A study of the incidence of posterior reversible encephalopathy syndrome in patients with eclampsia and their fetomaternal outcome at a tertiary care centre in India

Background: Hypertensive disorders are one of the most crucial and still unsolved problems in obstetrics. Eclampsia is one of the most serious acute complications of pregnancy, and the risk of morbidity and mortality for both the mother and baby is very high. Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition associated with eclampsia that can have severe consequences if not promptly diagnosed and managed. It presents with altered consciousness, acute cortical blindness and convulsions. “Delivery is the ultimate cure of eclampsia” is a traditional belief but it does occur in the postpartum period too. Methods: A retrospective analysis of medical records was conducted for eclamptic patients admitted to the tertiary care center over a specified period. Patients diagnosed with PRES were identified and their clinical characteristics, diagnostic imaging findings, treatment modalities, and maternal and neonatal outcomes were reviewed. Results: This study sheds light on the incidence of posterior reversible encephalopathy syndrome in eclamptic patients at a tertiary care center in India. PRES was more common in primigravidas in the younger age group (20-30 years) and patients who presented with multiple seizures, resulting in higher number of cesarean sections. Conclusions: Early recognition and management of PRES are crucial for improving maternal outcomes. Further research is warranted to refine strategies for timely diagnosis and intervention, ultimately contributing to the reduction of maternal and neonatal morbidity and mortality associated with eclampsia and its complications.

Maternal outcome in preterm labor in a tertiary care hospital

Background: To study the fetal and maternal outcome in preterm labor cases.Methods: It was Prospective, single centered, observational study. All women with preterm labor in the study period i.e. from September 2018 to March 2020 were included in the study i.e. 100 patients.Results: Out of 100 subjects, majority of mothers 65(65%) were in age group of 21-30 years followed by 23 (23%) in age group of ≤20 years. Majority 52 (52%) of study subjects were primigravida followed by 28 (28%) having parity 1. Only one case had parity 4. Majority 36 (36%) of study subjects were in lower class followed by 28 (28%) cases in lower middle class. 23 (23%) cases in middle class and 6 (6%) were in upper class. Maximum 61 (61%) cases were unbooked cases and rest 39 (39%) cases were booked. Out of 90 babies who were <2500 grams, maximum 57 (63.33%) were low birth weight (less than 2.5 kg) followed by 22 (24.44%) being VLBW babies. 10 cases were ≥2.5 kg, which are not LBW babies according to WHO Classification of low birth weight. Majority 34 (47.22%) stayed for 1-10 days followed by 17 (23.61%) babies for 11-20 days. Also 15 (20.83%) babies stayed for 21-30 days.Conclusions: Compared with term infants, preterm infants are at high risk of overall morbidity and mortality. Clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care back up facilities can improve the outcome of preterm labour and decrease the maternal complications as well

Fetomaternal outcome in pregnancy with hepatitis E infection

Background: HEV infection, a major public health concern, is known to cause large-scale epidemic and sporadic cases of acute viral hepatitis in developing countries. The infection occurs primarily in young adults and is generally mild and self-limiting; however, the case fatality rate is reportedly higher among pregnant women.Methods: Our study, a retrospective observational study, was conducted in a tertiary care center for over a period of 3 years (January 2017 to January 2020) to find out the fetal and maternal outcome in pregnant women with HEV infection.Results: A total of 38 antenatal cases with anti-HEV IgM-positive were included, and the maternal-fetal outcome was analyzed. The maternal mortality was 52.63 % especially during 3rd trimester and post-partum period, including 5 antenatal death. The most common maternal complication was acute fulminant hepatitis (39.5 %), DIC (36.8 %) and hepatic encephalopathy (31.6%). Prematurity (33.3% of total live births) and Still births (32.3 %) including 4 freshes still births were the commonest fetal complications noted.Conclusions: Our study shows that pregnant woman with acute viral hepatitis due to hepatitis E virus infection had a high mortality rate especially during 3rd trimester and post-partum period with poor obstetric and fetal outcome

A prospective observational study of post-partum intrauterine contraceptive device acceptance in a tertiary care centre

