Placenta previa: risk factors, feto-maternal outcome and complications

Background: Placenta previa is defined as placenta that is implanted somewhere in the lower uterine segment either over or very near the internal cervical os. Placenta previa and coexistent accrete syndromes contribute substantively to maternal and perinatal morbidity and mortality.Methods: All This is a retrospective study of 88 cases of placenta previa, which were admitted under department of obstetrics and gynecology in our institute during July 2017 to June 2019. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by ultrasound examination. Outcome measures prevalence of placenta previa, maternal and neonatal outcomes, and case fatality rate.Results: The total number of deliveries performed during the study period was 16330, of them, 88 cases were placenta previa. Thus, the prevalence of PP was 0.53%. Multiparity was one of the etiological factors in 84.09%, whereas previous LSCS was 47.73%, previous H/O D and E was 14.73%, previous H/O placenta previa was 7.95%. Obstetric hysterectomy was done in 7 (7.95%) patients out of 88 patients. 92.04% of patients delivered with cesarean section and 7.95% patients delivered with normal vaginal delivery. 22 (26.50%) babies out of 83 live born were admitted in NICU.Conclusions: Advancing maternal age, multiparity, prior cesarean section, and prior abortions are independent risk factors for placenta previa. Placenta previa remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa should encourage a careful evaluation with timely delivery to reduce the associated maternal and perinatal complications. Measures to reduce the primary caesarean section rate should be adopted

Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour

Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature

Measurement of cervical length using transvaginal sonography for prediction of preterm labour

Background: Preterm labour and delivery cause major health burden to the society due to high perinatal morbidities and mortality and long-term health implications and also affects maternal. An effective and objective way for predicting preterm delivery is measurement of cervical length by transvaginal sonography as it allows better quality and accurate visualization of uterine cervix. Cervical length (<25 mm) is good and accurate cervical biometry for prediction of preterm birth. The objective of this study was to measure cervical length by transvaginal sonography for predicting preterm labour and fetal outcome.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology, at SVPIMSR hospital, Ahmedabad from July 2018 to December 2019 in 150 antenatal women to assess cervical changes (cervical length, dilatation of internal OS, funnelling etc.) between 16 to 24 weeks of gestation and these cases followed till delivery and results were analysed.Results:150 antenatal women who fulfilled the selection criteria were studied using transvaginal ultrasound between 16-24 weeks of gestation, out of them 36 (24%) women delivered preterm babies. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) recorded in this study were 80.5%, 94.73%, 82.85% and 93.91% respectively.Conclusion: Transvaginal sonography is the most useful and better, safe, accurate, most effective, less expensive, objective and acceptable technique for assessing cervical length in all antenatal women and predicting the preterm labour when assessed between 16 -24 weeks of gestational age

Fetomaternal outcome in COVID-19 infected pregnant women: a preliminary clinical study

Background: WHO has declared COVID-19 infection a health emergency of international concern on 11th March, 2020. It is not clear whether clinical characteristics of pregnant women with COVID-19 differ from those of nonpregnant women and whether it aggravates COVID-19 symptoms and whether antiviral therapy is necessary for COVID-19 infected pregnant women.Methods: This is prospective study of 125 cases based on the compiled clinical data for pregnant women with COVID-19 between 15th April 2020 and 10th June 2020. A laboratory confirmed positive case of COVID-19 infection in pregnant women were included.Results: The most common symptoms at presentation were cough in 61.6% (77/125) and fever in 46.4% (58/125). Other reported symptoms were sore throat in 13.6% (17/125), myalgia in 10.4% (13/125) while 38.4% (48/125) were asymptomatic. There were total 97 deliveries (including 2 twins’ deliveries) among which 3 cases had IUD. Present study reported 96 live births. The incidence of missed abortion was 2.4% (3/125). The incidence of preterm birth before 37 weeks was 8.2% (8/97). Ninety-six (96.9%) of neonates were tested for SARS-CoV-2 viral nucleic acid on nasopharyngeal and pharyngeal samples and 16.67% (16/96) were resulted positive.Conclusions: At present, there is no evidence regarding the greater risk of pregnant women to succumb to COVID-19 infection and experience severe pneumonia. The risks of spontaneous abortion and preterm birth are not increased as reported in this study but shows possibility of vertical transmission when it manifests during the third trimester of pregnancy

A hospital based retrospective study of thyroid disorders on obstetric and perinatal outcomes

