Fetal and maternal outcomes among pregnant women with placental abruption associated with disseminated intravascular coagulation attending a rural tertiary care centre

Background: Placental abruption is the separation of the placenta from the uterine wall before the delivery of the fetus, and its frequency varies between 0.4 and 1%. The objective of this study was to determine risk factors and maternal and fetal complications in cases of abruptio placentae.Methods: A record-based study was conducted in the Obstetrics and Gynaecology department at a rural tertiary care centre between January 2015 and December 2019. All 72 pregnant women admitted with suspicion of placental abruption at 28 weeks of gestation and beyond were included in the study. All data were retrieved from the maternity register, patient files. The maternal outcome was assessed by mode of delivery, need for blood transfusion, parity, and any complications. Neonatal outcome was assessed by neonatal intensive care unit admission, still and live births. Data collected was entered and analysed by using coGuide software.Results: A total of 72 subjects were included in the final analysis. Most 58 (81%) of them were 21-30 years old. Forty-three patients (59.72%) were diagnosed to be preeclamptic. Forty-three (59.72%) of them had a vaginal delivery. Out of 72, 66 (91.67%) patients did not have any maternal complications. Most 41 (56.94%) births were stillbirths, and only 7 (9.72%) newborns required intensive care unit (ICU) admission.Conclusions: Placental abruption is one of the major threats to the well-being of pregnant women, with an alarmingly high rate of 41 (56.94%) stillbirths

Risk factor and perinatal outcome in umbilical cord prolapse

Background: This study is done to determine the risk factors and the perinatal outcomes in umbilical cord prolapse in a tertiary care centre. Umbilical cord prolapse is an utmost obstetrical emergency, which requires prompt intervention to have a good perinatal outcome. Identification of umbilical cord prolapse is of utmost important. Due to exposure of the cord to the external environment, the vessels undergo spasm, which leads to fetal compromise. Delivery of the baby either via caesarean section or vaginal delivery is required immediately following diagnosis. The goal of the current study is to identify the risk factor and also to see the perinatal outcome of umbilical cord prolapse in a tertiary care centre. Methods: It is a retrospective study conducted in R. L. Jalappa hospital, Kolar from June 2021 to June 2022. Out of 2570 deliveries at our facility throughout the study period, 45 cases were that of umbilical cord prolapse, who were chosen for this study. Both singleton and twin pregnancies were considered. Women below 28 weeks of gestation was not included in the study. Results: In this study, 45 patients were evaluated who had come with umbilical cord prolapse. It was seen that umbilical cord prolapse occurred in women of multiparity, 36% of the total study population. It was more commonly seen in fetuses weighing 1.5-3 kg, at term (93.3%). Babies that were delivered within 10 minutes of the diagnosis of umbilical cord prolapse has a survival rate of 100%. Whereas the babies delivered after 30 minutes of the diagnosis of cord prolapse did not survive. Conclusions: Umbilical cord prolapse is associated with increased perinatal morbidity, especially if diagnosed late

A case of degenerated cervical fibroid polyp

Cervical fibroids are often solitary. It may be either interstitial, subserous, submucous or polypoidal. Cervical fibroid usually develops in the wall of the cervix, supravaginal portion. They can change the shape of the cervix or lengthen it, grow rapidly and obstruct the cervix. As fibroids enlarge they may outgrow their own blood supply leading to various types of degeneration. Cystic degeneration is observed in 4% is considered an extreme sequelae of oedema. However atypical appearances that follow degenerative changes can cause diagnostic confusion. Hence misdiagnosis of adenomyoma, hematometra, pyometra, uterine sarcoma and ovarian masses is common.

Comparison of intravenous tranexamic acid versus sublingual misoprostol in reducing blood loss in patients undergoing caesarean section-an analytical observational study

Background: Preventing postpartum haemorrhage using uterotonics or other antifibrinolytic drugs is need of the hour among women undergoing caesarean section (CS). This study is to compare the effectiveness of intravenous Tranexamic acid versus sublingual misoprostol in reducing blood loss by assessing intraoperative and postoperative blood loss in patients undergoing CS. Methods: Analytical observational study was conducted in department of obstetrics and gynaecology at sri Devaraj URS medical college, among 118 pregnant women admitted for CS. Study was conducted between January 2020 to June 2021. The sample was divided equally into intravenous tranexamic acid and sublingual misoprostol groups. Number of mops, pads soaked, suction volume excluding the amniotic fluid, preoperative and post-operative haemoglobin, any complication were recorded. Results: The mean of mops counts in the misoprostol, TXA group were noted as 4.73±1.27, 3.2±1.45 respectively. Around 8.47% of the participants in the misoprostol group required uterotonics, whereas, 15.25% in the TXA group required uterotonics. The preoperative and postoperative haemoglobin in misoprostol group were identified as 11.67±1.37, 10.78±1.12 respectively, whereas it was identified as 11.76±1.43, 11.17±1.4 in TXA group. The common side effects identified in the misoprostol group was chills, vomiting and fever with 47.46%, 13.56% and 11.86% while, it was 11.86%, 5.08% and 3.39% in the TXA group. Conclusions: Both intravenous tranexamic acid, sublingual misoprostol could be prescribed as standard therapy to significantly control blood loss and increase the quality of surgery with better outcomes. But the use of TXA proved slightly better as there were lesser side effects and significantly lesser blood loss in uncomplicated cases.

