Incidence of maternal near-miss events in a tertiary care hospital of Gujarat, India

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, child birth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near-miss cases five-factor scoring system was used. In 2009 WHO working group has standardized the criteria for selecting these cases. Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss.Methods: A facility-based cross-sectional study was conducted in the department of obstetrics and gynecology in GMERS medical college and hospital, Sola, Ahmedabad from January 1, 2019 to August 31, 2019. All maternal near-miss cases admitted to the hospital during the study period were recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant’s record.Results: During the period of study, 3235 deliveries were done at the institution while 16 cases of near-miss were identified. The prevalence of near-miss case in this study was 0.5%. Near-miss per 1000 delivery was 5%. Maternal death to near miss ratio was 1:2.67. The leading causes of maternal near miss were hypertensive disorders (62%) and haemorrhage (32%) The morbidity was high in un-booked cases.Conclusions: Maternal near miss is good alternative indicator of health care system. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization

A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon

Obstetric and perinatal outcome in previous one cesarean section

Background: Women with previous cesarean sections constitute a high risk group in obstetrics, with associated complications. The cesarean section carries 3 fold risk of mortality compared with vaginal deliveries. The study was conducted to determine the mode of deliveries after previous one cesarean section, maternal and fetal complication.Methods: This is a prospective observation study. Total 150 patients of previous one caesarean with gestational weeks between 37 to 40 weeks admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital with spontaneous onset of labour, over a period of one year from April 2014 to April 2015 or till the desired sample will reached.Results: In the present study, out of 150 pregnant women with history of previous one LSCS who were subjected to this study, 39(26%) underwent elective LSCS, commonest indication being previous pregnancy bad experience (38.46%). 111(74%) underwent trial of labour after cesarean section out of it 77(69.36%) had successful VBAC and 34(30.63%) underwent repeat emergency LSCS. Maternal complications were higher in Emergency LSCS group than in those had a successful VBAC (17.64% vs.3.89%)). Neonatal complications were also higher in Emergency LSCS group than in those had a successful VBAC (2.95% vs. 0%).Conclusions: With proper case selection, appropriate timing and close supervision trial of labour after prior LSCS is safe and often successful

An obstetric outcome in pregnant women with consumption of tobacco

Background: Tobacco is known to be an established cause of adverse pregnancy outcome. Scientific studies, encompassing various ethnic groups, cultures and countries, have shown that cigarette smoking during pregnancy significantly affects mother, unborn fetus and the newborn baby.Methods: A hospital based cross sectional study was performed on 933 patients, separated in two groups: tobacco users and tobacco non-users and findings from each group were compared.Results: Incidence of complications like anemia, PIH and abruption increase with maternal usage of tobacco during pregnancy, chances of preterm delivery and ectopic pregnancy was raised, rate of wound complication was more in tobacco user women. There was no significant difference in mode of delivery.Conclusions: In the present study may establish association of tobacco consumption with adverse neonatal and obstetrics outcome and may encourage administration to focus on IEC (information, education, communication) to reduce tobacco consumption during pregnancy. Incidence of complications like anemia, PIH, abruption increase with maternal usage of tobacco during pregnancy. Chances of preterm delivery and ectopic pregnancy, was raised usage with of tobacco.

A comparative study of low dose magnesium sulphate therapy with Pritchard’s regime in management of Eclampsia

Background: Eclampsia is one of the most common causes of maternal and perinatal mortality and morbidity in India. Amongst the principles of management of eclampsia, the first is the control of convulsions. Magnesium sulphate is the main stay of treatment in eclampsia and imminent eclampsia. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used.  The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with standard Pritchard regimen in control of eclampsia.Methods: The study was carried out at emergency labour room, GMERS Sola Civil Hospital Ahmedabad. 120 patients of eclampsia were divided randomly into study group (n=60) receiving low dose MgSO4 and control group (n=60) receiving Pritchard regimen. The recurrence of convulsion, toxicity of MgSO4 and maternal and fetal outcome was studied.Results: It was observed that with low dose MgSO4 regime, convulsions were controlled in 91.7% of the cases. With standard Pritchard’s regime convulsions were controlled in 95% of patients. The maternal and perinatal mortality and morbidity were comparable in both groups.Conclusions: Low dose magnesium sulphate therapy is as effective as Pritchard’s regime for controlling convulsions in eclampsia and can be safely given in Indian women.

Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery.Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015.Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study.Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient

The association between isolated oligohydramnios at term and pregnancy outcome and perinatal outcome in case of isolated oligohydramnosis: a retrospective analysis

Background: Current study was carried out to assess the impact of isolated oligohydramnios on perinatal outcomes and mode of delivery.Methods: A retrospective observational cohort study was conducted at term pregnancy with sonographic finding of isolated oligohydramnios (AFI 5-25 cm).Results: When compared to the normal AFI, women with oligohydramnios had significantly lower birth weight babies and were delivered at a significantly earlier gestational age. However there was no difference in the APGAR scores at birth and NICU admissions between the two groups. Reactive NST had more chances of good APGAR score at 1 and 5 minute and that lower the AFI more the probability of nonreactive NST and abnormal Doppler. The number of inductions and caesareans done for foetal reasons were significantly higher in the exposed group.Conclusions: Obstetric and perinatal outcome remains similar in both isolated oligohydramnios with reactive NST as well as in patients with normal amniotic fluid index. Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and caesarean section

Prevalence of HIV in antenatal women at GMERS Medical College Sola, Ahmedabad

Background: Estimating the seroprevalence of HIV in a low risk population such as pregnant women provides essential information for an effective implementation of AIDS control programmes, and also for the monitoring of HIV spread within a country. Few studies are available from Gujarat, India showing the current trend in HIV prevalence in the antenatal population; which led us to carry out this study at a tertiary care hospital in GMERS medical college, Sola, Ahmedabad, India.Methods: This is a retrospective study. Total 8224 antenatal patients, who attended for first time at antenatal OPD at GMERS Medical College, Sola between April 2012 to March 2014, were included in the study. HIV testing was done by RAPID method after taking informed consent and pre-test counselling as per NACO guideline.Results: Out of total 8224 antenatal patients 7921 (96%) patient opted for HIV testing. Seroprevalence of HIV is found to be 15/7921 (0.19%). 7044/7921 (88.93%) women attended post-test counselling. 12/15 (80%) HIV positive women accepted post-test counselling.12/15 (80%) spouses accepted testing for HIV. 8/12 (66.66%) spouses of HIV positive women were also found to be HIV positive.Conclusions: The seroprevalence of HIV infection in antenatal women is low

Obstetric and perinatal outcome in previous one cesarean section

Background: Women with previous cesarean sections constitute a high risk group in obstetrics, with associated complications. The cesarean section carries 3 fold risk of mortality compared with vaginal deliveries. The study was conducted to determine the mode of deliveries after previous one cesarean section, maternal and fetal complication.Methods: This is a prospective observation study. Total 150 patients of previous one caesarean with gestational weeks between 37 to 40 weeks admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital with spontaneous onset of labour, over a period of one year from April 2014 to April 2015 or till the desired sample will reached.Results: In the present study, out of 150 pregnant women with history of previous one LSCS who were subjected to this study, 39(26%) underwent elective LSCS, commonest indication being previous pregnancy bad experience (38.46%). 111(74%) underwent trial of labour after cesarean section out of it 77(69.36%) had successful VBAC and 34(30.63%) underwent repeat emergency LSCS. Maternal complications were higher in Emergency LSCS group than in those had a successful VBAC (17.64% vs.3.89%)). Neonatal complications were also higher in Emergency LSCS group than in those had a successful VBAC (2.95% vs. 0%).Conclusions: With proper case selection, appropriate timing and close supervision trial of labour after prior LSCS is safe and often successful

Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery.Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015.Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study.Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient