ABSTRACT
Background: Thyroid disorder is one of the most common disorder in pregnancy. Thyroid disorder is known to be associated with abnormal maternal and foetal outcomes and overlooked in pregnant women because of non-specific symptoms and hypermetabolic state of pregnancy of pregnancy. It is well established that not only overt, but subclinical thyroid dysfunction also has adverse effects on mother and the foetus like miscarriages, preterm delivery, pre-eclampsia, eclampsia, polyhydramnios, placental abruption, postpartum haemorrhage, low birth weight, neonatal hypothyroidism. Decreased availability of thyroid hormones may also impair neurological and intellectual development of foetus. With this background, we are conducting a study to know the effect of thyroid disorder on pregnancy and its maternal and foetal outcome.Methods: The present study was conducted in Muzaffarnagar Medical College, Uttar Pradesh, India in collaboration of department of Gynecology and Obstetrics and Pediatrics Department. It is a prospective random cross-sectional study done over 400 pregnant women which includes known cases of thyroid disorder. Serum thyroid stimulating hormone (TSH) test was apart from the routine blood sample investigations as per FOGSI-ICOG good clinical practice recommendation. fT3, fT4 and thyroid peroxidase antibody test were done in patients with a deranged TSH value. Patients were followed up till delivery, and their obstetrics and perinatal outcomes were noted and managed.Results: In present study out of 400 cases, 25 cases are hypothyroidism and 16 cases are hyperthyroidism in pregnancy. Out of these 41 patients with thyroid dysfunction, complications associated were abortions (14.63%), maternal anaemia (9.7%), pre-eclampsia (12.2%), preterm labour (9.76%), abruption placenta (4.88%), IUGR (2.4%), Still birth (7.32%). Out of 41 patients with thyroid dysfunction, foetal complications seen were hyperbilirubinemia (12.2%), Foetal distress (4.88%), NICU admission (17.07%) and low birth weight (21.95%).Conclusions: Thyroid disorder in pregnancy have adverse effects on maternal and foetal outcome emphasizing the importance of routine antenatal thyroid screening.
ABSTRACT
Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. In India, they account for the third most important cause of maternal mortality. The objective of this study was to evaluate maternal and perinatal outcome and complications in cases with severe pre-eclampsia and eclampsia and measures to prevent them.Methods: A prospective study was carried out on 100 patients with severe pre-eclampsia and eclampsia in tertiary care referral hospital over a period of one year i.e. from November 2017 to October 2018. Only those cases with initial blood pressure reading of ≥160/110mmHg or presenting with eclampsia were in included in the study. Detailed history and examination was carried out. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed.Results: 48% of women were between 21-25 years age, 82% were from rural area, and 86% cases were unbooked, 68% cases were primigravida. Liver Function Tests were deranged in 18% of the patients and 19% had abnormal Renal Function Tests. Labetalol was the most commonly used antihypertensive. Lower segment cesarean section was the mode of delivery in 59% of the cases. Most common maternal complication was Eclampsia. There were 5 maternal deaths i.e. maternal death rate was 5%. 54.3% of live births needed NICU admission and out of these 50% were preterm deliveries.Conclusions: Accessible healthcare and health education and awareness regarding antenatal checkup for all women will lead to early detection of severe pre-eclampsia. Hence, early treatment and management of patient’s complications will certainly improve the maternal and perinatal outcome.
ABSTRACT
Background: Uterine scar dehiscence is a complication in which scar tissue remaining from previous C-section is disrupted and separated. Its incidence ranges between 0.2%-4.3% of all pregnancies with previous caesarean. It is asymptomatic in 48% of patients and thus is a serious complication because if not predicted it can lead to uterine rupture.Methods: Patients included in the study were of previous caesarean who were taken for repeat caesarean and scar dehiscence was not predicted preoperatively but seen intra-operatively. History, symptoms, signs and radiological investigations were interpreted to find out single or multiple factors responsible for scar dehiscence.Results: Incidence of scar dehiscence was found to be 8.3% .Scar dehiscence was detected in 55% of cases who were gravida 3 and above, all patients with intraoperative scar tenderness, 35% of patients with scar thickness ˂2mm, 70% cases with POG 37-40 weeks, 65% of patients with interpregnancy interval˂18 months,86.6% of patients with scar dehiscence had baby birth weight ˃3kg.Conclusions: Authors concluded that a single factor which has maximum predictive value for scar dehiscence is scar tenderness.