Factors leading to surgical evacuation in first trimester medical termination of pregnancy

Background: Aim of the study was to determine factors leading to surgical evacuation in first trimester medical termination of pregnancy of women attending SAT hospital, medical college, Thiruvananthapuram.Methods: A case control study was conducted at the department of obstetrics and gynaecology, Government Medical college, Thiruvananthapuram. The sample size was calculated to be 58 in each group. Antenatal women attending family planning OPD for termination of pregnancy in first trimester at SAT hospital over a period of one year were recruited for this study. A structured questionnaire was used to record history, examination findings, and investigations including ultrasound. The clinical outcome was defined as successful medical abortion and failed medical abortion which leads to surgical evacuation due to retained products.Results: Previous caesarean, previous induced abortion, previous pregnancy loss or increasing gestational age showed increasing rate of failed medical abortion. Also, in patients with anaemia with haemoglobin <11 gm/dl or diabetes or hypertension showed independent association with failed medical abortion.Conclusions: If patient planning for medical abortion, can do at earlier gestational age as advancing gestation will leads to increasing rate of failed medical abortion and also after correcting anaemia, with proper medication

A study to find out the association between duration of preterm premature rupture of the membrane’s delivery interval and maternofetal complications

Background: The main maternal complications of preterm premature rupture of the membranes (PPROM) are chorioamnionitis, puerperal pyrexia, abruption and the neonatal complications are neonatal sepsis, congenital pneumonia, neonatal ICU stay and neonatal death. The aim of the study is to find out the association between duration of latent period in PPROM i.e. the time period between rupture of membrane to delivery and maternofetal complications.Methods: The present study was a Prospective observational study conducted on 240 preterm antenatal women with PPROM in the Department Obstetrics and Gynecology, SATH, GMC, Thiruvananthapuram. The gestational age at rupture of membranes, latent period from time rupture of membranes to delivery, gestational age at time of delivery and the maternal and neonatal outcome were compared and subjected to statistical analysis.Results: Maternal chorioamnionitis in the group with PPROM delivery interval between 2-7 days (79.3%) whereas there were (13.8%) in which PPROM delivery interval was less than 24 hrs. Puerperal pyrexia in 2-7 days delivery interval was 11.3% and in <24 hrs were 2.6%. Neonatal sepsis in 2-7 days was 28.3% and 12.5% in<24 hrs. Congenital pneumonia in 2-7 days was 16.9% and in<24 hrs was 11.6%.Conclusions: In the present study membrane rupture between 28-34 weeks gest age and latency period. 2-7 days were associated with high incidence of maternal chorioamnionitis, puerperal pyrexia congenital pneumonia, early onset neonatal sepsis and neonatal death. Undue prolongation of pregnancy may increase the risk of chorioamnionitis, neonatal sepsis and neonatal deaths

A study on the obstetric outcome in preterm pre-labour rupture of membranes

Background: The major risks to the baby following preterm pre-labour rupture of membranes (PPROM) are related to the complications of prematurity. Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme for the patient less than 34 weeks is expectant management in the hospital which consists of careful observation for signs of infection, labour or fetal distress in an effort to gain time for fetal growth and maturation.Methods: Patients admitted in Obstetrics and Gynaecology Department SAT Hospital, Medical College Trivandrum, Kerala with PPROM meeting the inclusion and exclusion criteria were recruited for the study. They were followed in the antenatal, intrapartum and postnatal period and the babies were also followed in the postnatal ward. The maternal and neonatal outcome were analysed and studied.Results: Maternal chorioamnionitis developed in 12.1% of cases, abruption 1.7%, puerperal pyrexia 8.8%, early onset neonatal sepsis in 22.9% of cases, congenital pneumonia in 17% cases and neonatal deaths in 6.3% of cases. The mean gestational age at delivery in this study was 33.42 weeks with majority of cases delivering between 32-34 weeks.Conclusions: The study suggests that maternal chorioamnionitis, puerperal pyrexia, congenital pneumonia, early onset neonatal sepsis, neonatal death, and requirement for ICU care occur with increased frequency in cohorts with PPROM. The present study concluded that most common maternal morbidity associated with PPROM was chorioamnionitis, that of neonatal morbidity was prematurity and its complications. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure healthy and fruitful life for the mother and her baby

