Setting
This is an observational study conducted in the department of General Medicine at Christian Medical College Hospital, Vellore over a period of 11 months. All pregnant patients attending the Obstetric Medicine clinic, who newly register or are referred, from September 2016 to July 2017, were enrolled.
Design
This is an observational study with a follow up of a historical cohort. The historical cohort consists of patients who attend the clinic from September 2016 to March 2017. The prospective cohort consists of patients who attend the clinic from April 2017 to July 2017.
Objective
To study the common reasons for referral to the Obstetric Medicine clinic
To ascertain the frequency of common medical disorders in pregnancy
To study maternal and fetal outcomes of patients referred to the Obstetric Medicine clinic
To determine the correlation between age and frequency of medical disorders
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Participants
All pregnant patients who attend the Obstetric Medicine clinic are enrolled at their first visit. All patients below the age of 18 years as per hospital records were excluded. Postnatal patients who may also be referred to this clinic were excluded. Patients who refused an informed consent were excluded.
Results
In this study 445 patients attended the Obstetric Medicine clinic from September 2016 to July 2017. Out of which 52 were excluded. 393 patients were included in the analysis. 78 patients were yet to deliver at the end of the study period and 8 were lost to follow up. Hence 307 patient outcomes were available. The mean age of the population was 27±4.9 years. 49.4% were primigravida. Mean gestational age at delivery was 36±4.6 weeks. The mean birth weight was 2.8 ±0.5 kg. 57.3% delivered vaginally. 20% of patients delivered preterm and 25% were low birth weight. There were 16 abortions and 1 neonatal death. There were no maternal deaths. The most common reason for referral was for the evaluation of hypothyroidism (22.1%) followed by respiratory tract symptoms (20.4%), cardiac symptoms, control of blood pressure and blood sugar. The most common diagnosis made in the Obstetric Medicine clinic was hypothyroidism (25.4%), infections (17.5%) and chronic hypertension (13.4%). There was no correlation of age (≥35 years) and the common medical diseases in pregnancy. There was a significant correlation of chronic hypertension and preeclampsia with preterm birth (p <0.001), low birth weight (p- 0.002, <0.001) and other fetal complication (p- 0.012, <0.001). There was a significant association of family history of diabetes mellitus with gestational diabetes (p- 0.01) and family history of hypertension with chronic hypertension (p <0.001) and preeclampsia (p- 0.003).
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Outcome:
The most common reason for referral was for management of hypothyroidism. There was no correlation of age (≥35 years) with the common medical disorders. There was a significant correlation of chronic hypertension and preeclampsia with preterm birth, low birth weight and foetal complication.
Conclusion
This study illustrates the importance of an Obstetric Medicine referral clinic in helping manage the common medical illness and describes its impact on maternal and fetal outcome. Early diagnosis and targeted intervention can result in reducing the maternal and fetal morbidity and mortality
