ABSTRACT
Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.Methods: It is a prospective observational study done in a tertiary care centre.Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good.
ABSTRACT
Background: Pregnancy related morbidity is becoming a nightmare in Indian women. Some of these women end up in mortality and a few of them narrowly escape death. Critical care should be and is an authenticated part of obstetric practice. This study is an effort initiated to understand the risk of maternal morbidity, to investigate the contributing factors, foetal outcome, to study the adverse event, cause of maternal death and remedial measures.Methods: All the obstetric cases admitted in Intensive care unit in a government institute in Maharashtra during January 2018 to June 2019 were analyzed prospectively. The indications for transfer into intensive care, risk factors, co morbidities if any were studied. Maternal and fetal morbidity and mortality were included in the study.Results: During the study period, there were 10, 208 deliveries. There were 12 maternal deaths and 98 critically ill patients became morbid. Anemia is found to be a major pre-existing contributing factor (25.5%) and an important risk factor making pregnancy become critical. DIC is found to be a major reason for ICU admission (39.1%), 72.7% needed mechanical ventilator and 60.1% needed ionotropic support.Conclusions: Anemia is a major problem still existing in our country. Gestational hypertension is another leading cause of critical illness in pregnancy. Identification of patients who are going downhill, timely referral to higher centers and appropriate management can improve both the maternal and the fetal outcomes.
ABSTRACT
Background: “Make every mother and child count”- the slogan for World health day 2005 reflects the reality and need of the society even today. In India, many women die due to pregnancy-related complications and those who survive suffer from severe maternal morbidity. Authors have been impressed that the same obstetric conditions that kill mothers are also responsible for most of the stillbirths and many of the neonatal deaths as well. This is the study to identify the risk factors that has an effect on the health of both mother and baby, to evaluate the complications leading to maternal and perinatal morbidity or mortality so that timely interventions to prevent maternal and perinatal morbidity and mortality can be made.Methods: All the cases getting admitted in Dr SCGMC Nanded are analysed for maternal and foetal outcome over the study period of 18 months. The cases with both maternal and perinatal morbidity or mortality are included in the study. The associating factors and comorbidities if associated with the cases of double mishap are studied.Results: During the study period of 18mths, there were 21905 deliveries conducted in the study hospital and 742 reffered cases of outside hospital deliveries, it was found that there were 204 cases of double mishap. Out of 204 cases of double mishap, 71.56% had preeclampsia, 29.41% were anaemic, 6.86% had febrile illness, 4.41% were of placenta praevia, 33.33% had abruptio placenta.Conclusions: Authors can conclude by stating that through better antenatal care, early detection and proper management of risk factors like pre-eclampsia, anaemia and active management of third stage of labour with careful feto maternal monitoring the absolute goal of Obstetrics of having a healthy mother and healthy baby at the end of delivery can be achieved.
ABSTRACT
Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed. Hemorrhage due to uterine atony, adherent placenta and PPH are still the causes of maternal death in developing countries. Although advances have been made in the development of conservative medical and surgical treatment of obstetric haemorrhage like brace sutures, internal iliac artery ligation, selective arterial embolization etc emergency obstetric hysterectomy remains a lifesaving procedure in the management of intractable haemorrhage unresponsive to conservative management.