Fetomaternal outcome in morbidly adherent placenta in a tertiary referral hospital

Background: Morbidly adherent placenta is often associated with major pregnancy complications requiring massive blood transfusions, peripartum hysterectomy, etc. The prior number of caesarean sections and placenta previa are the critical risk factors. The aim of this study is to evaluate the fetomaternal outcome in women with morbidly adherent placenta and to quantify the risk factors predisposing to it.Methods: This is a retrospective cohort study. The study population comprises women, who had C-section for placenta accreta, increta and percreta at Government Raja Mirasudhar Hospital, Thanjavur from May 2016 to September 2017.Results: Eighteen women out of 21,083 who delivered during the study period had morbidly adherent placenta with an incidence of 0.085%. The mean gestational age at the time of C-section was 32.4 weeks. Twelve (66.66%) out of eighteen women had prior one C-section, two (11.11%) women had prior 2 C-section and two (11.11%) women had prior 3 C-section.10 cases were diagnosed antenatally by radiological imaging. Seventeen out of eighteen women underwent caesarean hysterectomy (94.44%). Average blood loss was 1.8 litres. The mean intraoperative blood transfusions were 3 units of PRBC, 3 units of FFP and 1.4 units of platelet. There was no maternal mortality. The average total hospital stay was 20.46 days. 11 neonates were preterm (61%) and 5 neonates were term (27.74%). FGR was seen in 2 preterm neonates (12.5%). The NICU admission rate was 81% (n=13). The perinatal mortality rate was 31.25% (n=5).Conclusions: As most of the women ended up in caesarean hysterectomy, early diagnosis will enable appropriate planning for blood components, anaesthetic and surgical resources, thereby reducing adverse fetomaternal outcomes. This will also allow adequate preoperative counselling of the women involved

Analysis of risk factors and treatment outcome following methotrexate therapy in ectopic pregnancy

Background: Ectopic pregnancy is a significant cause of morbidity and mortality in first trimester of pregnancy. Awareness regarding risk factors for ectopic pregnancy aids in early diagnosis and timely medical intervention before tubal rupture occurs. This study was undertaken to analyze the risk factors for ectopic pregnancy and to study the treatment outcome following methotrexate therapy.Methods: In this prospective study, 34 women with unruptured ectopic pregnancy selected for medical therapy were enrolled women with ectopic pregnancy who were hemodynamically stable with initial beta-human chorionic gonadotropin (β hCG) values of <5000 mIU/l, ectopic gestation mass size <5 cm and with no contraindication for methotrexate use were included in the study. Risk factors for ectopic pregnancy were studied and treatment outcome following single dose or 2 dose methotrexate regimen were analyzed.Results: The mean age of the study group was 26.88±4.5 years. Highest incidence of ectopic pregnancy was noted in 26-30 years and in second gravidas. Successful treatment outcome was observed in 61.8% with single dose methotrexate (MTX) and in 23.5% with 2 doses. Overall success rate of MTX therapy was 85.3%. Surgical intervention was instituted in 14.7% when pretreatment β hCG levels were <1500 mIU/ml. Single dose MTX was successful in 91.7% and with 2 doses it was 100%. None developed any major side effects to methotrexate therapy.Conclusions: MTX therapy is safe and effective in carefully selected women with ectopic pregnancy. Success rate of MTX therapy was 85.3%. MTX was most effective when pretreatment β hCG levels were less than 1500 mIU/ml

Risk factors of asymptomatic bacteriuria and fetomaternal outcome following treatment in early versus late gestation

Background: Asymptomatic bacteriuria (ASB) has higher incidence in pregnant than in non-pregnant women and is difficult to diagnose. It is associated with fetomaternal complications like prelabour rupture of membranes, preterm labour, low birth weight and increased perinatal mortality. The aim of this study is to analyse various risk factors and the maternal and fetal outcome following treatment of asymptomatic bacteriuria in early versus late gestation.Methods: This prospective study was conducted in Thanjavur Medical college and Hospital in 2019. The study population comprises all pregnant women attending antenatal clinic for their 1st antenatal visit.Results: Total of 800 antenatal women were enrolled in 2 groups based on gestational age &lt;20 weeks (n=394) and between 28 to 32 weeks (n=406) at the time of their 1st antenatal visit. Incidence of asymptomatic bacteriuria was 13.6% and 84.4% were in the age group of 21-30 years. High prevalence was noted in primigravidae (47.7%) and in lower socioeconomic class (70.9%). Commonest organism isolated was E. coli (42.2%) and most of the organisms were sensitive to gentamycin (89.9%) and cefotaxime (84.4%). Despite treatment of asymptomatic bacteriuria, complications like anaemia, gestational hypertension &amp; preterm labour were higher in late detection group than in early detection group.Conclusions: This study shows high prevalence of asymptomatic bacteriuria in pregnant women. The chances of developing maternal complications were significantly reduced after antibiotic therapy of asymptomatic bacteriuria. Hence, early screening and treatment of asymptomatic bacteriuria needs to be incorporated in routine antenatal care