Role of dinoprostone gel in induction of labour

Background: Labour induction is one of the most common intervention in obstetric practice. A simple application of PGE2 intracervical gel can ripen the cervix effectively and improve Bishop’s score there by helping in successful vaginal delivery. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labour in postdate pregnancy and in patients with term pregnancy of premature rupture of membranes.Methods: This was a single year retrospective study conducted in a tertiary care center of western India from May 2019 to May 2020.Results: In group I women who delivered within 24 hours were included, in group II women who required re-instillation were included. The most common indication for induction in both the groups was past dates (accounting for 36.1% in group I and 47.3% in group II). The success rate in group I was 68.1% while in group II was 36.8%.  The rate of cesarean delivery in group I was 25.9%, while in Group II, it was 60.1%. Negligible maternal and neonatal complications were seen in both the groups.  Conclusions: The study showed that intracervical application of prostaglandin E2 is an effective, safe and acceptable method for induction of labor in women with unfavorable cervix and indications for induction. All these effects were achieved without increasing maternal and neonatal morbidity

Maternal and perinatal outcome in severe pre-eclampsia and eclampsia: a study of 120 cases at a tertiary health care center in Western India

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. Pre-eclampsia accounts for the majority of referrals in a tertiary care center as it stands one of the major causes of maternal and perinatal morbidity and mortality. It complicates 6-10% of all pregnancies. In India, they account for the third most important cause of maternal mortality. Patients with PIH are at a greater risk of abruptio placenta, cerebrovascular events, organ failure and DIC. Fetuses are at a greater risk of IUGR, preterm birth, small for gestational age and IUD. This study aimed to determine the maternal and perinatal outcomes of hospitalized pregnant cases with severe preeclampsia and eclampsia.Methods: This was a single year retrospective study conducted in a tertiary care center of Western India from May 2019 to May 2020. Maternal and perinatal outcomes were analyzed among the severe preeclampsia and eclampsia groups.Results: A total 52 (43.33%) of the cases were in the age group of 21-25 years, 64 (53.33%) were primigravidae and the majority were referred from peripheral hospitals. Liver function tests were deranged in 26.68% of the patients and 32.5% had abnormal renal function. Labetalol was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases. Lower segment caesarean section was the mode of delivery in 62 (51.67%) of the cases. Commonest maternal complication was atonic PPH (12.5%). There was one maternal mortality due to aspiration pneumonia. 85 (70.83%) of the babies needed NICU admission. There were 5 (4.16%) perinatal deaths.Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia. Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome

Partographic analysis of labour by modified WHO partograph in tertiary care centre

Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Methods: A hospital-based observational study involving prospective review of partographs for births that occurred in 2020 was conducted in 2 hospitals including SVP Hospital and V.S hospital Ahmedabad. A partographic analysis of labour was done in randomly selected 200 patients using modified WHO partogram. The study population was divided into Primigravida (96) and Multigravida (104) term patients. partograph recording were commenced at 4 cm dilatation. close maternal and fetal monitoring was done throughout the labour and partogram was plotted to detect any deviation from normal course.Results: Patients were grouped into primigravida and multigravida and based on partogram finding divided into mode of delivery. 22 of total 96 primigravida underwent caesarean section and 74 delivered vaginally. 8 of total 104 multigravida underwent caesarean section and 96 delivered vaginally. Out of 200 newborn only 11 had Apgar score <7 at 5 minutes.Conclusion: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving neonatal outcome

Changing trends in cesarean section: from 1950 to 2020

Caesarean section (C.S) is a part of the standard care in modern obstetrics. The indications for a caesarean section as an alternative to vaginal delivery have evolved over the centuries. Its practicality, disponibility, and apparent safety have placed caesarean section, a first-line procedure in many clinical scenarios. The awareness of perinatal mortality and morbidity associated with safety of caesarean, expert anaesthesia, potent antibiotics, blood transfusion facilities and better neonatal care have increased incidence of caesarean section very fast. Thus, there is fast, steady and definite rise in incidence of caesarean section everywhere. But the question is ‘Is a rising caesarean section rate is inevitable?’. Studies carried out to understand CS deliveries has adopted different framework. The issue treats elements of ethics in the medical profession, gender issues, choices of women, the quality of institutional services, etc. The findings of retrospective studies have suggested that the caesarean section rate could be reduced in certain categories. In this study, we discuss the various ways in which it can be achieved

Study of maternal and perinatal outcome in case of premature rupture of membrane at term

Background: Premature rupture of membranes is characterized by the rupture of membranes before the onset of true labour. PROM is associated with a high risk of maternal morbidity and also perinatal morbidity and mortality. The objective of this study was the evaluation of various risk factors and maternal and perinatal outcomes for a better understanding of this oracular condition for its better understanding and timely management.Methods: This study was carried out on 75 cases of PROM fulfilling set criteria over one year at a tertiary care hospital of western India. Demographic details, risk factors and outcomes were studied.Results: Present study found the highest number of cases among the age group 21-24 years. 70% of patients were primigravida and almost 75% were un-booked. Around 2/3rd of cases were delivered vaginally, having the highest no of maternal and perinatal morbidity and mortality when the duration of PROM increased to more than 24 hours.Conclusions: In our study, it was seen that PROM is more commonly seen in younger primigravida having certain risk factors. Many delivered vaginally. Complications increased with increasing duration of PROM. Early recognition of premature rupture of membranes and their associated complications and appropriate management of the situation helps in reducing the problems due to PROM to a great extent

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause)

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome

Effect of systemic lupus erythematosus on pregnancy outcome: a study of 40 cases at a tertiary health care center

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease in which organs and cells undergo damage initially mediated by tissue-binding autoantibodies and immune complexes. SLE has an impact on various organ systems. Ninety percent of the patients are women of child-bearing age thus pregnancies and its outcomes are of particular importance among women with SLE. The current study aims to study the maternal and foetal outcomes in SLE patients and to identify the predictors of adverse maternal and foetal outcomes in pregnancy.Methods: Data of 60 pregnancies of 40 female SLE patients from September 2019 to May 2021 in V. S. general hospital, Ahmedabad, were retrospectively reviewed. All the patients met the 2012 SLICC classification criteria for SLE. SLE disease activity in pre-pregnancy state and during pregnancy were retrospectively evaluated using SLE disease activity index-(SLEDAI), based on medical history, physical examination and immunological evaluation. SLE disease activity during the current non pregnant state was also calculated using SLEDAI.Results: In our study carried out 3 years among 60 pregnancies, the disease flared up in 23 pregnancies (38.3%).  Out of 60 pregnancies with SLE, there 17 (28.3%) unfavourable outcomes. Unfavourable outcomes were significantly higher in patients with SLE flare (14, 60.9%). Similarly, patients with lupus nephritis (8, 66.7%) had unfavourable outcome.Conclusions: In spite of tertiary level care in the hospital, foetal loss is a significant risk in these patients, so proper periconceptional counselling should be don

A study of gestational diabetes mellitus and fetal outcome in a tertiary care center

Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers.