity of menstruation, interval and duration; presence of amenorrhoea; amount of blood loss; degree of pain during menstruation; activity during menstruation and BMI.Results: All the girls were in the age group 17 to 19 years i.e.; in the late adolescent period with the mean age of 18.2±0.7 3 years. 81.66% girls attained menarche between 12 to 14 years of age. 3.66% girls attained early menarche and 0.33% girls attained menarche late. 19 had scanty menstrual bleeding and 7 suffered from secondary amenorrhea. 27 girls suffered from heavy menstrual bleeding. 78.3% adolescent girls had various degrees of dysmenorrhea with 8.66% had severe dysmenorrhea. 17.66% girls had high BMI and 11% girls for underweight.Conclusions: There was a high prevalence of menstrual disorders among adolescent girls which affects their social and academic lives. Thus, more attention should be paid to identify and treat these menstrual morbidities

Maternal and perinatal outcome in eclampsia and factors affecting the outcome: a study in North Indian population

Background: Worldwide eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Hence the importance of continued efforts in reviewing each women with eclampsia and to analyze factors affecting the outcome. Aims of the study were to evaluate maternal and fetal outcome in patients of eclampsia and factors affecting the outcome.Methods: A retrospective epidemiological study was undertaken in the department of obstetrics and gynaecology, VMMC & Safdarjung hospital, New Delhi during the period ‘January to December 2010’. Women who presented as eclampsia or developed eclampsia during hospital stay were included in the study. Data analysed included various maternal parameters and fetal parameters and the outcome of the pregnancy. Pearson Chi-square test was used to see association between two parameters.Results: During the defined period incidence of Eclampsia was 3.2 per 1000 deliveries. Maternal death occurred in 8.4% of patients and still birth in 18.8%. Inadequate & delayed initiation of treatment and preterm deliveries was found to be associated with poor maternal and fetal outcome. As the time interval between ‘onset of fit and delivery’ increased, chances of adverse outcome also increased. However, age, parity, onset of seizures before, during or after delivery was not found to have any effect on maternal and fetal outcome.Conclusions: It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities and multidisciplinary units are available

The insertion I/deletion D polymorphism of angiotensin converting enzyme (ACE) gene in type II diabetic

Purpose: The causes of T2DM are mainly unknown, but they arise from interplay between several genetic and environmental factors. The I/D allele of the ACE gene has been studied in Indian population in relation to T2DM with contradictory results. Hence the present study was aimed to investigate whether the I/D polymorphism of ACE gene increase the susceptibility to T2DM. Material and methods: ACE gene was genotyped in 119 patients, 59 (aged matched and sex no matched) patients and 50 (age matched and no sex matched) controls. Results: The Hardy Weinberg equilibrium was tested for the entire group. The χ2 (chi-square) test with Fisher’s correction was used to compare the genotype and allele frequency in the cases, on the one hand, and the controls, on the other . The II genotype occurred more frequently in North Indian population with type II diabetes mellitus patient (30%) than in the control (12%). The genotypic and allele frequencies differed significantly in case from control subjects (p<0.05). Conclusion: From the present data it was observed that in T2DM patient genotypic and allele frequencies were significantly deviated from Hardy-Weinberg equilibrium (p<0.05).The involvement of II genotype occurred more frequently among the case subjects