Study of obstetric and fetal outcome of twin pregnancy in a tertiary care centre

Background: The past two decades have witnessed a sharp rise in the incidence of twin and higher order gestations. The progress and developments in assisted reproductive technology, availability and widespread use of ovulation inducing drugs and delayed childbearing are thought to be the causes responsible for the rise. Twin pregnancy is associated with increased maternal and perinatal morbidity and mortality as well as healthcare costs. Maternal complications like hypertensive disorders, anemia, gestational diabetes mellitus (GDM), preterm labour, preterm premature rupture of membranes (PPROM) and placental abruption increases. It is also responsible for repeated antenatal admissions, longer hospital stay, blood transfusions and increase in operative vaginal or cesarean delivery, post-partum hemorrhage and Hysterectomy. Twins have an increased risk of intraventricular hemorrhage, sepsis, necrotizing enterocolitis, respiratory distress syndrome and neonatal death. The objective of the study was to study the maternal and fetal outcome of twin pregnancy.Methods: Retrospective analytical review of all twin deliveries at the teaching hospital medical college of Central India, over a period of 3 years between January 2010 and December 2012.There were 55 twin deliveries, data analysis regarding maternal age, parity, presentation, gestational age at delivery, obstetric complication mode of delivery, birth weights, and perinatal morbidity & mortality was analyzed.Results: Majority of patients 44 (80%) were in age group of 20-30 years. 55% patients were booked and 62% were from urban area. 18 (32%) patients could reach beyond 37 weeks, there were 21 (38%) cases between 34 to 37 weeks and 16 (29%) between 30 to 34 weeks of gestation. Preterm delivery was the commonest complication occurring in 67% of the cases. Cephalic presentation of both the babies occurred in 36% of the cases. 50% of the twins needed admission to NICU for various indications like prematurity, birth asphyxia, low birth weight, meconium staining of liquor & delivery by caesarean section. In our study among the 55 twin births there were 16 (29 %) perinatal deaths and one maternal mortality.Conclusions: Twin pregnancies are high risk pregnancies with more maternal and fetal complications. The use of antenatal care services, identification and anticipation of complications, intrapartum management and good NICU facilities will help to improve maternal and neonatal outcome in twin pregnancies

Study of congenital anomalies of fetus and its outcome in a tertiary care centre

Background: According to WHO Congenital anomalies are defined as structural or functional anomalies, including metabolic disorders which are present at the time of birth. Congenital anomalies are a major health problem accounting for 8% to 15% of perinatal deaths and 13% to 16% of neonatal deaths in India. This study was done to know the frequency, pattern of congenital anomalies and various presentations, which may help to develop strategies for patient counseling and management. The objective of study was to present the spectrum of various congenital anomalies, epidemiological features of pregnant women with anomalous fetus.Methods: Retrospective, analytical hospital based study of 45 patients who delivered or aborted congenital anomalous baby from a period of 1st Jan 2012 to 31st August 2015. Relevant information regarding maternal age, parity, gestational age, birth weight, sex, and consanguinity antenatal ultrasound was documented.Results: During the study period 45 congenital anomalies were seen in delivered babies and aborted fetus, 32 (71%) patients were in the age group of 20-29 years. 35 (77%) patients were from rural area and 29 (65%)were unbooked patients. The incidence of congenital malformations was higher among abortions and preterm deliveries. Incidence of congenital anomalies was higher in stillborn. 31 (68%) patients had anomalies diagnosed on antenatal ultrasound. Central nervous system was the most common system involved followed by musculoskeletal system. Anencephaly was the common malformation seen in 12 (27%) patients.Conclusions: Our study concluded that number of congenital anomalies were more in rural patients and were higher in stillborn. Central nervous system was commonly involved. Early diagnosis, antenatal ultrasonography, proper counseling for this pregnancy and subsequent pregnancy in needed for proper management of the problem

Acceptability and feasibility of immediate postpartum IUCD insertion in a tertiary care centre in Central India

Background: This study was conducted to assess the acceptability and feasibility of immediate postpartum intrauterine contraception device insertion after vaginal deliveries in a tertiary care centre in Central India. Aims: To study acceptability, feasibility & complications of immediate PPIUCD.Methods: This is a prospective analytical study conducted at Department of Obstetrics and Gynecology, PCMS & RC Bhopal. 200 eligible postpartum women were counselled for IUCD insertion. After consent, Cu-T 380 A insertion was done. These women were also interviewed for their reasons for accepting and rejecting PPIUCD and their preference for other forms of contraception. Follow-up was done at 6 week or when they reported with any complaint.Results: Out of 200 eligible postpartum patient counselled, 72 (36%) women underwent PPIUCD insertion which was significantly low as compared to preference to use of other methods of contraception at a later date (66%). Acceptance of PPIUCD was higher in the age group of 21-29 years (35%), para-1 (48%), and educated (60%) clients. Expulsion rate was 22%. There was no case of perforation or any other major complication. 52 cases (72%) reported for follow up. 43% of cases were comfortable with PPIUCD at 6 weeks. There was no case of perforation, PID reported in our study. Only one patient reported with intrauterine pregnancy at 6months with IUCD in place.Conclusions: PPIUCD was not very acceptable in our set up but it is a safe, highly effective, long acting, cost effective method of contraception with very few side effects and no major complication and contraindication. The feasibility of accepting PPIUCD insertion can increase with antenatal counselling and institutional deliveries.