Intrauterine fetal demise: a retrospective study in tertiary care center in India

Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age 30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management

A study of obstetric acute renal injury

Background: Acute renal or kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome.Methods: This prospective study was conducted between January 2014 to December 2017. Out of 1057 patients delivered in our institute during this period, out of which 26 patients with Obstetric AKI were included in this study.Results: Incidence of obstetric AKI was 2.64 %. Their age varied from 19 to 34 years, with an average of 26.2 years. About 21(80.8%) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46%) and puerperal sepsis (15.38%). The outcome was favorable with complete renal function recovery in 55.76% patients. Two (7.69 %) patients became dialysis dependent. Maternal mortality was one (3.84%).Conclusions: Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8%) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46 %) is the most common cause of obstetric AKI. Late referral in 9 (34.61%), puerperal sepsis in three (33.33%), obstetric hemorrhage in three (33.33%) and combined sepsis and hemorrhage in two (27.77%) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an avoidable complication

Revisiting essential obstetric care from stakeholders’ view: knowledge and awareness about safe motherhood practices among stakeholders in tertiary care centre

Background: To assess stakeholder’s perception of giving importance to various aspects of antenatal care.Methods: This community based observational study was conducted by Dept. of OBGYN; SKNMC Medical college, Narhe Pune which started from Feb 2016 and culminated on occasion of  ‘Safe Motherhood Day’ on 11/04/2016. A poster showing components of safe motherhood was prepared and pregnant patients, their relatives, paramedical staff visiting antenatal OPD were targeted. They were asked to mark the most essential component (in their view) with ‘Bindi’; only one chance was given per participant. Total 2450 women were recruited.Results: Though many women are aware about essential obstetric care, still much emphasis is given on traditional component like diet. There is still unawareness about importance of other components like immunization and intake of iron, calcium tablets or role of investigations or conduction of delivery by trained health care personnel.Conclusions:  Knowledge gap found in this study points that easy access to medical care during pregnancy should be improved to have its impact on practices of safe motherhood

Prospective comparative study between colposcopy and histopathology for diagnosis of CIN and carcinoma cervix

Background: Cervical cancer develops from precursor lesions and detection of these lesions is of utmost importance. The detection of precancerous lesions is made with help of screening tests most important include PAP smear and colposcopy. So we conducted this study to understand the role of colposcopy in down staging of Carcinoma cervix.Methods: We performed a prospective study between Jan 2018 to Dec 2018 on 180 subjects chosen from patients who sought consultation for various gynaecological complaints between age group of 18-60 years. A Pap smear followed by a colposcopy was performed and colposcopic directed biopsies were taken and subjected to histolopathological examination.Results: Colposcopy had a sensitivity of 83.3%, specificity of 78.5%, PPV of 68.9% for CIN 1. It had a sensitivity of 90.9%, specificity of 95.2%, PPV of 83.33% for CIN 2 and 3 when co related with gold standard histopathology which is much higher as compared to Pap smear.Conclusions: Colposcopy is an effective tool in down staging of Carcinoma cervix

Comparative study of intravenous iron sucrose versus ferric carboxymaltose for the treatment of iron deficiency anemia in postpartum patients

Background: Objectives: To study the efficacy and safety of intravenous iron sucrose versus ferric carboxymaltose in the treatment of iron deficiency anaemia in postpartum patients.Methods: Well compensated anemic postpartum patients with Hb between 7-11 gm% at 24 hours after delivery were included in the study. Patients were thoroughly investigated for hematological parameters. All patients were checked for hemoglobin and serum ferritin at 24 hours after delivery and 42 days after delivery. Each patient in mild and moderate anemia group has received a fixed dose of 500 mg and 1000 mg respectively of both compounds. All other iron supplements (except from diet) were withheld during follow up period.  Results: Average rise in Hb in mild anemia group is 2.30 gm% with iron sucrose and 2.52 gm% with ferric carboxymaltose after 42 days of infusion. In moderate anemia group average Hb rise observed is 4.58 gm% with iron sucrose and 4.73 gm% with ferric carboxymaltose after 42 days. Significant improvement in iron stores is also observed at the end of 42 days in both groups. Unpaired‘t’ test was used to test the significance of rise and compare the rise between two groups. Both compounds have shown similar response and difference between them is not statistically significant.  Conclusions: Fixed dose iron sucrose and ferric carboxymaltose are equally effective and safe for the treatment of iron deficiency anemia in postpartum patients.