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Background: High-risk pregnancy refers to any condition in pregnancy that increases risk for morbidity or mortality in mother, fetus and neonate. Globally, nearly 5,29,000 women die due to pregnancy related complications. In India, 20-30% of the pregnant patients contribute to high risk group. This study was conducted to determine different high-risk factors prevalent in antenatal women in Haryana. Objective of this study was to find out prevalence of different high-risk factors in antenatal women.Methods: Data of all antenatal high-risk patients attending OPD during one year was taken from hospital record registers. Maternal characteristics such as age, gravida/parity, gestational age, and gestational age at the time of first visit were noted. High risk factors identified were noted.Results: The records of total 10073 antenatal women were analyzed, 1283 were included in the high-risk group. Most prevalent high-risk factors found were previous cesarean section (31.04%), anaemia (31.02%), malpresentation (12.93%) and thyroid disorders (13.09%).Conclusions: Antenatal surveillance for the high-risk factors complicating pregnancy may prevent or treat most of the complications. Authors should develop strategies for early screening of high-risk pregnancy cases to prevent maternal and perinatal mortality and to improve the maternal and perinatal outcome.
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Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.
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Background: Preeclampsia is the occurrence of hypertension in combination with proteinuria, developing after 20 weeks gestation in a previously normotensive non-proteinuric patient. The objective of this study was to study the prevalance of eclampsia at PGIMS, Rohtak. To study the clinical profile, maternal and perinatal outcome in eclamptic patients.Methods: This is a retrospective study and case records of all eclampsia cases were analysed from the study period of January 2018 to December 2018.Results: There were 113 cases of eclampsia out of 11,661 deliveries and prevalence of eclampsia was calculated to be 0.96%. Majority of the patients were not registered 95.57%. 58% of patients were Primigravidas. 56% of the patient in the age group of 21-25 years. Antepartum, intrapartum and postpartum eclampsia were 71%, 1.7% and 27% respectively. Caesarean section was the preferred mode of delivery and was performed in 57% cases. ICU admission was required in 25% and remaining cases were managed in general/eclampsia ward. All patients received MgSO4 by Zuspan regimen. 12% patient developed HELLP syndrome and pulmonary oedema developed in 6% patient. There were a total of 3.5% maternal deaths during the study period. Total percentage of perinatal deaths due to eclampsia was 23%.Conclusions: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality. This is due to lack of proper antenatal care, low socioeconomic condition and lack of education. Regular antenatal checkup, early recognition and proper management are vital to tackle this challenge. MgSo4 is the anticonvulsant of choice and Zuspan regimen of MgSO4 is effective in the management of eclampsia.
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Potter’s syndrome is a rare congenital disorder characterized by characteristic atypical appearance of a newborn due to the oligohydroamnios experienced during the intrauterine life. Its incidence varies from 1 in 2000 to 1 in 5000. 40 years old G7P4L1 A2 at 37 weeks of period of gestation was admitted at a tertiary care institute with labour pains. Her previous obstetric history included three full term vaginal deliveries, two of the babies expired in postnatal period of 2 months and 7 days age respectively. One was alive and healthy. In fourth pregnancy she underwent emergency LSCS, but baby expired 5 months after birth. She had history of 2 abortions which were spontaneous and not followed by curettage. She also gave history of intake of some drugs at 6th week of gestation prescribed by a local Baba to have a male child. Her ultrasonography revealed fetus with bilateral renal agenesis. On per abdomen examination, clinically liquor was very much reduced, Fetal heart sounds were not heard. She delivered vaginally a still born fetus with ambiguous genitalia, anal atresia and malformed limbs. The fetus had typical facial appearance of “potter facies”. Potter’s Syndrome or Sequence is a rare fatal disorder. Apart from typical Potter’s facies, pulmonary hypoplasia, skeletal deformities are associated with this condition, severity depends on the degree and duration of oligohydramnios. Therefore, it is very important to pick up this condition during antenatal ultrasound at earlier gestation so that timely decision regarding further workup and pregnancy termination can be undertaken. This case report emphasizes upon the importance of regular antenatal check ups and examination in each and every patient as it picks up the suspicious cases which can lead to further workup, definite diagnosis of the condition and timely decision regarding management.
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Background: Hospital acquired infections (HAIs) are the major causes of morbidity and mortality, functional disability and financial burden among the patients admitted in hospitals. The nosocomial infection has thrown a big challenge to the health sector in both the developing and developed countries; therefore, it is important to put in place surveillance system for monitoring its incidence rate and planning early interventions for its prevention. The aim and objective of the study was to study the socio demographic profile of the patients who underwent Obstetrical and Gynecological surgeries and to identify the risk factors and causative organisms associated with the post-operative nosocomial infection and pattern of antibiotics sensitivity.Methods: It was a record based retrospective study carried out in a tertiary care referral institute. The case files of all post-operative patients from January 2015 to July 2015 were retrieved from the Medical Record department and an extensive analysis was carried out.Results: It was found that majority of the patients (75%) with nosocomial infection were in the age group of 20-35 years and all were married. Most of them (72%) were from the rural background. It was observed that around 9% patients reported nosocomial infection after emergency laparotomy procedure as compared to 8% of patients after elective procedure.Conclusions: In this study it was found that surgical site infection (SSI) was most common nosocomial infection followed by Urinary tract infection. The majority of surgical site infections can be prevented by the preoperative, intraoperative and postoperative phases of care.
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A hospital-based cross-sectional study was undertaken to determine proportion of gross congenital malformation (GCMF) occurring at intramural births. Rate of GCMF was found to be 16.4/1000 consecutive singleton births (>28 weeks) with three leading malformation as anencephaly (44.68%), talipes equinovarus (17.02%) and meningomyelocele (10.63%). Higher risk of malformed births were noticed amongst un-booked (2.07%) in-comparison to booked (1.01%) mothers; women with low level of education (up to 8 years [2.14%] vs. at least 9 years of schooling [0.82%]); gravida status of at least 3 (2.69%) followed by 1 (1.43%) and 2 (1.0%) respectively; pre-term (5.13%) vs. term (0.66%); cesarean section (4.36%) versus vaginal delivery (0.62%). Mortality was signifi cantly higher among congenitally malformed (17.35%) than normal (0.34%) newborns. With-in study limitation, emergence of neural tube defect as the single largest category of congenital malformation indicates maternal malnutrition (especially folic acid) that needs appropriate attention and management.
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Background & objectives: Prevalence of gestational diabetes mellitus (GDM) is known to vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at a tertiary care hospital in Haryana. Methods: This study enrolled women, with their estimated gestational age between 24th and 28th week, attending antenatal care (ANC) clinic at a tertiary care hospital in Rohtak. After informing, women who consented to participate were given a standardized 2-h 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension and past history of GDM was filled up. American Diabetes Association (ADA) criteria for 75 g 2-h OGTT was used for diagnosing GDM. Results: A total of 607 women participated in the study and GDM was diagnosed in 43 (7.1%) women. A single abnormal value was observed in additional 66 (10.87%) women. On bivariate analysis risk factors found to be significantly associated with GDM were age, educational level, socio-economic status, pre-pregnancy weight and BMI, weight gain, acanthosis nigricans, family history of diabetes or hypertension and past history of GDM but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM. Interpretation & conclusions: The prevalence of GDM was found to be 7.1 per cent in a tertiary care hospital in Haryana. Appropriate interventions are required for control and risk factor modifications.
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Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.
ABSTRACT
Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.