Intrapartum cardiotocography and its correlation with umbilical cord blood pH in term pregnancies: a prospective study

Background: The purpose of intra-partum fetal monitoring is to identify early signs of developing hypoxia. Electronic fetal monitoring is performed using cardiotocograph, which is a paper record of the fetal heart rate (FHR) patterns plotted simultaneously in relation to uterine activity. In low resource settings umbilical cord artery blood gas analysis can provide important information about the foetuses exposed to intrapartum hypoxaemic events and can distinguish the infant at high risk for asphyxia and related sequelae. The aim of this study was to correlate intrapartum CTG findings with umbilical cord blood pH at birth in term pregnancies in labour and thus evaluate the success of CTG in predicting fetal acidosis during labour.Methods: The present study included 301 consecutive women with term singleton pregnancies in labour. Intrapartum CTG was taken and classified into normal (category I trace), indeterminate (category II trace) and abnormal (category III trace) according to NICHD 2008 Classification (Adapted by ACOG 2013). Umbilical cord arterial blood was taken immediately after birth, in a pre-heparinised syringe and sent to the laboratory for pH study to detect acidosis. Cord blood pH <7.2 was taken as acidosis and cord blood pH ≥7.2 was taken as normal.Results: In this study, 50.2% of the women had normal CTG, 36.5% had indeterminate CTG and 13.3% had abnormal CTG. 18.3 % of the babies had acidosis. Out of the subjects with abnormal intrapartum CTG, 52.5% had acidosis, of the subjects with normal intrapartum CTG trace, 7.3% had acidosis and of the 110 subjects with indeterminate intrapartum CTG, 22.7% had acidosis. A statistically significant association was found between intrapartum CTG and umbilical cord arterial pH (p <0.001).Conclusions: From the analysis of this study, it can be concluded that an abnormal CTG should be managed appropriately, without delay, in order to prevent acidosis in the neonate and adverse long-term sequelae. The obstetrician should be more vigilant in cases of indeterminate CTG tracings and monitor such labours closely

Role of Progesterone in Miscarriage

About 10-15% of clinically recognized pregnancies end in a miscarriage. Recurrent miscarriage defined as loss of three or more consecutive pregnancies complicate about 1-2% of couples trying to conceive. The most common cause of miscarriage is chromosomal aberration in the fetus. However in a vast majority, the cause of miscarriages remain unknown. This makes treatment options difficult and often empirical. It has been postulated that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone during the luteal phase of the menstrual cycle and in the early weeks of pregnancy. Therefore, progestogens have been used, beginning in the ï¬rst trimester of pregnancy, in an attempt to prevent spontaneous miscarriages. In women presenting with a clinical diagnosis of threatened miscarriage, there is preliminary evidence of a reduction in the rate of spontaneous miscarriage with the use of progesterone. Larger RCTs may help to validate these findings. Initial reports of favourable outcome with use of progesterone in recurrent pregnancy loss (RPL) could not be confirmed uniformly by larger randomized trials. This article aims at reviewing the role of progesterone in treatment of threatened and recurrent miscarriages

First Trimester Screening

Screening for aneuploidies in the first and second trimester of pregnancy is an important aspect of prenatal testing. The overall prevalence of aneuploidy is around 1 in 228 (0.4%). First trimester screening has proved effective in identifying aneuploid fetuses, the definitive diagnostic test for aneuploidy available in first trimester is chorion villous sampling (CVS)

Maternal and foetal outcome of eclampsia in a referral hospital

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery