Sociodemographic determinants of medical termination of pregnancy along with contraceptive practices

Background: Though the most common reasons for medical termination of pregnancy (MTP) is unwanted pregnancy due to nonuse of contraceptives by the women of reproductive age group and other are pregnancy before marriage or due to rape. Several studies indicate that most abortions are sought to limit family size or space the next pregnancy. There is need to study relation of MTP with contraceptive practices.Methods: The present cross-sectional study was conducted at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, to study socio-demographic factors associated with medical termination of pregnancy and its relation with contraceptive practices. Total 1840 women seeking care for medical termination of pregnancy were interviewed after their informed consent during period of January 2015 to December 2017. A detailed history regarding age, religion, income, marital status, parity, history of previous MTP, indications for MTP, use of contraception, gestational age was taken.Results: Statistical analysis-chi square test of significance for qualitative data using SPSS software version 24.0. The proportion of women coming for MTP due to nonuse of contraceptives was 86% the other indications for MTP were medical condition (9%) and contraceptive failure (5%). The factors like age, religion, education and socioeconomic status were significantly associated with MTP.Conclusions: There is need to counsel women of reproductive age group that MTP is not a way to control unwanted birth

A study of obstetric acute renal injury

Background: Acute renal or kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome.Methods: This prospective study was conducted between January 2014 to December 2017. Out of 1057 patients delivered in our institute during this period, out of which 26 patients with Obstetric AKI were included in this study.Results: Incidence of obstetric AKI was 2.64 %. Their age varied from 19 to 34 years, with an average of 26.2 years. About 21(80.8%) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46%) and puerperal sepsis (15.38%). The outcome was favorable with complete renal function recovery in 55.76% patients. Two (7.69 %) patients became dialysis dependent. Maternal mortality was one (3.84%).Conclusions: Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8%) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46 %) is the most common cause of obstetric AKI. Late referral in 9 (34.61%), puerperal sepsis in three (33.33%), obstetric hemorrhage in three (33.33%) and combined sepsis and hemorrhage in two (27.77%) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an avoidable complication

Intrauterine fetal demise: a retrospective study in tertiary care center in India

Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age 30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management

Hysteroscopy: a boon in abnormal uterine bleeding

Background: Aim of the study was to analyze retrospectively the efficacy of hysteroscopy in the diagnosis of abnormal uterine bleeding (AUB).Methods: Eighty-six women in the reproductive and perimenopausal age group (20-50 years) visiting the gynaecology OPD from March 2018 to February 2019 with the complaints of abnormal uterine bleeding were enrolled in the study. All the patients who underwent hysteroscopic examination were subjected to endometrial curettage; which was sent for histopathological examination (HPE). The hysteroscopic findings were then corelated and compared with HPE.Results: Mean age of the patients was 37.2 years. Around 60.46% patients presented within six months of complaints. Clinically, 54.65% were diagnosed as menorrhagia, 37.2% as polymenorrhoea and 8.13% as intermenstrual bleeding. On hysteroscopy, 44.1% showed abnormal pathology. The positive findings including polyps (8.13%), calcification (3.48%), submucous myoma (12.79%), necrotic mass and forgotten IUCD (2.32%) and adhesions in one case. On the other hand, the findings of histopathology; 56 patients (65.11%) had normal / proliferative / atrophic endometrium, 17 (19.76%) had hyperplasia, 10 (11.62%) had polyps and 3 (3.48%) had calcified endometrium. There was no significant difference between two modalities for normal / proliferative / atrophic endometrium. The HPE diagnosed slightly higher patients of hyperplasia as compared to hysteroscopy. Hysteroscopy diagnosed a higher number of patients with submucous myoma and necrotic mass.Conclusions: Hysteroscopy provided additional visual information for some pathologies which otherwise would remain undiagnosed by HPE

Factors influencing the likelihood of vacuum delivery success

Background: Instrumental or assisted vaginal birth is commonly used to expedite birth, for the benefit of either mother, baby or both. Objective of present study was to evaluate risk factors for unsuccessful vacuum delivery when variability between individual accoucheurs is taken into account.Methods: We conducted a retrospective cohort study of attempted 687 vacuum deliveries over a 10-year period (2008–2017 inclusive) in a tertiary care center at Smt. Kashibai Navale Medical College and General Hospital, Narhe to account for inter-accoucheur variability, we matched unsuccessful deliveries (cases) with successful deliveries (controls) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful vacuum deliveries.Results: During the study period of 10 years, there were 29861 deliveries, of which 19831 (66.4%) were vaginal deliveries. 8802 (29.47%) were cesarean deliveries and 1228 (4.1%) were instrumental deliveries. Among instrumental deliveries, 687 (56%) were vacuum deliveries and 541 (44%) were forceps deliveries. Six hundred and eighty-seven ventouse deliveries of vertex presenting, single, term infants were attempted, of which 38 were unsuccessful (5.5%). Increased birth weight (OR=1.11 p<0.001), second-stage duration (OR=1.01 p<0.001), rotational delivery (OR=1.52 p<0.05) and use of ventouse versus forceps (OR=1.33 p<0.05) were associated with unsuccessful outcome. When inter-accoucheur variability was controlled for, instrument selection and decision to rotate were no longer associated with vacuum delivery success. More senior accoucheurs had higher rates of unsuccessful deliveries (12% v. 5%, p<0.05), but undertook more complicated cases. Cesarean delivery in the second stage without prior attempt at ventouse delivery was associated with higher birth weight (OR=1.07 p<0.001), increased maternal age (OR=1.03 p<0.01), and epidural analgesia (OR=1.46 p<0.001).Conclusions: Careful selection of cases and adequate training of post graduate students during residency under direct supervision of senior experienced obstetrician can reduce the rate of failed vacuum delivery and related complications Results suggest that birth weight and head position are the most important factors in successful vacuum delivery, whereas the influence of patient selection and rotational delivery appear to be operator-dependent. Risk factors for lack of vacuum delivery success are distinct from risk factors for requiring vacuum delivery, and these should not be conflated in clinical practice

Clinical Study of Heart Disease Complicating Pregnancy

ABSTRACT--Heart disease complicating pregnancy is considered as a high risk situation. Increased cardiac demands during the course of pregnancy potentially increase morbidity and mortality in women with underlying heart disease. Risk of adverse outcome is more in rural population as compared to its urban counterpart. A prospective clinical study of 35 cases of pregnancy complicated by heart disease, reporting to tertiary care hospital for delivery ,was carried out to find out the incidence and maternal and fetal outcome. The incidence of heart disease in pregnancy in the present study was 1.3%%.Most of the women (91%) belonged to low socioeconomic class in the rural population..Rheumatic heart lesions constituted 77% of the cases. .Mitral stenosis was the commonest lesion in 40% of cases. Twenty two (62.8%) women delivered spontaneously vaginally at term and 4 ( 11% ) delivered prematurely. There were 7 ( 20%) cases of prophylactic forceps delivery. Cesarean section was performed in 2 cases .There was no maternal death .The perinatal mortality was 40 per 1000 live births. Early diagnosis of heart disease ,regular antenatal check up ,institutional delivery, limiting family size can reduce the maternal and perinatal mortality and morbidity associated with heart disease