Meconium stained liquor and perinatal outcome

Background: The aim of this study is to know the association between the meconium stained amniotic fluid and its association with the perinatal outcome.Methods: All the patients coming to present hospital for delivery with meconium stained liquor during the study period were included in the study.Results: 163 cases with meconium stained liquor (MSAF) were included in the study, 124(76.1%) and 39(23.9%) had thin and thick MSAF respectively. Among these cases, thick MSAF was more associated with high fetal heart rate (FHR) variability (p value- 0.030), associated with increased rate of operative interference (64.1%; p value- 0.001), abnormal Apgar score (p value-0.003 at 1min and 0.001 at 5min) and increased neonatal intensive care unit (NICU) admission (33.3%; p value - <0.001).Conclusions: Present study showed that thick meconium is associated with more complications like increased operative interference, birth asphyxia, meconium aspiration syndrome, low Apgar score, prolonged NICU stay and overall increased perinatal mortality compared to thin meconium stained liquor. As the gestational age increased the incidence of meconium increased and a greater number of thick meconium had abnormal CTG

Spontaneous rupture of vaginal varicose veins mimicking placenta praevia

Vaginal varicosities are often an asymptomatic venous disorder that rarely occur in pregnant women. There is little information in medical literature concerning diagnosis and management.1 We present an isolated incident of spontaneous rupture of vulvar varicosities mimicking the presentation of placenta previa. It was successfully managed with a simple surgical approach done under local anesthesia

Giant chorioangioma with severe polyhydramnios presenting with abruptio placenta: a case report

Chorioangioma is the most common non trophoblastic tumor of the placenta which can result in pregnancy complications with attendant maternal and fetal mortality and morbidity.Although majority of them are asymptomatic, clinical course depends mainly on the size of the neoplasm.We present a case of  large symptomatic placental chorioangioma managed successfully at Shri B M Patil Medical College,Vijayapura.The patient presented with acute features of abruptio placenta secondary to sudden decompression of uterus with polyhydramnios associated with large placental capillary chorioangioma of 10 cm size.Immediate intervention with Emergency LSCS helped rescue the baby of Intauterine demise and possible hemorrhagic morbidity in the mother.Further gross and histological examination confirmed the diagnosis

Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

Background: Prolonged pregnancy is one that exceeds 42 0/7weeks. Management of prolonged pregnancy is very challenging in modern obstetrics.Methods: It is prospective observational study in department of Obstetrics and Gynecology, Shri B.M Patil medical college and Research center, deemed to be University, Vijayapur, North karnataka. Study period was from January 2018 to January 2019.Results: Total of 186 pregnant women were included in the study. Results in terms of age, gravidity, gestational age, time of induction, mode of delivery, neonatal outcome and maternal complications.Conclusion: Pregnancies beyond 40 weeks require early detection, effective fetal monitoring and proper planning of labour. In pregnancies beyond 40 weeks, decision of induction should be taken cautiously as early induction leads to failure of induction and increased rates of lower (uterine) segment Caesarean section (LSCS), while delayed induction leads to increased fetal complications

OEIS complex: a rare foetal anomaly

OEIS (Omphalocele, extrophy of bladder/cloaca, imperforate anus, spinal defects) is a rare constellation of malformations involving multiple organs in humans. It is the most serious manifestation of exstrophy-epispadias sequence. The exact aetiology of this condition is not known. It is sporadic but genetic associations have also been hypothesised. It results from defective blastogenesis leading to improper closure of anterior abdominal wall and defective development of cloacae and urogenital septum. Incidence ranges from 1 in 200000 to 1 in 400000. Prenatal diagnosis of OEIS complex can be done by anomaly scan between 18 to 22 weeks of gestation. It carries a poor prognosis. Survival is nil or very less. Even if baby survives it requires multiple surgeries with many potential complications. We had an undiagnosed case of this complex presenting to us in advanced labour, but a timely ultrasound helped in the diagnosis and avoided an unnecessary caesarean section which we would have done for an elderly primigravida with breech presentation

Why do mothers die? A retrospective analysis of maternal mortality over 7 years in a tertiary care teaching Hospital in North Karnataka, India

