ABSTRACT
Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality.
ABSTRACT
Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available.
ABSTRACT
Background: Jaundice in pregnancy and pregnancy in women with preexisting liver disease is not very uncommon. However it takes a major toll on health of both mother and fetus, due to increased morbidity and mortality for both mother and fetus, categorizing pregnancy as a high risk one. The distribution of jaundice in pregnancy varies throughout the world, but is seen more in developing countries. The course and outcome of liver disorder in pregnancy is altered due to various hemodynamic, hormonal and immunological changes unique to pregnancy. The hepatic functions during pregnancy are affected by increase in serum estrogen and progesterone levels.Methods: This was a prospective study of 70 cases of pregnancy with jaundice admitted in the department of obstetrics and gynecology at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India. The duration of study was from June 2015 to December 2018. During this period 70 patients were admitted with jaundice in pregnancy. Patients were analyzed with regards to socio demographic profile, investigations, maternal and perinatal outcome.Results: The incidence of pregnancy with jaundice in present study was 0.32%. Most common cause identified was viral hepatitis in 27 cases (38.57%) out of which 23(32.85%) cases being hepatitis E. Followed by HELLP syndrome, pre eclempsia, eclempsia in 24(34.28%) cases. 13(18.57%) cases were belonged to cholestatic jaundice of pregnancy. Rest 6(8.56%) cases belonged to malaria, portal hypertension due to liver disease etc. Out of total 70 patients 53(75.71%) women from rural area, 54(77.13%) patients were from age group of 20-29years.Maximum patients were multigravida i.e. 28 (40%) and 66(94.28%) women coming from lower middle and lower socio economic class. There were 9 maternal deaths, 5 due to DIC. Total vaginal deliveries were 40, 24 patients underwent LSCS, 4 patients had abortion, and 2 expired undelivered. Most common complication was DIC in 16(22.85%) cases and thrombocytopenia in 14(31.67%) cases. 30(42.85%) babies were LBW and 18(25.7%) babies were IUGR.Conclusions: Prompt diagnosis and accurate evaluation and multidisciplinary approach of management in pregnancy with jaundice at a tertiary care center with good NICU is helpful in reducing maternal and perinatal mortality and morbidity.
ABSTRACT
Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome.
ABSTRACT
Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome.Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded.Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series.Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.
ABSTRACT
Background: The aim is to study various investigative modalities to diagnose Mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of malformation of genital tract.Methods: A prospective study of reproductive anomalies and its outcome was performed by using data from women with congenital anomalies attended in OPD either with complains or for operative treatment or incidental diagnosis during caesarean section, manual removal of placenta, during laparoscopy or laparotomy at tertiary care center. Total 70 women with different types of congenital anomalies were included in study. Out of them gynecological cases (27) were diagnosed on basis of clinical examination and other diagnostic aids while Mullerian anomalies in obstetric cases (43) were observed and their outcomes were studied.Results: Most common utero-vaginal anomaly seen in present study was septate uterus with 18 (25.7%) cases, followed by bicornuate uterus with 13 (18.6%) cases. Most common presenting symptom is primary amenorrhea 21 (30%) followed by cyclical abdominal pain 11 (15.7). HSG, USG are the primary tools to detect genital tract anomalies. Surgical correction was required in 47.1% patients.Conclusions: Present study shows prevalence of congenital malformation of female reproductive tract is 0.17% at our tertiary care center. Utero-vaginal anomalies are a morphologically diverse group of developmental disorders. Establishing an accurate diagnosis is essential for planning treatment and management strategies. The surgical approach for correction of utero-vaginal anomalies is specific to the type of malformation and may vary in a specific group.