A study to evaluate feto-maternal outcome of trial of labour in previous cesarean patients: a prospective observational study at a tertiary care centre in India

Background: Vaginal birth after cesarean section (VBAC) is associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, and fewer thrombo-embolic events than cesarean section (C-section). A 60 to 70% success rate of vaginal birth after previous C-section has been reported by many authors if the primary cesarean was done for nonrecurring indications the subsequent pregnancyMethods: A prospective observational study was conducted at Sassoon general hospital, Pune, India. The 100 patients who fulfilled the inclusion criteria were studied. Maternal and fetal outcomes were analysed.Results: Out of the total 100 cases with previous C-section, successful vaginal delivery was possible in 65% cases. Most common reason for failed attempt to vaginal delivery was failure of labour to progress (40%) followed by failure of induction (28.6%) and non-reassuring FHR (22.9%). Out of the total 35 cases with gestation age over 40 weeks, 51.4% underwent C-section delivery as compared to 26.2% with gestation age of less than 40 weeks (p25, gestation ≥40 weeks and history of previous emergency CS while high success rate was seen with history of any vaginal deliveries. We thus recommend that pregnant woman with history of C-section should be given the option of trial of labour after caesarean (TOLAC), unless contraindicated

A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

Background: Prevalence of heart disease in pregnancy vary from 0.3-3.5%. Normal pregnancy is associated with physiological cardiovascular changes. These changes may unmask underlying cardiac disease in normal women and increase morbidity and mortality in women with heart disease. Heart disease in pregnancy is an important cause of maternal mortality in India. The aim of this study was to evaluate the maternal and neonatal outcome of pregnancy with heart disease.Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India. 75 patients who fulfilled the inclusion criteria were studied. Maternal and neonatal outcome were analyzed.Results: Maternal heart disease was classified into congenital (36%) and acquired (64%). In acquired variety, rheumatic heart disease was most commonly seen. In congenital, ASD was most common. We divided the cases into two groups based on their NYHA status, low risk group had 74.67% patients and high risk group had 25.33% patients. The most common antenatal complication was PROM (41.3%). There was statistically significant association between ICU admission and high-risk group. The most common neonatal complications were IUGR and prematurity. Maternal mortality rate in the study group was 6.6%.Conclusions: The perinatal outcome of heart disease in pregnancy is more dependent on the severity of symptoms rather than the duration and type of heart disease. Multidisciplinary evaluation is necessary. Suboptimal optimization of the heart condition in the antenatal period and delayed referral were the major risk factor for maternal mortality.

Study of obstetric factors in perinatal morbidity and mortality at a tertiary centre

Background: Safe motherhood and child survival have always been a concern for the policymakers but perinatal mortality, especially stillbirths, have not received due attention. There are 5.9 million perinatal deaths worldwide, almost all of which occur in developing countries. Stillbirths account for over half of all perinatal deaths. This study was aimed to determine perinatal mortality rate and related obstetrics risk factors. Perinatal mortality is only a tip of the iceberg, morbidity being much higher. Vital statistics obtained through this study may serve an important source of information to guide the public health policy makers and health care providers in future.Methods: Present observational study was undertaken in a tertiary center to look into various maternal factors and possible cause of perinatal death. All perinatal deaths including stillbirths (SBs) and early neonatal deaths (ENNDs) within 0-7 days of birth after 28 weeks of gestation were analysed. The data was collected through a pre-designed proforma.Results: Perinatal mortality is 66.27/1000 births in our centre, where 37% were intrauterine deaths, 34% were neonatal deaths and 29% were still births. Preterm, pregnancy induced hypertension; abruptio placentae remain the most important factors for perinatal loss.Conclusions: One of the reasons for high perinatal mortality in tertiary centres is because of poor antenatal care at peripheral centres and late referrals. Early detection of obstetric complications and aggressive treatment is one of golden rule to reduce perinatal loss