Profile of obstetric patients in intensive care unit -a retrospective study

Background: Obstetric patients form a particular subgroup of population to intensive care admission. Pregnancy specific problems like pre-eclampsia, postpartum haemorrhage or deterioration of pre-existent conditions can be sudden and life threatening, requiring immediate intensive management and monitoring. The main objective was to determine the pattern and outcome of obstetric admissions to intensive care unit. Methods: It was a retrospective study from June 2020 to June 2022. Obstetric patients admitted to intensive care unit were included in the study. Data were obtained from the patient’s case notes and records from the ICU and were entered into a predesigned proforma. Results: Maximum study subjects were between age group 21-25 years of age. Most of them were primigravida and admitted in the postpartum period. The most common indications for admission to ICU were preeclampsia with severe features followed by obstetric haemorrhage. The mortality rate was 18.8% and shock attributing to the main cause. Conclusions: Maternal and child health have become an important measure of human and social development. Early and prompt diagnosis and treatment of high-risk obstetric patients in intensive care unit can prevent and ameliorate serious maternal morbidity

Torsion of dermoid cyst in a perimenopausal woman: a case report

Mature cystic teratoma comprise 20-30% of all ovarian tumours. They are mostly seen in patients between 20 and 40 years of age and are mostly asymptomatic. Incidence of malignancy is high in perimenopausal and postmenopausal group. Here, authors report a case of torsion of dermoid cyst presenting unusually in a 45-year-old perimenopausal woman with acute abdomen. A 45-year-old perimenopausal woman presented with lower abdominal pain of 8 hours duration and 3-4 episodes of vomiting. Abdominal examination revealed a regular, firm to cystic, tender abdomino-pelvic mass corresponding to the size of 28 weeks gravid uterus by palpation. Abdominal ultrasonography revealed the presence of right ovarian cyst measuring 12.9x12.8x10.1 cm. Total abdominal hysterectomy with bilateral salpingo oopherectomy was done. Histopathological examination confirmed mature cystic teratoma. Although mature cystic teratoma is rare after 40 years age, especially in perimenopausal women and are usually malignant in that age group, it can have an unusual age presentation at 45 years with benign nature as in present case

Prevalence and cause of gestational diabetes mellitus in a tertiary care center in Kolar district: a population based study

Background: Gestational diabetes mellitus (GDM) is carbohydrate intolerance at the onset of pregnancy which induces pathological short term or long term outcomes for both mother and baby. The aim of the present study was to know the prevalence of GDM in pregnant women who were attending the antenatal care (ANC) center at a tertiary care hospital in Kolar, Karnataka, India.Methods: This prospective study was conducted in Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, a constituent of Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. The duration of the study was two months. In this study, 108 pregnant women above 24 weeks of gestation were screened for GDM by oral glucose tolerance test. Fasting 2 milli liter blood was collected and were given 75 grams of glucose in 200 milli liters of water and asked to drink within 5 minutes. Again 2 milli liters venous blood was collected after 1 hour and 2 hours from all participants. Plasma sample was used for the estimation of glucose by glucose oxidase and peroxidase (GOD-POD) method.Results: Out of 108, 12 women (11.1%) were diagnosed with GDM. The prevalence rate was higher in the age group of 26-30 years (41.6%).  Among 12 diabetic women, five (47.2%) exercised regularly and seven (58.3%) did not doing exercise. Out of 12 GDM subjects, eight of them had family history of diabetes in first degree relatives; among which one was hypertensive and five were suffering from thyroid problems.Conclusions: In the present study, the prevalence of GDM was found to be 11.1%. Prevalence of GDM might be influenced by increasing age, pre pregnancy weight, family history of diabetes, past history of pregnancy complications, status of literacy and exercise

A comparative study of maternal outcome between vacuum extraction and outlet forceps delivery

