A clinical study of feto-maternal outcome in pregnancies with oligohydramnios

Background: The amniotic fluid that surrounds the fetus serves several roles during pregnancy. Oligohydramnios is diagnosed when ultrasonographically the AFI is less than 5cm/5th percentile. It affects 3-5% of all pregnancies. Assessment of amniotic fluid volume is a helpful tool in determining who is at risk for potentially adverse obstetric and perinatal outcome.Methods: Pregnant women with oligohydramnios reporting to Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysore from December 2012- June 2014 were included in the clinical study of maternal and fetal outcome. All singleton, non-anomalous, low risk pregnancies with AFI≤5cm with intact membranes and gestational age between 28-42 weeks were included in the study. Various outcomes such as mode of delivery, meconium staining, Apgar at 1 and 5 minutes, birth weight and NICU admissions were assessed.Results: A total of 130 cases of isolated oligohydramnios were assessed. 55.4% had vaginal delivery. 13.8% underwent elective LSCS and 30.8% had emergency LSCS. 18.5% had meconium stained liquor, 4.6% babies had APGAR of <7 at 5 minutes. 17.7% had birth weight of <2.5 kg and 6.9% of babies required NICU admission.Conclusions: The present study was conducted to know the feto-maternal outcome in pregnancies with oligohydramnios. The study showed that isolated oligohydramnios had no adverse maternal or perinatal outcome

Factors influencing perinatal outcome in eclampsia at a tertiary referral hospital

Background: Perinatal mortality in eclampsia still continues to be high in developing countries mainly due to prematurity and birth asphyxia. This study was conducted at a tertiary referral hospital to analyse the perinatal outcome in eclampsia and identify the associated risk factors.Methods: A prospective study wherein 170 cases of eclampsia admitted to Cheluvamba Hospital, Mysore, India over a period of one and half years were analysed.Results: The incidence of eclampsia was 1.08%. 88.8% of the cases were delivered vaginally and 8.2% by LSCS. Majority of the babies (48.8%) weighed between 1000-2000 gms. The perinatal mortality rate in this study was 55.3%. Prematurity (61%), SGA (55%) and birth asphyxia (55%) were the most common causes of perinatal morbidity. Birth asphyxia was the commonest cause of perinatal death (51.2%) followed by respiratory distress syndrome (20.93%), septicemia (13.95%) and meconium aspiration syndrome (6.98%). Jaundice, pulmonary hemorrhage and intracranial hemorrhage contributed to 2.33% of early neonatal deaths each. Among various probable risk factors for poor perinatal outcome, BP ≥160/110 mmHg, gestational age <28 weeks, vaginal route of delivery, antepartum eclampsia and convulsion delivery interval ≥24 hours were associated with significantly higher perinatal mortality (p < 0.05).Conclusions: Strict fetal monitoring and prompt timely intervention may help to reduce the perinatal mortality rate. The NICU facilities have to improve especially in government hospitals so that smaller babies can be taken care of and salvaged

A real time application on Neutrosophic Nano Soft Topology

In this paper, we introduce Neutrosophic Nano Topological Space inducedby soft set. The “Neutrosophic Nano Soft Topological Space”(NNSTS) is generated by soft lower approximation, soft upper approximation and soft boundary region. The approximations are derived by the soft relation. Also a real life problem is converted to Neutrosophic Nano Soft Topology and solved by calculating score value.Publisher's Versio

Effects of twin pregnancy chorionic properties on fetal outcomes: a comparative study

Background: Twins carry significant risks to both mothers and babies. The purpose of this study was to evaluate chorionicity and its impact on perinatal outcomes in twins.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Government T. D. Medical College, Alappuzha, Kerala. A total of 106 cases of twin pregnancies were included in the prospective descriptive study. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the cases were divided into the twin group with monochorionic diamniotic (MCDA) and twin group with dichorionic diamniotic (DCDA group). The relationships of different chorionic properties and fetal outcomes were determined by comparing various fetal outcomes.Results: Among 106 twin pregnancies, 61.3% were DCDA twins, 38.7% were MCDA. Average maternal age of monochorionic twin was 25 and that of dichorionic twin was 27. Perinatal mortality of monochorionic twin was 14.7% when compared to 8.6% for dichorionic twin. The mean gestational age for monochorionic twin pregnancy was 34.78 weeks whereas it was 35.91 weeks for dichorionic pregnancy. Elective and emergency LSCS was done more for dichorionic twin pregnancies compared to monochorionic twin pregnancies. Low Apgar scores were seen in monochorionic twins compared to dichorionic twins.Conclusions: The incidence of fetal outcomes in the monochorionic group was inferior to those in the dichorionic group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention

A cross sectional study on immunization status of anganwadi children in a rural area of north Kerala, India

