A retrospective study: twin gestation at tertiary care, maternal and fetal outcome

Background: The objective of our study was to study the maternal and neonatal outcome in twin gestation in a tertiary care center.Methods: A retrospective analysis of 197 twin pregnancies admitted and managed at M S Ramaiah medical college. Parameters in the mother and fetus were studied for any adverse antenatal complications, mode of delivery.Results: Prim gravid patients with twin pregnancy constituted (45.6%). 4.5% of patients had an IVF conception. 45.1% patients were unbooked to our institute, 82% of the unbooked patients presented with preterm labour and preterm premature rupture of membrane. PIH was noted in 32.9% of the patients, premature rupture of membranes (32.9%), Intra- Uterine Death of one fetus (6.09%) and intra uterine growth retardation (2.03%) was the antenatal complications observed. Out of the 197 patients 63 (31.97%) delivered by vaginal route whereas 134 (68.02%) had to undergo cesarean section. Section for the second twin was done in 4(2.03%). The 197 women of twin pregnancy gave birth to 378 live-born babies, 16(9.5%) stillborn and 32 (16.2%) died by the end of seven days due to complications related to prematurity: hyaline membrane disease, hyperbilirubinemia.Conclusions: Early active intervention in twin gestation can reduce the maternal and fetal mortality and morbidity

A study of feto-maternal outcome of jaundice in pregnancy

Background: Jaundice in pregnancy complicates 3-5% of cases and carries a grave prognosis. The purpose of the study was to assess the epidemiology, magnitude, causes and the maternal and fetal outcome of pregnancies complicated by jaundice.Methods: The maternal and fetal outcomes of 101 cases of jaundice in pregnancy were reviewed retrospectively from July 2013-June 2016.Results: The incidence of jaundice in pregnancy was 2.32%. Primigravidas constituted 46.53%. Women aged 20-30 years constituted 86.13%. Unbooked cases included 60.39%. Serum bilirubin was >10 mg/dl at admission in 1.98%. Out of the 101 women, 4 remained undelivered. Labor was spontaneous in 53.52%, vaginal delivery in 55.67%. However, 38.63% newborns required NICU care.  Perinatal mortality was 8.91% (3.96% stillbirths and 4.95% early neonatal deaths. The causes for jaundice were viral hepatitis (30.69%), HELLP syndrome (30.69%), intrahepatic cholestasis (15.84%), acute fatty liver of pregnancy (13.86%) and the rest in combination constituted 8.91%. Maternal mortality was 3 in 101. The various maternal complications were DIC (44.55%), septicemia (10.89%), ARDS (7.92%), acute renal failure (8.91%) and MODS (3.96%). ICU was needed in 14.85% of mothers and blood component therapy in 70.29% cases. All deaths were within 3 weeks of admission.Conclusions: This study emphasizes the need for essential antenatal care at domiciliary and peripheral levels. Early detection and treatment can prevent most of the complications

A study of intrauterine fetal death in a tertiary care hospital

Background: Intra uterine fetal death (IUFD) is the most traumatic event for the parents and the treating obstetrician. If the causes of IUFD can be found, an effective strategy for prevention can be formulated. This study was done to study the etiological factors and other determinants of IUFD.Methods: A retrospective observational study was carried out in M. S. Ramaiah medical college and teaching hospital, Bangalore, India between December 2011 to December 2014. 120 cases of IUFD were included in this study.Results: Out of 4103 deliveries that occurred during the study period, there were 120 IUFD (2.9%). 52 cases (43.3%) were referral cases. Majority were multigravida(n=73,60.8%) aged less than 30 years (n=96,80%) with 28 to 36 weeks period of gestation(n=66,55%).91 patients had presented with absent fetal movements(75.8%).In 25% of the cases(n=30) there was preeclampsia and in 21.6% (n=26)of the cases there were no causes determined.99.1%(n=119) delivered by vaginal route.Conclusions: The leading cause of IUFD in our study was preeclampsia. Majority of the cases were referred and they did not have regular antenatal checkups. A bigger impact in reduction of IUFD can be achieved if the importance of antenatal care can be stressed upon at the community level