 Background: Maternal mortality ratio (MMR) is still high in many developing countries. In Southern India, the maternal mortality is highest in the state of Karnataka. Therefore, a study was conducted at BLDE (DU) Shri BM Patil medical college, hospital and research centre to study the causes of maternal deaths, and to make recommendation to reduce the maternal mortality.Methods: A retrospective analysis of all the maternal deaths between 2012 to 2019 was done.Results: A total of 58 women died due to pregnancy and its complications during the period of 2012-2019. Average age of death was 25.42 years. It was noted that 70.7% of the patients travelled over 30 km to reach Vijayapura city. The predisposing causes of death were post-partum haemorrhage (44.8%) eclampsia (18.9%), anaemia (17.2%), pulmonary or amniotic fluid embolism (12.1%), sepsis (10.3%) antepartum haemorrhage (3.4%) and cardiac disease (6.9%). A death each occurred in patients suffering cholestasis and adult respiratory distress syndrome. A majority of the deaths were post-partum deaths (84%). Most of the deaths of the occurred during the first 12 hours of admission (82.76). A total of 11 patients received blood and blood components. Of the 58 deaths, 56(96%) required ventilatory support., 47 (81%) patients received ionotropic support. 11 (19%) patients underwent peripartum hysterectomy.Conclusions: Timely intervention can save maternal lives. Services of well-equipped hospitals with obstetric intensive care units having a dedicated team of well-trained obstetricians, intensivists and anaesthesiologist are recommended in a facility which is near the residence of the pregnant women. Facilities for quick transfer of the cases who are high risk are required

A randomised controlled trial to compare the efficacy of preinduction with mifepristone 12 hours versus 24 hours prior for second trimister pregnancy termination

Background: Since the second trimester termination of pregnancy is on rise due to the detection of anomalies, this study aims to provide a safe regimen with respect to efficacy, side effects and acceptability for second trimester pregnancy termination.Methods: It is a randomized controlled trial, conducted on 48 cases at BLDE Medical college, Vijayapur, Karnataka. They were divided into two groups; all patients were given mifepristone 200mg orally followed by misoprostol 400mcg vaginally after 12 hours in group I and 24 hours in group II respectively. Subsequent doses were decided depending on the Bishops score. Results were analyzed in terms of induction-abortion interval and dosage of misoprostol.Results: The mean induction abortion interval was 563.9 minutes (9.3hrs) in group I and 714.6 minutes (11.9hrs) in group II; but was statistically not significant (p value 0.611) The total dose of misoprostol used was 783.3mcg in group I compared to 550mcg in group II, but was statistically not significant. The success rate was 100% in both the groups as none of them had incomplete abortion. There were no cases of uterine rupture, infection, need for check curettage and laparotomy.Conclusions: Our study proves that the interval between mifepristone and misoprostol can be safely reduced to 12 hours without affecting the efficacy. But in gestational age <16 weeks and primigravida 24 hours interval may be of benefit. Both the regimens were 100% successful

Menstrual Morbidities, Menstrual Hygiene, Cultural Practices during Menstruation, and WASH Practices at Schools in Adolescent Girls of North Karnataka, India: A Cross-Sectional Prospective Study

Background. Issues of menstrual morbidities, menstrual hygiene, and cultural practices are rarely discussed by adolescents. The burden of menstruation and cultural practices which the adolescent girls have to face has been less quantified. This study aims to assess the issues related to menstruation in school girls. Method. A cross-sectional prospective study was conducted on 1016 school-going adolescent girls in January 2020. A questionnaire in English and in Kannada was distributed to girls of class 8–12 of ages between 10 and 19 years. Results. 70.5% of the girls attained menarche by 12 to 14.9 years, 37.2% of the girls had their periods every 28–34 days, and 12.2% of the girls said they have heavy periods. 61.95% of the girls had dysmenorrheal, and 9.7% of the girls said that they required medications for the pain. 70.7% of the girls were using commercial sanitary napkins, 12.7% were using cloth, and 15.3% were using both. 55.5% of the girls who were using cloth as an absorbent were not drying the cloth in sunlight. 57.1% of the girls were washing their genitals more than 2 times a day. 93.8% were having bath during menses and 87.2% were using soap along with water. 37.7% of the girls disposed their pads by burning them, 50.8% of then disposed them in the dust bin, and 4.9% of them buried them. 8.6% of the girls said that they remained completely absent from school during periods. 17.85% said that they remained absent for a day. 53.4% of the respondents said that they have difficulty in concentrating at school. 76.1% said that they had adequate water and sanitation facilities at school. 22.3% said that there was adequate facility to change their pads at school. 73.2% said that they could get a spare pad at school. 43.3% of the girls said they avoided cultural functions during their periods, and 38.5% said that they avoided religious ceremonies and practices during their periods. 8.7% of the girls were made to sit outside the house during their periods. The girls from rural areas had poorer hygienic habits, in comparison to the urban girls. Cultural restrictions such as sitting outside the house during menstruation and restricting play were more in the rural girls than the urban girls. Conclusion. Menstrual morbidities, menstrual hygiene management, and cultural beliefs all play a role in school absenteeism in adolescent girls. Improvement of facilities at school and conducting awareness programs can help adolescent girls to attend schools