A study of gestational diabetes mellitus and fetal outcome in a tertiary care center

Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers.

Study of obstetric and perinatal outcome of twin pregnancy

Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies.

Study of effects of oligohydramnios on perinatal outcome

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).

Role of hysterolaparoscopy in the diagnosis and management of infertility

Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility.

Analytical study of 50 cases of fetal growth restriction.

The objective of the study is to earlier diagnose the cases of FGR (Fetal growth restriction) and to identify the possible causes and management option to prevent further damage and to study the fetomaternal outcome and improve fetomaternal outcome in FGR cases. Methods: This is an analytical study of 50 cases of FGR pregnancies done during the period of 1st April 2013 to 31st March 2014. Data was collected from the OPD books and indoor case papers of patients attending routine antenatal care and emergency services provided by obstetrics and gynaecology department of our institute. Results: 50 cases of FGR were studied. Various possible etiological factors were studied like presence of anaemia, hypoproteinemia and PIH, maternal pre-pregnancy weight, and average weight gain during pregnancy. Among them, malnutrition (64%) was the commonest aetiology of FGR followed by PIH (44%). Ante partum surveillance was done by serial fundal height measurement, maternal weight gain monitoring and serial ultrasound. 40% patients were having severe oligoamnios and 30% were having altered Doppler waveforms. Operative interference was required in 44% cases. 30 babies out of 50 were admitted to NICU. And perinatal mortality was 13.72%. Conclusion: Timely diagnosis, proper management at all levels in well-equipped centre can definitely prevent morbidity and mortality from FGR. Improving pre-pregnancy health, ensuring better antenatal care, effective use of contraception, preventing teenage pregnancies, stop smoking are some preventive measures.