Risk factors for neonatal hyperbilirubinemia: a case control study

Background: Neonatal Hyperbilirubinemia is one of the most common reasons for NICU admissions. The frequency of neonatal jaundice has been on an increase since the last decade. Is the increase due to changes in obstetric practice or drugs? There is no definite reason. This study was undertaken to find out any obstetric characteristics which may contribute to the development of Neonatal Hyperbilirubinemia and which is modifiable.Methods: Record review data from 140 singleton deliveries at the Institute of Maternal & Child Health ,Govt. Medical College, Kozhikode, Kerala were analyzed to determine the relationship between neonatal hyperbilirubinemia (>10mg/dl) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis.Results: There was statistically significant relationship between hyperbilirubinemia and LBW, preterm delivery, PPROM, breast feeding, neonatal infection, instrumental delivery and presence of GDM and IUGR.Conclusions: By identifying these obstetric characteristics, we may be able to modify them and reduce the need for NICU admissions for Neonatal Hyperbilirubinemia

A case of severe preeclampsia presenting as acute pulmonary oedema

Pulmonary edema refers to an excessive accumulation of fluid in the pulmonary interstitial and alveolar spaces. It may occur in low risk pregnancies but one very important predisposing factor is association with preeclampsia. We are reporting a case of severe preeclampsia presenting as acute pulmonary oedema. 21 year old primi, a known case of gestational hypertension on drugs had pedal edema which was progressively increasing. She was admitted at 29w5d as her BP was still high. Since her preeclampsia profile was normal and her BP was controlled she was continued on conservative management. After 2 days she developed cough, tachypnoea and tachycardia with clinical findings suggestive of A/c pulmonary oedema. Shifted to HDU and started on diuretics and other symptomatic management. After 1 hour as patient’s condition was worsening with O2 saturation fall, decided for LSCS + elective post operative ventilatory support. LSCS done showed evidence of Grade 3 abruption with couvelaire changes on uterus. Baby weighed 1.24 kg, severely asphyxiated, died after 3 days. Patient was put on ventillatory support and she improved postoperatively. Acute pulmonary oedema in pregnant women is a life-threatening event. Prompt diagnosis and management is very important for the survival of the patient

Maternal near miss review from a tertiary care center in South India

Background: Maternal near miss review acts as complimentary for mortality audits. It indicates the quality of obstetric care and helps obstetricians to revise policies and practices.Methods: A retrospective observational study was carried out at institute of maternal and child health, Government Medical College Kozhikode from January to December 2014. Cases were defined based on WHO criteria 2009.Results: Total live births during the study period were 15604 and there were 24 maternal deaths. Near Miss cases were 267. Maternal mortality rate was 153.5/lakh live births and maternal near miss incidence ratio was 17.03/1000 live births. Maternal near miss to mortality ratio was 11.1 and mortality index was 8.2%. Hypertensive disorders comprised 46%, followed by haemorrhage 36%, sepsis 7% and other causes 10%.Conclusions: Even with improving care, maternal near miss incidence (17.03 per 1000 live births) is found to be higher in our institution compared to developed nations. However high maternal near miss to mortality ratio (11.1) and low mortality index (8.2%) shows good quality of obstetric care in our institution