ABSTRACT
Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%, and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.
ABSTRACT
Background: Pregnancy in sickle cell women has numerous obstetrical, nonobstetrical and fetal complications. Our objective was to study the pregnancy outcome in women with sickle cell disease/trait.Methods: A descriptive cross sectional study in 2 years study period was conducted. 57 women with sickle cell disease/trait were identified. They were attending the antenatal clinic and were admitted in obstetric ward and followed till 7 days after delivery.Results: Out of total 57 women 49 women (85.96%) were sickle cell trait (AS pattern) and 8 women (14.03%) were sickle cell disease (SS pattern). In women with sickle cell trait Pregnancy induced hypertension was the most common complication. Anaemia and hypothyroidism was the common associated medical problem. 5 babies need NICU admission, 6 babies PBU admission and 33 babies given to mother side just after birth. In women with sickle cell disease severe anaemia, preeclampsia, oligohydramnios and intrauterine growth restriction, lower segment caesarean section for preterm baby was the most common complication. 1 baby required NICU admission, 5 babies require PBU admission and only 2 babies given to mother just after delivery. There were no maternal mortality and neonatal mortality.Conclusions: Maternal morbidity and neonatal morbidity is more in sickle cell disease women. They require early diagnosis, premarital and preconceptional counselling, good multidisciplinary obstetrics and neonatal care and early referral to higher centre.
ABSTRACT
Background: The risks to the fetus increase after 41 weeks mainly due to increasing fetal weight, decline in placental function, oligohydramnios which increase chances of cord compression, and meconium aspiration. Perinatal mortality after 42 weeks is twice as compared to the perinatal mortality at 40 weeks and by 44 weeks the rate is increased up to threefold. In cases of prolonged pregnancy, fetus is more at risk of hypoxia during labor than a fetus at term.Methods: This cross sectional observational study of feto-maternal outcome in post dated pregnancy (Women beyond 40 weeks of gestation) was carried out in the department of obstetrics and gynaecology in a rural based tertiary care centre from October 2016 to September 2018, willing to participate and fulfilling the inclusion and exclusion criteria in the study period.Results: Majority i.e. 45 patients (46.9%) went into spontaneous labour and delivered vaginally, whereas 16 patients (16.7%) required caesarean section. Among all 45 participants who were given induction, maximum 26 (57.78%) were induced by Dinoprostone gel, 4 patients (8.89%) were induced by Tab. Misoprostol.Conclusions: The present study, we conclude that, the post dated pregnancy can be considered as a high risk factor from the point of view of fetal outcome as there is more fetal morbidity.