Background: Instrumental delivery is an art that is fading and may disappear in the near future as more and more obstetricians are resorting to caesarean sections. Instrumental vaginal deliveries comprise the use of vacuum assisted devices and /or forceps to assist in delivering a fetus, offering the alternative to accomplish vaginal delivery in properly selected cases thereby reducing maternal morbidity in terms of blood loss and increase hospital stay which is a consequence of cesarean sections. The objective of the present study is to compare the maternal morbidity with vacuum and outlet forceps delivery.Methods: A prospective comparative study was conducted in women delivering at department of obstetrics and gynaecology, in SDUMC, R L Jalappa Hospital, Kolar from March 2016 - March 2017 for a period of one year. A minimum of 180 patients were taken up for study. 90 women delivered by outlet forceps delivery and 90 women by vacuum delivery. Cases which require instrumental vaginal delivery and fulfilling the inclusion criteria for forceps or vacuum were taken up for the study, after taking informed consent. Maternal outcomes including episiotomy wound and extension, perineal tear, post-partum hemorrhage, hospital stay was analyzed and compared.Results: Mostly forceps and vacuum were applied for age group of 26-30 years and primigravida, which showed a statistical significance. Extension of episiotomy was more with forceps that is 21.1% and with vacuum being 4.4%. This difference was statistically significant. Postpartum hemorrhage was also more common in forceps group that is 13.3%compared to vacuum 11.1% but the difference was not statistically significant. The need for blood transfusion was seen more in cases of forceps that is 11.1% cases whereas in vacuum i.e. 6.7% cases but was not statistically significant.Conclusions: With the expertise and appropriate decision on the indication and meticulous handling of the instrument whether outlet forceps or vacuum, especially in a tertiary care centre, the maternal outcome is equally good with both the instruments

Feto-maternal outcome in patients with peripartum cardiomyopathy: a 5-year study in a tertiary care hospital in Kolar district

Background: Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first 5 months postpartum. PPCM remains a diagnosis of exclusion. There have been numerous proposed causes including hormonal abnormalities, inflammation, viral pathogens, autoimmune response, and genetic predisposition. Aim of study was to study the clinical profile, risk factors, and the management along with obstetric and perinatal outcome, in women with peripartum cardiomyopathy.Methods: This retrospective observational study was conducted on the antenatal women of age group of 18 years to 40 years, admitted in the labour ward of R. L. Jalapa hospital who presented with heart failure in last month of pregnancy till 5 months postpartum, without previously having a heart disease over the 5 year period, January 20 15 to December 2019.Results: Majority of the patients (15/18) presented with complaints of exertional dyspnoea. Mean LVEF at the time of diagnosis was 38.39%. There were 5 (27%) maternal mortality and all of them had global hypokinesia on echocardiography and presented in NYHA class III and IV. Two (11%) out of eighteen patients had intrauterine death, and all the patients who had IUFD belonged to class IV. Four babies (22.22%) had intrauterine growth restriction.Conclusions: The present study came to conclusion that in rural tertiary center, maternal outcome and prognosis was poor as patients presenting to us were majority of them in cardiogenic shock and lower LVEF in terminal stages. The associated risk factors were preeclampsia, anemia and multiple gestation which could also contribute to the poor prognosis which was noticed in the study. Early recognition of the disease is of paramount importance as the clinical manifestations can conceal and can lead to high morbidity and mortality especially within 3 months postpartum

Evaluation of vitamin D levels in term pregnancy and its obstetric outcome in Indian women

Background: Vitamin D deficiency is currently a global pandemic affecting all age groups. Vitamin D is considered a fundamental hormone in calcium homeostasis and bone health. Risk of vitamin D deficiency increases during pregnancy due to increased maternal and fetal demands and altered vitamin D metabolism. Recently, maternal vitamin D deficiency has been linked to adverse pregnancy outcomes, including preeclampsia, gestational diabetes, fetal growth restriction and preterm birth. Adequate vitamin D status appears to be relevant to health at all ages, and even in prenatal life.Methods: This is a cross sectional, observational study conducted in the department of obstetrics and gynaecology at R. L. Jalappa Hospital. A total number of 160 subjects were included. 5 ml of venous blood was collected and was centrifuged at 3000 rpm and stored at - 80°C till analysis. Analysis of 25-hydroxy Vitamin D was done using ELISA.Results: Majority of the subjects were vitamin D deficient (81.87%) and 12.5% were vitamin D insufficient and only 5.63% were vitamin D sufficient. The prevalence of vitamin D deficiency was more among primigravidas (85.6%) and was associated with higher rates of caesarean section (92.4%). High prevalence of vitamin D deficiency was seen in lower middle socioeconomic class (62.5%). Maternal vitamin D deficiency was associated low birth weight of neonates (100%).Conclusions: In this study it was concluded that majority of subjects were vitamin D deficient and belonged to lower middle socioeconomic class. Majority of this subjects who underwent caesarean section were vitamin D deficient. Vitamin D deficiency was associated only with low birth weight of neonates and no other adverse obstetric outcome