ABSTRACT
Background: With the globally emerging trend of Caesarean deliveries, there arises a more pressing matter of subsequent pregnancy outcomes with previous caesarean deliveries. Especially, the physiology of Placental localisation being a poorly understood phenomena, question arises, whether a previous caesarean scar can influence the site of placental implantation, subsequent migration and pregnancy outcome. The objective of present study is placental localisation and study of maternal and foetal outcome in previous caesarean delivery patients. Methods: A prospective longitudinal study on 100 previous caesarean patients was conducted over a period of 20 months at Department of obstetrics and gynaecology at JNIMS. Placental location was determined ultrasonographically between 28 to 42 weeks gestation, Patients followed up and feto-maternal outcomes analysed. Results: In most, placenta located fundo-anterior and fundo-posterior (30% each) and five (5%) patient reported placenta previa. The study suggests that maternal complications like postpartum haemorrhage (60% vs 6.3) and requirement for interventions (40% Vs 11.6%) were higher among praevia patients. Foetal complications like low Apgar (40% Vs 9.5%) were higher in patients with placenta praevia w.r.t. normal placentation. Low birth weight was 57 fold higher, Preterm birth 10.9 fold higher and NICU admissions were 1.7 fold higher among placenta praevia. Conclusion: A caesarean first birth is associated with increased risks of low lying placentation, previa and abruption, intraoperative blood loss, perioperative morbidity and increased operative time in subsequent pregnancy.
ABSTRACT
Background: The progress of labour can be graphically represented using the WHO partogragh, which helps in early detection and prevention of complication of labour, thus resulting in a better feto-maternal outcome especially in high risk cases.Methods: The study was undertaken at Hitech Medical College and Hospital, Bhubaneswar from March 2017 to February 2019 on 200 high risk patients. The progress of labour was plotted and assessed on Modified WHO partograph.Results: Majority of the cases were referred cases. Augmentation of labour was carried out in 56 cases. The mean duration of labour in the first stage was 5.4 hours and 4.1 hours in primi and multigravidas, whereas that of the second stage of labour are 37.5 minutes and 26.3 minutes respectively. 51 cases had prolonged labour and 15 cases had arrest of labour in the second stage. Maximum number of cases underwent LSCS due to abnormal labour progression. 8.7% of the cases had PPH and 2.3% had puerperal sepsis. Neonatal asphyxia was seen in 13.6% cases and 2.8% had early neonatal death.Conclusion: The results conclude that the WHO modified partograph is an inexpensive useful tool in monitoring the progress of labour and reducing foeto maternal morbidity in high risk groups.
ABSTRACT
Objective :To study the clinico-social risk factors for preeclampsia in a tertiary care hospital in Bhubaneswar, Odisha. Methodology :Acase control study was done in a tertiary care hospital in Bhubaneswar. Clinical and socio-demographic data was collected from 167 inpatients with preeclampsia and similar number of controls and was analysed. Results : Majority of the women(63.9%) belonged to the low socioeconomic class with low education level. More than half were overweight(57.3%) and 61% of them were primipara. A significant number of patients(18.5%) gave a previous history of preeclampsia. Insulin resistance also presented as a risk factor. Conclusion: Though the aetiology of preeclampsia still remains obscure, there are certain risk factors which have remarkable association with the prevalence of the disease. Understanding these will enable the clinicians for early diagnosis and timely intervention.