Correlation of estimated fetal weight by ultrasound and birth weight in low risk pregnancy: a prospective study

Background: Sonographic fetal weight estimation is an important aspect of antenatal care. It is one of many important factors used to determine when and how to terminate pregnancy. This study was therefore carried out to sonographically estimate fetal weight with actual birth weight, to analyze various demographic parameters with birth weight and thus predict neonatal outcomes. Aim of the study was to correlate estimated fetal weight by ultrasound and actual birth weight in all low-risk antenatal women attending regular antenatal check-ups at tertiary care centerMethods: This was time bound prospective study, was conducted in pregnant women undergoing antenatal check-up in a tertiary care center from April 2022 to August 2022. During antenatal check-up, the subject was advised to undergo ultrasound imaging at 32-36 weeks and at term to look for BPD, AC, HC, FL, EFW. Clinically estimated fetal weight noted. Following delivery of baby, birthweight is recorded. Estimated fetal weight and actual birth weight are correlated and neonatal outcomes assessed.Results: As per the study sonographically estimated fetal weight at 32-36 weeks and at term, clinically estimated fetal weight correlated positively with actual birth weight.Conclusions: The statistics as per this study conducted in tertiary care centre in mangalore could be applied to Indian population, which may aid obstetricians in planning the mode of delivery, improve pre-labour counselling and efficient management of antenatal mother and large babies. Clinically estimated fetal weight could be used as a diagnostic tool sufficient to manage labour and delivery efficiently in low resource setting

Study on semen analysis in the evaluation of male infertility in coastal Karnataka, India

Background: According to current recommendation a couple has to be evaluated if they fail to achieve pregnancy within one year of unprotected regular intercourse. The current incidence of infertility is around 15% which is increasing because of various factors including delay in attaining first pregnancy. The male partner evaluation includes detailed history and examination including the sexual history and semen analysis. Observational study performed on patients with primary and secondary infertility. The detailed semen analysis evaluation done in addition to notifying brief sexual history and chronic medical ailments like diabetes.Method: After proper counselling, and obtaining consent, the patients were made to collect the semen sample in a room attached to the andrology lab. Detailed evaluation of each sample was done. Prior to this procedure, relevant information like occupation, age of the patient, duration of abstinence, coitus frequency and presence of chronic medical ailments like, diabetes mellitus and chronic hypertension were noted.Results: The study, done in a tertiary care centre in coastal Karnataka, revealed that a majority of the patients were in the age group of 25-30 years with a larger group of patients having liquefaction time of <20minutes and 25% were in the oligospermia group.Conclusions: Semen analysis is an indispensable diagnostic tool in the evaluation of the male partner of infertile couples in addition to brief sexual history and occupational history

Retrospective study on laparoscopic hysterectomy by vaginal vault closure method in a tertiary care centre

Background: Hysterectomy is the frequently performed operation for benign conditions of uterus, but the route of hysterectomy is always a matter of discussion. Laparoscopic hysterectomy is an expensive and time-consuming procedure and could be associated with increased risk of thermal damage related injuries to the surrounding structures. Presently, laparoscopic hysterectomy is considered to be a day care surgery because of technological improvement in electro-surgical unit and expertise of doing surgery. The objective of this study was as a retrospective observational study conducted in teaching hospital to study the factors like age, parity, indication and procedure related complications in detail.Methods: A total number of 40 patients who have undergone laparoscopic hysterectomy for various indications with vault closure by vaginal method with no. 1 PDS. A detailed analysis of cases was done according to age, parity, indication, intra-operative and post-operative outcomes.Results: Fibroid uterus was the most common indication for laparoscopic hysterectomy. Overall postoperative complication rate was 22.5% with no major morbidity reported.Conclusions: Laparoscopic hysterectomy has to be done with proper selection of patient and good peri-operative care. Vault closure by vaginal method has significantly reduced operating time, without increasing the morbidity

