Abnormal fetal heart tracing patterns in patients with meconium staining of amniotic fluid and its association with perinatal outcomes

Background: CTG is the most commonly used test for antepartum and intrapartum fetal surveillance. Objective: Evaluation of labours complicated by MSAF or abnormal fetal heart rate tracings or both and its predictability of adverse perinatal outcomes.Methods: Prospective observational study of laboring patients with evidence of suspected fetal distress carried out at department of Obstetrics and Gynecology, Institute of Maternal and Child Health, Kozhikode, Kerala during the time period July 2013 - December 2013. Analysis of clinical data of 600 labouring women with evidence of presumed fetal jeopardy (either in the form of abnormal FHR tracings or MSAF or both) were done. Pregnancy variables and perinatal outcomes were compared and correlated with FHR tracings. Statistical analysis was carried out by chi-square and ANOVA tests. Level of significance was set at P value <0.05.Results: The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and neonatal morbidity. There was significantly higher Caesarean Delivery (CD), low APGAR scores, higher requirement of neonatal resuscitation and admission to NICU and higher perinatal deaths among abnormal FHR tracing group.Conclusions: 1) The presence of abnormal FHR tracing pattern in MSAF patients is associated with an increased risk of adverse perinatal outcomes. 2) Adverse fetal outcomes were also noted in patients with clear liquor but abnormal FHR tracings. 3) Similar adverse outcomes were more common in the tracing showing decelerations

Maternal near miss review from a tertiary care center in South India

Background: Maternal near miss review acts as complimentary for mortality audits. It indicates the quality of obstetric care and helps obstetricians to revise policies and practices.Methods: A retrospective observational study was carried out at institute of maternal and child health, Government Medical College Kozhikode from January to December 2014. Cases were defined based on WHO criteria 2009.Results: Total live births during the study period were 15604 and there were 24 maternal deaths. Near Miss cases were 267. Maternal mortality rate was 153.5/lakh live births and maternal near miss incidence ratio was 17.03/1000 live births. Maternal near miss to mortality ratio was 11.1 and mortality index was 8.2%. Hypertensive disorders comprised 46%, followed by haemorrhage 36%, sepsis 7% and other causes 10%.Conclusions: Even with improving care, maternal near miss incidence (17.03 per 1000 live births) is found to be higher in our institution compared to developed nations. However high maternal near miss to mortality ratio (11.1) and low mortality index (8.2%) shows good quality of obstetric care in our institution