Expression of Bcl-2 marker in premalignant lesions of cervical cancer

Background: Cervical cancer is one of the most common gynecological cancers in women of developing countries. HPV DNA testing is preferred cervical screening method for woman 30-65 years old as HPV is the proved causative agent of cervical carcinoma. Due to the high costs involved in doing HPV DNA test there is a need for a biomarker such as Bcl-2 which can indicate the initiation of carcinogenic process of HPV infection and thus can be used to identify those woman who will need more surveillance.Methods: Specimens of cervical biopsy retrieved from incident cases for routine histopathological evaluation from the Department of Obstetrics and gynecology, M.S. Ramaiah hospital, Bangalore, India from March 2013 to September 2015 formed the source of data for the study.Results: In this study total of 46 cases were studied which included 9 cases of CIN-1, 8 cases of CIN-2, 7 cases of CIN-3, 12 cases of squamous cell carcinoma and 10 cases of on specific cervicitis. Higher number of malignant lesions (75%) expressed Bcl-2 positivity as compared to premalignant lesions (62.5%). In case of CIN lesions, Bcl-2 positivity increased as the grade increased (CIN-1- 55.56%; CIN-2 - 62.5%; CIN-3 -71.43%).Conclusions: Bcl-2 which is an intracellular membrane protein which prevents apoptotic cell death can be used as a biomarker to know the severity of the CIN lesion and hence help in identifying the high risk CIN lesions which need further surveillance and treatment

Recurrent pregnancy loss: challenge to obstetricians

Background: Recurrent pregnancies loss (RPL) is physically and emotionally devastating situation for the parents, along with difficult situation for obstetrician to handle. Present study aimed at investigation of the significance of various etiology in relation to pregnancy outcome in cases of recurrent pregnancy loss.Methods: It is a retrospective analysis of patients who presented to M. S. Ramaiah Medical college with recurrent miscarriage between April 2014 and August 2015. ANA was done on the basis of clinical and laboratory data which was obtained and eventually diagnosis was made. The study results were analysed in terms of term live births, maternal and fetal complications.Results: Out of the RPL cases that were studied, 78 patients came with recurrent pregnancy loss. Out of these cases, endocrine abnormalities, like diabetes mellitus and hypothyroidism were the maximum 26.92% and 12.82% respectively. Followed by unexplained causes were 37.3%. Thrombophila and APLA positive cases constituted for 16.66% and 3.4% respectively. ANA positive and cervical incompetence were 6.4% each.Conclusions: Recurrent pregnancy loss is very difficult situation to handle. Various etiology need various specialists, and requirements, and management mainly depends on the cause for recurrent pregnancy loss

Preterm birth: associated risk factors and outcome in tertiary care center

Background: The major cause of infant mortality and morbidity is preterm birth. WHO has defined it as any birth before 37 completed weeks of gestation or fewer than 259 days since the last day of menstrual period. Objective of present study was to identify major etiological factors associated with preterm birth, and their effects on mode of delivery and neonatal mortality and morbidity.Methods: Retrospective cohorts study, which was conducted in M. S. Ramaiah Medical College, over period of 12 months (January 2015 to December 2015). The study included 343 women who delivered preterm they were followed from admission to discharge. Various parameters were analyzed like maternal characteristics, gestational age, associated risk factors, tocolysis, administration of steroids, and neonatal outcome.Results: The incidence of preterm birth among the total deliveries was approximately 18.01%. Although the risk factors included many, the most common occurring were hypertensive disorders during pregnancy approximately 32.9%, followed by preterm rupture of membranes (18.1%), idiopathic 14.9%, and previous LSCS at 12.2%. Neonatal mortality was 6.9% (24 neonates), and stillborn were 0.5% (2 neonates).Conclusions: Various risk factors for preterm labour are modifiable hence early detection and treatment prevents maternal morbidity and neonatal morbidity and mortality. Specific emphasis on regular antenatal checkups

