Study of correlation between placental morphology and adverse perinatal outcome in different conditions affecting pregnancy

Background: Placenta acts as a mirror which reflects intrauterine status of fetus. Placenta is considered as a leading cause of maternal and perinatal mortality and important factor affecting foetal growth which is generally associated with placental insufficiency. Pregnancy complications like hypertension or gestational diabetes are reflected macroscopically and microscopically in the placenta.Methods: The study was carried out on 129 placentae which were divided into four groups- normal, pregnancy induced hypertension, anaemia and diabetes mellitus. The various parameters were studied like placental weight, placental surface area, foetal birth weight, placental coefficient, feto-placental weight ratio, foetal outcome in the form of still birth or alive.Results: It was observed that placental weight was quite low in PIH group than normal. Conversely it was on higher side in Anaemia and Diabetes group. Birth weight of babies show marked reduction in PIH group and Anaemia group, but it is increased in diabetic group. In normal group, stillbirth was observed in 3.33% deliveries. In conditions complicating pregnancy the percentage of still birth is comparatively higher.Conclusions: These conditions also affect the perinatal outcome. Placental parameters are also altered along with foetal parameters like foetal weight. So the diagnosis of such risk factors in pregnancies during antenatal period will improve the outcome

A retrospective study to evaluate etiological factors associated with intrauterine fetal death at tertiary referral centre

Background: Amongst various community health indicators available for measurement of quality and impact of health services in developing countries, perinatal mortality finds its position as being one of the top most single indicators even today. In order to have a decrease of the fetal mortality rate, it is necessary to know the etiology of fetal death and its associated risk factors in different populations. Thus the purpose of this study was to investigate about the prevalence, patient profile, socio-demographical and etiological risk factors associated with fetal losses beyond 24 weeks of pregnancy in our hospital.Methods: This study was conducted at Chirayu Medical College & Hospital, Bhopal, India. Retrospective data of all the cases with ≥24 weeks gestation with intrauterine fetal death, admitted in the study period (November 2010- December 2015) were collected (n=51). All socio-demographic, antenatal and intrapartum risk factors associated with IUFD were recorded in proforma and statistical analysis done.Results: Total numbers of births in the study period were 1410, out of which fetal losses beyond 24 weeks of gestation occurred in 51 cases. This gave the perinatal mortality rate for our hospital as 36.17/1000 live births. This rate is much more than the national figure quoted by the central government in 2012 as 28/1000 live birth. Hypertensive disorders of pregnancy were the most commonly responsible factor (27.45%) in the study group followed by congenital malformations (9.80%). In 11.76% cases cause was not explained.Conclusions: It is a well-established fact that adequate antenatal care is associated with better pregnancy outcome, but universal antenatal care is not the protocol in our area, reasons being ignorance, illiteracy, lack of awareness of importance of antenatal care, poverty and non-availability of health care facilities/skilled personnel/infrastructure/transport. Health education and emphasis on the need of each and every delivery being institutional under supervision of appropriate personnel needs to be propagated in the community aggressively. This only will help in reducing a number of preventable fetal deaths and huge loss of our national asset

Sweeping of the fetal membranes and its effect on duration of pregnancy in low risk cases

Background: This study aimed to determine effectiveness of sweeping of membranes on the duration of pregnancy at term, and its effect on maternal and neonatal outcomes.Methods: In this prospective study, 145 women with uncomplicated pregnancy at 39 weeks or more gestation who were attending regular ANC clinic, were recruited for study, out of them 60 were cases (sweeping group) and 85 were control (no sweeping group). Primary outcome measure was occurrence of spontaneous labour and total duration of pregnancy. Other outcome measures included were interval of onset of labour from membrane sweeping, incidence of premature rupture of membranes, total duration of active labour, mode of delivery, rate of caesarean section and causes, and neonatal and maternal outcome.Results: There were no statistically significant differences between the two groups regarding maternal age, parity and bishops score at recruitment. There was a significant difference observed in spontaneous labour rate and interval time between recruitment to delivery in groups. There was no significant difference regarding mode of delivery, maternal and fetal outcomes.Conclusions: Membrane sweeping is a safe procedure that reduces the incidence of post-term pregnancies if applied at term

Study of correlation between perinatal outcome, placental coefficient and feto-placental ratio

Background: Pregnancy and birth are nature’s finest marvel wherein perfect symbiosis between the two individuals protects the little and weak one and also allows the propagation of genetic prototype of the other individual generation after generation. Placenta acts as a mirror which reflects intrauterine status of fetus. Placenta has an undisputed role in foetal development but still is grossly neglected organ which is equal to liver, lung and kidney in function.Methods: Placentae collected from labor rooms and operation theatres were studied for various parameters like weight, surface area, volume, area of calcification and infarction, number of cotyledons etc. Birth weight of babies was also noted, feto-placental weight ratio and placental coefficient was calculated.  Results: Average placental weight being 490.5 gm (range 295-660 gm). Placenta of male baby was found to be slightly heavier as compared to female babies. Birth weight of male babies was also more than female babies. Average placental surface area was found to be 225.5 sq. cm. Mean placental volume was recorded as 450.5 cu. cm. Foeto-placental weight ratio was found to be 5.41:1 irrespective of sex of the baby, 5.61:1 in case of male baby and 5.40:1 for female babies.Conclusion: The placenta is a mirror which reflects intrauterine status of the fetus.

A retrospective study to evaluate etiological factors associated with intrauterine fetal death at tertiary referral centre

Background: Amongst various community health indicators available for measurement of quality and impact of health services in developing countries, perinatal mortality finds its position as being one of the top most single indicators even today. In order to have a decrease of the fetal mortality rate, it is necessary to know the etiology of fetal death and its associated risk factors in different populations. Thus the purpose of this study was to investigate about the prevalence, patient profile, socio-demographical and etiological risk factors associated with fetal losses beyond 24 weeks of pregnancy in our hospital.Methods: This study was conducted at Chirayu Medical College & Hospital, Bhopal, India. Retrospective data of all the cases with ≥24 weeks gestation with intrauterine fetal death, admitted in the study period (November 2010- December 2015) were collected (n=51). All socio-demographic, antenatal and intrapartum risk factors associated with IUFD were recorded in proforma and statistical analysis done.Results: Total numbers of births in the study period were 1410, out of which fetal losses beyond 24 weeks of gestation occurred in 51 cases. This gave the perinatal mortality rate for our hospital as 36.17/1000 live births. This rate is much more than the national figure quoted by the central government in 2012 as 28/1000 live birth. Hypertensive disorders of pregnancy were the most commonly responsible factor (27.45%) in the study group followed by congenital malformations (9.80%). In 11.76% cases cause was not explained.Conclusions: It is a well-established fact that adequate antenatal care is associated with better pregnancy outcome, but universal antenatal care is not the protocol in our area, reasons being ignorance, illiteracy, lack of awareness of importance of antenatal care, poverty and non-availability of health care facilities/skilled personnel/infrastructure/transport. Health education and emphasis on the need of each and every delivery being institutional under supervision of appropriate personnel needs to be propagated in the community aggressively. This only will help in reducing a number of preventable fetal deaths and huge loss of our national asset