ABSTRACT
Background: Across the world, there is a rising trend among women towards delaying pregnancy and child birth. The wide educational and career choices available currently encourage women to pursue their professional goals relentlessly and many opt to delay pregnancy. Easy access to the wide range of modern contraceptive methods has enabled them to achieve better control of fertility. Methods: The study conducted in Chennai Medical College and Research Centre, Trichy over a period of 18 months compared pregnancy related complications, maternal and perinatal outcomes in elderly women, with non-elderly women as controls. Forty two elderly gravidae were compared with 50 non-elderly gravidae. Results: The mean age of women in study group was 37.1 and 27.6 in the control group. 14.3% in the study group of patients had assisted conception whereas all of patients in the control group conceived spontaneously. There were 4 (9.5%) miscarriages in the study group and none in the control group. The incidence of pre-gestational diabetes, gestational diabetes and preeclampsia was found to be higher in the study group and this was statistically significant (P Value <0.0001). Conclusion: This study analyzing the effect of advanced maternal age on pregnancy has shown favourable maternal and perinatal outcomes. The study showed a significant difference in the incidence of pre-gestational diabetes, gestational diabetes, preeclampsia, miscarriage, antepartum hemorrhage, induction of labour, instrumental deliveries and caesarean section rates in elderly gravidae. But the risk of aneuploidy, malpresentations, placenta previa and prolonged labour were not found to be high. The incidence of low APGAR score was high in the study group, but it was attributable to specific causes like placental abruption. There were no perinatal deaths in both groups.
ABSTRACT
Background: Rheumatic Heart Disease remains the most common type of heart disease in pregnancy in developing countries. Over a period of 2 years,129 pregnant patients with Rheumatic Heart Disease attending our outpatient department, were observed from admission till discharge and the clinical course during pregnancy and the maternal, foetal outcomes, and desire of future contraception studied. Methods: Patients were routinely examined every antenatal visit for signs of anemia and congestive cardiac failure. They were usually admitted at 28-32 weeks of gestation unless they presented with symptoms of cardiac failure earlier in pregnancy. Frequency of the antenatal visits depended on the functional cardiac status. Results: The incidence of heart disease was 0.96% for all deliveries during our study period. The incidence of RHD was 71.6%. 65.1% of women gave a h/o rheumatic fever. 45(34.9%) patients had undergone surgical correction and 84(65.1%) did not undergo surgical correction. 95.3% had moderate to severe disease but only 18.6% were in NYHA class III/IV. Hence severity of disease did not correlate with NHYA class. 76.7% of women had vaginal delivery. LSCS was done for obstetric reasons alone. Conclusion: The association of the pre pregnancy functional class with the risk of maternal events raises attention to the possibility of reducing these complications in pregnant women with mitral stenosis by means of early interventions aimed at improving their functional class.