Background: The study was undertaken in pregnant women to understand and analyze the obstetric and foetal outcomes of thyroid disorders.Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5 mIU/ml in first trimester and above 3 mIU/ml in second and third trimesters were evaluated for free T3, free T4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery.Results: Total no of pregnant women screened were 904 over a period of 1 year from 15 March 2019 to 14 March 2020, of which 115 had abnormal thyroid functions, thereby the prevalence of thyroid disorders being 12.72%. Of the 115 patients with thyroid disorders, 112 were hypothyroid and 3 were hyperthyroid. Among the 112 hypothyroid cases, 48 were known cases and 64 were new cases. The total cases of subclinical hypothyroidism were 88, prevalence being 9.73% and overt cases were 24, prevalence being 2.65%; 3 cases were overt hyperthyroid, prevalence being 0.33%. 66% of subclinical hypothyroidism were TPO positive and 34% of overt hypothyroidism were TPO positive (p<0.05). Out of 115 abnormal thyroid function patients, 92 patients delivered in our hospital. There were 15 abortions, 13 spontaneous and 2 terminations of pregnancies; 7 patients have delivered outside and 1 patient lost follow up.Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and foetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients

Effect of eclampsia on pregnancy outcome at the tertiary care center

Background: Eclampsia is a common medical and life-threatening emergency condition mainly seen in 5-10% of all pregnancies and that is a major cause of maternal and perinatal morbidity and mortality The aim of the study to find out the fetomaternal outcomes of eclampsia in tertiary care hospital and to analyse the trend of eclampsia and associated epidemiological variables.Methods: This retrospective analytical study was undertaken with 40 clinically diagnosed women with eclampsia in their third trimester of pregnancy in the Department of Obstetrics and Gynaecology, at tertiary care hospital from July 2020 to December 2021. Women who came to the hospital with eclampsia or developed eclampsia during hospital stay were included in our study.Results: In our study, the antepartum eclampsia was in 32 cases (80%), primigravida 27 cases (67.5%), maternal age (21-30 years) 26 cases (65%). Cesarean section was the mode of delivery in 26 cases (65%). NICU admission is required by 20 neonates (50%).Conclusions: Eclampsia is an important cause of maternal and perinatal morbidity and mortality. Providing quality antenatal health care services, increasing awareness of patients about warning symptoms, proper investigations, timely delivery, and proper monitoring in the intrapartum and postpartum period have the potential to improve maternal and perinatal outcomes.

Pregnancy outcome in patients with fibroid: a retrospective study

Background: Fibroids are benign smooth muscle cell tumour of the uterus. In some patients of pregnancy associated with fibroid, it does not affect the outcome of pregnancy. On the other hand, various complications have been reported. The aim of our study was to evaluate the outcome in antenatal women with fibroids.Methods: This retrospective study was conducted at tertiary care center, obstetrics & gynecology department over a period of eighteen months between June 2018 to November 2019. Total 26 pregnant patients with >3 cm fibroid was included in the study. They were followed during antenatal period. Maternal age, parity, size of fibroid, complications during pregnancy, labour, and delivery, mode of delivery and indications of cesarean section were noted.Results: Out of 26 patients, 15 (57.6%) were between 26-30 years of age group and 16 (61.53%) were multigravidas. Normal vaginal delivery occurred in 8 (33.33%), while 16 (66.66%) delivered by caesarean section. There were 9 (34.61%) patients who had no complication whereas 17 (65.38%) had some complication. Pain was present in 8 (30.76%). PROM and preterm labour were present in 3 (18.75%) and 5 (19.23%) respectively. PPH was present in 2 (7.69%).Conclusions: Pregnant patients who have fibroids are to be carefully screened in the antenatal period, so as to have a regular follow up. The widespread use of ultrasonography has facilitated diagnosis and management of fibroids in pregnancy. The site and size of fibroid is very important to predict its effect on pregnancy

Utility of first trimester ultrasound before 12 weeks of gestation at tertiary care centre in western India