A prospective study on awareness of postnatal mothers regarding self and newborn care in a tertiary care centre in Mangalore, Karnataka

Background: Postnatal care is the important portion of maternal health care as it helps to assess the health status of mother and newborn. It promotes to rectify the defect and to identify the progress of the baby that is essential to solve the health issues.Methods: All 100 postnatal women were assessed regarding awareness of self and newborn care using structured questionnaire.Results: In this study maximum number were in age group of 21-25 years (42%). Majority of respondents were literate (88%). Main source of information regarding postnatal and neonatal care is given by health care personnel (49%). 77% cleaned the perineum after defecation and urination. 39% of postnatal mothers practice postnatal exercise. 54% were aware of spacing between two pregnancies. Majority of mothers agreed that colostrum is first breast milk and are aware on giving it to newborn (68%). 78% are aware of exclusively breast feeding baby for 6 months. 79% of postnatal women were aware vaccines prevent diseases in baby. Postnatal mothers had good awareness about self and newborn care.Conclusions: The first 48 hours after delivery is the time when the mother and baby are most vulnerable to morbidity and mortality associated with childbirth. Postnatal care is one of the most important maternal health care for not only prevention of impairment and disabilities, but also for reduction of maternal and neonatal mortality and morbidity

An undiagnosed case of placenta increta: a nightmare for obstetricians

Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. The major clinical problem in placenta accreta spectrum disorder is failure of placenta to separate normally from the myometrium after fetal delivery. It is associated with high morbidity and sometimes with a lethal outcome, mainly as a result of severe bleeding, uterine rupture and infections. 33-year-old Mrs. X primigravida at 38 weeks 5 days admitted in our hospital for elective LSCS with the indication of hysteroscopy and laproscopic ACUM (accessory and cavitated uterine mass) excision in the past. Adherent placenta diagnosis was done on table, senior anesthetic team was called and decision was taken to remove the placenta manually with adequate resuscitative measures i/v/o torrential bleeding. Defect of 4×6 cm on the anterolateral part of the upper uterine segment (previous ACUM excision site). Decision was done to go ahead with vigilant watch, keeping ready for systematic devascularization of the uterus followed by caesarean hysterectomy in case torrential bleeding continues. With a multidisciplinary approach, Patient was serially monitored with USG, beta hCG levels, attempting to preserve uterus in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post ACUM scarred uterus and it was successfully managed by sequential monitoring with backed up uterine embolization team if secondary PPH occurs.

A prospective study of maternal and fetal outcome in repeat LSCS mother

Background: Cesarean section is one of the most commonly performed abdominal operations on women in most countries. The incidence of primary LSCS is increasing all over the world, Consequently, there is a rise in multiple repeat LSCS with associated complications. Previous LSCS is a common indication for repeat LSCS. Primarily, authors aim at studying the influence of repeat LSCS on maternal and fetal outcome in a tertiary centre.Methods: All mothers with one previous LSCS admitted for emergency/elective LSCS at term gestation with singleton pregnancy in A.J. Institute of Medical Sciences and Research centre, Mangalore were recruited in the study from July to December 2018. Detailed history with antenatal risk factors were noted. Intraoperative and postoperative events were noted. Neonatal outcome was also noted correlated.Results: Majority of patients (58%) were in age group of 20-24years. Most of them were between 38 to 39 weeks of gestation. Most common intraoperative complication was bladder adhesion (18% of cases). In postoperative period febrile morbidity (7%) was common followed by urinary tract infection (2%). Most of the neonates (80%) weighed 2.5 to 3kg at birth. The incidence of poor APGAR respiratory distress, NICU admission was not significantly increased. There were 5 morbidly adherent placenta, 1 scar rupture, 4 scar dehiscence, no maternal or perinatal death.Conclusions: Previous caesarean is the most common cause of repeat caesarean and is associated with maternal morbidity. Measures should be taken to reduce primary caesarean sections which indirectly reduces the incidence of repeat cesarean sections

Maternal serum lactate dehydrogenase level and adverse pregnancy outcomes in women with hypertensive disorder of pregnancy at a tertiary care centre: a retrospective study

Background: Hypertensive disorder of pregnancy affect 6-8% of all pregnancies, contributing immensely to maternal morbidity and mortality. Thus, presence of lactate dehydrogenase (LDH) signifies tissue damage and haemolysis. The aim of the study was to correlate LDH levels with blood pressure ranges and maternal and foetal outcome in women with gestational hypertension, pre-eclampsia.Methods: This retrospective study was conducted in the department of obstetrics and gynaecology of AJ Institute of Medical Sciences and Research Centre, Mangalore for a period of 1 year (January 2020 to January 2021). Based on the eligibility criteria, 52 hypertensive pregnant women were enrolled as cases.Results: Mean±SD period of gestation at delivery was lowest (34.57±1.39 weeks) for pregnant women with S. LDH levels>800 IU/l, whereas with S. LDH800 IU/l, mean±SD Apgar scores at the end of 1 min, 5 minutes and 10 min were 4.42±0.79, 4.75±2.26 and 5.50±2.65 respectively.Conclusions: It can be concluded that S. LDH has the potential to be considered as a screening tool or predictor of the outcome of pregnancy in women with hypertensive disorders of pregnancy. However, studies of larger magnitude may be required to confirm the presence and the strength of association of S. LDH levels with pregnancy outcome

Retrospective study on assessment of risk for gestational diabetes using fetal medicine foundation’s gestational diabetes risk assessment calculator in a tertiary care hospital in coastal Karnataka, India

Background: Gestational diabetes is defined as impaired glucose tolerance with onset or first recognition during pregnancy. Undiagnosed or inadequately treated gestational diabetes can lead to significant maternal and fetal complications. Even though there are guidelines for diagnosis of GDM (gestational diabetes mellitus) by the Government of India, there is poor penetration of the implementation throughout the nation.Methods: The study was conducted in A. J. Institute of Medical Sciences between April to June 2019. 56 patients were evaluated with the fetal medicine foundation GDM risk calculator to assess the risk for gestational diabetes in a retrospective approach.Results: Incidence of GDM in the study was 15.9%. At a cut-off of 1/80, the calculator predicted increased risk for 37 out of 56 patients. There was a sensitivity of 91.6% and specificity of 63.6% with a negative predictive value of 96.5% and positive predictive value of 29.5%. there was a false positive rate of 43.2%.Conclusions: The fetal medicine foundation GDM risk calculator will prove to be an invaluable tool to predict high risk patients who need closer monitoring of blood glucose into the third trimester

Retrospective study on laparoscopic hysterectomy by vaginal vault closure method in a tertiary care centre

Background: Hysterectomy is the frequently performed operation for benign conditions of uterus, but the route of hysterectomy is always a matter of discussion. Laparoscopic hysterectomy is an expensive and time-consuming procedure and could be associated with increased risk of thermal damage related injuries to the surrounding structures. Presently, laparoscopic hysterectomy is considered to be a day care surgery because of technological improvement in electro-surgical unit and expertise of doing surgery. The objective of this study was as a retrospective observational study conducted in teaching hospital to study the factors like age, parity, indication and procedure related complications in detail.Methods: A total number of 40 patients who have undergone laparoscopic hysterectomy for various indications with vault closure by vaginal method with no. 1 PDS. A detailed analysis of cases was done according to age, parity, indication, intra-operative and post-operative outcomes.Results: Fibroid uterus was the most common indication for laparoscopic hysterectomy. Overall postoperative complication rate was 22.5% with no major morbidity reported.Conclusions: Laparoscopic hysterectomy has to be done with proper selection of patient and good peri-operative care. Vault closure by vaginal method has significantly reduced operating time, without increasing the morbidity