ABSTRACT
Background: Ectopic pregnancy means pregnancy outside the normal uterine cavity. It is the leading cause of maternal morbidity and mortality in first trimester. Early diagnosis and timely intervention can significantly improve the outcomes.Methods: Retrospective observational study done in the department of obstetrics and gynecology ABVIMS and Dr. RML hospital, New Delhi from January 2016 to March 2019. Case records of 76 patients of confirmed ectopic pregnancy were retrieved and studied from the medical record section. The main aims were to see the clinical presentation, mode of diagnosis, predisposing risk factors; treatments offered and associated morbidity and mortality.Results: The incidence of ectopic pregnancy in present study was 1.7%, highest in 21 to 30 years age multiparous patients. 85.1% presented as acute emergencies, 75% patients had classic triad of amenorrhea, pain and bleeding. Pain was the commonest symptom in 96.1%. The commonest clinical sign was adnexal mass and tenderness. Ultrasound findings had adnexal mass in 98.7% and free fluid in 84.7% cases with empty uterus in 100%. 90.7 % case were tubal ectopic and 69.73 % were ruptured. Surgery was the main treatment modality in 96.0% cases. Salpingectomy was the commonest surgery in 80.25%. There was 0% mortality and 78.9% cases required blood transfusions, 44.7% patients had no known risk factors whereas some of the common identifiable risk factors were history of previous abortion, previous pelvic surgeries and pelvic inflammatory disease.Conclusions: ABVIMS and Dr. RML hospital is a tertiary care center so majority of patients with ectopic pregnancies presented late, as such surgery was the main treatment modality but there was 0% mortality in our study. Conservative treatments such as laparoscopy and medical management can also be offered to hemodynamically stable patients.
ABSTRACT
Background: Chronic kidney disease is a heterogeneous group of renal dysfunctions with complex and varied presentations in pregnancy. With a long asymptomatic course, timely diagnosis and management is crucial for fetomaternal wellbeing.Methods: A retrospective cohort study over a period of 3 years and 4 months included all obstetric in patients with known or newly diagnosed renal disorders. Maternal outcome was measured with regard to biochemical parameters presence /absence of proteinuria, hypertension, mode of pregnancy termination and complications. Fetal outcome was noted with respect to antenatal complications, weight, Apgar, NICU stay. Computation of results was done using percentages, mean and proportions.Results: Out of 13 women studied, 53.8% were pre-diagnosed cases of renal dysfunction and 46.2% were diagnosed during pregnancy. 38% had proteinuria at first visit and 50% remained so even after delivery. 60% had history of pregnancy induced hypertension in their previous pregnancies. Secondary hypertension and superimposed preeclampsia were seen in 30% and 38% cases respectively, with only one patient requiring magnesium sulphate prophylaxis in post-partum. Cardiac dysfunction was found to be coexisting in 15.3% cases with pre-existing renal leision. Intrauterine growth restriction was seen in 61.5% cases Average fetal weight was 2. 26kg with 30% having NICU stay. 30.6% had preterm delivery. Mode of delivery was caesarean section in 46% cases.Conclusions: Pregnancy with CKD is a high-risk pregnancy with adverse fetomaternal outcomes. For optimal pregnancy outcomes, an expert multidisciplinary team is required. With limited studies in south Asian population, there needs to be an upgradation in registry system.