ABSTRACT
Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal morbidity in form of operative delivery and induced labour. Material and Methods: Present study was done over a period from May 2009 to November 2011. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7% patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of growth retardation and NICU (neonatal intensive care unit) admission. Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.
ABSTRACT
Background: The phencyclidine derivative Ketamine is widely used as intramuscular and intravenous anaesthetic agent. In contrast to other anaesthetics, ketamine has potent analgesic properties in sub-anaesthetic doses. Recent studies indicate that analgesia produced by ketamine is mediated through opiate receptors and N-methyl D aspartate receptors. As systematically administered ketamine is unlikely to produce the respiratory depression, it seemed to offer an obvious advantage over the narcotics in which major drawback is respiratory depression. Aims & Objective: (1) To study the following parameters in pregnant women given ketamine v/s pregnant women not given analgesic - (a) Maternal outcome in form of duration of labour, mode of delivery, complication of third stage of labour. (b) Foetal outcome in form of Apgar score at 1 min and 5 min. (2) To study pharmacological effect of ketamine on mother (3) To evaluate patient’s satisfaction about this method. Material and Methods: The present study was Randomized controlled trial, conducted in Department of Obstetrics and Gynaecology at Smt. SCL Municipal General Hospital affiliated to NHL Medical College Ahmedabad over a span of 3 yrs. from 2010 to 2012. Study included primigravida and multigravida. 100 women fulfilling the inclusion and exclusion criteria were taken for the study. Study population divided into Control Group (no drug administered) and Study group (intravenous ketamine administered). Results: The duration of 1st and 2nd stage was remarkably shortened in study group. 64% of parturient in study group delivered within 3 hours of entering the active phase of labour compared to only 10% in control group. In study group 98% delivered vaginally only 2% required instrumental delivery. There was no inhibition of bearing down reflex by ketamine, no maternal exhaustion in study group. In present study ketamine had no effect on APGAR score at 1 min & at 5 min. 30% had marginal rise in pulse rate with range of 10-15 beats /min. 16% had risen in B.P. not beyond 15-20 mm of Hg. 10% cases had nausea but no vomiting. 90% of cases had excellent pain relief & 8% had satisfactory pain relief, while 2% had no pain at all. Conclusion: The low dose intravenous ketamine suits best to this situation as it provides effective analgesia in low doses, safe without significant maternal and foetal complications, does not prolong duration of labour and there is no increase in rate of instrumental delivery or caesarean section rate. Since it reduces maternal pain thereby reducing the maternal exhaustion the patients on ketamine are very co-operative during labour, easy to administer and monitor without the help of an expertise and cost effective. KEY-WORDS: Normal Labour; Intravenous Ketamine; Study Group; Control Group