Evaluation of outcome of mode of delivery in severe preeclampsia

Background: Preeclampsia is new onset hypertension of more than 140/90 mmHg on 2 occasions, 4 hours apart in pregnancy, which occurs after 20 weeks of gestation and frequently near term. If there are other symptoms like as headache, blurred vision from end organ damage, and thrombocytopenia, it is characterized as severe preeclampsia. Regardless of the foetal outcome, treatment for severe preeclampsia is immediate delivery. The goal of the current study is to assess how different delivery methods affect individuals with severe preeclampsia.Methods: It is a retrospective study conducted in RL Jalappa hospital, Kolar from January 2021 to February 2022. Out of 2568 deliveries at our facility throughout the study period, 150 singleton pregnancies complicated by severe preeclampsia delivered at 24-34 weeks of gestation were chosen for the study. Women who had additional obstetric, foetal, or medical difficulties were not included in the study.Results: 110 study participants had an LSCS form of delivery out of the total. Among them, non-reassuring fetal heart rate, obstructed labor, and malpresentation were the most typical indicators for LSCS. The difference between Bishop's score and the mode of delivery was statistically significant. There was no discernible difference between the newborn's APGAR score immediately following delivery and the method of delivery.Conclusions: There are strong chances of a normal vaginal birth if the Bishop score at the time of admission and induction is more than 4

A cross sectional observational study to evaluate the maternal and fetal outcome in postdated pregnancies

Background: Post-dated pregnancy is when the gestation is more than 40 weeks or 280 days. They last longer than the estimated date of delivery. Postdated pregnancies are associated with increased perinatal and maternal complications. These risks are greater than it was originally thought. Risks have been underestimated in the past leading to increasing number of complicated postdated pregnancies which appears to be otherwise low risk. The maternal risks are very often underappreciated resulting in increased maternal morbidity.Methods: This cross sectional observational study was done to evaluate maternal and fetal complications associated with Postdated pregnancies was carried out in the department of obstetrics and gynecology in a tertiary care centre, Sir Devraj Urs Medical College and RL Jalappa Hospital, Kolar between July 2018 and July 2019, fulfilling all the inclusion and exclusion criteria.Results: 50 out of 100 patients had full term normal deliveries where as 45% patients required cesarean section. Most common indication for cesarean section was meconium stained liquor with fetal distress (25%). 42% of the babies born needed NICU admission. Most common maternal complication seen was Postpartum Hemorrhage.Conclusions: The present study we conclude that postdated pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR. There was increased risk of obstetric complications as well like atonic PPH, oligohydramnios, obstructed labor

The efficacy of doppler indices in predicting the neontal outcome in term preeclamptic women with intrauterine growth restriction: an observational study in a tertiary care centre

Background: Doppler flow velocimetry of the umbilical and fetal cerebral circulation is a non-invasive modality used to access the fetal well-being. Doppler is comparatively more specific and is potentially a useful tool in predicting adverse perinatal outcome in high risk cases. Objectives of this study were to evaluate the efficacy of Middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and cerebroplacental ratio (CPR) doppler indices in assessment of fetal well-being. To document neonatal outcome in preeclamptic women with doppler changes.Methods: A retrospective observational study of term preeclamptic women with clinical IUGR admitting in labour room of RLJ Hospital from January 2019 to December 2019. All these women underwent Doppler study and were followed up till delivery.Results: A total 89 term preeclamptic women, 47.19% women had normal delivery, 52.81% lower segment caesarean section. 74.16 % delivered babies required NICU (neonatal ICU) care, 51.69 % babies had a longer duration of NICU care (more than 5 days). The perinatal complications like respiratory distress 8.99% low birth weight 39.33%, meconium stained 10.11%, still born 4.49% and perinatal asphyxia (6.06%). Women with abnormal MCA-PI 46.07% of cases, UA-PI in 40.45% and CPR 57.30%.Conclusions: It was observed that all three parameters CPR, MCA-PI and UA-PI when taken into account together are good utilities in predicting perinatal outcome

Effect of placental cord drainage on third stage of labour and in prevention of postpartum hemorrhage: randomized control trial at tertiary care centre

Background: Postpartum hemorrhage is the leading cause associated with 25% of maternal mortality. Prolonged duration of third stage of labour accounts for postpartum hemorrhage. The new trend in third stage management is placenta cord drainage (PCD). The physiology of PCD is decrease in bulkiness of placenta which consequently increases the uterine contractility. Effective uterine contraction mostly shortens third stage duration and decrease the risk for PPHMethods: This study is a randomized control trial in which full term pregnant women admitted in labour unit at Sri Devaraj Urs medical college and research centre, Kolar, Karnataka. Total 80 women were included in this study. They were divided into two groups, control group and study group with n=40 in each group. Placental cord drainage was done in the study group. In the Group 1 placental end of the cut umbilical cord remained clamped. In the Group 2, the placental end of the cut umbilical cord unclamped immediately and collected in a vessel till the flow ceased. Thus, the drained blood was prevented from getting mixed with blood lost in the third stage. Blood lost in the third stage was collected in a clean drape sheet. Placenta was delivered by controlled cord traction after the signs of placental separation were seen. The duration of third stage was calculated using a stopwatch.Results: In our study, the mean duration of third stage of labour in control group was 6.58minute and in study group was 2.28 minutes. Significant statistical difference was found in duration of third stage of labour.Conclusions: PCD is noninvasive and safe intervention during third stage of labour and effective in reduction of incidence of postpartum hemorrhage

