ABSTRACT
Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta is mandatory to exclude over diagnosis or migration. All cases of placenta previa need to be managed in a higher centre with facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.
ABSTRACT
BACKGROUND:The benefits of self-foot care management are well recognized in type 2 diabetes subjects. However, a substantial proportion of patients don't perform self-foot care assessment at all. We aimed to enumerate the barriers to self-foot care management in Type 2 Diabetes Mellitus (T2DM) patients and factors associated with these barriers. METHODOLOGY: A cross-sectional study of successive 600 type 2 diabetes patients attending routine out-patient diabetes clinics in tertiary care hospitals in Kolkata, India from 1st June 2018 to 31st March 2019.Besides demographic details, patient particulars, laboratory investigations, the questionnaire included 2 direct questions on possible barriers to self-foot care management. The questions were grouped into five categories viz. environmental (4 questions), behavioral (9 questions), occupational (2 questions), physical inability (7 questions) and medical reason (1 question). RESULTS:An overwhelming 60% of the study population have more than one barrier to self-foot management. Alarger proportion of females (69.9%) were not taking self-foot care management compared to their male counterparts (55.5%). Around one-third of the male participants cited lack of time as a major barrier to self-foot care management. Around 40% females reported lack of foot care education and training as the major obstacle to self-foot care management. CONCLUSION: This study elaborates the need for awareness regarding possible barriers when counseling T2DM patients. Behavioral causes seem to be the commonest barrier to self-foot care management and hence strategies to target the same needs to be thought of.