A Critical Assessment of Stillbirths at a Tertiary Care Hospital

Background: Globally in 2015, 2.6 million stillbirths occurred with estimated stillbirth rate (SBR) of 18.4/1000 births. India is the world capital of stillbirth accounting for 22.6% of world’s stillbirths. Objectives: The objective of the study is to study the demographic profile of women experiencing stillbirth, to understand the risk factors for stillbirth in low resource settings, and to find the etiology of stillbirth so as to facilitate designing of a stillbirth prevention strategy. Methods: This was a cross?sectional observational study done at a tertiary care hospital of Delhi from June 2017 to December 2019. All babies delivered after 20 weeks of gestation showing no sign of life after birth were considered stillborn. Prestructured proforma was filled for each case and data were analyzed. Results: A total of 50,461 births took place during the study period, out of which 1824 were stillborn, making SBR of 36.15/1000 births of our institution. Most of the women belonged to age group 21–25 years and more than 50% of women were illiterate. Twenty?nine percent of women were completely unbooked, 48% were referred from other centers and 23% were registered at our hospital. Placental causes accounted for 22%, hypertension for 23%, and labor complications for 9% of cases while in 22% cases, cause could not be found. Conclusion: Stillbirth remains a neglected issue. A significant proportion of stillbirths are preventable by adequate antenatal care. Notification of stillbirths will give us the exact figures and realization of the seriousness of the problem which will help us work towards the solutions.

Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

Midgut antibodies reduce the reproductive capacity of Anopheles stephensi (Diptera: Culicidae).

Rabbits immunized with polypeptides of midgut of glucose fed A. stephensi resulted in high titer of antibodies (10(4)-10(6)) as detected by ELISA. Effect of antisera on fecundity, hatchability and engorgement was investigated. Fecundity was reduced drastically (62.4%). Eight polypeptides were recognized by the antisera raised against midgut tissues viz., 92, 85, 55, 52, 45, 38, 29 and 13 kDa. Cross reactivity of these antibodies with different tissues of A. stephensi as well as different species of Anopheles was also analyzed. The results indicated that anti-mosquito midgut antibodies had the potential to disrupt the reproductive physiology of mosquitoes in view of the present study, there is a need for further investigation with target antigens.

Dilantin as anticonvulsant in eclampsia.

Sixty-six cases of eclampsia amongst 9178 deliveries were managed from July, 1997 to December, 1998 in the department of obstetrics and gynaecology at UCMS & GTB Hospital, Delhi. The aim was to evaluate the changing trends in patients of eclampsia and to assess the efficacy of dilantin in its treatment. The incidence recorded was 1 in 139 deliveries (0.7%). Majority (90.91%) were unsupervised in antenatal period and 68.18% were primigravidae. Eclampsia developed at < 28 weeks of pregnancy in 3.03% of patients. All the patients had hypertension and proteinuria at the time of admission and 51.52% showed hypertensive changes on fundus examination. While single anticonvulsant therapy in the form of dilantin was used to manage 57.57% of patients, 13.64% required intubation and positive pressure ventilation. Fit recurrence on treatment was noticed in 40.91% of patients. Lower segment caesarean section was conducted in 18.18% of patients. Three maternal deaths (4.56%) attributed to ventricular tachycardia, aspiration and intracerebral haemorrhage were recorded. Morbidity was frequent in the form of status eclampticus (n = 5), postpartum psychosis (n = 5), retinal detachment (n = 1), coagulation abnormality (n = 11). The perinatal mortality rate was 30.43%. The study concludes that eclampsia is still rampant in India and despite better medical facilities, maternal and perinatal mortality remains high. The efficacy of dilantin as anti-eclamptic needs to be reviewed.

Del Castello syndrome--an unusual presentation.

Del Castello syndrome in a 28-year-old female, characterised by bilateral galactorrhoea, amenorrhoea and hyperinvoluted uterus, has been described. She had hyperprolactinaemia without any demonstrable pituitary tumour. She was successfully treated with two short courses of bromocriptine and was spontaneously cured after her second conception. The case is discussed with a brief review of the literature.