Correlation between obstetric outcome and amniotic fluid index (AFI) in preterm prelabour rupture of membranes (PPROM)

Background: The purpose was to determine whether AFI 5 after PPROM between 24- and 37-weeks’ gestation

To study the association of antiphospholipid syndrome in patients with bad obstetric history

Background: Antiphospholipid syndrome is an autoimmune condition characterized by vascular thrombosis and /or pregnancy morbidity in the presence of antiphospholipid antibodies. A failure or significant delay in recognizing APS as the underlying disease entity may leave to the loss of an opportunity to prevent serious consequences of the disease and the associated pregnancy complications. Aim of the study was to study the association of Antiphospholipid Syndrome (APS) in patients with bad obstetric history (BOH).Methods: Patients registered in Obstetrics and Gynecology Department SAT Hospital, Medical College, Trivandrum, Kerala with bad obstetric history (BOH) meeting the inclusion and exclusion criteria were recruited for the study. They were followed up in the postnatal ward after abortion and preterm delivery as per protocol for bad obstetrics outcome evaluation. They were offered lab test in standard labs for APL Syndrome especially LAC and anti-cardiolipin antibodies IgM and IgG. Those tested positive were retested 12 weeks later also to confirm the test. Then the various adverse pregnancy outcomes were studied in both APLA positive and negative groups.Results: The association of APLA with bad obstetric history (BOH) in the present study are as follows- Late miscarriages-16%, miscarriages less than 10 weeks-12%, Preterm- 10.8%, unexplained death-14%, Severe Pre-eclampsia-12.3%, IUGR-11.8%, Abruption-11.1% of which late miscarriages more than10 weeks was the commonest association.Conclusions: The study shows that women with bad obstetric history (BOH) and those cases where miscarriage occurred after the appearance of foetal cardiac activity should be investigated for APLA in the preconceptional period itself in the next pregnancy earlier and if positive should be given prophylaxis for the same to prevent a miscarriage in future pregnancy

To study the association of antiphospholipid syndrome in patients with bad obstetric history

Background: Antiphospholipid syndrome is an autoimmune condition characterized by vascular thrombosis and /or pregnancy morbidity in the presence of antiphospholipid antibodies. A failure or significant delay in recognizing APS as the underlying disease entity may leave to the loss of an opportunity to prevent serious consequences of the disease and the associated pregnancy complications. Aim of the study was to study the association of Antiphospholipid Syndrome (APS) in patients with bad obstetric history (BOH).Methods: Patients registered in Obstetrics and Gynecology Department SAT Hospital, Medical College, Trivandrum, Kerala with bad obstetric history (BOH) meeting the inclusion and exclusion criteria were recruited for the study. They were followed up in the postnatal ward after abortion and preterm delivery as per protocol for bad obstetrics outcome evaluation. They were offered lab test in standard labs for APL Syndrome especially LAC and anti-cardiolipin antibodies IgM and IgG. Those tested positive were retested 12 weeks later also to confirm the test. Then the various adverse pregnancy outcomes were studied in both APLA positive and negative groups.Results: The association of APLA with bad obstetric history (BOH) in the present study are as follows- Late miscarriages-16%, miscarriages less than 10 weeks-12%, Preterm- 10.8%, unexplained death-14%, Severe Pre-eclampsia-12.3%, IUGR-11.8%, Abruption-11.1% of which late miscarriages more than10 weeks was the commonest association.Conclusions: The study shows that women with bad obstetric history (BOH) and those cases where miscarriage occurred after the appearance of foetal cardiac activity should be investigated for APLA in the preconceptional period itself in the next pregnancy earlier and if positive should be given prophylaxis for the same to prevent a miscarriage in future pregnancy