Biometric Authentication using Nonparametric Methods

The physiological and behavioral trait is employed to develop biometric authentication systems. The proposed work deals with the authentication of iris and signature based on minimum variance criteria. The iris patterns are preprocessed based on area of the connected components. The segmented image used for authentication consists of the region with large variations in the gray level values. The image region is split into quadtree components. The components with minimum variance are determined from the training samples. Hu moments are applied on the components. The summation of moment values corresponding to minimum variance components are provided as input vector to k-means and fuzzy kmeans classifiers. The best performance was obtained for MMU database consisting of 45 subjects. The number of subjects with zero False Rejection Rate [FRR] was 44 and number of subjects with zero False Acceptance Rate [FAR] was 45. This paper addresses the computational load reduction in off-line signature verification based on minimal features using k-means, fuzzy k-means, k-nn, fuzzy k-nn and novel average-max approaches. FRR of 8.13% and FAR of 10% was achieved using k-nn classifier. The signature is a biometric, where variations in a genuine case, is a natural expectation. In the genuine signature, certain parts of signature vary from one instance to another. The system aims to provide simple, fast and robust system using less number of features when compared to state of art works.Comment: 20 page

Feto-maternal outcome in patients with peripartum cardiomyopathy: a 5-year study in a tertiary care hospital in Kolar district

Background: Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first 5 months postpartum. PPCM remains a diagnosis of exclusion. There have been numerous proposed causes including hormonal abnormalities, inflammation, viral pathogens, autoimmune response, and genetic predisposition. Aim of study was to study the clinical profile, risk factors, and the management along with obstetric and perinatal outcome, in women with peripartum cardiomyopathy.Methods: This retrospective observational study was conducted on the antenatal women of age group of 18 years to 40 years, admitted in the labour ward of R. L. Jalapa hospital who presented with heart failure in last month of pregnancy till 5 months postpartum, without previously having a heart disease over the 5 year period, January 20 15 to December 2019.Results: Majority of the patients (15/18) presented with complaints of exertional dyspnoea. Mean LVEF at the time of diagnosis was 38.39%. There were 5 (27%) maternal mortality and all of them had global hypokinesia on echocardiography and presented in NYHA class III and IV. Two (11%) out of eighteen patients had intrauterine death, and all the patients who had IUFD belonged to class IV. Four babies (22.22%) had intrauterine growth restriction.Conclusions: The present study came to conclusion that in rural tertiary center, maternal outcome and prognosis was poor as patients presenting to us were majority of them in cardiogenic shock and lower LVEF in terminal stages. The associated risk factors were preeclampsia, anemia and multiple gestation which could also contribute to the poor prognosis which was noticed in the study. Early recognition of the disease is of paramount importance as the clinical manifestations can conceal and can lead to high morbidity and mortality especially within 3 months postpartum

A comparative study of maternal outcome between vacuum extraction and outlet forceps delivery

Background: Instrumental delivery is an art that is fading and may disappear in the near future as more and more obstetricians are resorting to caesarean sections. Instrumental vaginal deliveries comprise the use of vacuum assisted devices and /or forceps to assist in delivering a fetus, offering the alternative to accomplish vaginal delivery in properly selected cases thereby reducing maternal morbidity in terms of blood loss and increase hospital stay which is a consequence of cesarean sections. The objective of the present study is to compare the maternal morbidity with vacuum and outlet forceps delivery.Methods: A prospective comparative study was conducted in women delivering at department of obstetrics and gynaecology, in SDUMC, R L Jalappa Hospital, Kolar from March 2016 - March 2017 for a period of one year. A minimum of 180 patients were taken up for study. 90 women delivered by outlet forceps delivery and 90 women by vacuum delivery. Cases which require instrumental vaginal delivery and fulfilling the inclusion criteria for forceps or vacuum were taken up for the study, after taking informed consent. Maternal outcomes including episiotomy wound and extension, perineal tear, post-partum hemorrhage, hospital stay was analyzed and compared.Results: Mostly forceps and vacuum were applied for age group of 26-30 years and primigravida, which showed a statistical significance. Extension of episiotomy was more with forceps that is 21.1% and with vacuum being 4.4%. This difference was statistically significant. Postpartum hemorrhage was also more common in forceps group that is 13.3%compared to vacuum 11.1% but the difference was not statistically significant. The need for blood transfusion was seen more in cases of forceps that is 11.1% cases whereas in vacuum i.e. 6.7% cases but was not statistically significant.Conclusions: With the expertise and appropriate decision on the indication and meticulous handling of the instrument whether outlet forceps or vacuum, especially in a tertiary care centre, the maternal outcome is equally good with both the instruments

