ABSTRACT
Background: Vaginal bleeding at any stage of pregnancy is an alarming event. As it is estimated that approximately one fifth of pregnancies are accompanied by vaginal bleeding, The present study was carried out to investigate the relationship between second and third trimester vaginal bleeding and the outcome of pregnancy. Methods: This prospective cohort study population comprises of 150 pregnant women who were booked at the antenatal clinics and presented with complaints of bleeding or spotting per-vaginum in the second and third trimester. These patients were on continuous follow up till their final outcome of pregnancy. Results: Out of 100 cases of second trimester bleeding per vaginum, pregnancy continued in 84 cases. Subjects of second trimester with vaginal bleeding have been clinically diagnosed with threatened abortion in 84% patients, missed abortion (08%) followed by incomplete (06%) and complete (02%) abortion. Placenta previa was the leading cause of the vaginal bleeding both in second and third trimester vaginal bleeding subjects 26% and 21%. Forty-eight second trimester cases and 26% of third trimester cases had repeated episode of bleeding. The vaginal and caesarean delivery rate (majority of them were at term) were 33%, 51% and 36%,64% respectively in cases of second & third trimester bleeding groups. Conclusion: The overall prognosis of the patients who present in second and third trimester with history of bleeding per vaginum is favorable. At the same time physicians should be aware of the adverse outcomes that are associated with second and third trimester bleeding and remain alert for signs of these complications
ABSTRACT
Nutritional iron deficiency is the main cause of anemia throughout the world. It is especially common in women of reproductive age and particularly during pregnancy. Anemia during pregnancy is associated with adverse perinatal outcomes in the form of preterm birth, stillbirth, small for gestational age babies and increased perinatal mortality. There is persistently high prevalence of anemia in Indian mothers despite a national program in place. Objective: To assess the prevalence of anaemia, its different types and their association with maternal and perinatal outcomes. Methods: This study was conducted on 100 pregnant patients with severe anemia. The study population was divided into 3 groups based on basis of peripheral smear picture i.e. microcytic, macrocytic and dimorphic anemia. These pregnant mothers were followed up until their time of delivery and associations between anaemia types and maternal as well neonatal adverse outcomes were explored. All the data collected was analyzed using statistical computer software (STATA Version 13.0). Result: Microcytic hypochromic anemia was most commonly present (45 patients, 45%). Intrauterine growth restriction was seen in 20% of total study population and out of these, majority were born to mother with macrocytic anemia (32.5%). The same trend was also seen for gestational hypertension with 8.9%. 32.5% and 6.7% patients having gestational hypertension in microcytic, macrocytic and dimorphic anemia groups respectively (p=0.009). A total of 23 patients had low birth weight babies; 65.2% patients with low birth weight babies had macrocytic anemia and this difference was statistically significant (p=0.024). Overall 15% of babies were small for gestational age, out of which 66.7% babies were in macrocytic anemia group. Low Apgar score at one minute after birth was seen in four babies born to mothers having macrocytic anemia and this was a statistically significant relationship (p=0.044). Conclusion: Anemia is increasingly becoming prevalent and is associated with poor maternal and perinatal outcomes. Public health interventions should be made by way of appropriate food fortifications to reduce prevalence of anemia Early diagnosis should be made by appropriate investigations and proper therapy should be started as soon as possible according to type of anemia, in order to prevent adverse maternal and foetal outcomes.
ABSTRACT
Prostaglandin E2(cerviprime gel), an inducing agent is instilled intracervically or placed high in the posterior fornix of the vagina and may need to be re-in- stilled after 6 h if required. Another alternative is misoprostol (15-deoxy-16- hydroxy-16-methyl prostoglandin E1) which is used in various dosages. Methods: This was a prospective observational study of nulliparous women undergoing labor induction for one year, 100 womens, in a tertiary care center. Participants were then randomly assigned to pre-induction cervical ripening with a dinoprostone vaginal insert (0.5mg) (group I), and with misoprostol (50 microg) intravaginally(group II). Result: From our study observation, maximum patients delivered normal vaginal delivery. Of the vaginal deliveries six (18%) of PGE2 group and five patients(10%) of PGE1 having meconium stained liquor after ARM or spontaneous rupture of membrane, fetal heart was reassuring i.e, no fetal distress was there. The caesarean section rate in both groups nine (18%) and (10%) was statistically insignificant. Mean change in bishop score was also not significant in both groups. Need for oxytocine after 8hrs of induction between both group was significant, 84% in dinoprostone group and 56% in misoprostol group. Gastrointestinal side effects, uterine tacchysystole, uterine hyperstimulation was more common in misoprostol group than dinoprostone group, that is statistically significant. Induction to delivery time was shorter in misoprostol group that is statistically significant. No adverse neonatal outcomes that can directly be related with both drugs. Both agents are equally efficacious in causing cervical repining and almost equal changes in mean bishops. Conclusion: Misoprostol is an excellent labour-inducing agent and can be used liberally for labour induction, unlike PGE2 gel, is comparatively cheaper and is stable at room temperature; thus, it could be an ideal inducing agent in poor resource settings. Local application of misoprostol tablet in posterior vagina is easier method than dinoprostone insertion. Intravaginal insertion of misoprostol tablet is superior to dinoprostone gel in inducing labour and shorter interval between induction and delivery.