Background: Provision of PPIUCD is being rapidly scaled up in India with facilities in at least 19 states offering the method in 2013. According to National Family Health Survey (NFHS)-3, the prevalence of modern method of contraceptive use is 48.5% and all methods 56% in India. PPIUCD placement remains a viable option for patients who wish to use a long-acting reversible contraceptive (LARC) method and to have it placed at the time of their delivery.  Hence, we planned this study with an aim to evaluate acceptability PPIUCD at tertiary care centre. Methods: It was an observational and prospective study of acceptance of PPIUCD as a method of contraception in patients who delivered within the study period in our institute Grant Medical Hospital and College, Mumbai. Data analysis was done with statistical software SPSS V 25.0. Results: A total of 2014 patients were enrolled in the study. The mean age was noted to be 25.87 years. Frequency of ANC visits among the patients was 4 to 6 (39.87%). Commonest obstetric history finding was previous live birth history in 59.38% cases. Pregnancy outcome was vaginal delivery noted in 63.01% of the females. 879 (43.65%) cases accepted PPIUCD. For those who did not accept PPIUCD, commonest cause was tubal ligation in 34.19%, followed by fear of pain in 18.94%, partner’s refusal in 10.31%. Conclusions: The acceptance rate in study for PPIUCD was 43.65% which was higher than most of the published evidence. The common reasons for not accepting PPIUCD were tubal ligation

Effect of adolescent pregnancy on maternal and foetal health

Background: Adolescence is a time when structural, functional, and psychosocial developments occur. Pregnancy during teenage can adversely affect the health of both the mother and the foetus as the adolescent female concerned is yet to attain her full growth potential. Adolescent pregnancy is a global phenomenon with serious health, social and economic consequences. Methods: It was a single centric, prospective, observational study. 211 Patients who attended the inpatient or outpatient department of obstetrics and gynaecology in an urban tertiary care hospital and followed up till outcome. Results: As per the study conducted, almost 83% of teenage mothers conceive by 19 years of age. Owing to the increasing awareness regarding maternal and foetal wellbeing, majority of the teenage mothers were booked. Teenage mothers and their babies are prone to intrapartum and postpartum complications as well as stillbirths. The most common comorbidity associated in teenage mothers was pregnancy induced hypertension (PIH) spectrum disorders followed by anaemia. The rate of neonatal intensive care unit (NICU) admission for babies of teenage mothers was 10%. Conclusions: Adolescent mothers and their babies are at a risk of complications than other mothers in the twenties. The need of the hour are comprehensive measures and convergence among various departments to address all the needs of adolescents. Robust measures and policies to end teenage marriages and consequent pregnancies are exactly what the developing nations need at present

Taking stock and looking ahead

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Fetal outcome in maternal near miss, retro-prospective study at tertiary centre

Background: Women are not dying because of diseases we cannot treat. They are dying because societies are yet to decide that their lives are worth saving. The statement completely comprises the unawareness of the importance of maternal health existing in society. As a result of which, there is still a lag in maternal health progression. As a part and parcel, fetal health is compromised giving rise to poor fetal outcomes. Studying fetal outcomes in such near-miss cases establishes a relationship between them.Methods: A retro-prospective observational study, conducted in the Department of Obstetrics and Gynaecology. Study involves all women who are very ill pregnant or recently delivered women who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy and their fetal outcome during study period of 18 months.Results: In a study of 3604 deliveries, MNM cases were 107 births. The MNM IR was 30/1000 live births, and the most common determinant leading to near-miss is hypertensive disorders followed by hemorrhage. Total perinatal mortality was 439 with a PNMR of 125/1000 births. Among the 107 near-miss cases perinatal mortality was seen in 29 pregnancies contributing to 6.6% of the total PNMR.Conclusions: Fetal outcome improves with improvement in maternal health, as the maternal morbid condition is directly proportional to fetal outcome. This requires identifying and filling up gaps in the maternal health system to improve women’s health, further reducing fetal morbid conditions and consumption of neonatal resources

Contraceptive trends and fetal outcome in women with short and long interpregnancy interval: a prospective observational study

Background: The present study was conducted at our tertiary health centre with the objective of analyzing contraceptive trends and fetal outcome in women with various interpregnancy interval (IPI). Methods: The present study was a prospective observational study. Women were segregated into three categories as per their IPI (short, normal and long) and contraceptive trends and fetal outcome were deliberated. All women attending ANC clinic with previous pregnancy, regardless of outcome and registration status were included in our study. Results: We found that 21.1% of women with short IPI were unaware about contraception and this difference was statistically significant. It was seen that among women not using any method of contraception, majority had short ICP, almost 31.1% cases. This difference was also statistically significant. Amidst those with adverse outcomes of previous pregnancy, i.e. 169 cases, 87 cases i.e. 51.5% of the women conceived within 2 years. Short IPI is linked with an escalated risk of low birth weight, preterm birth and congenital anomaly whereas long IPI caused large for gestational age babies. Conclusions: Contraception and previous pregnancy outcome have a significant effect on interpregnancy interval which in turn affects the maternal and fetal outcome. So it is essential to maintain an optimum interpregnancy interval as most of these complications are avoidable. Short interpregnancy interval is associated with low birth weight, preterm and congenital anomaly whereas long interpregnancy interval is associated with large for gestational age babies