Study of maternal and fetal outcome in HIV positive women on HAART therapy in a tertiary hospital

Background: India has the third largest population of HIV. Moving from single dose nevirapine in labor to use of HAART treatment for all pregnant women and the outcome of the same was the subject of present study.Methods: Retrospective study of HIV positive pregnant women on HAART treatment admitted in labor room at Karnataka institute of medical sciences from June 2015 to December 2016. A retrospective analytical study of 93 women with HIV positive status on HAART therapy admitted in labor at KIMS was done by collecting data from case records. Baby follow up details were collected from ART center, KIMS.Results: Parameters studied were maternal and fetal outcomes. Maternal outcome in terms of mode of delivery, morbidity and mortality and fetal outcomes in terms of APGAR at birth, weight of the baby, NICU admission, incidence of meconium, still birth and intrauterine fetal demise, follow up of the babies at 6 weeks, 6 Months and 18 Months for seropositivity.Conclusions: HAART in pregnant women significantly improved the maternal and fetal outcomes.

Clinical study on postpartum eclampsia

Background: Eclampsia constitutes one of the deadly triad along with malnutrition and anemia which authors encounter in the present tertiary hospital Karnataka Institute of Medical Sciences, Hubli. This study was done to study the epidemiological factors associated with postpartum eclampsia, correlation with neuroimaging and the maternal outcome. The objective of the present study was retrospective study of postpartum eclampsia over a period of 22 months.Methods: A retrospective study conducted over a period 22 months from June 2015 to March 2017 in a tertiary care hospital, Karnataka Institute of Medical Sciences, Hubli. Case records of all postpartum eclampsia patients admitted during the period were analyzed.Results: This study showed that incidence of postpartum eclampsia in our hospital was 1.4%. It is more common in age group of 20-25 years, more common in primipara  (67.24%), commonest mode of delivery was vaginal route (86.2%), the occurrence of convulsion was more common within 24hrs after delivery. Most common CT scan finding was normal study (51.72%) followed by cerebral infarct (15.5%), cerebral edema (13.72%), PRES (10.34%). There were no cases of maternal mortality due to postpartum eclampsia during study period.Conclusions: Eclampsia still remains a major cause of maternal morbidity, CT scan of brain gives valuable intracerebral information, and aids in a better management.

A clinical study on the analysis of caesarean section rates using Robson’s ten group classification in a tertiary care hospital

Background: Auditing c section rates can be done using Robson’s classification which in turn helps achieve a uniform basis for comparison across centers and across various countries.Methods: A retrospective analysis was done in a tertiary care hospital in north Karnataka KIMS, over a period of 6 months May 2017 to October 2017. All cases of LSCS done during this period were classified according to Robson’s classification and analyzed.Results: Out of 5080 overall deliveries 1876 delivered by cesarean section attributing to 36.76% cesarean section rate. Highest contribution was from group 5 (36%) and group 2 (19.24%).Conclusions: Robson’s classification helps to identify and analyze the group that contribute to the most to overall cesarean section rate and this helps us to modify strategies and interventions to optimize cesarean section rate.

Risk factors and outcome analysis of post-partum haemorrhage in a tertiary care centre

Background: Maternal haemorrhage is the major cause of maternal mortality and morbidity all over the world and more so in developing countries. PPH is the commonest cause of maternal mortality in India. Identification of risk factors, early diagnosis and timely intervention can help in reducing maternal mortality and morbidity significantly. The aim of this study is to analyse the risk factors and causes and study the maternal and perinatal outcomes of PPH in North Karnataka.Methods: It is a retrospective study of 228 patients admitted with the diagnosis of PPH, at KIMS, Hubli during 2016.Results: Average age of the patients was 27 years. Commonest risk factor was PIH, followed by APH and prolonged labour. The commonest cause of PPH was atonicity followed by retained placenta. Majority of the patients recovered successfully with medical management. While 29 patients required Para cervical clamp. Sixteen patients underwent hysterectomy. Commonest complication was anaemia. Total maternal deaths were four; all of them were due to DIC, mostly due to late referrals.Conclusions: Maternal mortality and morbidity due to PPH can be reduced by encouraging regular anti natal visits, timely referral of high-risk patients, training of the health personals and timely intervention. Well stocked blood banks play an important role in management of PPH.