Background: The current scenario depicts that immunization coverage has been steadily increasing but the average level remains far less than the desired. Though there is increased accessibility of health care services in rural areas, its utilization is low. Hence the present study is undertaken in an attempt to assess immunization status of children between 2 to 5 years of age enrolled in anganwadi centers in a field practice area of Pariyaram Medical College. The aim of the study was to assess the immunization status of anganwadi children in a rural area of north Kerala, India.Methodology: A cross Sectional Study was done among anganwadi Children between ages 2 to 5 years from January 2013 to March 2013 at Cheruthazham. Cluster sampling method was used. Each Anganwadi centre was considered as a single cluster and all children from the selected anganwadi centers were included in the study. Data was analyzed by SPSS Version 17, Microsoft excel 2007. Results: 94% of children were fully immunized with BCG, DPT, OPV and measles. Coverage was highest for BCG, DPT-1 and OPV-1 (100%) and least for measles, 94%. The major cause of incomplete immunization was postponement of immunization due to inter current illness of the child. There is only marginal difference in immunization coverage according to gender, religion or education of parents. Conclusion: Regular health education sessions, and regular reminders and removal of misconceptions prevailing among people will solve the problems of non-immunization.

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

Efficacy of 50µg oral misoprostol versus 25µg vaginal misoprostol in induction of labor

Background: Misoprostol is the latest drug for induction of labour which is cheap and stable at room temperature. Our study was conducted to test the efficacy of misoprostol for labor induction through oral and vaginal route.Methods: 250 women who required induction of labor at Govt. Medical College, Kottayam was included in this study. Both oral misoprostol 50µg and vaginal misoprostol 25µg 4 hourly upto maximum of four doses were used for induction of labor as per consultant’s preference. Out of these 125 patients were selected for study in both groups. Singleton term pregnancies with cephalic presentation were selected. The mean induction pain interval, induction delivery interval, mode of delivery, maternal complications like uterine contraction abnormalities, neonatal complications were observed.Results: Induction to pain interval was shorter in oral misoprostol group compared to vaginal misoprostol group (2.48+1.3 hours vs. 3.91+2.17 hours P ≤0.001). But the mean induction to delivery interval was comparable in both groups (12.98±3.04hrs vs. 12.59±3.28 hrs.) Vaginal delivery and cesarean section rate in both groups were comparable. The oral group required more number of misoprostol (>2 misoprostol 38.4% in oral 25.6% in vaginal p=0.030). There was insignificant increased incidence of uterine hyperstimulation in vaginal group. The neonatal outcome was comparable.Conclusions: Misoprostol administered either by oral or vaginal route was equally effective in induction of labor and found to be safe

Condom tamponade in the management of atonic postpartum hemorrhage

Background: Postpartum hemorrhage (PPH) remains a leading direct cause of maternal death in both developed and developing countries. Millennium development goal of reducing maternal mortality rate cannot be achieved unless the prevention and treatment of PPH is prioritized. Objectives of the study were to study the efficacy of condom tamponade to arrest bleeding in cases of atonic PPH unresponsive to uterotonics.Methods: Prospective study conducted in the Kottayam Medical College where mothers who develop atonic PPH following childbirth unresponsive to uterotonics (after ruling out traumatic PPH) were included in study. Condom tamponade was applied in them and inflated with normal saline until the bleeding stops. Intrauterine drain was fitted with this to find out ongoing bleeding with tamponade in situ. The Condom tamponade was kept for 12-24 hrs and gradually deflated when bleeding ceased. Outcome measures were (1) Ability of condom catheter to stop bleeding; (2) Cases requiring further intervention; (3) Time required to stop bleeding and (4) Subsequent morbidity in terms of infection.Results: Of the 487 cases of atonic PPH, 61 required condom tamponade; bleeding controlled in 59 cases (96.7%); two patients (3.3%) needed further surgical intervention. No cases of maternal mortality due to PPH. No clinical evidence of intrauterine infection.Conclusions: The hydrostatic condom tamponade controls PPH quickly and effectively. It is simple, inexpensive, easily available, needs less expertise and life saving. Any healthcare provider may use this procedure as a timely measure to save the life of patients especially during referral to decrease ongoing loss

The risks for thromboembolism following caesarean section

Background: Maternal mortality can be due to various reasons. Maternal mortality following thromboembolism is a cause for concern. Venous thromboembolism is a very serious condition following caesarean section. Thromboprophylaxis should be given to the mothers with high risk for thromboembolism, who deliver by caesarean section. The objective of this study was to do to assess the risk status for thromboembolism among women delivered by caesarean section.Methods: A hospital based cross- sectional study was conducted among four hundred mothers who delivered by caesarean section. The study was conducted for a period of eight months from January to August 2017. The risks for thromboembolism was assessed and as per the guideline and hospital policy, thromboprophylaxis was given.Results: Out of four hundred patients, medical comorbidities were present for three patients. Patients who were overweight were 122. Two had systemic infection. The number of patients with high, intermediate and low risk of venous thromboembolism were 4,65 and 331.Conclusions: The study suggests that thromboprophylaxis is to be given for all the patients with any risk for thromboembolism, after caesarean section