Feto-maternal outcome in patients with couvelaire uterus: a 3 year study in a tertiary care hospital in rural Karnataka, India

Background: Couvelaire uterus also known as uteroplacental apoplexy is a life threatening condition where abruptio placenta causes bleeding that penetrates into the uterine myometrium. It can only be diagnosed on direct visualization. Therefore, its occurrence is perhaps under reported and underestimated in the literature. The objective of this study was to determine the risk factors for couvelaire uterus and feto-maternal outcomes associated with couvelaire uterus in comparison with patients who presented with abruption without couvelaire uterus in a tertiary care hospital in rural Karnataka.Methods: All women who had abruptio placenta who were delivered by cesarean section were included in the study. Cases were women with couvelaire uterus and controls were women without couvelaire uterus observed intraoperatively during cesarean section.Results: Patients without couvelaire uterus had significantly more vaginal bleeding (22.2% vs 75%). However, patients with couvelaire uterus had a higher incidence of PPH (66.7% vs 28.6%), need for blood transfusion (5.9±3.2 pints vs 1.6±1.8 pints), DIC (22.2% vs 14.3%), maternal mortality (5.6% vs 0) and adverse neonatal outcome.Conclusions: We conclude that patients with couvelaire uterus had an increased risk of maternal complications such as postpartum hemorrhage and disseminated intravascular coagulation which resulted in increased need for blood transfusion, prolonged hospital stay and maternal morbidity and mortality. Present study further highlights that adverse neonatal outcomes such as low birth weight, low Apgar score and neonatal death were more frequently associated with couvelaire uterus. Thus, the presence of couvelaire uterus may be considered as a severe form of abruption and such patients should be anticipated for higher incidence and risk for maternal and neonatal morbidity

A study of maternal and fetal outcome in cardiac disease in pregnancy at tertiary care center

Background: Cardiac disease complicating pregnancy is an indirect cause of maternal mortality. The incidence of cardiac disease during pregnancy has remained stable for many years even with significant decrease in the occurrence of rheumatic heart disease (RHD) as this decrease is being compensated by significant increase of pregnancy in women with congenital heart disease (CHD). Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy and to assess the obstetrical outcome.Methods: A retrospective study carried out in 32 women with cardiac disorders at a tertiary care centre during the period of 5 years.Results: In the present study the incidence of cardiac disease in pregnancy was observed to be 0.21%. With 62.6% rheumatic, 21.8% congenital being and 15.6% peripartum cardiomyopathy. Among rheumatic valvular heart disease, mitral valve stenosis was most common followed by mitral regurgitation and tricuspid regurgitation. Non-cardiac complications like pre-eclampsia and anaemia were also noted. No of vaginal delivery were higher compared to caesarean (26 versus 6). Adverse perinatal outcomes in form of preterm, NICU admission and perinatal death were also noted.Conclusions: A cardiac disease has a major impact on pregnancy. It is a multidisciplinary teamwork to have optimal maternal and foetal outcome in women with cardiac disease. Hence, constant vigilance is required throughout antenatal, intrapartum and postpartum period to avoid adverse outcomes

Epidural analgesia in labour and its obstetric outcome

Background: Labour is a natural phenomenon which produces intolerable pain that requires effective methods for pain relief which is often challenging and complex task without regional analgesia. Epidural analgesia is most widely accepted method used to reduce labour pain. Aims and objectives were assessment of epidural analgesia in pain relief during labour, duration of different stages of labour, maternal and foetal outcome. Methods: This study was a prospective observational study conducted at RL Jalappa Hospital, Kolar from January 2020 to June 2021. 40 women admitted for normal vaginal delivery opting labour analgesia were studied. Data collected was entered in Microsoft excel spread sheet and results were analysed. Results: The mean duration of first stage of labour was 153 minutes, mean duration of second stage was 30 minutes, and mean duration of third stage was 12 minutes. During first stage of labour, 20 women (52%) had no pain, 12 women (31%) had mild pain and 6 women (15%) had moderate pain. During second stage of labour, 16 women (42%) had mild pain, 15 women (39%) had no pain and 7 women (18%) had moderate pain. During third stage of labour, 30 women (78.9%) had no pain and 8 women (21%) had mild pain. The mean Apgar score of all babies at 1 minute was 7/10 and 5 minute was 9/10. Conclusions: Epidural analgesia is a safe and effective technique during labour and provides significant pain relief with excellent patient satisfaction.