Management of prolonged second stage of labor

Second stage of labour has been often neglected leading to increased maternal and perinatal morbidity. Recognising and managing prolonged second stage is a challenge even to an experienced obstetrician. This article reviews the changes in the definition of prolonged second stage over the years. It discusses the causes, recognition and management options along with the difficulties in delivering a patient with prolonged second stage of labour. Though adding an extra hour to the definition of second stage in patients may reduce the rate of caesarean section but some studies also show a rise in maternal and perinatal morbidity. Obstetricians are familiarized to the different techniques of delivery of the impacted head. Once diagnosis of prolonged second stage is confirmed, causes should be identified and addressed, and treatment should be individualised, and timing and mode of intervention planned

Intramuscular oxytocin 10 units versus intravenous methylergometrine 0.2 mg in active management of third stage of labour for prevention of postpartum haemorrhage: a comparative study

Background: To compare the effectiveness of 10 IU of oxytocin IM with 0.2 mg methyl ergometrine IV in the prevention of post-partum hemorrhage when used as a part of active management of third stage of labour. This study aims to compare their influence on duration of the third stage of labour, the amount of blood loss during the third stage of labour and the immediate post-partum period and side effects of the drugs if any.Methods: The study was conducted in a tertiary care teaching hospital. 200 women, who underwent normal delivery with or without episiotomy, were enrolled and were randomly distributed into two groups. 100 women received 10 IU of intramuscular Oxytocin and 100 women received intravenous 0.2 mg of methyl ergometrine. Women of both the groups were given the medication after delivery of anterior shoulder of the baby. Comparison done between percentages fall in Hb from before delivery to 24 hours after delivery, need for additional uterotonic agents, need for blood transfusion, duration of third stage of labour and any side effects including retained placenta and need for manual removal of placenta.Results: Intravenous methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage. There was no difference in the duration of third stage of labour, amount of blood loss, need for additional uterotonic agents, and need for blood transfusion in both the groups. There was no significant side effect in both the groups.Conclusions: Intramuscular oxytocin is as efficacious as Intravenous methylergometrine in the prevention of postpartum hemorrhage with no side effects

Liver ailments in pregnancy: our experience

Background: The spectrum of liver disease is varied and is associated with increased maternal and perinatal morbidity and mortality when pregnancy coexists with the liver disease. This study aims to analyze the incidence, spectrum, clinical presentation and outcome of liver diseases complicating pregnancyMethods: A retrospective cohort study was conducted and data was collected from the hospital records of obstetric cases diagnosed with liver disease complicating pregnancy in a tertiary care hospital, over a period of two years.Results: A total 146 cases of liver diseases complicating pregnancies were recorded out of 5018 deliveries (2.9%). Intrahepatic cholestasis of pregnancy (n=52, 35.62%) and severe preeclampsia (n=47, 32.19%, with HELLP n=8, 5.48%) accounted for majority of cases. The incidence of chronic hepatitis B infection was 20.56% (n=30). There were two maternal deaths (1.37%) attributed to severe post-partum HELLP and severe preeclampsia with multi organ failure.Conclusions: Liver diseases in pregnancy have a non-specific presentation and may be associated with a wide range of conditions, early diagnosis and timely appropriate intervention can help reduce the mortality and morbidity

A rare case of Takayasu’s arteritis in pregnancy

Takayasu’s arteritis (TA) is an uncommon, chronic inflammatory vascular disease of unknown etiology that primarily involves aorta and its branches and pulmonary arteries. Though it is present worldwide, it is more prevalent in Asian countries. It usually presents during reproductive age group with non-specific symptoms. The symptoms of the disease are varied and patients can present asymptomatically with impalpable pulses. There are no specific laboratory tests to diagnose TA. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions. Though the disease process theoretically is not aggravated by the pregnancy, development of preeclampsia and fetal growth restriction may occur during pregnancy. Preconception counseling and careful monitoring of pregnant mother by a multidisciplinary team, improves the pregnancy outcome. Here we present a bad obstetric case with TA who subsequently developed severe preeclampsia and fetal growth restriction. The pregnancy outcome could be made favourable by strict monitoring and multidisciplinary team approach

Antenatal risk factors in emergency caesarean sections done for fetal distress

Background: Fetal distress is an important indication for emergency caesarean deliveries. The objective of this study is to identify the antenatal and intrapartum risk factors in emergency caesareans done for non-reassuring fetal status and compare with patients who underwent emergency caesareans for other indications.Methods: It was a retrospective study and data was collected from the labour room records of a tertiary care hospital. Patients undergoing emergency caesareans for fetal distress were the cases and the remaining emergency caesareans were the controls. Data was statistically analyzed.Results: There were 5184 deliveries during this period of which, 669 were emergency caesareans. 126 (18.83%) of these were due to fetal distress/ non-reassuring fetal status and 543 (81.17%) were for other indications. Caesarean due to fetal distress accounted for 2.43% of the total deliveries. There were more primigravidae (61.11% Vs 46.04%) in the fetal distress group (Odds Ratio 1.84, p=0.003). Intra uterine growth restriction (OR 5.44, p<0.0001) and antepartum haemorrhage mainly due to abruption (OR 11.19, p <0.0001) were other important antenatal risk factors. Those with neonates of birth weight between 1.5 to 2.0 kgs were more likely to undergo emergency caesarean for fetal distress (OR 1.78, p=0.0435). The risk of a lower APGAR was higher in the fetal distress group (12.59%). 28.34% neonates in this group required NICU admission.Conclusions: Primiparity, intrauterine growth restriction, antepartum hemorrhage and prematurity, have shown to significantly increase the risk of emergency cesareans due to non-reassuring fetal status. We need to improve antenatal care with a goal of early detection of the above risk factors for timely institution of appropriate intervention and thus contributing to a reduction of emergency caesareans due to fetal distress

A rare case of Takayasu's arteritis in pregnancy

Takayasu’s arteritis (TA) is an uncommon, chronic inflammatory vascular disease of unknown etiology that primarily involves aorta and its branches and pulmonary arteries. Though it is present worldwide, it is more prevalent in Asian countries. It usually presents during reproductive age group with non-specific symptoms. The symptoms of the disease are varied and patients can present asymptomatically with impalpable pulses. There are no specific laboratory tests to diagnose TA. Angiographic imaging is considered to be the gold standard investigation in diagnosing TA. Steroids with subsequent tapering doses are the mainstay of medical treatment. Reconstructive vascular surgery is limited to the severe and irreversible stenotic lesions. Though the disease process theoretically is not aggravated by the pregnancy, development of preeclampsia and fetal growth restriction may occur during pregnancy. Preconception counseling and careful monitoring of pregnant mother by a multidisciplinary team, improves the pregnancy outcome. Here we present a bad obstetric case with TA who subsequently developed severe preeclampsia and fetal growth restriction. The pregnancy outcome could be made favourable by strict monitoring and multidisciplinary team approach