Maternal and perinatal outcomes in pregnancy associated with placenta previa

Background: Placenta previa is associated with increased maternal and perinatal complications like malpresentation, premature labor, higher rates of caesarean section, peripartum hysterectomies, postpartum hemorrhage, sepsis, shock and retained placenta and even death. Antepartum haemorrhage may frequently result in low birth weight babies, preterm labour or repeated small events of haemorrhage causing chronic placental insufficiency and foetal growth retardation or intrauterine fetal death.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, SMGS, hospital, Jammu over a period of 1 year. All admitted cases of placenta previa were included in the study.Results: The total numbers of deliveries in one our hospital were 18567 during the study period. 364 patients admitted with antepartum heamorrhage so the incidence of APH in our hospital was 1.96%. 157 cases out of 346 were of placenta previa. It was observed that placenta previa cases were highest in the maternal age group of 26-30 yrs, i.e. 55.42%, 71.97% were multigravidae and 26.75% with prior caesarean section. 15.92% had undergone peripartum hysterectomy due to massive PPH. The percentage of perinatal death was 18.23% and the main cause was prematurity.Conclusions: Based upon observation made during this study, it is concluded that placenta previa is a serious condition with significant maternal and perinatal morbidity and mortality. Improvements in management of placenta previa have helped in improving neonatal survival and reduce maternal morbidity and mortality

Platelet count estimation: a prognostic index in pregnancy induced hypertension

Background: Hypertension in pregnancy is one of the serious complications of pregnancy with an incidence of 5% to 7% of all pregnancies, particularly in cases with preeclampsia and eclampsia. Though platelet count during pregnancy is within the normal non pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity of the disease process and duration of PIH syndrome.Methods: A prospective observational study was conducted on 200 pregnant women attending OPD Or Inpatients in the Department of Obstetrics and Gynecology, SMGS Hospital, GMC Jammu from November 2015 to October 2016. Pregnant women beyond 28 weeks gestation of pregnancy are included and divided into two groups i.e. the study and control group. Platelet counts will be done every 4 weeks in controls and weekly in subjects from 28 weeks till delivery.Results: The mean platelet count observed among cases of mild preecclampsia, severe preeclampsia and ecclampsia was 2.26, 1.63 and 0.99 lakh/mm3 respectively. The difference in mean platelet count among cases and controls was statistically significant. The association of platelet count with severity of different categories of PIH was analysed statistically and was highly significant.Conclusions: Platelet count is a very important investigation for the antenatal mother having PIH, as it is directly related to maternal and perinatal outcome. Routine and regular monitoring of platelet count can be included in the routine antenatal checkup among the pregnant women with PIH

The study of association between maternal serum magnesium levels and preterm labour in a tertiary care hospital

Background: Serum magnesium level in pregnancy is a valuable tool to find out preterm onset of labour. In the asymptomatic group, greater surveillance and administration of steroids, tocolytics and transfer to a higher centre wherever necessary has to be done with mothers with low serum magnesium level. The objective of the study is to find association between serum magnesium levels and women with preterm labour, and to compare these values with those patients who have a term delivery.Methods: The subjects included 100 pregnant women with preterm labour (cases) between 28 and 37 weeks gestation (Group A) and similar number of pregnant women with term labour (controls) between 37 and 40 weeks (Group B). Inclusion criteria for cases was singleton pregnancy, painful uterine contractions more than two in 30 minutes, intact fetal membranes, cervical dilatation (at least 1 cm) and effacement (80%). Serum magnesium levels were done in both the groups. Patients were followed until delivery. Routine antenatal investigations were done. Serum levels of magnesium were estimated by Erba’s semi auto-analyser.Results: 62% patients in Group A were from rural areas. More patients in Group A (70%) were from low socioeconomic class. More women in Group A were anaemic (44%). Mean value of hemoglobin in Group A was 9.93gm/dL. More patients in Group A had muscle cramps (89%). VLBW (3cm in Group A.Conclusions: Low maternal serum magnesium level is associated with preterm labour. Patients with preterm labour have significantly low serum magnesium level when compared with labour at term

Study the incidence, management and outcome of primary postpartum hemorrhage in a tertiary care hospital

Background. Postpartum hemorrhage (PPH) is a major cause of serious maternal morbidity and mortality worldwide. To avoid the same, it is essential to find out avoidable factors and to reduce their consequences. So, the present study is taken to see the incidence, management and outcome of primary PPH in a tertiary care centre. Objective of current study was to study the incidence, management and outcome of primary PPH in a tertiary care hospital.Methods: This observational cross-sectional study was conducted in a tertiary care hospital over a period of one year. A total of 200 patients developing primary PPH after delivery were divided into two groups-Group A: Patients with primary atonic PPH and Group B: Patients with traumatic PPH.Results: The incidence of primary PPH in our study came out to be 8.3%. Most of the cases were in the age group of 26 -30 years. 84% of the patients belonged to rural areas. 72.5% of patients had hemoglobin levels below 9g%. The main cause of PPH in our study was uterine atony with an incidence of 73% followed by traumatic PPH in 24% cases. Cesarean sections constitute about 55% cases whereas spontaneous vaginal delivery constitutes 45% cases. Primary PPH was noted in 60% cases that underwent induction of labor followed by 28.9% having augmented labor and 11.1% had spontaneous onset of labor. Conclusions: Every pregnancy should culminate in a healthy mother and healthy baby and for that we should make sure that every woman should have access to top quality essential and emergency obstetric services to cut back maternal mortality. Finally, the surest prophylaxis of PPH is that the correct management of all stages of labor should be done.

Platelet count estimation: a prognostic index in pregnancy induced hypertension

Background: Hypertension in pregnancy is one of the serious complications of pregnancy with an incidence of 5% to 7% of all pregnancies, particularly in cases with preeclampsia and eclampsia. Though platelet count during pregnancy is within the normal non pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity of the disease process and duration of PIH syndrome.Methods: A prospective observational study was conducted on 200 pregnant women attending OPD Or Inpatients in the Department of Obstetrics and Gynecology, SMGS Hospital, GMC Jammu from November 2015 to October 2016. Pregnant women beyond 28 weeks gestation of pregnancy are included and divided into two groups i.e. the study and control group. Platelet counts will be done every 4 weeks in controls and weekly in subjects from 28 weeks till delivery.Results: The mean platelet count observed among cases of mild preecclampsia, severe preeclampsia and ecclampsia was 2.26, 1.63 and 0.99 lakh/mm3 respectively. The difference in mean platelet count among cases and controls was statistically significant. The association of platelet count with severity of different categories of PIH was analysed statistically and was highly significant.Conclusions: Platelet count is a very important investigation for the antenatal mother having PIH, as it is directly related to maternal and perinatal outcome. Routine and regular monitoring of platelet count can be included in the routine antenatal checkup among the pregnant women with PIH