Background: The first trimester begins on the first day of the last menstrual period (LMP) and lasts until the end of 12 weeks of gestation. Transvaginal ultrasound is modality of choice for establishing the presence of an intrauterine pregnancy in the first trimester. The focus of our study is routine early pregnancy ultrasound. The purpose of this study was to diagnose various conditions of pregnancy at an early stage by using ultrasound.Methods: We conducted retrospective data analysis of random 250 pregnant patients who had undergone first-trimester ultrasonography USG) (transvaginal/abdominal) in their first antenatal visit at S.V.P. Hospital, Ahmedabad, Gujarat, India from March 2021 to February 2022. The patient was selected by a simple randomized method. Maternal age, parity, gestational age, and special features regarding maternal gestational history were compared with USG findings. Patients were divided into 13 groups on the basis of ultrasonographic diagnosis.Results: We noted 76.8% of patients had single, viable, intrauterine pregnancies, while 23.2% had complicated pregnancies with uterine anomalies, ovarian cysts, leiomyoma, caesarean scar pregnancy or subchorionic hematomas.Conclusions: Ultrasound measurement of fetus in first trimester is most accurate method to confirm gestational age. It is less expensive and easily available modality. First-trimester ultrasound is useful to define embryonic landmarks in developmental stages with reference to gestational age, early diagnosis of miscarriage, ectopic pregnancy, molar pregnancy, multifetal pregnancy, major fetal malformation. And also, to diagnose pregnancy with leiomyoma, caesarean scar pregnancy, uterine anomaly and pre-eclampsia with the help of uterine artery PI

Classification of Caesarean Section According to Robson Criteria: An Approach to Optimize Caesarean Section Rates at Tertiary Care Hospital in Western India

Introduction: Caesarean section (CS) rates have been increasing worldwide. For proper assessment of CS rate, the ten group Robson classification is recommended by WHO. We are analyzing the CS rates by classifying the caesarean sections using Robson‘s ten group classification. The aim of this study is to perform an analysis based on Robson‘s ten group classification system and to identify strategies to optimize CS rate in our institution. Materials and Methods: This was a retrospective observational study conducted in the department of obstetrics and gynaecology between July 2022 to December 2022 at SardarVallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR) in Ahmedabad, western India. Results: Total number of deliveries during the study period was 3121. The total numbers of CS were 1078 (34.55%) and total vaginal deliveries were 2043 (65.45%). The main contributors to overall caesarean section rate were group 5 (previous CS) (14.03%) and group 2 (nullipara, singleton cephalic,>=37 weeks) (11.40%). Women with one previous LSCS contributed majorly to the CS rate. Conclusions: Robson‘s classification is easily implementable and an effective tool for surveillance. The results can be compared between Institutions, states and countries. By using Robson classification, groups identified which contributed the most to the overall CS rate and approach to reduce the same has to be our prime objective. Any reduction in CS in nullipara group affect the CS rate in the total group of nulliparous women with a potential for vaginal birth and would also reduce number of women in group 5 (previous CS)

Analysis of labour by modified WHO partograph in primigravida and multigravida term patients: an observational study

Background: The World Health Organization (WHO) recommends the use of a partograph to follow labor and delivery, with the aim of improving health care and reducing maternal and foetal mortality. The partograph is a graphic representation of events of labour and is an effective visual resource for early detection of abnormal progress of labour and prevention of prolonged labour. The aim of this study is to use partograph to monitor labor, analyse cervical effacement and dilatation, uterine contraction, foetal presentation while avoiding uterine hypo-stimulation, hyperstimulation and reducing the risk of sepsis, obstructed labor or postpartum haemorrhage (PPH).Methods: This was a single year hospital-based observational study conducted in 2021 of the deliveries in Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR) and Sheth V.S General Hospital, Ahmedabad. Analysis of labor of 60 randomly selected patients was done using WHO modified partograph. The patients were classified as primigravida and multigravida. The partograph recording started at 4cm dilatation, continuous maternal and foetal monitoring was ensured throughout the labor and partogram was plotted against time in hours. Any deviations from the normal course were recorded.Results: In this observational study, 60 patients were analysed. They were classified into primigravida and multigravida and based on the recordings from partograph further classified into mode of delivery. 3 out of 26 primigravida and 1 out of 34 multigravida patients underwent caesarean deliveries. 25 patients crossed the alert line and 4 patients crossed the action line. 5 deliveries out of 60 had APGAR score of &lt;7 at 5 minutes.Conclusions: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It is an excellent visual resource to analyse cervical effacement and dilatation, uterine contraction and foetal presentation in relation to time. It is effective in early detection of abnormal progress of labor, prevention of prolonged labor, obstructed labor, PPH and improvement in neonatal outcome