Ectopic pregnancy in a tertiary care center: a retrospective study

Background: Ectopic pregnancy is an obstetric emergency which if not diagnosed in time can cost the life of the patient. This emphasizes the importance of diagnosing this perilous condition and hence this study was undertaken to study symptoms with which the patients with ectopic pregnancy present.Methods: Retrospective study of 5 years was done in the department of Obstetrics and Gynecology, M. S. Ramaiah medical college and teaching hospital, Bangalore, India between January 2011 to January 2016. Detailed analysis of patients with ectopic pregnancy inclusive of the age and clinical features were studied.Results: A total of 90 patients with ectopic pregnancy were studied. 95.5% of the patients (n=86) presented with abdominal pain, 81.1% (n=73) of the patients presented with amenorrhea, 24.4% (n=22) patients presented with bleeding per vagina, 30% (n=27) patients with nausea, vomiting and 48.8% (n=44) presented with fainting and giddiness.Conclusions: It is very essential to study the symptoms of ectopic pregnancy as this may help in early detection of ectopic pregnancy and hence can reduce the mortality in this catastrophic condition

A retrospective study: twin gestation at tertiary care, maternal and fetal outcome

Background: The objective of our study was to study the maternal and neonatal outcome in twin gestation in a tertiary care center.Methods: A retrospective analysis of 197 twin pregnancies admitted and managed at M S Ramaiah medical college. Parameters in the mother and fetus were studied for any adverse antenatal complications, mode of delivery.Results: Prim gravid patients with twin pregnancy constituted (45.6%). 4.5% of patients had an IVF conception. 45.1% patients were unbooked to our institute, 82% of the unbooked patients presented with preterm labour and preterm premature rupture of membrane. PIH was noted in 32.9% of the patients, premature rupture of membranes (32.9%), Intra- Uterine Death of one fetus (6.09%) and intra uterine growth retardation (2.03%) was the antenatal complications observed. Out of the 197 patients 63 (31.97%) delivered by vaginal route whereas 134 (68.02%) had to undergo cesarean section. Section for the second twin was done in 4(2.03%). The 197 women of twin pregnancy gave birth to 378 live-born babies, 16(9.5%) stillborn and 32 (16.2%) died by the end of seven days due to complications related to prematurity: hyaline membrane disease, hyperbilirubinemia.Conclusions: Early active intervention in twin gestation can reduce the maternal and fetal mortality and morbidity

A study of feto-maternal outcome of jaundice in pregnancy

Background: Jaundice in pregnancy complicates 3-5% of cases and carries a grave prognosis. The purpose of the study was to assess the epidemiology, magnitude, causes and the maternal and fetal outcome of pregnancies complicated by jaundice.Methods: The maternal and fetal outcomes of 101 cases of jaundice in pregnancy were reviewed retrospectively from July 2013-June 2016.Results: The incidence of jaundice in pregnancy was 2.32%. Primigravidas constituted 46.53%. Women aged 20-30 years constituted 86.13%. Unbooked cases included 60.39%. Serum bilirubin was >10 mg/dl at admission in 1.98%. Out of the 101 women, 4 remained undelivered. Labor was spontaneous in 53.52%, vaginal delivery in 55.67%. However, 38.63% newborns required NICU care.  Perinatal mortality was 8.91% (3.96% stillbirths and 4.95% early neonatal deaths. The causes for jaundice were viral hepatitis (30.69%), HELLP syndrome (30.69%), intrahepatic cholestasis (15.84%), acute fatty liver of pregnancy (13.86%) and the rest in combination constituted 8.91%. Maternal mortality was 3 in 101. The various maternal complications were DIC (44.55%), septicemia (10.89%), ARDS (7.92%), acute renal failure (8.91%) and MODS (3.96%). ICU was needed in 14.85% of mothers and blood component therapy in 70.29% cases. All deaths were within 3 weeks of admission.Conclusions: This study emphasizes the need for essential antenatal care at domiciliary and peripheral levels. Early detection and treatment can prevent most of the complications

Hematometra and acute abdomen

We report a case of a young woman who presented as acute abdomen due to hematometra resulting from cervical fibroid. This uncommon cause of acute abdominal pain should be considered in women especially with amenorrhea